Incidence, severity, aetiology and prevention of sports injuries. A review of concepts

Injury incidence rates in women's football: a systematic review and meta-analysis of prospective injury surveillance studies

OBJECTIVE

To review the literature to establish overall, match and training injury incidence rates (IIRs) in senior (≥18 years of age) women's football (amateur club, elite club and international).

DESIGN

Systematic review and meta-analysis of overall, match and training IIRs in senior women's football, stratified by injury location, type and severity.

DATA SOURCES

MEDLINE via PubMed; EMBASE via Ovid; CINAHL via EBSCO and Web of Science were searched from earliest record to July 2021.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

(1) football players participating in a senior women's football league (amateur club or elite club) or a senior women's international football tournament; (2) the study had to report IIRs or provide sufficient data from which this outcome metric could be calculated through standardised equations; (3) a full-text article published in a peer-reviewed journal before July 2021; (4) a prospective injury surveillance study and (5) case reports on single teams were ineligible.

RESULTS

17 articles met the inclusion criteria; amateur club (n=2), elite club (n=10), international (n=5). Overall, match and training 'time-loss' IIRs are similar between senior women's elite club football and international football. 'Time-loss' training IIRs in senior women's elite club football and international football are approximately 6-7 times lower than their equivalent match IIRs. Overall 'time-loss' IIRs stratified by injury type in women's elite club football were 2.70/1000 hours (95% CI 1.12 to 6.50) for muscle and tendon, 2.62/1000 hours (95% CI 1.26 to 5.46) for joint and ligaments, and 0.76/1000 hours (95% CI 0.55 to 1.03) for contusions. Due to the differences in injury definitions, it was not possible to aggregate IIRs for amateur club football.

CONCLUSION

Lower limb injuries incurred during matches are a substantial problem in senior women's football. The prevention of lower limb joint, ligament, muscle and tendon injuries should be a central focus of injury prevention interventions in senior women's amateur club, elite club and international football.

PROSPERO REGISTRATION NUMBER

CRD42020162895.

Contribution of sex, sports and activity types and curriculum load distribution to intracurricular injury risk in physical education teacher education: a cohort study

Objectives

To investigate the influence of sports/activity types and their distribution over the curriculum years on intracurricular injury risk differences between curriculum years and sexes in Physical Education Teacher Education (PETE) studies.

Methods

In a cohort study over 14 years (2000-2014), injuries reported at the medical facility of a Dutch vocational institute by PETE students who completed their full curriculum were registered. Intracurricular injury rates (IR) per 1000 hours and 95% CIs were calculated per sport, sex and curriculum year and compared with injury rate ratios (RR) and 95% CI. Exposure times per sports category per curriculum year were compared with the χ2 test.

Results

Intracurricular IR was highest for gymnastics, team ball sports and track and field (0.76-1.23, 95% CI 0.65 to 1.45). IRs were higher for female compared with male students (RR 2.38, 95% CI 1.97 to 2.87). Comparisons for all individual sports and for all three curriculum years showed the same pattern. IR for the first year was higher than for the second (RR 1.79, 95% CI 1.45 to 2.21) and third year (RR 2.74, 95% CI 2.13 to 3.54) with similar patterns for all sports categories. Over the curriculum years, exposure time distributions per sport showed small differences (p<0.001, Cramer's V=0.07).

Conclusion

Curriculum year, sex and sports types are risk factors to be independently targeted for preventive and rehabilitative measures in PETE studies. The nature and aetiology of injuries in mixed sports, and the adaption to increased loads in first-year and female PETE students, need further investigation.

Sport-related injuries in Iranian basketball players: evidence from a retrospective epidemiologic study (2019-20)

OBJECTIVES

Basketball is a contact sport with complex movements that include jumps, turns, and changes in direction, which cause frequent musculoskeletal injuries in all regions of the body. Also, injury patterns among athletes, particularly basketball players, continue to evolve and change. The current retrospective epidemiologic study aimed to investigate the incidence, severity, and sports-related risk factors of injuries in Iranian basketball players from 2019 to 2020.

METHODS

Using the Information Retrospective Injury Questionnaire (online version), data on basketball-related injuries were collected retrospectively for 204 basketball players of the Iranian league (professional super league and first-division league) during the 2019/2020 season.

RESULTS

A total of 628 injuries were reported, which was equivalent to 6.07 injuries/1000 h. The ankle was the location of most injuries (n = 116 or 26.9%; overuse injuries (n = 40 or 20.3%)), followed by lower back/pelvis injuries (acute injury n = 67 (15.5%) and overuse injuries (n = 23; 11.6%)), knee injuries (acute injury n = 62 (15.7%) and overuse injuries (n = 31 (14.3%)), wrist/fingers injuries (acute injury (n = 85 (13.4%)) and overuse injuries (n = 8; 4.0%)), and shin/calf injuries (acute injury (n = 35; 8.1%) and overuse injuries (n = 28; 14.2%)). Mean time loss in first-division league players was much higher than professional super league players (7.84/1000 h exposure vs. 4.30/1000 h exposure), respectively.

CONCLUSION

The ankle sprain was the most common injury in our study. Lower back/pelvis injuries had the longest time loss. Injury was more frequent among first-division league players than those in the professional super league. Injuries during practice were notably more frequent than during competition with different patterns of injuries.

Injuries in Canadian high school boys’ collision sports: insights across football, ice hockey, lacrosse, and rugby

Background

Collision sport participation rates among high school youth in Canada are high. While participation is beneficial for physical and mental well-being, the rates of injury in these sports are high.

Aims

This study aims to compare injury rates and profiles across four common youth collision sports (ice hockey, tackle football, lacrosse, rugby).

Methods

Data from a cross-sectional questionnaire of 2029 high school youth were used to identify male collision sport participants to be included in this secondary analysis (n = 360).

Results

Of the 2029 students who completed the questionnaire, 360 participated in collision-based sports [Ages: 14 (5%), 15 (41%), 16 (25%), 17 (26%), 18 (3%)]. The rates of injury ranged from 12.7 injuries/100 participants/year (rugby) to 33.1 injuries/100 participants/year (ice hockey). Concussion rates ranged from 12.4 (football) to 15.8 (ice hockey) concussions/100 participants/year. Similarities existed in the profile of injuries between sports, with most injuries occurring due to contact with another player (range 57.0% to 87.5%). Injuries to the head (33.3%), wrist/hand (16.0%), shoulder (12.8%), and knee (12.0%) were the most prevalent injury type. Substantial differences in previous playing experience existed between sports.

Discussion

The high rate of injury and concussion reported across each of these sports highlights the need for the introduction of primary prevention strategies in these sports aimed to reduce the risk of injury.

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.

Cross-sectional study of gender differences in physical activity-related injuries amongst Chinese college students majoring in rehabilitation

The main objective of the paper was to explore the potential risk factors for physical activity-related injuries (PARI) amongst college students majoring in rehabilitation and to analyse gender differences. A random whole group sampling method was used to recruit freshmen to seniors aged 15-25 years from over 90 universities in China that offer rehabilitation. The total number of people included was 6,032, of which 1,989 were male and 4,043 were female. The underlying risk factors for PARI of different genders were assessed using a structured self-management questionnaire including sociodemographic characteristics, physical activity levels, risk-taking and protective behaviors, and PARI. Totally 6,032 questionnaires were obtained for final analysis, with 792 total number of injured persons (415 males, 377 females), the sum of the cumulative frequency of injuries to injured persons is 1,607 (881 males, 726 females) and a PARI risk of 0.27 (males: 0.44, females: 0.18; p < 0.001; sum of the cumulative frequency of injuries/total number of people surveyed/year). For male and female students, participation in sports teams, having a high level of PA as well as with antisocial behavior were risk factors for developing PARI. Regarding female students, regional differences was associated with elevated odds to suffer from PARI. The prevalence rates of PARI vary between male and female students. The research subjects were university students in rehabilitation. Compared to general college students, rehabilitation students have a certain knowledge base related to injuries, which defines the specificity and research value of this subjects. This study provides guidance for reducing PARI in students in rehabilitation and may provide a basis for developing future injury prevention mechanisms for university students in general.

