Epidemiology of Injuries in Women Playing Competitive Team Bat-or-Stick Sports: A Systematic Review and a Meta-Analysis

Effectiveness of Percutaneous Needle Electrolysis to Reduce Pain in Tendinopathies: A Systematic Review With Meta-Analysis

CONTEXT

Tendon injuries are common disorders in both workers and athletes, potentially impacting performance in both conditions. This is why the search for effective treatments is continuing.

OBJECTIVE(S)

The objective of this study was to analyze whether the ultrasound-guided percutaneous needle electrolysis technique may be considered a procedure to reduce pain caused by tendinosis.

EVIDENCE ACQUISITION

The search strategy included the PubMed, SCOPUS, CINAHL, Physiotherapy Evidence Database, SciELO, and ScienceDirect up to the date of February 25, 2024. Randomized clinical trials that assessed pain caused by tendinosis using the Visual Analog Scale and Numeric Rating Scale were included. The studies were evaluated for quality using the Cochrane Risk of Bias 2, and the evidence strength was assessed by the GRADEpro GDT.

EVIDENCE SYNTHESIS

Out of the 534 studies found, 8 were included in the review. A random-effects meta-analysis and standardized mean differences (SMD) were conducted. The ultrasound-guided percutaneous needle electrolysis proved to be effective in reducing pain caused by tendinosis in the overall outcome (SMD = -0.97; 95% CI, -1.26 to -0.68; I2 = 58%; low certainty of evidence) and in the short-term (SMD = -0.83, 95% CI, -1.29 to -0.38; I2 = 65%; low certainty of evidence), midterm (SMD = -1.28; 95% CI, -1.65 to -0.91; I2 = 0%; moderate certainty of evidence), and long-term (SMD = -0.94; 95% CI, -1.62 to -0.26; I2 = 71%; low certainty of evidence) subgroups.

CONCLUSION(S)

The application of the ultrasound-guided percutaneous needle electrolysis technique for reducing pain caused by tendinosis appears to be effective. However, due to the heterogeneity found (partially explained), more studies are needed to define the appropriate dosimetry, specific populations that may benefit more from the technique, and possible adverse events.

Association between eHealth literacy and health outcomes in German athletes using the GR-eHEALS questionnaire: a validation and outcome study

BACKGROUND

Athletes face various sports-related stressors, which may increase their risk for physical and mental health symptoms. With the internet as an important source of (health) information, it is important for athletes to have eHealth literacy, i.e. the ability to access, understand and use electronic health information and services. However, it is presently uncertain whether eHealth literacy of athletes is linked to better health outcomes such as reduced injury frequency and behaviours like decreased substance abuse.

METHODS

A cross-sectional study was conducted with N = 373 German athletes (229 females) from different types of sport (e.g., ball sports and water sports) who were included in the statistical analyses. The survey included medical, socio-demographic, eHealth- and sports-related data as well as the eHealth Literacy Scale (GR-eHEALS) questionnaire, which measures eHealth literacy. Confirmatory factor analyses and correlational analyses were performed to determine the convergent and discriminant (compared to the 8-item Impulsive Behavior-8 Scale) validity of the GR-eHEALS and to assess the relation between eHealth literacy scores and health outcomes.

RESULTS

The more frequently athletes had sustained minor or moderate injuries in the past, the higher the level of eHealth literacy they reported. Furthermore, consumption frequency of painkillers (r = .18, p = .002), sedatives (r = .12, p = .040), and cannabis (r = .29, p = .000) was significantly correlated with eHealth literacy scores. The confirmatory factor analysis of the GR-eHEALS showed an acceptable model fit with a 2-factor solution (information seeking and information appraisal). The GR-eHEALS showed good discriminant (r = - .09, p = .21) and convergent validity (digital confidence; r = .28, p < .001).

CONCLUSION

The GR-eHEALS is a valid instrument to assess eHealth literacy within the cohort of German athletes. Potential dangers of dealing with injury and psychological strain without reaching out for professional help should be considered.

A systematic literature review of injury epidemiology and surveillance practices in elite adult female field-based team sport

OBJECTIVES

To describe injury incidence and surveillance practices in elite adult female field-based team sports.

