An operational model to investigate contact sports injuries

A Visualization Template for the Graphical Representation of Sport Injury Antecedents and Consequences Models and Data

A template for visually representing factors affecting and affected by the occurrence of sport injury is presented. The visualization template is designed to facilitate comparison among graphic depictions of models and data pertaining to the antecedents and consequences of sport injury. Innovative aspects and limitations of the visualization template are highlighted, and future applications of the visualization template are discussed.

Snowsport experience, expertise, lower limb injury and somatosensory ability

OBJECTIVES

Previous research demonstrates that a history of ankle injuries increases the risk of overall future injuries, and that somatosensory scores are correlated to sport performance. This research explores the relationship between lower limb somatosensory scores in snowsport participants and ankle injury history; and the relationship between lower limb somatosensory scores and Instructor qualification.

DESIGN AND METHODS

Experienced snowsport participants who were recruited through a western Canadian snowsport school completed a questionnaire that included their ankle injury history, the Identification of Functional Ankle Instability (idFAI), the Cumberland Ankle Instability Tool (CAIT), and their current instructor qualification level, as a proxy for sport performance. Lower limb somatosensory was assessed using the active movement extent discrimination assessment (AMEDA) method.

RESULTS

Of the 75 participants, 55% reported at least one previous ankle injury. An independent sample t-test did not show any significant difference in somatosensory scores of those with an ankle injury history (x¯=.66, SD=.05) or not (x¯=.66, SD=.05). Nor was there any difference between those with a functionally unstable ankle (i.e. CAIT<24 and idFAI>11) and all others [x¯=.66, SD=.04 cf. x¯=.66, SD=.05; t(67)=.54, p=.78]. An ANOVA exploring the relationship between Instructor Qualification and somatosensory scores was significant at p<.05 [F(4, 68)=4.0, p=.006].

CONCLUSIONS

The results did not reveal any significant difference in perceived functional instability and somatosensory scores, which contrasts with previous research. The sport performance finding is consistent with previous work examining the relationship between somatosensory scores and sport performances. Further research is needed to explore if the dynamic snowsport working environment impacts ankle instability and somatosensory scores.

A systematic approach to the characterisation of human impact injury scenarios in sport

Background

In contact sports (eg, American football or rugby), injuries resulting from impacts are widespread. There have been several attempts to identify and collate, within a conceptual framework, factors influencing the likelihood of an injury. To effectively define an injury event it is necessary to systematically consider all potential causal factors but none of the previous approaches are complete in this respect.

Aims

First, to develop a superior deterministic contextual sequential (DCS) model to promote a complete and logical description of interrelated injury event factors. Second, to demonstrate systematic use of the model to construct enhanced perspectives for impact-injury research.

Method

Previous models were examined and elements of best practice synthesised into a new DCS framework description categorising the types of causal factors influencing injury. The approach's internal robustness is demonstrated by consideration of its completeness, lack of redundancy and logical consistency.

Results

The model's external validity and worth are demonstrated through its use to generate superior descriptive injury models, experimental protocols and intervention opportunities. Comprehensive research perspectives have been developed using a common rugby impact-injury scenario as an example; this includes: a detailed description of the injury event, an experimental protocol for a human-on-surrogate reconstruction, and a series of practical interventions in the sport of rugby aimed at mitigating the risk of injury.

Conclusions

Our improved characterisation tool presents a structured approach to identify pertinent factors relating to an injury.

A human factors approach to snowsport safety: Novel research on pediatric participants' behaviors and head injury risk

OBJECTIVE

This study applied a human factors approach to snowsport resort systems to contribute to the understanding of the incidence and severity of pediatric snowsport head accelerations.

BACKGROUND

Previous research indicates low magnitude head accelerations are common among snowsport participants. This study adds to the knowledge of snowsport safety by measuring aspects of participants' snowsport behavior and linking this with head acceleration data.

METHOD

School-aged students (n = 107) wore telemetry-fitted helmets and Global Positioning System (GPS) devices during snowsport activity. Data was collected over 159 sessions (total hours 701). Head accelerations recorded by the telemetry units were compared with GPS-generated data.

RESULTS

This study found speeds attained normally exceed the testing rating for which helmets are designed; lower rates of head accelerations compared to earlier studies and that when head accelerations did occur they were generally below the threshold for concussions.