Hamstring Muscle Injuries and Hamstring Specific Training in Elite Athletics (Track and Field) Athletes

OBJECTIVE

We aimed to describe hamstring muscle injury (HMI) history and hamstring specific training (HST) in elite athletes. A secondary aim was to analyse the potential factors associated with in-championships HMI.

METHODS

We conducted a prospective cohort study to collect data before and during the 2018 European Athletics Championships. Injury and illness complaints during the month before the championship, HMI history during the entire career and the 2017-18 season, HST (strengthening, stretching, core stability, sprinting), and in-championship HMI were recorded. We calculated proportions of athletes with HMI history, we compared HST according to sex and disciplines with Chi2 tests or ANOVA, and analysed factors associated with in-championship HMI using simple model logistic regression.

RESULTS

Among the 357 included athletes, 48% reported at least one HMI during their career and 24% during the 2017-18 season. Of this latter group, 30.6% reported reduced or no participation in athletics' training or competition at the start of the championship due to the hamstring injury. For HST, higher volumes of hamstring stretching and sprinting were reported for disciplines requiring higher running velocities (i.e., sprints, hurdles, jumps, combined events and middle distances). Five in-championship HMIs were recorded. The simple model analysis showed a lower risk of sustaining an in-championships HMI for athletes who performed more core (lumbo-pelvic) stability training (OR = 0.49 (95% CI: 0.25 to 0.89), p = 0.021).

CONCLUSIONS

Our present study reports that HMI is a characteristic of the athletics athletes' career, especially in disciplines involving sprinting. In these disciplines, athletes were performing higher volumes of hamstring stretching and sprinting than in other disciplines. Further studies should be conducted to better understand if and how HST are protective approaches for HMI in order to improve HMI risk reduction strategies.

Data Collection Procedures and Injury Definitions in Badminton: A Consensus Statement According to the Delphi Approach

ABSTRACT

Previous studies involving injury surveillance in badminton players have used nonstandardized injury definitions and data collection methodologies. The purpose of this study was to apply a Delphi method to (1) reach a consensus on an injury definition in badminton and (2) develop a standardized badminton injury report form. An Injury Consensus Group was established under the auspices of the Badminton World Federation, and initial injury definitions and injury report form were developed. An internal panel was formed from the Injury Consensus Group, and an external panel was selected based on a combination of profession, experience in the field, sport-specific knowledge/expertise, and geographical location to obtain a widely representative sample. Through 2 rounds of voting by the external panel, consensus was reached on both the definition of an injury in badminton and a standardized injury report form. The agreed injury definition was "Any physical injury sustained by a player during a match or training regardless if further diagnostic tests were done or if playing time was lost" and the injury report form contained the following 7 sections: Injury record, Diagnosis, Injury mechanism, Regarding pain, Pain and return to play/training after injury, Grade of severity, and Recurrence. We recommend the use of the definitions and methods presented in this consensus statement for the reporting of injury in all international and domestic badminton players. This should make future injury surveillance reports directly comparable and hence more informative in recognizing trends over time and differences between countries.

Risk factors and prevention strategies for shoulder injuries in overhead sports: an updated systematic review

PURPOSE

The aim of this systematic review was to update the knowledge on risk factors and prevention strategies for shoulder injuries in overhead sports with special emphasis on methodological quality.

METHODS

All methodological procedures were performed in line with a previous systematic review by Asker et al. (2018). The literature search was conducted in the PubMed, Google Scholar, Cochrane, and SPORT-Discuss databases. Due to the risk of bias assessment, only studies with at least an acceptable methodological quality were included. A best-evidence synthesis was performed to clarify the evidence and direction of the risk factors and prevention strategies.

RESULTS

A total of nine studies were included in the data extraction process. One study had a high and eight studies had an acceptable methodological quality. Seven cohort studies investigated risk factors and two randomised controlled trails evaluated prevention strategies. Moderate evidence was found for two non-modifiable (playing position, gender) and three modifiable factors (shoulder rotational strength, scapular dyskinesia, shoulder prevention programme) that were associated with the shoulder injury risk. All further risk factors had moderate and no association with risk (shoulder rotational ROM, joint position sense) or limited (history of shoulder/elbow pain, age, training experience, training volume, school grade, playing level), and conflicting evidence (setting).

CONCLUSIONS

There is moderate evidence for two non-modifiable (playing position, gender) and three modifiable factors (shoulder rotational strength, scapular dyskinesia, shoulder prevention programme) being associated with the shoulder injury risk in overhead sports.

Longitudinal study on locations of injury among junior high school, high school, and university badminton athletes at Japanese national-level competitions

[Purpose] The aim of study was to examine incidence of injury according to location of injury to develop an injury prevention program for elite badminton players of junior high school, high school, and university. [Participants and Methods] We conducted a prospective longitudinal study, between April 2012 and March 2013, on 133 national-level badminton players attending junior high school, high school, and university. Injury rates in athletes per 1,000 exposures were calculated based on gender and school age for the five most common injury locations, in addition, severity, type and circumstance were investigated. [Results] Injury rates in athletes per 1,000 exposures were the highest in the racket-side (RS) shoulder/clavicle among the female university students (4.35), RS thigh of high school females (2.21), and lumbar spine/lower back of males of all school ages and junior high school females (1.83–1.25). Significantly higher injury rates were noted for the overuse of the lumbar spine/lower back and RS shoulder/clavicle, trauma of the RS thigh and ankle, and injury, when compared with slight injury of the RS ankle. [Conclusion] Injury prevention programs should be developed for RS shoulder/clavicle overuse in university females, RS thigh trauma in high school females, and lumbar spine/lower back in males of all school ages and junior high school females.

Adherence to an injury prevention program in male amateur football players is affected by players’ age, experience and perceptions

Objectives

Adherence to injury prevention programmes in football remains low, which is thought to drastically reduce the effects of injury prevention programmes. Reasons why (medical) staff and players implement injury prevention programmes, have been investigated, but player’s characteristics and perceptions about these programmes might influence their adherence. Therefore, this study investigated the relationships between player’s characteristics and adherence and between player’s perceptions and adherence following an implemented injury prevention programme.

Methods

Data from 98 of 221 football players from the intervention group of a cluster randomised controlled trial concerning hamstring injury prevention were analysed.

Results

Adherence was better among older and more experienced football players, and players considered the programme more useful, less intense, more functional and less time-consuming. Previous hamstring injuries, educational level, the programme’s difficulty and intention to continue the exercises were not significantly associated with adherence.

Conclusion

These player’s characteristics and perceptions should be considered when implementing injury prevention programmes.

New Zealand cricket injury analysis based on 12 years of Accident Compensation Corporation data

Objectives

To provide epidemiological data for cricket injuries in New Zealand.

Methods

A retrospective analytical review using epidemiological cricket data obtained from the national Accident Compensation Corporation (ACC) for 2005–2016. Injury incidence was calculated per 1000 participants.

