Prevention of Ankle Sprain Injuries in Youth Soccer and Basketball: Effectiveness of a Neuromuscular Training Program and Examining Risk Factors

Best practices for the dissemination and implementation of neuromuscular training injury prevention warm-ups in youth team sport: a systematic review

OBJECTIVE

To evaluate best practices for neuromuscular training (NMT) injury prevention warm-up programme dissemination and implementation (D&I) in youth team sports, including characteristics, contextual predictors and D&I strategy effectiveness.

DESIGN

Systematic review.

DATA SOURCES

Seven databases were searched.

ELIGIBILITY

The literature search followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

INCLUSION CRITERIA

participation in a team sport, ≥70% youth participants (<19 years), D&I outcomes with/without NMT-related D&I strategies. The risk of bias was assessed using the Downs & Black checklist.

RESULTS

Of 8334 identified papers, 68 were included. Sport participants included boys, girls and coaches. Top sports were soccer, basketball and rugby. Study designs included randomised controlled trials (RCTs) (29.4%), cross-sectional (23.5%) and quasi-experimental studies (13.2%). The median Downs & Black score was 14/33. Injury prevention effectiveness (vs efficacy) was rarely (8.3%) prioritised across the RCTs evaluating NMT programmes. Two RCTs (2.9%) used Type 2/3 hybrid approaches to investigate D&I strategies. 19 studies (31.6%) used D&I frameworks/models. Top barriers were time restrictions, lack of buy-in/support and limited benefit awareness. Top facilitators were comprehensive workshops and resource accessibility. Common D&I strategies included Workshops with supplementary Resources (WR; n=24) and Workshops with Resources plus in-season Personnel support (WRP; n=14). WR (70%) and WRP (64%) were similar in potential D&I effect. WR and WRP had similar injury reduction (36-72%) with higher adherence showing greater effectiveness.

CONCLUSIONS

Workshops including supplementary resources supported the success of NMT programme implementation, however, few studies examined effectiveness. High-quality D&I studies are needed to optimise the translation of NMT programmes into routine practice in youth sport.

Ankle Injury Prevention Programs for Youth Sports: A Systematic Review and Meta-analysis

CONTEXT

Previous research has demonstrated that using a multicomponent approach to ankle injury preventions can significantly reduce ankle injuries; however, these studies lack specific intervention recommendations.

OBJECTIVE

To evaluate the exercise components of prevention programs on ankle injuries specifically in high school athletes. Secondary objectives were to assess the overall effectiveness of prevention programs on ankle injuries in this population and how compliance and education may impact success.

DATA SOURCES

A total of 5 databases were searched through September 26, 2022.

STUDY SELECTION

Study inclusion criteria included randomized control trials (RCTs) investigating exercise interventions in high school athletes aged 13 to 19 years, participation in sports competition, reporting of injury incidence, and specific exercise interventions used.

STUDY DESIGN

Systematic review and meta-analysis.

LEVEL OF EVIDENCE

Level 1.

DATA EXTRACTION

Pooled overall ankle injury incidence rate ratio and 95% CIs were calculated using random-effects meta-analysis.

RESULTS

A total of 10 studies were included, of which 9 used multicomponent exercise interventions and 1 used only balance training. Of the 10 studies, 3 demonstrated statistically significant reduction in ankle injuries. When data from all 10 studies were pooled and analyzed, there was a statistically significant overall reduction (incidence rate ratio, 0.74; 95% CI 0.60-0.91) in ankle injuries when comparing intervention groups with controls.

CONCLUSION

The most effective injury prevention programs included multiple components, emphasized strengthening and agility exercises, and promoted high adherence to the intervention. The importance of coach and player education on how and why to perform an injury prevention program as well as the frequency and duration of programs was also important. Exercise-based injury prevention programs may reduce ankle injury incidence in youth athletes by 26% when pooling data from a multitude of sport types/settings.

Effectiveness of a specific strength program of the gluteus maximus muscle to improve dynamic postural control in female basketball players. A randomized controlled trial

BACKGROUND

Basketball is a team sport in which players perform multidirectional movements, jumps and landings, experiencing abrupt accelerations and decelerations and numerous changes of rhythm. In this sport, speed and intensity are two key factors that are associated with an increased risk of injury. The aim of this randomized controlled trial was to determine the effectiveness of a specific gluteus maximus strength programme as preventive work for young female basketball players, to improve dynamic postural stability and to observe its impact in the rate of lower limb injuries, vertical jump, dynamic knee valgus and pain.

RESEARCH QUESTION

Is effective a strength programme to improve dynamic postural stability, vertical jump and dynamic valgus in female basketball players?