CONCLUSION

Pediatric snowsport head accelerations are rare and are generally of low magnitude. Those most at risk of a head acceleration >40 g were male snowboarders. Given the recorded speeds in first time participants, increased targeting of novice snowsport participants to encourage education about the use of protective equipment, including helmets, is warranted. Post event recall was not a good indicator of having experienced a head impact. Consideration should be given to raising the standard design speed testing for snowsport helmet protective devices to reflect actual snowsport behaviors.

From monocausality to systems thinking: a complementary and alternative conceptual approach for better understanding the development and prevention of sports injury

The science of sports injury control, including both its cause and prevention, has largely been informed by a biomedical and mechanistic model of health. Traditional scientific practice in sports injury research has routinely involved collapsing the broader socioecological landscape down in order to analyse individual-level determinants of injury - whether biomechanical and/or behavioural. This approach has made key gains for sports injury prevention research and should be further encouraged and allowed to evolve naturally. However, the public health, Applied Human Factors and Ergonomics, and injury epidemiological literature more broadly, has accepted the value of a socioecological paradigm for better understanding disease and injury processes, and sports injury research will fall further behind unless it does the same. A complementary and alternative conceptual approach towards injury control known as systems thinking that builds on socioecological science, both methodologically and analytically, is readily available and fast developing in other research areas. This review outlines the historical progression of causal concepts in the field of epidemiology over the course of the modern scientific era. From here, causal concepts in injury epidemiology, and models of aetiology as found in the context of sports injury research are presented. The paper finishes by proposing a new research agenda that considers the potential for a systems thinking approach to further enhance sports injury aetiological understanding. A complementary systems paradigm, however, will require that sports injury epidemiologists bring their knowledge and skillsets forwards in an attempt to use, adapt, and even refine existing systems-based approaches. Alongside the natural development of conventional scientific methodologies and analyses in sports injury research, progressing forwards to a systems paradigm is now required.

The relationship between pre-season fitness testing and injury in elite junior Australian football players

OBJECTIVES

Australian Football (AF) is a collision sport containing high injury rates in junior competition. Successful performance at the elite junior level not only requires superior specific football knowledge and skills, but also well developed fitness qualities. However, no studies have examined the link between physical fitness qualities and injury in AF.

DESIGN

Prospective cohort.

METHODS

Injury data were collected through the use of a Player Movement Record (PMR) and a standardized Injury Report Form (IRF). Fitness test data was collected during the pre-season of the 2010 and 2011 seasons.

RESULTS

382 players consented to participate in the study. The cohort experienced an injury incidence rate of 24.29/standardized club (40 players/club). A faster 5-m sprint was associated with 'injury status' (p=0.016) and a 'knee' region (p≤0.001) injury. A faster planned agility score was associated with an increased risk of a 'hip/groin/thigh' region (p=0.010) injury, and specifically a 'quadriceps strain' (p=0.005). A lower 20-m shuttle run was associated with an increased risk of a 'shin/ankle/foot' (p=0.045) injury. Increased injury severity was associated with a higher left foot running vertical jump (VJ) (p=0.040), and faster 5-m sprint (p=0.043).

CONCLUSIONS

Lower aerobic endurance, faster 5-m acceleration and greater planned agility were associated with an increased risk of various injury types in elite junior AF players. Furthermore, a higher left foot running VJ and faster 5-m acceleration were associated with injury severity. These results may largely relate to a greater work capacity placing a higher load upon the musculoskeletal system in contact and non-contact situations.

Behaviour, the key factor for sports injury prevention

Safety in sports and physical activity is an important prerequisite for continuing participation in sports, as well as for maintenance of a healthy physically active lifestyle. For this reason, prevention, reduction and control of sports injuries are important goals for society as a whole. Recent advances in sports medicine discuss the need for research on real-life injury prevention. Such views call for a more behavioural approach when it comes to actual sports injury prevention. Nevertheless, the role of behaviour in sports injury prevention remains under-researched. In order to push the field of sports injury prevention forward, this article provides an overview of the relationship between behaviour and sports injury risk. Different types of behaviour relate to injury risk factors and injury mechanisms. Behaviour that influences risk factors and injury mechanisms is not confined only to the athlete. Various types of behaviour by, for example, the coach, referee, physical therapist or sports associations, also influence risk factors and injury mechanisms. In addition, multiple behaviours often act together. Some types of behaviour may directly affect injury risk and are by definition a risk factor. Other behaviours may only affect risk factors and injury mechanisms, and influence injury risk indirectly. Recent ideas on injury prevention that call for studies on real-life injury prevention still rely heavily on preventive measures that are established through efficacy research. A serious limitation in such an approach is that one expects that proven preventive measures will be adopted if the determinants and influences of sports safety behaviours are understood. Therefore, if one truly wants to prevent sports injuries in a real-life situation, a broader research focus is needed. In trying to do so, we need to look at lessons learned from other fields of injury prevention research.