Results

There were 86 562 injuries (77 212 males and 9350 females) during the 12 years with higher injury incidence for males (64.1) than females (36.1). While cricket-related injury claims increased by 42.6%, the injury incidence decreased from 59.0 in 2006 to 42.8 in 2016. The pooled injury rate per 1000 participants was highest for hand/fingers (9.2) and lumbar (8.1) body regions, and for contact (44.7) activities. Players aged 10–20 years were more likely to experience injury.

Conclusions

Analysis of 12 years of ACC cricket-related injury claims showed only minimal reductions in injury incidence over the years. Therefore, cricket-related contact injuries to the hand/fingers and head need to be the focus of injury prevention programmes (eg, via promoting use of protective gear and correct technique), particularly in players aged 10–20 years.

The knowledge and attitudes of field hockey athletes to injury, injury reporting and injury prevention: A qualitative study

OBJECTIVES

Researchers have often struggled to successfully implement injury prevention strategies in real-world practice. This is despite such strategies proving successful in reducing overall injury incidence and burden. It has been hypothesised that this may be because the behavioural and contextual factors related to sports injury are not fully understood. Such factors stem from multiple key stakeholders, including the athlete. The primary aim of this study was to investigate athletes' knowledge and attitudes towards injury, injury reporting and prevention, as well as some of the barriers that may impact the future implementation of prevention strategies.

DESIGN

Qualitative; with semi-structured interviews following an interpretivist approach.

METHODS

Twenty-two field hockey athletes, playing in the top-tier Irish Hockey League were interviewed. Data were analysed using reflexive thematic analysis, with three general dimensions containing six higher-order themes.

RESULTS

The findings highlighted that athletes have a varied understanding of injury, which tends to improve with experience. The reporting of injuries by athletes to members of the coaching staff was relatively poor. This may be due to limited resources and supports available to athletes which also cause challenges to injury prevention.

CONCLUSIONS

Future injury prevention strategies in field hockey need to account for athletes' varied understanding of what constitutes an injury. Furthermore, policy changes to influence potential barriers to injury may assist in preventing or reducing the number of injuries being sustained by athletes.

Injury Rates and Characteristics Associated with Participation in Organized Dance Education: A Systematic Review

INTRODUCTION

Several studies and recent systematic reviews have investigated injury in dance settings and have largely focused on specific concert dance genres (i.e., ballet, contemporary) and elite levels (i.e., pre-professional, professional) of dance. Less is known about the health of those who participate in dance education settings, namely teachers and students from private dance studios. Given that these individuals constitute a large proportion of the dance community, greater clarity of risks in the dance training environment could benefit an underserved majority by informing the development of effective injury prevention strategies.<br/> Objective: The primary objective was to describe injury rates and characteristics associated with participation in organized dance education settings.<br/> Methods: Six electronic databases were searched to April 2021 (Medline, EMBASE, SportDiscus, CINAHL, SCOPUS, Cochrane). Selected studies met a priori inclusion criteria that required original data from dance teacher and student samples within formal dance education settings. All genres of dance were eligible. Studies were excluded if no injury outcomes or estimates of dance exposure were reported, if injuries occurred during rehearsal and performance, or if dance was used as a therapeutic intervention or exercise. Two reviewers independently assessed each paper for inclusion at abstract and full text screening stages. The quality of included studies was assessed using the Joanna Briggs Institute Level of Evidence tool.<br/> Results: The initial database search identified 1,424 potentially relevant records, 26 were included and scored. Most studies (n = 22) focused on dance students only, three included only dance teachers, and one study included both. Among both dance students and teachers, the majority of injuries reported were overuse or chronic and involved the lower limb. For studies that reported injury rates (n = 14), estimates ranged from 0.8 to 4.7 injuries per 1,000 dance hours, 4.86 per 1,000 dancer-days, and 0.21 to 0.34 per 1,000 dance exposures.<br/> Conclusions: Based on the current research, dance students and teachers experience a similar rate of injury to concert and professional dancers, and their injuries are most commonly overuse injuries involving the lower extremity. There have been few high-quality investigations of injury specific to the dance training environment. Therefore, consensus around the burden of injury in the dance education settings remains difficult. Future dance epidemiological investigations that examine the burden of injury among dance teachers and students, include operational injury and exposure definitions, and utilize prospective designs are warranted.

Multiple Factors Influencing Healthy Performance for Pre-professional and Professional Classical Violinists: An Exploratory Study Focusing on Physical Health

Musculoskeletal complaints are common in pre-professional and professional classical violinists and these complaints can affect violinists' performance. Therefore, it is important to identify the factors that contribute to healthy performance in this population. Qualitative studies with a variety of stakeholders are able to provide insights from different perspectives into factors influencing healthy performance for the pre-professional and professional classical violinist. In the current small-scale, exploratory study, semi-structured interviews were conducted with various stakeholders; two classical violin students, one classical violin teacher, a physiotherapist, a professional classical violinist, who is also a performance coach, and a health specialist who also graduated as a professional classical violist. Thematic analysis was conducted using Atlas.ti 9. We identified six themes that were indicated as important by the participants in terms of ensuring healthy performance for the pre-professional and professional classical violinist. The themes were: (1) physical aspects (involved in playing the violin); (2) practice routine and techniques; (3) interaction between physical and mental aspects; (4) culture; (5) role of the main subject teacher; and (6) preventive measures. Furthermore, when asked specifically about the development of a physical screening tool, the participants indicated that such a tool should include multiple factors covering various regions of the body, the inclusion of a questionnaire on risk-factors, and follow-up measurements. Also, collaborations between health professionals and main subject teachers were recommended as part of the screening tool to increase commitment of participating students. The results of the current study are based on the opinions, attitudes, and ideas of a small, selected group of participants only and cannot be generalized to a wider group of violinists. More research is needed regarding factors influencing healthy performance, before conservatoires and professional orchestras can develop programs for a healthy playing environment for pre-professional and professional violinists.

Injuries in elite level male beach soccer players: a prospective three year study

OBJECTIVES

The aim of this study was to investigate the incidence and characteristics of match and training injuries in elite-level national male beach soccer players.

METHOD

The incidence, mechanism, location, type, severity, and burden of injuries of the Turkish national beach soccer team were recorded between 2017 and 2019.

RESULTS

A total of 136 injuries occurred during the study period. Total injury incidence was 238.9 injuries/1,000 match hours (MHs) and 37.7 injuries/1,000 training hours (THs) (p < 0.001). Twenty-seven injuries led to time-loss, and the incidences for match and training injuries were 36.7 and 7.9 per 1,000 hours, respectively. Of medical attention injuries (MAI) caused by trauma, 54.6% (n = 53) were due to another player and, 60.9% (n = 14) of time-loss injuries (TLI) caused by trauma were due to non-contact trauma (p < 0.001). While 82% (n = 91) of training injuries occurred in lower extremities, 29% (n = 9) of match injuries occurred in the head/neck region (p < 0.001). Head injury incidence was 45.9 per 1,000 match hours. Of MAI, 50% (n = 57) were contusion, and 32.1% (n = 9) of TLI were strain (p < 0.001). Also, the most common injury subtype was foot/toe contusion during match and training (19.4%; n = 6, 27.9%; n = 31, respectively). The majority of injuries 91.9% (n = 125) had slight severity.

CONCLUSION

Head trauma, tendon injury, and foot/toe contusion are important for clinical practice in beach soccer. Protective measures (rule regulation, use of protective equipment, etc.) should be considered to prevent these injuries.

Injury and Illness Incidence in 2017 Super Rugby Tournament: A Surveillance Study on a Single South African Team

Background

Professional rugby presents significant injury and illness risks to players, which need to be regularly assessed to monitor the effects of interventions and competition rules changes.