DESIGN

Systematic literature review.

METHODS

This review was prospectively registered (PROSPERO CRD42022318642). CINAHL, PubMed, MEDLINE, Scopus, SPORTDiscus, Web of Science, Open Grey and Google Scholar were searched from inception to 30th June inclusive. Peer reviewed original research articles that reported the incidence of injury sustained by females aged ≥18 years in elite field-based team sports were included. The Newcastle Ottawa Scale was used to assess the risk of bias.

RESULTS

Twenty prospective cohort studies investigating injury incidence in Australian football, American football, soccer, field hockey, rugby, rugby-7s and cricket were eligible. A higher injury incidence in match play compared to training was reported with the highest match and training incidence (132.7 and 42.1/1000 h of exposure respectively) in Australian football. The majority of the reported injuries were to the lower limb and involved muscle/tendon or joint/ligaments. There was heterogeneity in definitions of injury, severity and exposure, variations in methods of injury data collection and reporting with, not all data being collected/reported optimally, which limited comparison of studies.

CONCLUSIONS

This review highlights the lack of and need for injury data specific to this cohort. Establishing the incidence of injury with a robust injury surveillance system is the first step in the sequence of injury prevention. It requires consistency in definitions and methodologies, providing accurate and useful injury data, to guide targeted injury prevention strategies.

Validity of the frame subtraction method in dynamic postural stability

Background

The movement of targeted subjects can be calculated using the frame subtraction method. However, the validity of this evaluation method of dynamic postural stability has not been clarified yet. This study aimed to verify the validity of the evaluation method for jump landing using the frame subtraction score based on the ground reaction force (GRF).

Methods

Twenty subjects performed single-leg jump landing, and their dynamic postural stability index (DPSI), medial‒lateral stability index (MLSI), anterior‒posterior stability index, and vertical stability index (VSI) were calculated from the GRF. Simultaneously, motion images were captured using digital video cameras in the sagittal and frontal planes. After the motion images were analyzed using the frame subtraction method, the frame subtraction scores in the frontal, sagittal, and combined planes were calculated. To confirm its validity, the relationship between the frame subtraction scores and GRF parameters was investigated using Pearson's correlation analysis.

Results

The frame subtraction scores in the frontal and combined planes were significantly correlated with the DPSI, MLSI, and VSI (r = 0.46–0.75, P < 0.05).

Conclusions

Therefore, the frame subtraction method could be applied to the evaluation of dynamic postural stability. Markerless systems are deemed useful in clinical practice.

Knee Kinetics and Kinematics of Young Asymptomatic Participants during Single-Leg Weight-Bearing Tasks: Task and Sex Comparison of a Cross-Sectional Study

This cross-sectional study aimed to describe and compare kinetic and kinematic variables of the knee joint during stair descent, single-leg step down, and single-leg squat tasks. It also aimed to investigate potential sex difference during the tasks. Thirty young asymptomatic individuals (15 males, 15 females) were assessed during the performance of single-leg weight-bearing tasks. The kinetic and kinematic data from the knee were evaluated at the peak knee moment and at peak knee flexion. Single-leg squat presented a higher peak knee moment (2.37 Nm/kg) and the greatest knee moment (1.91 Nm/kg) at knee peak angle in the frontal plane, but the lowest knee flexion (67°) than the other two tasks (p < 0.05). Additionally, the single-leg step down task presented a higher varus knee angle (5.70°) when compared to stair descent (3.71°) (p < 0.001). No substantial sex difference could be observed. In conclusion, in asymptomatic young individuals, single-leg squats presented the greatest demand in the frontal and sagittal planes. Single-leg step down demanded a greater angular displacement than stair descent in the frontal plane. We did not identify a significant difference among the sex and studied variables.

Prevalence and incidence of injuries among female cricket players: a systematic review and meta-analyses

OBJECTIVE

The objective of the review was to describe the incidence and prevalence of injuries among female cricket players of all ages, participating in all levels of play.