Incidence, mechanisms, and severity of game-related college football injuries on FieldTurf versus natural grass: a 3-year prospective study

BACKGROUND

Numerous injuries have been attributed to playing on artificial turf. More recently, FieldTurf was developed to duplicate the playing characteristics of natural grass. No long-term studies have been conducted comparing game-related collegiate football injuries between the 2 playing surfaces.

HYPOTHESIS

Collegiate athletes do not experience any difference in the incidence, mechanisms, and severity of game-related injuries between FieldTurf and natural grass.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

Twenty-four universities were evaluated over 3 competitive seasons for injury incidence, injury category, time of injury, injury time loss, player position, injury mechanism, primary type of injury, grade and anatomical location of injury, type of tissue injured, trauma (head, knee, and shoulder), and environmental factors.

RESULTS

In sum, 465 collegiate games were evaluated for game-related football injuries sustained on FieldTurf or natural grass during 3 seasons. Overall, 230 team games (49.5%) were played on FieldTurf versus 235 team games (50.5%) played on natural grass. A total of 2253 injuries were documented, with 1050 (46.6%) occurring during play on FieldTurf, and 1203 (53.4%) on natural grass. Multivariate analysis per 10 team games indicated significantly lower total injury incidence rates, F(3, 2249) = 3.468, P = .016, n - beta = 0.778, on FieldTurf, 45.7 (95% confidence interval [CI], 44.2-46.3), versus natural grass, 51.2 (95% CI, 49.8-51.7). Significantly lower minor injury incidence rates, 38.0 (95% CI, 36.9-38.5) versus 39.9 (95% CI, 39.1-40.0, P = .001), substantial injury incidence rates, 5.0 (95% CI, 4.3-5.6) versus 7.2 (95% CI, 6.6-7.7, P = .020), and severe injury incidence rates, 2.7 (95% CI, 2.1-3.3) versus 4.1 (95% CI, 3.5-4.1; P = .049), were documented on FieldTurf versus natural grass, respectively. Multivariate analyses also indicated significantly less trauma on FieldTurf when comparing injury time loss, injury situation, grade of injury, injuries under various field conditions, and temperature. No significant differences in head, knee, or shoulder trauma were observed between playing surfaces.

CONCLUSION

FieldTurf is in many cases safer than natural grass. It must be reiterated, however, that the findings of this study may be generalizable to only this level of competition. Because this study is still in the early stages, investigation is ongoing.

Prevalência de lesões em corredores de rua e fatores associados

O objetivo deste estudo foi analisar a prevalência de lesões esportivas e os fatores associados em corredores de rua por meio de um inquérito de morbidade referida. Os participantes foram selecionados por convite e por voluntariedade entre os corredores do Circuito de Ruas da Cidade de Curitiba-PR. Foram entrevistados 295 indivíduos (77,3% homens). As prevalências foram descritas de acordo com as variáveis de estudo e a regressão de Poisson foi utilizada para testar as associações (p < 0,05). A prevalência de lesões nos últimos seis meses foi de 28,5% (29,8 e 23,9% para homens e mulheres, respectivamente). Maior prevalência de lesões foi observada na faixa etária dos 30,1 aos 45 anos (32,8%), para aqueles com sobrepeso/obesidade (35,2%), para mulheres que treinam mais do que 30 min/dia (31,3%) e homens que treinam mais que 60 min/dia (34,2%). Nenhuma das variáveis investigadas apresentou associação com o relato de lesões. A maior parte dos indivíduos lesionados (60,5%) permaneceu menos de três meses afastada, sendo maior a probabilidade dessa ocorrência (RP: 2,44; IC95%: 0,99-6,06; p = 0,05) para aqueles com volumes de treino entre 31 e 60 min/dia. Conclui-se que a prevalência de lesões foi de aproximadamente 1/3 nos homens e 1/4 nas mulheres. As variáveis investigadas não apresentaram associação com a prevalência de lesões entre os participantes de corrida de rua e a gravidade destas está associada ao volume de treino.

Tackle injuries in professional Rugby Union

BACKGROUND

The tackle is the most dangerous facet of play in rugby union, but little is known about risk factors for tackle injuries.