METHODS

A hundred and thirteen female basketball players that play in professional clubs were recruited, reaching the final stage 92 (46 per group). One group (CG) received conventional injury prevention training while the experimental group (EG) added to the conventional team prevention program, a gluteus maximus strength programme of 5 months composed of 4 exercises/2 days per week/2 sets of 10 repetitions per leg.

RESULTS

The total injury incidence decreased from 0.33 to 0.16 cases (control group pre=0.43 to post=0.14 cases, EG pre=022 to post=0.19). The EG improved overall (p = 0.000), posterior (p = 0.001), posteromedial (p = 0.001) and posterolateral (p = 0.000) dynamic stability of the right leg; anterior (p = 0.024), medial (p = 0.07) and posteromedial (p = 0.01) of the left leg. Both groups improved vertical jump (GC: p = 0.045 and GE: p = 0.000). There was no significant improvement in pain or valgus.

SIGNIFICANCE

This strength programme is effective in improving dynamic stability especially of the dominant leg and jump height.

A multicomponent neuromuscular warm-up program reduces lower-extremity injuries in trained basketball players: a cluster randomized controlled trial

OBJECTIVE

To assess the effects of a novel multicomponent neuromuscular warm-up program on lower-extremity injury incidence in basketball players competing at the regional level.

METHODS

A cluster randomized controlled experimental design was adopted to compare injury incidence between players exposed to the injury prevention warm-up program and those exposed to a typical warm-up program across an entire basketball season. Four teams consisting of 57 players (male: n = 42; female: n = 15) were allocated to the intervention group (age: 21.6 ± 2.5 years; height: 186.2 ± 8.8 cm; body mass: 80.0 ± 10.4 kg) and four teams consisting of 55 players (male: n = 43; female: n = 12) were allocated to the control group (age: 21.6 ± 2.6 years; height: 186.9 ± 9.1 cm; body mass: 81.5 ± 10.9 kg). The novel warm-up combined running exercises with active stretching, plyometrics, balance, strength, and agility drills. Coaching and medical staff provided details on injury incidence each week. Data analyses included the use of poisson regression analyses and the incidence rate ratio (IRR) with 95% confidence intervals (CI).

RESULTS

The intervention group experienced a significantly lower ankle sprain incidence rate (IRR = 0.26, 95% CI = 0.05, 0.98, p = 0.02) and a tendency toward a lower knee injury incidence rate (IRR = 0.32, 95% CI = 0.03, 1.78, p = 0.07) compared to the control group. Considering only non-contact lower-extremity injuries of any type, the intervention group experienced a significantly lower incidence rate compared to the control group (IRR = 0.26, 95% CI = 0.05, 0.98, p < 0.001).

CONCLUSION

This multi-team study demonstrated a novel multicomponent warm-up program resulted in less lower-extremity injuries, particularly ankle sprains and knee injuries, compared to a typical warm-up program in regional-level male and female basketball players.

Evaluation of an injury prevention programme (Prep-to-Play) in women and girls playing Australian Football: design of a pragmatic, type III, hybrid implementation-effectiveness, stepped-wedge, cluster randomised controlled trial

INTRODUCTION

Due to the increase in participation and risk of anterior cruciate ligament (ACL) injuries and concussion in women's Australian Football, an injury prevention programme (Prep-to-Play) was codesigned with consumers (eg, coaches, players) and stakeholders (eg, the Australian Football League). The impact of supported and unsupported interventions on the use of Prep-to-Play (primary aim) and injury rates (secondary aim) will be evaluated in women and girls playing community Australian Football.

METHODS AND ANALYSIS

This stepped-wedge, cluster randomised controlled trial will include ≥140 teams from U16, U18 or senior women's competitions. All 10 geographically separated clusters (each containing ≥14 teams) will start in the control (unsupported) phase and be randomised to one of five dates (or 'wedges') during the 2021 or 2022 season to sequentially transition to the intervention (supported Prep-to-Play), until all teams receive the intervention. Prep-to-Play includes four elements: a neuromuscular training warm-up, contact-focussed football skills (eg, tackling), strength exercises and education (eg, technique cues). When transitioning to supported interventions, study physiotherapists will deliver a workshop to coaches and player leaders on how to use Prep-to-Play, attend team training at least two times and provide ongoing support. In the unsupported phase, team will continue usual routines and may freely access available Prep-to-Play resources online (eg, posters and videos about the four elements), but without additional face-to-face support. Outcomes will be evaluated throughout the 2021 and 2022 seasons (~14 weeks per season).

PRIMARY OUTCOME

use of Prep-to-Play will be reported via a team designate (weekly) and an independent observer (five visits over the two seasons) and defined as the team completing 75% of the programme, two-thirds (67%) of the time.