INTRODUCTION

Cricket, a bat-and-ball sport, is becoming popular among women of all ages and abilities worldwide. However, cricket participation carries a risk of injury. Injuries negatively affect sport participation, performance, and short- and long-term health and well-being. Injury prevention, therefore, is the key to safe, long-term cricket participation as a physical activity goal. Epidemiological data are needed to underpin evidence-based injury-prevention strategies.

INCLUSION CRITERIA

Studies reporting incidence and prevalence of injuries in female cricket players of all ages, participating in all levels of play, were included in this review, including studies that report data by sex or by sport. Studies without enough data to calculate prevalence or incidence, that do not distinguish female injury data from males', that focus on athletes participating in other sports, or that focus on case studies were excluded.

METHODS

A systematic review and meta-analyses were conducted according to the JBI and PRISMA 2020 guidelines. MEDLINE, SPORTDiscus, Physiotherapy Evidence Database (PEDro), EBSCO MasterFILE Premier, EBSCO CINAHL Complete, ProQuest Health and Medical Complete, Scopus, and Science Direct were systematically searched from inception to August 2021. Additionally, Cochrane Controlled Trials Register and ClincalTrail.gov were searched. EBSCO MegaFile Premier (EBSCO), OpenGrey (SIGLE), WorldCat, Grey Matters, Grey Literature, and Google Scholar databases were searched for gray literature. Full-text articles that met the inclusion criteria were critically appraised using JBI-tools, and were extracted and synthesized in narrative summary and tabular forms. Three meta-analyses were conducted: injury incidence rate, injury prevalence proportions, and injury incidence proportions. Heterogeneity was assessed using the I2 statistic and the random-effects model.

RESULTS

Of the 7057 studies were identified and only 4256 screened after duplicates removed, 23 studies met the inclusion criteria. Risk of bias was low for 21 studies. The injury incidence rate for elite cricket was 71.9 (SE 21.3, 95% CI 30.2-113.6) injuries per 1000 player hours, time-loss injury incidence rate was 13.3 (SE 4.4, 95% CI 4.6-22.0) injuries per 1000 player hours, and non-time-loss injury incidence rate was 58.5 (SE 16.9, 95% CI 25.6-91.7) injuries per 1000 player hours. The injury prevalence proportions for community to elite cricket was 65.2% (SE 9.3, 95% CI 45.7-82.3) and injury prevalence proportions for community cricket was 60% (SE 4.5, 95% CI 51.1-68.6). The injury incidence proportions for community cricket was 5.6 (SE 4.4, 95% CI 0.1-18.3) injuries per 10,000 participants. Elite cricket players were more frequently injured than community cricket players. The most prevalent body regions injured were the shoulder and knee, and most were sustained by fast bowlers. Injuries to the hand, wrist, and fingers had the highest incidence and were most sustained by fielders.

CONCLUSIONS

The study's findings can help stakeholders (including players, coaches, clinicians, and policymakers) make informed decisions about cricket participation by informing and implementing strategies to promote cricket as a vehicle for positive public health outcomes. This review also identified gaps in the available evidence base and addressing these through future research would enhance women's cricket as a professional sport.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42020166052.

Prevalence and incidence of injuries among female cricket players: a systematic review protocol

OBJECTIVE

The objective of this systematic review is to describe the incidence and prevalence of injuries in female cricket players participating in recreational-, school-, club-, and elite-level cricket.

INTRODUCTION

Recent investments in women's cricket, stand-alone tournaments, and increased visibility through new broadcasting milestones has increased participation in many countries. With increased participation of women in cricket comes increased risk of injury. Epidemiological data are needed to underpin evidence-based injury-prevention strategies. No systematic review or meta-analysis of injuries is currently available to provide a comprehensive overview of synthesized findings to make the evidence accessible.

INCLUSION CRITERIA

Studies on female cricket players of all ages and participating in all levels of cricket will be included. Studies that contain data on only male cricket players will be excluded. Studies where data from female cricket players can be distinguished from male players will be included. Injuries sustained when playing cricket, that are self-reported or diagnosed by a health care professional will be included. Definitions of injury including, but not limited to, medical-attention injuries, general time-loss injuries, or player-reported injuries will be considered.