PURPOSE

To estimate the injury risk associated with various characteristics of tackles in professional rugby union matches.

STUDY DESIGN

Descriptive epidemiology study.

METHOD

All 140 249 tackles in 434 professional matches were coded from video recordings for height and direction of tackle on the ball carrier, speed of tackler, and speed of ball carrier; injuries were coded for various characteristics, including whether the tackler or ball carrier required replacement or only on-field assessment.

RESULTS

There were 1348 injury assessments requiring only on-field treatment and 211 requiring player replacement. The inciting event and medical outcomes were matched to video records for 281 injuries. Injuries were most frequently the result of high or middle tackles from the front or side, but rate of injury per tackle was higher for tackles from behind than from the front or side. Ball carriers were at highest risk from tackles to the head-neck region, whereas tacklers were most at risk when making low tackles. The impact of the tackle was the most common cause of injury, and the head was the most common site, but an important mechanism of lower limb injuries was loading with the weight of another player. Rates of replacement increased with increasing player speed.

CONCLUSION

Strategies for reducing tackle injuries without radically changing the contact nature of the sport include further education of players about safe tackling and minor changes to laws for the height of the tackle.

A survey of injury knowledge and technical needs of junior Rugby Union coaches in Townsville (North Queensland)

Data of the injury knowledge and technical needs of registered coaches of junior Rugby Union teams in the Townsville district junior Rugby Union (North Queensland) were collected via a questionnaire mailed to coaches to determine the knowledge of the management, risk and protective factors of injury. A total of 35 completed self-administered questionnaires were returned in March 2003 for a response rate of 100%. Half of all coaches (54%, n=18) identified the upper limb of the tackler as the body part most likely to be injured in a tackle and one-quarter (26%, n=9) identified the lower limb of the ball carrier. Half (46%, n=16) of coaches identified rest/ice/compression/elevation as the treatment for soft tissue injury. The total injury knowledge score increased with the total number of seasons coached (Spearman's r(s)=0.401, p=0.017). Coaches with a current first aid qualification were more likely to identify rest/ice/compression/elevation as the treatment for soft tissue injury (Fishers Exact test, p=0.002). The results of this survey demonstrate that coaches of junior Rugby Union teams require education of the mechanisms of injury and procedures for the early management of minor and soft tissue in Rugby Union coaching courses.

Preparticipation medical evaluation in professional sport in the UK: theory or practice?

OBJECTIVE

To determine the level of pre-employment, pre-season, and post-injury medical evaluation of players undertaken within UK professional team sports.

DESIGN

A postal, whole population survey.

SETTING

Elite professional sports teams in England.

POPULATION

Six groups comprising the following clubs: professional football (Premiership, 15 of 20; Championship, 22 of 24), rugby union (Premiership, 9 of 12; Division 1, 11 of 14), rugby league (Super League, 6 of 11) and cricket (County, 12 of 18).

MAIN OUTCOME MEASURES

Number (percentage) of clubs recording players' medical history and undertaking medical examinations of players' cardiovascular, respiratory, neurological, and musculoskeletal systems at pre-employment, pre-season and post-injury.

RESULTS

The overall response to the survey was 74%, with a range from 55% to 92% among groups. Almost 90% of football (Premiership and Championship) and rugby union (Premiership) clubs took a pre-employment history of players' general health, cardiovascular, respiratory, neurological, and musculoskeletal systems, but fewer than 50% of cricket and rugby union (Division 1) clubs recorded a history. The majority of football (Premiership and Championship) and rugby union (Premiership) clubs implemented both cardiovascular and musculoskeletal examinations of players before employment. Fewer than 25% of clubs in any of the groups implemented neurological examinations of players at pre-employment, although 100% of rugby union (Premiership) and rugby league clubs implemented neurological testing during pre-season.

CONCLUSIONS

None of the sports implemented best practice guidelines for the preparticipation evaluation of players at all stages of their employment. Departures from best practice guidelines and differences in practices between clubs within the same sport leave club physicians vulnerable if their players sustain injuries or ill health conditions that could have been identified and avoided through the implementation of a preparticipation examination.