Hypothesis/Purpose

The purpose of this study was to determine the incidence and nature of time-loss injuries and illness during the pre-season and competition period of the 2017 Super Rugby tournament in a single South African team.

Study Design

Descriptive Epidemiology Study.

Methods

Forty-five adult players were recruited from one 2017 Super Rugby South African team, with 39 included in the final data set. Daily injury and illness data were routinely collected during the season by support staff over a 28-week period (January to July 2017), based on standardized injury and illness definitions. Retrospective analyses of the data were performed.

Results

The incidence of match injuries (241.0 per 1000 player hours) was significantly higher than training injuries (3.3 per 1000 player hours). Twenty one percent of all injuries occurred during the tackle; 37.5% of all injuries were of a "moderate" severity. The proportion of players who sustained a time-loss injury was 76.9% (n=30). The overall incidence of illness was 1.8 per 1000 player days. Acute respiratory tract infection (28.6%) was the most common diagnosis, and the majority of illnesses (64.3%) did not result in time-loss.

Conclusion

This study presented a longer study period than previous research by including the pre-season training, but represented only one single team. The incidence of match injuries was significantly higher than previously reported in Super Rugby tournaments, whereas illness rates were significantly lower. Support staff in professional rugby need to be trained on the standardized Orchard System of Classifications to ensure good quality data that can be compared to other teams within the same or other sporting codes.

Level of evidence

Level 3.

Effect of laterality and fatigue in peroneal electromechanical delay

Introduction: Extremity dominance is one of the intrinsic factors that have been identified for ankle sprains. Electromechanical delay (EMD) is an integral part of the peroneal motor response and, therefore, substantial in preventing ankle sprains. This study aimed to investigate the effect of laterality on EMD times before and after fatigue. Methods: Fifteen healthy male volunteers participated in the study. Measurements were taken with the ankle in a neutral (0°) position, and all subjects followed an isokinetic fatigue protocol. Repeated ANOVA was used for statistical analysis, and the α level was set a priori at p ≤ 0.05. Results: No significant difference was noted in EMD times between the dominant and non-dominant legs of the volunteers (p = 0.940). Fatigue caused a significant increase in EMD by 10–15 ms (p = 0.003), while the leg × fatigue interaction was not significant (p = 0.893). Conclusions: In a non-injured athlete, both ankles seem to be under the same protection of the reactive response of the peroneal muscles. Therefore, athletes should be aware that both their extremities are equally exposed to the danger of an ankle injury. Also, fatigued ankles demonstrate longer EMD times, implying that improving resistance to fatigue may add another layer of protection that has the potential to prevent ankle sprain recurrence.

Non-contact Anterior Cruciate Ligament Injury Epidemiology in Team-Ball Sports: A Systematic Review with Meta-analysis by Sex, Age, Sport, Participation Level, and Exposure Type

Background

Not all anterior cruciate ligament (ACL) injuries are preventable. While some ACL injuries are unavoidable such as those resulting from a tackle, others that occur in non-contact situations like twisting and turning in the absence of external contact might be more preventable. Because ACL injuries commonly occur in team ball-sports that involve jumping, landing and cutting manoeuvres, accurate information about the epidemiology of non-contact ACL injuries in these sports is needed to quantify their extent and burden to guide resource allocation for risk-reduction efforts.

Objective

To synthesize the evidence on the incidence and proportion of non-contact to total ACL injuries by sex, age, sport, participation level and exposure type in team ball-sports.

Methods

Six databases (MEDLINE, EMBASE, Web of Science, CINAHL, Scopus and SPORTDiscus) were searched from inception to July 2021. Cohort studies of team ball-sports reporting number of knee injuries as a function of exposure and injury mechanism were included.

Results

Forty-five studies covering 13 team ball-sports were included. The overall proportion of non-contact to total ACL injuries was 55% (95% CI 48–62, I² = 82%; females: 63%, 95% CI 53–71, I² = 84%; males: 50%, 95% CI 42–58, I² = 86%). The overall incidence of non-contact ACL injuries was 0.07 per 1000 player-hours (95% CI 0.05–0.10, I² = 77%), and 0.05 per 1000 player-exposures (95% CI 0.03–0.07, I² = 97%). Injury incidence was higher in female athletes (0.14 per 1000 player-hours, 95% CI 0.10–0.19, I² = 40%) than male athletes (0.05 per 1000 player-hours, 95% CI 0.03–0.07, I² = 48%), and this difference was significant. Injury incidence during competition was higher (0.48 per 1000 player-hours, 95% CI 0.32–0.72, I² = 77%; 0.32 per 1000 player-exposures, 95% CI 0.15–0.70, I² = 96%) than during training (0.04 per 1000 player-hours, 95% CI 0.02–0.07, I² = 63%; 0.02 per 1000 player-exposures, 95% CI 0.01–0.05, I² = 86%) and these differences were significant. Heterogeneity across studies was generally high.

Conclusion

This study quantifies several key epidemiological findings for ACL injuries in team ball-sports. Non-contact ACL injuries represented over half of all ACL injuries sustained. The proportion of non-contact to total ACL injuries and injury incidence were higher in female than in male athletes. Injuries mostly occurred in competition settings.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40279-022-01697-w.

The Use of Wearable Sensors for Preventing, Assessing, and Informing Recovery from Sport-Related Musculoskeletal Injuries: A Systematic Scoping Review

Wearable technologies are often indicated as tools that can enable the in-field collection of quantitative biomechanical data, unobtrusively, for extended periods of time, and with few spatial limitations. Despite many claims about their potential for impact in the area of injury prevention and management, there seems to be little attention to grounding this potential in biomechanical research linking quantities from wearables to musculoskeletal injuries, and to assessing the readiness of these biomechanical approaches for being implemented in real practice. We performed a systematic scoping review to characterise and critically analyse the state of the art of research using wearable technologies to study musculoskeletal injuries in sport from a biomechanical perspective. A total of 4952 articles were retrieved from the Web of Science, Scopus, and PubMed databases; 165 were included. Multiple study features-such as research design, scope, experimental settings, and applied context-were summarised and assessed. We also proposed an injury-research readiness classification tool to gauge the maturity of biomechanical approaches using wearables. Five main conclusions emerged from this review, which we used as a springboard to propose guidelines and good practices for future research and dissemination in the field.

Risk of surgery and epidemiological profile of athletes presenting to a single sports injury clinic in Hong Kong

Background

Although participation in sports and exercise is promoted widely due to its health benefits, sports-related injuries can also be a detriment to an individual's health and a burden for the healthcare system. Herein, the aim of this study is to provide a comprehensive review on the epidemiological profile and the risk for surgery of athletes presented to a sports injuries clinic in Hong Kong.

Methods

A total of 566 patients attending the sports injuries clinic at a local hospital between October 2017 and September 2018 were reviewed. Only 271 patients sustaining injuries from sports activities were included. These patients attended a survey-based data collection session, which recorded their demographic, injury site, events leading to injury, exercise details (type, level-of-play, frequency, experience), and functional score according to the injury site.

Results

The highest proportion of injuries was observed in amateur athletes (45.4%) than in recreational (28.8%) and professional (25.8%). Those patients aged between 18–29 years old (50.2%) had the most injuries. Both soccer (25.1%) and basketball (25.1%) were the two most common sports to incurred injuries. Whereas, the lower extremities being the most common injured sites. Based on our logistic model, athletes with less experience were more prone to required surgeries with injuries in the lower extremities.