METHODS

MEDLINE, SPORTDiscus, Physiotherapy Evidence Database (PEDro), EBSCO MasterFILE Premier, EBSCO CINAHL Complete, ProQuest Health and Medical Complete, Scopus, and ScienceDirect will be systematically searched from inception to the present. Cochrane Central Register of Controlled Trials and ClincalTrials.gov will be searched as well as gray literature databases. Retrieval of full-text studies, assessment of methodological quality, and data extraction will be performed independently by two reviewers. If possible, meta-analyses will be performed.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42020166052.

A Field-Based Approach to Determine Soft Tissue Injury Risk in Elite Futsal Using Novel Machine Learning Techniques

Lower extremity non-contact soft tissue (LE-ST) injuries are prevalent in elite futsal. The purpose of this study was to develop robust screening models based on pre-season measures obtained from questionnaires and field-based tests to prospectively predict LE-ST injuries after having applied a range of supervised Machine Learning techniques. One hundred and thirty-nine elite futsal players underwent a pre-season screening evaluation that included individual characteristics; measures related to sleep quality, athlete burnout, psychological characteristics related to sport performance and self-reported perception of chronic ankle instability. A number of neuromuscular performance measures obtained through three field-based tests [isometric hip strength, dynamic postural control (Y-Balance) and lower extremity joints range of motion (ROM-Sport battery)] were also recorded. Injury incidence was monitored over one competitive season. There were 25 LE-ST injuries. Only those groups of measures from two of the field-based tests (ROM-Sport battery and Y-Balance), as independent data sets, were able to build robust models [area under the receiver operating characteristic curve (AUC) score ≥0.7] to identify elite futsal players at risk of sustaining a LE-ST injury. Unlike the measures obtained from the five questionnaires selected, the neuromuscular performance measures did build robust prediction models (AUC score ≥0.7). The inclusion in the same data set of the measures recorded from all the questionnaires and field-based tests did not result in models with significantly higher performance scores. The model generated by the UnderBagging technique with a cost-sensitive SMO as the base classifier and using only four ROM measures reported the best prediction performance scores (AUC = 0.767, true positive rate = 65.9% and true negative rate = 62%). The models developed might help coaches, physical trainers and medical practitioners in the decision-making process for injury prevention in futsal.

Injury Profile in Women's Football: A Systematic Review and Meta-Analysis

BACKGROUND

Football is the most popular sport among women; however, little is known about the injury profile in this population. This information would help design tailored injury risk mitigation strategies that may make football safer for women.

OBJECTIVE

The aim of this study was to perform a systematic review and meta-analysis of epidemiological data of injuries in women´s football.

METHODS

A systematic review following PRISMA guidelines was performed up to January 2020 in PubMed, Web of Science, Sportdiscus and the Cochrane Library databases. Twenty-two studies reporting the incidence of injuries in women football were analysed. Two reviewers independently extracted data (intraclass correlation coefficient [ICC] for inter-reviewer reliability = 0.87) and assessed study quality using the STROBE statement, GRADE approach, Newcastle Ottawa Scale and Downs and Black assessment tools. Studies were combined in pooled analyses (injury incidence and injury proportion) using a Poisson random effects regression model.

RESULTS

The overall incidence of injuries in female football players was 6.1 injuries/1000 h of exposure. Match injury incidence (19.2 injuries/1000 h of exposure) was almost six times higher than training injury incidence rate (3.5 injuries/1000 h of exposure). Lower extremity injuries had the highest incidence rates (4.8 injuries/1000 h of exposure). The most common types of injuries were muscle/tendon (1.8 injuries/1000 h of exposure) and joint (non-bone) and ligament (1.5 injuries/1000 h of exposure), which were frequently associated with traumatic incidents. Slight/minimal injuries (1-3 days of time loss) were the most common. The incidence rate of injuries during matches in the top five world ranking leagues was higher than the rest of the leagues (19.3 vs 10.7 injuries/1000 h of exposure, respectively). The weighted injury proportion was 1.1 (95% confidence interval = 0.6-1.7) whereby on average players sustained more than one injury per season.