A dynamic model of etiology in sport injury: the recursive nature of risk and causation

The purpose of this manuscript is to outline a new model representing a dynamic approach that incorporates the consequences of repeated participation in sport, both with and without injury. This model builds on the previous work, while emphasizing the fact that adaptations occur within the context of sport (both in the presence and absence of injury) that alter risk and affect etiology in a dynamic, recursive fashion. Regardless of the type of injury, it is often preceded by a chain of shifting circumstances that, when they come together, constitute sufficient cause to result in an injury. If we are to truly understand the etiology of injury and target appropriate prevention strategies, we must look beyond the initial set of risk factors that are thought to precede an injury and take into consideration how those risk factors may have changed through preceding cycles of participation, whether associated with prior injury or not. This model considers the implications of repeated exposure, whether such exposure produces adaptation, maladaptation, injury or complete/incomplete recovery from injury. When feasible, future studies on sport injury prevention should adopt a methodology and analysis strategy that takes the cyclic nature of changing risk factors into account to create a dynamic, recursive picture of etiology.

Downhill Ski Injuries in Children and Adolescents

Downhill skiing is considered to be an enjoyable activity for children and adolescents, but it is not without its risks and injuries. Injury rates now range between 3.9 and 9.1 injuries per 1000 skier days, and there has been a well documented increase in the number of trauma cases and fatalities associated with this sport. Head and neck injuries are considered the primary cause of fatal injuries and constitute 11-20% of total injuries among children and adolescents. Cranial trauma is responsible for up to 54% of total hospital injuries and 67% of all fatalities, whereas thoracoabdominal and spine injuries comprise 4-10% of fatalities. Furthermore, there has been an increase in the proportion of upper extremity trauma with acromioclavicular dislocations, and clavicle and humeral fractures accounting for the majority (22-79%) of the injuries. However, the most common and potentially serious injuries in children and adolescents are those to the lower extremity, with knee sprains and anterior cruciate ligament tears accounting for up to 47.7% of total injuries. Knee sprains and grade III ligament trauma associated with lower leg fractures account for 39-77% of ski injuries in this young population. Approximately 15% of downhill skiing injuries among children and adolescents are caused by musculoskeletal immaturity. Other factors include excessive fatigue, age, level of experience, and inappropriate or improperly adjusted equipment. Collisions and falls constitute a significant portion (up to 76%) of trauma, and are commonly associated with excessive speed, adverse slope conditions, overconfidence leading to carelessness, and behavioural patterns within and among gender. The type and severity of injuries are typically functions of biomechanical efficiency, skiing velocity or slope conditions; however, a multiplicative array of intrinsic and extrinsic factors may simultaneously be involved. Despite extensive efforts to provide a comprehensive picture of the aetiology of injury, limitations have hampered reporting. These limitations include age and injury awareness, data collection challenges, lack of uniformity in the definition or delineation of age classification and lack of knowledge of predisposing factors prior to injury. Since skill level is the primary impetus in minimising ski injuries, formal instruction focusing on strategies such as collision avoidance and helmet use, fall training minimising lower extremity trauma, altering ski technique and avoiding behaviours that lead to excessive risk are, therefore, highly recommended. Skiing equipment should be outfitted to match the young skier's height, weight, level of experience, boot size and slope conditions. Additionally, particular attention should be paid to slope management (i.e. overcrowding, trail and obstacle marker upkeep) and minimising any opportunity for excessive speed where children are present. Whether increases in knowledge, education and technology will reduce predisposition to injury among this population remains to be seen. As with all high-risk sports, the answer may lie in increased wisdom and responsibility of both the skier and the parent to ensure an adequate level of ability, self-control and simply common sense as they venture out on the slopes.

Craniomaxillofacial injury in sport: a review of prevention research

Current decision making in prevention of sport related craniomaxillofacial injury is based on available data derived from surveillance and attitude based studies. The literature on this type of injury prevention lacks the high quality scientific design and evidence on which mandatory interventions can be based. Currently available prevention methodology can provide a better understanding of injury mechanisms and produce valid interventions.

Pancreatic Injury in the Athlete

Pancreatic injuries in the athlete are seldom reported in the literature. These injuries can result from atraumatic etiologies and blunt abdominal trauma. Atraumatic pancreatic injuries in the athlete are diagnosed and treated in a similar manner to the nonathletic patient. Fluid replacement, analgesic support, metabolic stabilization, and minimization of gastric stimulation are the primary management methods for this type of pancreatic injury. Athletically related traumatic pancreatic injury is associated with a high morbidity and mortality. The consequences of a delayed diagnosis make this type of injury an important diagnostic consideration in an athlete with abdominal pain. Initial clinical, radiologic, and laboratory findings of direct injury to the pancreas are often equivocal, and require clinical suspicion and further investigation. Current evidence suggests that pancreatic duct injury is the primary cause of the morbidity and mortality associated with the direct trauma. A conservative or surgical management plan should be based on a combination of serial clinical examinations, pancreatic enzyme levels, and either magnetic resonance retrograde choleopancreatogram or endoscopic retrograde chloangiopancreatography investigations to rule out ductal injury. The prevention of pancreatic and other intra-abdominal injuries is an evolving area of sports medicine research. Sports specific epidemiologic data collection and analysis are important elements in the development of evidence-based interventions.