Conclusion

Preventive measures should be targeted at less experience athletes, focusing on strengthening the knee region, to reduce sports-related injuries and surgeries. Importantly, this study demonstrates the need to further identify factors to develop effective sports injury prevention programmes for tailoring athletes at different levels-of-play.

Prevalence and burden of health problems in top-level football referees

BACKGROUND

Top-level football referees take decisions during strenuous physical activity, and often under great mental pressure. Despite their central role in a football match, little is known about referees' health problems, particularly in female referees.

AIM

To investigate the prevalence and burden of health problems in female and male top-level referees.

STUDY DESIGN

Prospective cohort study.

METHOD

Fifty-five Norwegian male and female top-level referees reported health problems (injuries and illnesses) in pre-season and during the 2020 competitive season, using the Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H2).

RESULTS

We recorded data for 49 weeks with a compliance of 98%. On average, 34% (95% CI 31-36%) of referees reported at least one health problem each week, and 20% (95% CI 19-22%) reported substantial health problems. Female referees reported more health problems than male referees, and on-field referees reported more health problems than assistant referees. Gradual-onset injuries were most prevalent and caused the greatest absence from training and matches, whereas illnesses represented only a small portion to the overall burden of health problems. The injury incidence was three injuries per athlete-year (95% CI 2.5-3.5) and 11 injuries per 1000 match hours (95% CI 7-18). The illness incidence was 1.4 illnesses per athlete-year (95% CI 1.1-1.8). Injuries to the lower legs and feet represented the highest burden of health problems.

CONCLUSION

Top-level referees, especially females, reported a high prevalence of health problems. Gradual-onset injuries to the lower leg and foot represented the highest injury burden.

Diagnostics of tissue involved injury occurrence of top-level judokas during the competition: suggestion for prevention

Background

Judo, as a high-intensity contact sport, may lead to the occurrence of injuries, especially in competitions. This work aims to assess the likelihood of soft and hard tissue injuries in top-level judokas during competition with defining factors that determine the probability of injury occurrence.

Methods

The injuries that occurred in 123 official international competitions from 2005-2019 were recorded by the European Judo Union (EJU) Medical Commission as a survey that was a part of the EJU Injury Registration form with internal consistency shown by a Crombach Alpha of 0.69. This survey data identified factors such as: sex, anatomical localisation of injury, type of injury, tissue involved and mechanisms of the injury. A total of 650 tissue injuries were reported correctly in terms of tissue injury definition.

Results

The most frequent soft tissue injury (STI) reported was a ligament STI (48.15%), closely followed by skin STI (12.15%) and muscles STI (11.38%). In turn, the most frequent hard tissue injury occurred in bones (8.56%). The highest rates of injuries occurred during the fight in the standing position (78%). Injuries in the standing position mainly occurred while executing a throw (25.85%) and followed by the attempt to throw, i.e., the action of reaching the throwing position (22.30%), grip fighting (15.07%), and during falls (14.77%). Opposite to this, fight in groundwork reached only 18.30% soft and hard tissue injuries combined. The ongoing registration of injuries during judo combat and training and the early diagnosis of risk factors for injuries are the basis for the development of effective strategies for injury prevention and further treatment.

Injury and Illness in Elite Athletics: A Prospective Cohort Study Over Three Seasons

Background

Athletics (also known as track and field) is one of the most popular sports in the world and is the centrepiece of the Summer Olympic Games. Participation in athletics training and competition involves a risk of illness and injury.

Purpose

To describe injury and illness in British Olympic track and field athletes over three full training and competition seasons.

Study Design

Descriptive Epidemiology Study.

Methods

A total of 111 athletes on the British national program were followed prospectively for three consecutive seasons between 2015-2018. Team medical personnel recorded all injuries and illnesses during this time, following current consensus-based methods. All data pertaining to these records were reviewed and analyzed for sports injury and illness epidemiological descriptive statistics.

Results

The average age of the athletes was 24 years for both males and females (24 years, +/- 4). Total exposure for the three seasons was 79 205 athlete days (217 athlete years). Overuse injuries (56.4%) were more frequent than acute injuries (43.6%). The thigh was the most common injury location (0.6 per athlete year), followed by the lower leg (0.4 per athlete year) and foot (0.3 per athlete year). Muscle and tendon were the most commonly injured tissues, while strains and tears were the most common pathology type. Hamstring muscle strain was the most common diagnosis causing time loss, followed by Achilles tendinopathy and soleus muscle strain. Respiratory illness was the most common illness type (0.3 per athlete year).

Conclusion

Hamstring strains, Achilles tendinopathy, and soleus strains are the most common injuries in athletics and have highest burden. Respiratory illness is the most common illness and has the highest burden. Knowledge of this injury and illness profile within athletics could be utilised for the development of targeted prevention measures within the sport at the elite level.

Level of Evidence

3.

In Professional Male Soccer Players, Time-Loss Groin Injury Is More Associated With the Team Played for Than With Training/Match-Play Duration

OBJECTIVE

To investigate the relationship between training/match-play duration and time-loss groin injury in professional male soccer players, and to determine whether previously identified intrinsic risk factors influenced this relationship.

DESIGN

Prospective cohort study.

METHODS

A total of 579 professional male soccer players were prospectively followed from July 2013 to June 2015. Time-loss groin injuries and individual training and match-play duration were recorded using standardized surveillance methods. Acute training/match-play duration and chronic training/match-play duration were considered as interacting variables. Nonlinear Cox regression analysis (modeled using restricted cubic splines), clustered by player identification number, examined the relationship between training/match-play duration and groin injury. Previously identified intrinsic risk factors of previous groin injury and eccentric adduction strength were included in the multivariable regression analysis.

RESULTS

There was no clinically meaningful relationship between training/match-play duration and groin injury risk. Team played for had the strongest influence on groin injury risk (relative log hazard ratio -2.28 to 0.97). Groin injury risk was highest when accumulated chronic and acute training duration was also highest, but large confidence intervals indicate considerable uncertainty around this finding. Previous groin injury and eccentric adduction strength were not associated with groin injury risk when training/match-play duration and team were included in the model.

CONCLUSION

In professional male soccer players, there was no clinically meaningful relationship between groin injury risk and training/match-play duration. Team played for either protected against or increased groin injury risk, indicating that team-related factors not measured in this study had greater effect on groin injury risk than training/match-play duration. J Orthop Sports Phys Ther 2022;52(4):217-223. Epub 5 Feb 2022. doi:10.2519/jospt.2022.10845.

Prevalence and Associated Factors of Complains on Depression, Anxiety, and Stress in University Students: An Extensive Population-Based Survey in China

Mental health issues are becoming increasingly prevalent amongst university students. However, research on the psychological profile of the general university population is relatively limited. Thus, this study analyses the current state of university students' psychological conditions; the demographic differences in depression, anxiety, and stress and the influencing factors. The objectives are to provide additional appropriate guidance in mental health for university students with different demographic characteristics. A cross-sectional study of 6,032 university students nationwide was conducted from October 2020 to January 2021. A randomized whole-group sampling method was used to select the study participants, and the 21-item Depression, Anxiety, and Stress Scale (DASS) was used. P < 0.05 in the final model were considered statistically significant. The number of university students with no complain of depression, anxiety, or stress was 3,751 (62.2%). The odds of developing complain of depression were higher amongst anxious respondents (AOR = 23.417, 95% CI: 19.706, 27.826) and senior year (AOR = 2.210, 95% CI: 1.657, 2.947) than their counterparts. Students with "myopia" were 1.263 times more likely to be anxious (AOR = 1.263, 95% CI: 1.042-1.530). In terms of "impaired" or not, impaired is defined as any injury, such as sprain, strain, and fracture, "impaired" university students were 1.321 times more likely to be anxious (AOR = 1.321, 95% CI: 1.064-1.641). Furthermore, history of impairment and myopia increased the odds of stress by 1.305 (AOR = 1.305, 95% CI: 1.022-1.667) and 1.305 (AOR = 1.305, 95% CI: 1.012-1.683), respectively. Myopia, physical-activity-related injury (PARI) and irrational eating habits are risk factors for complain of anxiety and stress. Males, upper grades, low parental education, and irrational eating habits are risk factors for complain of depression. Low physical activity levels are also an influential factor for complain of depression. DASS consists of interchangeable risk factors and multiple complains of DASS may coexist.