CONCLUSIONS

Female football players are exposed to a substantial risk of sustaining injuries, especially during matches that require the highest level of performance. To markedly reduce overall injury burden, efforts should focus on introducing and evaluating preventative measures that target match specific dynamics to make football players more capable of responding to the challenges that they have to deal with during match play.

REGISTRATION

This systematic review was registered in the PROSPERO international prospective register of systematic reviews (ID = CRD42019118152).

Epidemiology of Injuries in Ultimate (Frisbee): A Systematic Review

Ultimate is a high-intensity, non-contact team sport played with a flying disc (e.g., frisbee). Despite the growing popularity of ultimate worldwide, there is limited information about the epidemiology of injury in the sport. The purpose of this review is to provide a comprehensive overview and synthesis of the literature on the epidemiology of injury in ultimate. A comprehensive search of the literature was conducted in five electronic databases (i.e., MEDLINE, Embase, AMED, SPORTDiscus, and AusportMed). All databases were searched from inception to 1 July 2020. A total of eleven studies were included and qualitatively synthesized. Injury incidence rate estimates ranged from 0.4 to 84.9 injuries per 1000 athlete-exposures. The lifetime prevalence of any injury and concussion were 100% and 26%, respectively. The most commonly injured body region was the lower limb, with the knee and thigh being the most frequently injured anatomical locations. The most frequent injury types were muscle injuries and superficial contusions. The most common injury situation was direct contact with another player. There is a substantial risk of injury in ultimate, in particular muscle strains and joint sprains to the knee and shoulder areas. Development and implementation of effective, sport-specific injury prevention initiatives, including improved injury risk management and sport safety culture, should be a priority to reduce the burden of injury in ultimate.

The prevalence of depressive symptoms in high-performance athletes: a systematic review

Objective: To provide an up-to-date overview of the prevalence of depressive symptoms in high-performance athletes and describe the tools used to assess for these in order to identify knowledge gaps and potential future research priorities. Data sources: PubMed, EMBASE, SPORTDiscus, PsychINFO, and Cochrane were systematically searched from December 1993 to December 2018. Peer-reviewed original research articles reporting the prevalence of depression among high-performance athletes aged ≥ 17 years were included. Study selection: Sixteen studies satisfied the inclusion criteria, and seven had a low risk of bias. Data extraction: The Center for Epidemiologic Studies Depression Scale (CES-D) was the most commonly used tool to assess for depressive symptoms. The prevalence of those with high depression symptom cutoff scores ranged from 6.7% to 34.0%. Data synthesis: Higher levels of competition, injuries, > 3 concussions, and female sex were identified as potential risk factors for depression. Female athletes and athletes playing individual sports had high risk of having elevated depression symptom scores. Conclusions: Prevention of mental illness in high-performance sports is a novel and emerging field of research interest. This review highlights the prevalence of high depression symptom scores among high-performance athletes. The data collection methods, sample size, sport and athlete population, and tools used to assess depression vary across studies; thus, findings cannot be generalized. This review establishes the need for data collection enhancements with robust longitudinal study designs and standardized depression assessment tools to guide the development of evidence-based mental wellbeing interventions.

Injury Profile of Male and Female Senior and Youth Handball Players: A Systematic Review

Handball is a team sport in which players are exposed to high physical conditioning requirements and several contacts and collisions, so they must face various musculoskeletal injuries throughout their career. The aim of this study was to summarize the characteristics of handball injuries both in training and in competition contexts, differentiating by gender and age. A systematic review was conducted and a total of 15 studies (33 cohorts) met the inclusion criteria. Higher injury incidence was reported during matches compared to training sessions in all groups (i.e., male and female senior and youth players), with male senior players presenting the greatest values. Lower extremities were more frequently injured, being contusions and sprains the most common type of injuries. Females reported more serious injuries than males, who presented a higher percentage of acute injuries caused by direct contact, while in female players these injuries were not caused by direct contact actions. Wings and backs presented the highest injury incidence; additionally, players registered higher match incidence during international championships compared to national leagues. Due to the differences in the injury profile of handball players, specific preventive strategies should be implemented for each group to optimize the injury prevention process.

