Junior Australian football injury research: Are we moving forward?

Combining physical performance and Functional Movement Screen testing to identify elite junior Australian Football athletes at risk of injury

The Functional Movement Screen (FMS) and physical performance testing are often suggested to be related to sports injury risk. This study explored if the combination of FMS and physical performance testing improved identification of non-contact injury risk over FMS testing alone in an elite junior Australian football cohort. Over a 3-year period, 573 players completed pre-season injury history questionnaires, FMS, physical performance testing (20-m sprint, vertical jump, planned agility testing, and shuttle run test), and subsequent in-season injury surveillance. Results: Neither previous injury or FMS score <14 were related to an increased risk of subsequent injury in isolation. The combination of FMS composite score ≤14 and previous injury moderately increased the risk of injury (Hazard ratio [HR] = 2.22 [1.09-4.54]). None of the physical performance measures improved the ability to predict injuries based on FMS composite score. FMS asymmetry was only associated with injury when combined with previous injury and vertical jump performance. Players with ≥1 FMS asymmetry and history of previous injury experienced a large increase in injury risk when vertical jump was poor (HR = 4.26 [1.35-13.42]) or good (HR = 3.17 [1.08-9.29]). Players with a combination of a good vertical jump, no previous injury, and no FMS asymmetries were also at moderately increased risk of injury (HR = 3.41 [1.11-10.42]). No physical performance tests improved the ability to identify non-contact injury risk using an FMS composite score threshold. However, a U-shaped relationship between vertical jump and injury risk was identified with both poor and good vertical jump height associated with a moderate-large increase in non-contact injury risk in the presence of ≥1 asymmetrical FMS sub-test.

Absolute and Relative Load and Injury in Elite Junior Australian Football Players Over 1 Season

PURPOSE

To investigate the association between training and match loads and injury in elite junior Australian football players over 1 competitive season.

METHODS

Elite junior Australian football players (n = 290, age 17.7 [0.3] y, range 16-18 y) were recruited from the under-18 state league competition in Victoria to report load and injury information. One-week load (session rating of perceived exertion multiplied by duration) and all time-loss injuries were reported using an online sport-injury surveillance system. Absolute load measures (weekly sums) enabled the calculation of relative measures such as the acute:chronic workload ratio. Load measures were modeled against injury outcome (yes/no) using a generalized estimating equation approach, with a 1-wk lag for injury.

RESULTS

Low (<300 arbitrary units [au]) and high (>4650 au) 1-wk loads were associated with significantly higher risk of injury. Furthermore, low (<100 au) and high (>850 au) session loads were associated with a higher risk of injury. High strain values (>13,000) were associated with up to a 5-fold increase in the odds of injury. There was a relatively flat-line association between the acute:chronic workload ratio and injury.

CONCLUSIONS

This study is the first investigation of elite junior athletes demonstrating linear and nonlinear relationships between absolute and relative load measures and injury. Coaches should focus player loads on, or at least close to, the point at which injury risk starts to increase again (2214 au for 1-wk load and 458 au for session load) and use evidence-based strategies across the week and month to help reduce the risk of injury.

Australian Football League Injury Characteristics Differ Between Matches and Training: A Longitudinal Analysis of Changes in the Setting, Site, and Time Span From 1997 to 2016

Background:

Injury surveillance has been used to quantify the scope of the injury burden in Australian football. However, deeper statistical analyses are required to identify major factors that contribute to the injury risk and to understand how these injury patterns change over time.

Purpose:

To compare Australian Football League (AFL) injury incidence, severity, prevalence, and recurrence by setting, site, and time span from 1997 to 2016.

Study Design:

Descriptive epidemiology study.

Methods:

A total of 15,911 injuries and medical illnesses recorded by team medical staff at each club were obtained from the AFL’s injury surveillance system and analyzed using linear mixed models with 3 fixed effects (setting, time span, site) and 1 random effect (club). All types of injuries and medical illnesses were included for analysis, provided that they caused the player to miss at least 1 match during the regular season or finals. Five-season time spans (1997-2001, 2002-2006, 2007-2011, and 2012-2016) were used for comparisons. Incidence rates were expressed at the player level. Recurrences were recoded to quantify recurrent injuries across multiple seasons.

Results:

Compared with training injuries, match injuries had a 2.8 times higher incidence per season per club per player (matches: 0.070 ± 0.093; training: 0.025 ± 0.043; P < .001). Match injuries resulted in 1.9 times more missed matches per club per season (matches: 17.2 ± 17.0; training: 9.1 ± 10.5; P < .001). and were more likely to be recurrences (matches: 11.6% ± 20.0%; training: 8.6% ± 21.8%; P < .001). From the 1997-2001 to 2007-2011 time spans, overall injury severity increased from a mean of 3.2 to 3.7 missed matches (P ≤ .01). For the most recent 2012-2016 time span, injuries resulted in 3.6 missed matches, on average. Hip/groin/thigh injuries had the highest incidence (0.125 ± 0.120) and prevalence (19.2 ± 16.4) rates, and recurrences (29.3% ± 27.9%) were 15% more likely at this site than any other injury site.