SECONDARY OUTCOMES

injuries will be reported by the team sports trainer and/or players. Injury definition: any injury occurring during a football match or training that results in: (1) being unable to return to the field of play for that match or (2) missing ≥ one match. Outcomes in the supported and unsupported phases will be compared using a generalised linear mixed model adjusting for clustering and time. Due to the type III hybrid implementation-effectiveness design, the study is powered to detect a improvement in use of Prep-to-Play and a reduction in ACL injuries.

ETHICS AND DISSEMINATION

La Trobe University Ethics Committee (HREC 20488) approved. Coaches provided informed consent to receive the supported intervention and players provided consent to be contacted if they sustained a head or knee injury. Results will be disseminated through partner organisations, peer-reviewed publications and scientific conferences.

TRIAL REGISTRATION NUMBER

NCT04856241.

Absence of Injury Is Not Absence of Pain: Prevalence of Preseason Musculoskeletal Pain and Associated Factors in Collegiate Soccer and Basketball Student Athletes

Unlike musculoskeletal (MSK) injuries, MSK pain is rarely studied in athletes. In this study, we examined the prevalence of preseason MSK pain in apparently healthy collegiate soccer and basketball players and its relationship with previous injuries (1-year history), among other factors. Ninety-seven eligible student athletes (mean age: 20.1 (SD: 1.6) years; 43% male; 53% soccer players) completed a baseline questionnaire comprising questions related to demographics, medical and 1-year injury history and any current MSK pain and the corresponding body location. The overall prevalence of preseason MSK pain was 26% (95% CI: 17–36%) and it did not differ by sex or sport. The back (6.2%) and knee (5.2%) regions were reported to be the most frequently affected body parts for preseason MSK pain. Athletes with a previous injury and with perception of incomplete healing had 3.5-fold higher odds (OR: 3.50; 95% CI: 1.28–9.36) of baseline MSK pain compared with those without a previous injury. One in four collegiate soccer and basketball players had preseason MSK pain. Collegiate sports medicine professionals should consider conducting routine preseason evaluations of MSK pain in their athletes and initiate appropriate interventions for the prevention of MSK pain and its potential consequences among athletes.

Treatment Variability and Complications Associated With Pediatric Lateral Ankle Injuries: A POSNA Quality, Safety, and Value Initiative Survey

Background

Isolated pediatric lateral ankle injuries, including ankle sprain (AS) and nondisplaced Salter-Harris type 1 (SH-1) distal fibular fracture, are common orthopaedic sports-related injuries. Variability in treatment is suspected among pediatric orthopaedic surgeons. Complications from medical treatment or lack thereof have not been reported in this population.

Purpose

The purpose of this study was to investigate treatment variability and associated complications after pediatric AS and SH-1 via a survey of members of the Pediatric Orthopaedic Society of North American (POSNA).

Study Design

Cross-sectional study. Level of evidence, 5.

Methods

A voluntary, anonymous survey was distributed to POSNA membership (approximately 1400 members) via email. Survey questions, specific to both grade 1 or 2 AS and nondisplaced or minimally displaced SH-1 injuries in skeletally immature patients, focused on initial evaluation, immobilization, return to sports, and complications. We analyzed variability both in treatment between AS and SH-1 injury and in respondent characteristics. For statistical analysis, chi-square or Fisher exact test was used for categorical variables, and analysis of variance was used for continuous variables.

Results

The survey response rate was 16.4% (229/1400). Of the respondents, 27.7% used examination only to distinguish between AS and SH-1, whereas 18.7% performed serial radiography to aid with diagnosis. A controlled ankle motion boot or walking boot was the most common immobilization technique for both AS (46.3%) and SH-1 (55.6%); the second most common technique was bracing in AS (33.5%) and casting in SH-1 (34.7%). Approximately one-third of all respondents recommended either outpatient or home physical therapy for AS, whereas only 11.4% recommended physical therapy for SH-1 (P < .01). Results showed that 81.2% of respondents reported no complications for SH-1 treatment and 87.8% reported no complications for AS treatment. Cast complications were reported by 9.6% for SH-1 and 5.2% for AS. Rare SH-1 complications included distal fibular growth arrest, infection, nonunion, late fracture displacement, and recurrent fracture.

Conclusion

Significant variability was found in primary treatment of pediatric AS and SH-1 injuries. Rare complications from injury, treatment, and neglected treatment after SH-1 and AS were reported.