Hand fractures and return to play in elite Australian cricketers

Introduction

Hand fractures are one of the most common injuries sustained whilst playing cricket. Further research is required to inform future clinical management and risk-reduction strategies.

Methods

This retrospective cohort study reviewed all cases of hand fractures in elite Australian cricket players over a three-year period. Data included specific activity when injury occurred, location of injury, management (non-surgical or surgical) and days to return to play.

Results

Seventy (17%, 95% CI 14-21 of players; 43 male, 27 female) players sustained 90 hand fractures. Seventy-three (81%, 95% CI 72-89) fractures occurred whilst fielding the ball. Eighty-four (93%, 95% CI 86-97) fractures occurred to the 'exterior' bones of the hand: distal phalanx, middle phalanx, first and fifth rays. Thirteen (14%, 95% CI 9-23) fractures were managed with surgical internal fixation, of which 11 were to the phalanges, most commonly at the proximal phalanx (n = 5, 36% of all proximal phalanx fractures) or fifth ray middle and proximal phalanges (n = 5, 42% of all fifth ray phalangeal fractures). Fractures requiring surgical management typically had longer time injured (median 33 days, IQR 27-41) than fractures managed non-surgically (median 6 days, IQR 0-21) (p = 0.001). Total time to return to full unrestricted play was similar between surgical (49 days, IQR 45-52) and non-surgical (32 days, IQR 15-45) management (p = 0.197).

Conclusions

Hand fractures sustained by elite male and female Australian cricket players were found to display a pattern of occurring to the 'exterior' bones of the hand. The results of this study may inform clinical decision making with respect to non-surgical or surgical management and anticipated return to play times. Further effort is needed to address risk reduction strategies including gloves and skill proficiency.

Symptomatic stress reaction of the humerus in a professional cricketer

A symptomatic bone stress reaction is an early pathological feature, which can lead to stress fractures. It typically affects bones of the lower limbs in response to unaccustomed disproportional compressive loading. Professional sportspeople are susceptible to both bone stress reaction and stress fractures, where training regimes and competition predispose to overuse injuries. We discuss a unique case of a professional cricketer developing pain in the throwing arm due to bone stress reaction in the distal humerus, as confirmed on MRI. Modification of the patient's training regime, presented in this case, facilitated complete recovery within 6 weeks. The positive response to modified training suggests a biomechanical origin of the pain. This case illustrates that tensile stress associated with throwing activities can result in a symptomatic bone stress reaction of the humerus in elite cricketers.

Epidemiology of hospital-treated cricket injuries sustained by women from 2002-2003 to 2013-2014 in Victoria, Australia

OBJECTIVES

To present the first comprehensive epidemiological profile of hospital-treated injuries sustained by female cricketers from 2002-2003 to 2013-2014 in Victoria, Australia.

DESIGN

Analysis of routinely collected hospital data (detailed case-series).

METHODS

A retrospective analysis of hospital-treatment data associated with cricket injuries sustained by women between 1 July 2002 and 30 June 2014, inclusive were extracted from databases held by the Victorian Injury Surveillance Unit in Australia.

RESULTS

Over the 12-year period, 668 cases were treated in Victoria. Of these, 547 were emergency department (ED)-presentations. There were 121 hospital-admissions, of which, the length of stay was <2 days for 78.5% cases. All cases were treated and released, and no fatalities were reported. The 10-14 year age group most frequently presented to ED (19.9%) and were most commonly admitted to hospital (16.5% of the total admissions). Fractures were the most common cause of hospital-admissions (47.1%) but only accounted for 17.2% of the ED-presentations. Dislocations, sprains and strains, were the most common (36.4%) cause of ED-presentations. The head was the most commonly injured anatomical location (27.8% of ED-presentations and 28.1% of hospital-admissions), followed by the wrist and hand (27.8% ED-presentations and 17.4% hospital-admissions).

CONCLUSIONS

These findings provide the first overview of the nature of injuries requiring hospital attendance in female cricketers, and a foundation to inform the development of targeted injury prevention programs for female cricketers.