Advances in sports genomics

Sports genomics is the scientific discipline that focuses on the organization and function of the genome in elite athletes, and aims to develop molecular methods for talent identification, personalized exercise training, nutritional need and prevention of exercise-related diseases. It postulates that both genetic and environmental factors play a key role in athletic performance and related phenotypes. This update on the panel of genetic markers (DNA polymorphisms) associated with athlete status and soft-tissue injuries covers advances in research reported in recent years, including one whole genome sequencing (WGS) and four genome-wide association (GWAS) studies, as well as findings from collaborative projects and meta-analyses. At end of 2020, the total number of DNA polymorphisms associated with athlete status was 220, of which 97 markers have been found significant in at least two studies (35 endurance-related, 24 power-related, and 38 strength-related). Furthermore, 29 genetic markers have been linked to soft-tissue injuries in at least two studies. The most promising genetic markers include HFE rs1799945, MYBPC3 rs1052373, NFIA-AS2 rs1572312, PPARA rs4253778, and PPARGC1A rs8192678 for endurance; ACTN3 rs1815739, AMPD1 rs17602729, CPNE5 rs3213537, CKM rs8111989, and NOS3 rs2070744 for power; LRPPRC rs10186876, MMS22L rs9320823, PHACTR1 rs6905419, and PPARG rs1801282 for strength; and COL1A1 rs1800012, COL5A1 rs12722, COL12A1 rs970547, MMP1 rs1799750, MMP3 rs679620, and TIMP2 rs4789932 for soft-tissue injuries. It should be appreciated, however, that hundreds and even thousands of DNA polymorphisms are needed for the prediction of athletic performance and injury risk.

The ISPA Int Injury Prevention Programme for Youth Competitive Alpine Skiers: A Controlled 12-Month Experimental Study in a Real-World Training Setting

Evidence-based injury prevention programmes for youth competitive alpine skiers are widely absent. The aims of this controlled 12-month experimental study were to introduce a novel injury prevention programme targeted to the injury patterns of youth skiers, called ISPA_Int, and to compare the differences in injury occurrence between an intervention group (IG) additionally performing the ISPA_Int programme and an independent, historical control group (CG) following their regular training routines. None of the skiers of the CG were part of the IG and vice versa. The study was directly conducted within the real-world youth development structures of skiers competing at the under 16 years (U16) level in Switzerland. Seventy-one skiers (aged 14.4 ± 0.3 years) assigned to the IG were compared to 58 age- and gender-matched controls. The IG was offered the ISPA_Int programme with the recommendation to perform it at least once per week. Skiers’ adherence to this recommendation was surveyed but not enforced. Injuries were recorded using the Oslo Sports Trauma Research Centre Questionnaire. Primary outcomes were the absolute injury rates (number of injuries/100 athletes per season) and epidemiological incidence proportion (number of injured athletes/100 athletes per season). The secondary outcome was the average 2-weekly prevalence of traumatic knee, knee overuse, and lower back overuse injuries. There were lower absolute rates of all traumatic injuries [rate/risk difference, RD: −57.1 (−98.1, −16.0); rate/risk ratio, RR: 0.665 (0.485, 0.884)] and overuse injuries [RD: −35.9 (−71.0, −0.7); RR: 0.699 (0.493, 0.989)] in the IG than in the CG. Likewise, the epidemiological incidence proportion for all overuse injuries was smaller in the IG [RD: −28.4 (−44.8, −12.0); RR: 0.598 (0.435, 0.822)], while the proportion of skiers suffering from traumatic injuries did not significantly differ between the groups. Notably, the IG particularity differed from the CG in the average 2-weekly prevalence of knee trauma, knee overuse, and lower back overuse complaints, three of the major injury-related hot spots in youth skiers. Based on these promising results, the ISPA_Int programme may have great potential to prevent injuries in youth competitive alpine skiers, and the underlying exercises should be considered complementary training content at the U16 level.

Ankle Sprain in Young Athletes: A 2-Year Retrospective Study at a Multisport Club

Objective  The present study aimed to analyze ankle sprains in young athletes of basketball, futsal, artistic gymnastics, trampoline, tennis, judo, and volleyball over 2 seasons. Methods  Data of 529 athletes in the 1 ^st year and of 495 athletes in the 2 ^nd year of analysis were investigated from the injury record database of a sports club. The following data were considered: the demographic characteristics (age, body mass, height, and sex), the mechanism (contact or noncontact), the severity, the moment at which the injury occurred, and the recurrence. Also, the incidence rate, the injury risk of the first ankle sprain, and the incidence rate ratio between sports were calculated. Results  The athletes sustained 124 ankle sprains in the 2 years of analysis. The majority occurred during training (76.6%) and lead to absence from sports practice (75.8%). The injury recurrence was low: 2 athletes (1.6%) had a recurrence in the same year and 5 (4.0%) in the following year. The incidence rate (0.79 to 12.81 per 1,000 hours) and the injury risk (1.14 to 19.44%) varied among sports. Volleyball, basketball, and futsal presented the highest injury rate incidence. Tennis, gymnastics, and trampoline showed the lowest injury rate incidence. Judo showed an incidence rate different from those of basketball and volleyball in the 1 ^st year and similar to those of other sports in the 2 ^nd year. Conclusion  Ankle sprain greatly impacted sports practice and presented characteristics that differ among the investigated sports. These findings may contribute to developing preventive injury programs.

Electromyography-Assisted Neuromusculoskeletal Models Can Estimate Physiological Muscle Activations and Joint Moments Across the Neck Before Impacts

Knowledge of neck muscle activation strategies before sporting impacts is crucial for investigating mechanisms of severe spinal injuries. However, measurement of muscle activations during impacts is experimentally challenging and computational estimations are not often guided by experimental measurements. We investigated neck muscle activations before impacts with the use of electromyography (EMG)-assisted neuromusculoskeletal models. Kinematics and EMG recordings from four major neck muscles of a rugby player were experimentally measured during rugby activities. A subject-specific musculoskeletal model was created with muscle parameters informed from MRI measurements. The model was used in the calibrated EMG-informed neuromusculoskeletal modeling toolbox and three neural solutions were compared: (i) static optimization (SO), (ii) EMG-assisted (EMGa), and (iii) MRI-informed EMG-assisted (EMGaMRI). EMGaMRI and EMGa significantly (p < 0.01) outperformed SO when tracking cervical spine net joint moments from inverse dynamics in flexion/extension (RMSE = 0.95, 1.14, and 2.32 N·m) but not in lateral bending (RMSE = 1.07, 2.07, and 0.84 N·m). EMG-assisted solutions generated physiological muscle activation patterns and maintained experimental cocontractions significantly (p < 0.01) outperforming SO, which was characterized by saturation and nonphysiological "on-off" patterns. This study showed for the first time that physiological neck muscle activations and cervical spine net joint moments can be estimated without assumed a priori objective criteria before impacts. Future studies could use this technique to provide detailed initial loading conditions for theoretical simulations of neck injury during impacts.