Incidence, causes, and severity of high school football injuries on FieldTurf versus natural grass: a 5-year prospective study

BACKGROUND

Numerous injuries have been attributed to playing on artificial turf. Recently, FieldTurf was developed to duplicate the playing characteristics of natural grass. No long-term study has been conducted comparing game-related, high school football injuries between the 2 playing surfaces.

HYPOTHESIS

High school athletes would not experience any difference in the incidence, causes, and severity of game-related injuries between FieldTurf and natural grass.

STUDY DESIGN

Prospective cohort study.

METHODS

A total of 8 high schools were evaluated over 5 competitive seasons for injury incidence, injury category, time of injury, injury time loss, player position, injury mechanism, primary type of injury, grade and anatomical location of injury, type of tissue injured, head and knee trauma, and environmental factors.

RESULTS

Findings per 10 team games indicated total injury incidence rates of 15.2 (95% confidence interval, 13.7-16.4) versus 13.9 (95% confidence interval, 11.9-15.6). Minor injury incidence rates of 12.1 (95% confidence interval, 10.5-13.6) versus 10.7 (95% confidence interval, 8.7-12.7), substantial injury incidence rates of 1.9 (95% confidence interval, 1.4-2.6) versus 1.3 (95% confidence interval, 0.8-2.1), and severe injury incidence rates of 1.1 (95% confidence interval, 0.7-1.7) versus 1.9 (95% confidence interval 1.2-2.8) were documented on FieldTurf versus natural grass, respectively. Multivariate analyses indicated significant playing surface effects by injury time loss, injury mechanism, anatomical location of injury, and type of tissue injured. Higher incidences of 0-day time loss injuries, noncontact injuries, surface/epidermal injuries, muscle-related trauma, and injuries during higher temperatures were reported on FieldTurf. Higher incidences of 1- to 2-day time loss injuries, 22+ days time loss injuries, head and neural trauma, and ligament injuries were reported on natural grass.

CONCLUSIONS

Although similarities existed between FieldTurf and natural grass over a 5-year period of competitive play, both surfaces also exhibited unique injury patterns that warrant further investigation.

Risk factors for sports injuries--a methodological approach

The methodology for studies designed to investigate potential risk factors for sports injury is reviewed, using the case of hamstring strains as an example. Injuries result from a complex interaction of multiple risk factors and events. Therefore, a multivariate statistical approach should be used. In addition, the sample size of the study needs to be considered carefully. Sample size mainly depends on the expected effect of the risk factor on injury risk, and to detect moderate to strong associations 20-50 injury cases are needed, whereas small to moderate associations would need about 200 injured subjects. Studies published to date on the risk factors for hamstring strains have methodological limitations, and are too small to detect small to moderate associations.

Injuries in a modern dance company: effect of comprehensive management on injury incidence and time loss

BACKGROUND

Professional dancers experience high rates of musculoskeletal injuries.

OBJECTIVE

To analyze the effect of comprehensive management (case management and intervention) on injury incidence, time loss, and patterns of musculoskeletal injury in a modern dance organization.

STUDY DESIGN

Retrospective/prospective cohort study.

METHODS

Injury data were analyzed over a 5-year period, 2 years without intervention and 3 years with intervention, in a modern dance organization (42 dancers). The number of workers' compensation cases and number of dance days missed because of injury were compared across a 5-year period in a factorial design.

RESULTS

Comprehensive management significantly reduced the annual number of new workers' compensation cases from a high of 81% to a low of 17% and decreased the number of days lost from work by 60%. The majority of new injuries occurred in younger dancers before the implementation of this program. Most injuries involved overuse of the lower extremity, similar to patterns reported in ballet companies. Benefits of comprehensive management included early and effective management of overuse problems before they became serious injuries and triage to prevent overutilization of medical services.

CONCLUSIONS

This comprehensive management program effectively decreased the incidence of new cases and lost time. Both dancers and management strongly support its continuance.