Conclusion:

The risks of match injuries are significantly higher than those of training injuries in the AFL. Compared with the 1997-2001 time span, injuries became more severe during the 2007-2011 time span.

Priorities for injury prevention in women's Australian football: a compilation of national data from different sources

Background/aim

Participation in Australian football (AF) has traditionally been male dominated and current understanding of injury and priorities for prevention are based solely on reports of injuries in male players. There is evidence in other sports that indicates that injury types differ between males and females. With increasing participation in AF by females, it is important to consider their specific injury and prevention needs. This study aimed to provide a first injury profile from existing sources for female AF.

Methods

Compilation of injury data from four prospectively recorded data sets relating to female AF: (1) hospital admissions in Victoria, 2008/09–13/14, n=500 injuries; (2) emergency department (ED) presentations in Victoria, 2008/09–2012/13, n=1,879 injuries; (3) insurance claims across Australia 2004–2013, n=522 injuries; (4) West Australian Women's Football League (WAWFL), 2014 season club data, n=49 injuries. Descriptive results are presented as injury frequencies, injury types and injury to body parts.

Results

Hospital admissions and ED presentations were dominated by upper limb injuries, representing 47% and 51% of all injuries, respectively, primarily to the wrist/hand at 32% and 40%. Most (65%) insurance claim injuries involved the lower limb, 27% of which were for knee ligament damage. A high proportion of concussions (33%) were reported in the club-collected data.

Conclusions

The results provide the first compilation of existing data sets of women's AF injuries and highlight the need for a rigorous and systematic injury surveillance system to be instituted.

High prevalence of dysfunctional, asymmetrical, and painful movement in elite junior Australian Football players assessed using the Functional Movement Screen

OBJECTIVES

The purpose of this study was to describe the prevalence of dysfunctional, asymmetrical, and painful movement in junior Australian Football players using the Functional Movement Screen (FMS).

DESIGN

Cross-sectional study.

METHODS

Elite junior male Australian Football players (n=301) aged 15-18 years completed pre-season FMS testing. The FMS consists of 7 sub-tests: deep squat, hurdle step, in-line lunge, shoulder mobility, active straight leg raise, trunk stability push-up (TSPU) and rotary stability. The shoulder mobility, TSPU, and rotary stability tests were combined with an accompanying clearing test to assess pain. Each sub-test was scored on an ordinal scale from 0 to 3 and summed to give a composite score out of 21. Composite scores ≤14 were operationally defined as indicating dysfunctional movement. Players scoring differently on left and right sides were considered asymmetrical. Players reported whether they missed any games due to injury in the preceding 22 game season.

RESULTS

Sixty percent of players (n=182) had composite scores ≤14, 65% of players (n=196) had at least one asymmetrical sub-test, and 38% of players (n=113) had at least one painful sub-test. Forty-two percent of players (n=126) missed at least one game in the previous season due to injury. Previous injury did not influence composite score (p=0.951) or asymmetry (p=0.629). Players reporting an injury during the previous season were more likely to experience pain during FMS testing (odds ratio 1.97, 95% confidence interval 1.23-3.18; p=0.005).

CONCLUSIONS

Junior Australian Football players demonstrate a high prevalence of dysfunctional, asymmetrical, and painful movement during FMS testing.

Translating Guidelines for the Diagnosis and Management of Sports-Related Concussion Into Practice

Sports injuries are a significant clinical and public health concern. There is a growing call to improve the translation of available evidence-based and expert-informed sports injury prevention interventions into sustained use in practice by physicians and others (eg, athletic trainers, coaches, and parents) who care for injured athletes. This article provides a brief overview of the current sport injury prevention implementation literature before focusing specifically on the translation of guidelines (including consensus and position statements) developed to assist physicians and others diagnose and manage athletes with sport-related concussion and the associated return-to-play decisions. The outcomes of more than 20 published studies indicate that physician, athletic trainer, coach, parent, and athlete knowledge, use of, and compliance with sport-related concussion guidelines are limited. More concerted, coordinated, and theory-informed efforts are required to facilitate the widespread dissemination, translation, and implementation of such guidelines. An example is provided of how implementation drivers could be used to inform the development of a comprehensive, multilevel implementation strategy targeting the individual, organizational, and system-level changes necessary to support the translation of available sport-related concussion guidelines in both the clinical and sports settings.