An 8-Week Neuromuscular Training Program After Concussion Reduces 1-Year Subsequent Injury Risk: A Randomized Clinical Trial

BACKGROUND

Existing data suggest that after concussion, athletes experience an increased risk of subsequent injury. Exploring methods that may reduce injury risk after successful postconcussion return to play may lead to new treatment approaches.

PURPOSE

To examine the efficacy of a neuromuscular training (NMT) intervention on acute sports-related time-loss injury over the subsequent year relative to standard of care.

STUDY DESIGN

Randomized clinical trial; Level of evidence, 1.

METHODS

A total of 27 youth athletes were assessed initially postconcussion (median, 7 days postconcussion; interquartile range [IQR], 5-10) and after return-to-play clearance (median, 40 days postconcussion; IQR, 15-52). After return-to-play clearance, they were randomly assigned to NMT intervention (n = 11; mean ± SD age, 14.7 ± 1.7 years; 36% female) or standard of care (n = 16; mean ± SD age, 15.3 ± 1.8 years; 44% female). The intervention (duration, 8 weeks; frequency, 2 times per week) included guided strength exercises with landing stabilization focus. Standard of care received no recommendations. For the subsequent year, athletes prospectively completed a monthly log of sports-related injuries and organized sports competitions.

RESULTS

During the first year after postconcussion return-to-play clearance, sports-related time-loss injuries were more common among standard of care relative to NMT intervention (75% [95% CI, 48%-93%] vs 36% [95% CI, 11%-69%]). After adjusting for age and sex, the hazard of subsequent injury in the standard-of-care group was 3.56 times (95% CI, 1.11-11.49; P = .0334) that of the NMT intervention group. Sports participation was similar between NMT intervention and standard of care during the year-long monitoring period (hours of organized sports per month; median, 12 [IQR, 2.6-32.1] vs 15.6 [IQR, 3.5-105.9]; P = .55). The age- and sex-adjusted incidence of injuries was 10.2 per 1000 competitive exposures (95% CI, 3.7-28.4) in the standard-of-care group as opposed to 3.4 per 1000 (95% CI, 0.9-13.4) in the NMT intervention group. After adjusting for age and sex, incidence of injuries was higher for standard of care vs NMT intervention (rate ratio, 2.96 [95% CI, 0.89-9.85]; P = .076).

CONCLUSION

Although preliminary, our findings suggest that an NMT intervention initiated after return-to-play clearance may significantly reduce sports-related time-loss injuries over the subsequent year.

REGISTRATION

NCT03917290 (ClinicalTrials.gov identifier).

Maternal Pre-Pregnancy Nutritional Status and Physical Activity Levels and a Sports Injury Reported in Children: A Seven-Year Follow-Up Study

Objective: Our aim was to analyze dose–response associations between maternal pre-pregnancy body mass index and physical activity levels with childhood sports injury rates. Methods: Participants included pre-pregnant mothers (n = 4811) and their children at the age of 7 years (n = 3311). Maternal anthropometry (height, weight, and body mass index), time spent in physical activity, and education level were recorded. All sports injuries were defined as injuries reported in the past year by the children at the age of 7 years. Results: Children whose mothers were overweight/obese in the pre-pregnancy period were 2.04 (OR = 2.04, 95% CI = 1.12–3.71) times more likely to report a sports injury at the age of 7 years. Underweight mothers exhibited a 74% decrease in the odds of their children reporting a sports injury at follow-up (OR = 0.26, 95% CI = 0.10–0.68). Finally, an increase in maternal physical activity across the last three quartiles was associated with a lower odds of sports injuries. Conclusions: The risk of reporting a sports injury was greater for children whose mothers were overweight/obese in the pre-pregnancy period. However, there was a lower risk with both maternal underweight status and increasing minutes of physical activity.

The prevalence of chronic ankle instability in basketball athletes: a cross-sectional study

Background

Ankle sprain is the most common injury in basketball. Chronic ankle instability develops from an acute ankle sprain may cause negative effects on quality of life, ankle functionality or on increasing risk for recurrent ankle sprains and post-traumatic osteoarthritis. To facilitate a preventative strategy of chronic ankle instability (CAI) in the basketball population, gathering epidemiological data is essential. However, the epidemiological data of CAI in basketball is limited. Therefore, this study aims to investigate the prevalence of CAI in basketball athletes and to determine whether gender, competitive level, and basketball playing position influence this prevalence.

Methods

In a cross-sectional study, in total 391 Taiwanese basketball athletes from universities and sports clubs participated. Besides non-standardized questions about demographics and their history of ankle sprains, participants further filled out the standard Cumberland Ankle Instability Tool applied to determine the presence of ankle instability. Questionnaires from 255 collegiate and 133 semi-professional basketball athletes (male = 243, female = 145, 22.3 ± 3.8 years, 23.3 ± 2.2 kg/m²) were analyzed. Differences in prevalence between gender, competitive level and playing position were determined using the Chi-square test.

Results

In the surveyed cohort, 26% had unilateral CAI while 50% of them had bilateral CAI. Women had a higher prevalence than men in the whole surveyed cohort (X²(1) = 0.515, p = 0.003). This gender disparity also showed from sub-analyses, that the collegiate female athletes had a higher prevalence than collegiate men athletes (X²(1) = 0.203, p = 0.001). Prevalence showed no difference between competitive levels (p > 0.05) and among playing positions (p > 0.05).

Conclusions

CAI is highly prevalent in the basketball population. Gender affects the prevalence of CAI. Regardless of the competitive level and playing position the prevalence of CAI is similar. The characteristic of basketball contributes to the high prevalence. Prevention of CAI should be a focus in basketball. When applying the CAI prevention measures, gender should be taken into consideration.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13102-022-00418-0.

Epidemiology of Concussions in National Collegiate Athletic Association (NCAA) Sports: 2014/15-2018/19

BACKGROUND

Updated epidemiology studies examining sports-related concussions (SRCs) are critical in evaluating recent efforts aimed at reducing the incidence of SRCs in National Collegiate Athletic Association (NCAA) sports.

PURPOSE

To describe the epidemiology of SRCs in 23 NCAA sports during the 2014/15-2018/19 academic years.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

SRC and exposure data collected in the NCAA Injury Surveillance Program were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics by sport, event type (practices, competitions), injury mechanism (player contact, surface contact, equipment/apparatus contact), and injury history (new, recurrent). Injury rate ratios (IRRs) were used to examine differential injury rates, and injury proportion ratios (IPRs) were used to examine differential distributions.

RESULTS

A total of 3497 SRCs from 8,474,400 athlete-exposures (AEs) were reported during the study period (4.13 per 10,000 AEs); the competition-related SRC rate was higher than was the practice-related SRC rate (IRR, 4.12; 95% CI, 3.86-4.41). The highest SRC rates were observed in men's ice hockey (7.35 per 10,000 AEs) and women's soccer (7.15 per 10,000 AEs); rates in women's soccer and volleyball increased during 2015/16-2018/19. Player contact was the most prevalently reported mechanism in men's sports (77.0%), whereas equipment/apparatus contact was the most prevalently reported mechanism in women's sports (39.2%). Sex-related differences were observed in soccer, basketball, softball/baseball, and swimming and diving. Most SRCs reported in men's sports (84.3%) and women's sports (81.1%) were reported as new injuries.

CONCLUSION

Given the increasing SRC rates observed in women's soccer and volleyball during the latter years of the study, these results indicate the need to direct further attention toward trajectories of SRC incidence in these sports. The prevalence of equipment/apparatus contact SRCs in women's sports also suggests that SRC mechanisms in women's sports warrant further investigation. As most SRCs during the study period were reported as new injuries, the prevalence of recurrent SRCs in men's and women's ice hockey is also noteworthy.

Test-Retest Reliability of the Isometric Soleus Strength Test in Elite Male Academy Footballers

BACKGROUND

Currently there is no reliability data available for the isometric soleus strength test (ISST), commonly used as a monitoring tool in elite football settings. Isometric strength testing for other muscle groups, most notably the hamstrings, is utilized to identify injury risk and readiness to train/play. To profile athletes efficiently, performance practitioners require optimal measures that are reliable. The aim of this study was to investigate the test-retest reliability of the isometric strength test of the soleus and propose a standardized protocol for its use within an elite male football population.

STUDY DESIGN

Test-retest reliability single cohort study.

METHODS

Thirty elite male footballers (age = 22.8±5.0 years, height = 180.0±0.08 cm, weight = 70.57±4.0 kg) performed the ISST, through three maximum 3-second hold efforts with one minute rest between repetitions and 48 hours between tests, in each test. The test was performed mid-competitive season. All data bilaterally were checked for normality using the Shapiro-Wilk test before a Pearson's Correlations and Bland-Altman's analyses were performed.

RESULTS

Test-retest reliability demonstrated high reliability for ISST bilaterally (Right: r = 0.89; Left: r = 0.79, p<0.05). The standard error of measurement (SEM) (%) was 9.09 - 12.47% and minimal detectable change (MDC) was 25.19 - 34.56 (N) for Peak Force (PF) measures of the ISST. Bilateral levels of agreement were found to be +/- 2 standard deviations (SD) of the interval of agreement bilaterally for ISST (Levels of agreement (LOA): Right: Upper 352.49 - Lower -494.76; Left: Upper 523.82 - Lower -591.30. Bilaterally no significant difference was detected between values (Right: p=0.09, CI: -153.21-10.95; Left: p=0.52, CI: -139.81-72.33).

CONCLUSION

The results of this study demonstrate high reliability for the ISST. The ISST displays a high test-retest reliability for assessing PF characteristics of the soleus in elite male academy footballers. This test may be beneficial for performance practitioners for profiling soleus function of athletes.

Paediatric injuries around the knee: Soft tissue injuries

We review the diagnosis, management and potential pitfalls of acute soft tissue injuries in the skeletally immature knee, including anterior cruciate ligament (ACL) injuries, meniscal injuries, patellar dislocation and patellofemoral instability (PFI). There has been an increasing incidence of such injuries in the paediatric population, and controversy remains regarding their treatment. We summarise evidence-based treatments for these injuries and discuss strategies to minimise complications as the child reaches skeletal maturity.

Epidemiology of injuries in elite male and female futsal: a systematic review and meta-analysis

The main purpose of this study was to conduct a systematic review and meta-analysis quantifying the incidence of injuries in futsal players. A systematic search was conducted using MEDLINE, PubMed, Web of Science and Scopus databases and subsequently, six studies (14 cohorts) were selected. Separate meta-analyses for male and female players were conducted using a Poisson random-effect regression model approach. The overall and match incidence rates in elite male futsal players were 6.8 (95% CI = 0.0-15.2) and 44.9 (95% CI = 17.2-72.6) injuries/1000 hours of exposure. Pooled training injury rate in male players was not calculated due to the lack of studies reporting training injuries in this cohort. For females, an overall, training and match incidence rates of 5.3 (95% CI = 3.5-7), 5.1 (95% CI = 2.7-7.6) and 10.3 (95% CI = 0.6-20.1) injuries/1000 hours of exposure were reported. In males, match incidence rate in International tournaments was 8.5 times higher than in national leagues (77.2 [95% CI = 60.0-94.5] vs 9.1 [95% CI = 0.0-19.3] for international tournaments and national leagues, respectively). Elite male and female futsal players are exposed to a substantial risk of sustaining injuries, especially during matches.

Injury History and Perceived Knee Function as Risk Factors for Knee Injury in Youth Team-Sports Athletes

BACKGROUND

The identification of risk factors for sports injuries is essential before injury prevention strategies can be planned.

HYPOTHESIS

Previous acute knee injury and lower perceived knee function measured by Knee injury and Osteoarthritis Outcome Score (KOOS) will increase the risk of acute knee injury in youth team-sports athletes.

STUDY DESIGN

Prospective cohort study.

LEVEL OF EVIDENCE

Level 3.

METHODS

At baseline, youth (≤21 years old) male and female basketball and floorball athletes completed a questionnaire on previous acute knee injuries and perceived knee function (KOOS). A total of 211 male and 183 female athletes were followed for an acute knee injury up to 3 years. Unadjusted and adjusted Cox regression models were used in risk factor analyses.

RESULTS

In male athletes, previous acute knee injury and lower KOOS Pain, Activities of Daily Living, Sport and Recreation, and knee-related Quality of Life subscale scores increased the risk of acute knee injury in the unadjusted analyses. Adjusted analyses for male injuries were not performed because of low number of acute knee injuries (n = 18). In female athletes, previous acute knee injury increased the risk of acute knee injury when adjusted for athletes' age and body mass index (hazard ratio, 2.6 [95% CI, 1.3-5.2]). In female athletes, none of the KOOS subscale scores were associated with the increased risk of acute knee injury in the adjusted analyses.

CONCLUSION

Previous acute knee injury was associated with the risk of new acute knee injury in youth male and female athletes. In youth male athletes, additionally, lower perceived knee function in 4 out of 5 KOOS subscale scores were associated with the increased risk of new acute knee injury.

CLINICAL RELEVANCE

The treatment and rehabilitation of the present acute knee injury and secondary prevention of reinjury should be emphasized in youth team-sports athletes.

Sports Injury and Illness Epidemiology: Thailand Team Surveillance During the 30th Southeast Asian Games

Background: Injury and illness surveillance in sports is the first step of the injury prevention model that generates effective injury prevention measures. Objectives: To identify the incidence, severity, and causes of injuries and illness in the Thailand national team during the 30th Southeast Asian (SEA) Games. Methods: All medical encounters were documented using the International Olympic Committee (IOC) injury and illness surveillance system for multi-sport events. We recorded the daily occurrence of injuries and illnesses reported by Thailand’s medical teams over the 12 days of the competition period. Results: Among 980 Thai athletes (568 male and 412 female), that participated in the 30th SEA Games, a total of 105 injuries and illnesses were reported. There were 84 injuries and 21 illnesses which equated to an incidence of 86 injuries and 21 illnesses per 1000 athletes. The most commonly injured body part was the lower leg (14% of all injuries), followed by the shoulder and clavicle. Ligament sprain or rupture and contusion (25% of all injuries) were reported as the most common type of injury. Of all injuries, 56 were classified as needing medical attention (only), 26 caused performance restriction, and two caused complete-time loss. The most common athlete illness was respiratory illness (48% of all illnesses) followed by gastrointestinal illness (19% of all illnesses). One-third (7 out of 21) of athlete illnesses restricted the athlete's performance, and the remaining 14 only required medical attention. Conclusions: Overall, 8% of athletes incurred at least one injury during the competition, and 2% suffered from an illness. Lower leg injury and respiratory illness were the most common, which is similar to other multi-sport events. Based on the research data, injury prevention, especially of ligamentous sprain and lower limb injuries, should be the focus in multi-sport events.