Effectiveness of Warm-Up Intervention Programs to Prevent Sports Injuries among Children and Adolescents: A Systematic Review and Meta-Analysis

Sports participation by children and adolescents often results in injuries. Therefore, injury prevention warm-up programs are imperative for youth sports safety. The purpose of this paper was to assess the effectiveness of Warm-up Intervention Programs (WIP) on upper and lower limb sports injuries through a systematic review and meta-analysis. Searches for relevant studies were performed on PubMed, EMBASE, Web of Science, SPORTDiscus, and Cochrane databases. Studies selected met the following criteria: original data; analytic prospective design; investigated a WIP and included outcomes for injury sustained during sports participation. Two authors assessed the quality of evidence using Furlan’s criteria. Comprehensive Meta-Analysis 3.3 software was used to process and analyze the outcome indicators of the literature. Across fifteen studies, the pooled point estimated injury rate ratio (IRR) was 0.64 (95% CI = 0.54−0.75; 36% reduction) while accounting for hours of risk exposure. Publication bias assessment suggested a 6% reduction in the estimate (IRR = 0.70, 95% CI = 0.60−0.82), and the prediction interval intimated that any study estimate could still fall between 0.34 and 1.19. Subgroup analyses identified one significant moderator that existed in the subgroup of compliance (p < 0.01) and might be the source of heterogeneity. Compared with the control group, WIPs significantly reduced the injury rate ratio of upper and lower limb sports injuries in children and adolescents.

What is New in Pediatric Orthopaedic Foot and Ankle

BACKGROUND

This paper aims to report on the last 5 years of relevant research on pediatric foot and ankle pathology with specific focus on clubfoot, congenital vertical talus, toe walking, tarsal coalitions, pes planovalgus with or without accessory navicular, foot and ankle trauma, and talar dome osteochondritis dessicans.

METHODS

The Browzine platform was used to review the table of contents for all papers published in the following target journals related to the treatment of pediatric foot and ankle conditions. Search results were further refined to include clinical trials and randomized controlled trials published from March 1, 2015 to November 15, 2021.

RESULTS

A total of 73 papers were selected for review based on new findings and significant contributions in treatment of clubfoot, congenital vertical talus, toe walking, tarsal coalitions, pes planovalgus with or without accessory navicular, foot and ankle trauma, and talar dome osteochondritis dessicans. Also included were several papers that did not fit into any of these categories but provided new insight into specific foot and ankle pathologies.

CONCLUSIONS

Treatment strategies for children with foot and ankle pathology are continually evolving. We review many of the most recent publications with the goal of improving understanding of these pathologies and highlighting current best practices.

LEVEL OF EVIDENCE

Level III.

Is Kinesio Taping Effective for Sport Performance and Ankle Function of Athletes with Chronic Ankle Instability (CAI)? A Systematic Review and Meta-Analysis

Background and Objectives: Ankle injuries are the most common type of injury in healthy active individuals. If not treated properly, recurrent sprains can lead to a condition of chronic ankle instability (CAI). The aim of the present review is to evaluate the effects of Kinesio Taping (or KT) on sports performances and ankle functions in athletes with CAI. Materials and Methods: This systematic review with meta-analysis was carried out following the criteria of the Prisma Statement system (registered on Open Science Framework, number: 10.17605/OSF.IO/D8QN5). For the selection of the studies, PubMed, Scopus and Web of Science were used as databases in which the following string was used: (“kinesiology tape” OR “tape” OR “taping” OR “elastic taping” OR “kinesio taping” OR “neuro taping”) AND (unstable OR instability) AND (ankle OR (ankle OR “ankle sprain” OR “injured ankle” OR “ankle injury”)). The Downs and Black Scale was used for the quality analysis. The outcomes considered were gait functions, ROM, muscle activation, postural sway, dynamic balance, lateral landing from a monopodalic drop and agility. Effect sizes (ESs) were synthesised as standardized mean differences between the control and intervention groups. Calculation of the 95% confidence interval (CI) for each ES was conducted according to Hedges and Olkin. Results: In total, 1448 articles were identified and 8 studies were included, with a total of 270 athletes. The application of the tape had a significant effect size on gait functions, ROM, muscle activation and postural sway. Conclusions: The meta-analysis showed a significant improvement in gait functions (step velocity, step and stride length and reduction in the base of support in dynamics), reduction in the joint ROM in inversion and eversion, decrease in the muscle activation of the long peroneus and decrease in the postural sway in movement in the mid-lateral direction. It is possible to conclude that KT provides a moderate stabilising effect on the ankles of the athletes of most popular contact sports with CAI.

Is lateral ankle sprain of the child and adolescent a myth or a reality? A systematic review of the literature

BACKGROUND

Ankle trauma in children and adolescents is the most common orthopedic injury encountered in pediatric trauma. It has long been recognized that a lateral ankle injury in this population is often a Salter and Harris type I fracture of the distal fibula (SH1). The purpose of this study is to confirm the existence of a lateral ankle sprain and to report the incidence of each pathology of the lateral ankle compartment: SH1 fracture, ATFL injury, and osteochondral avulsions.

METHODS

A systematic review of the literature is done using the database provided by PubMed and Embase. All articles reporting the incidence of imaging modality-confirmed lateral ankle injury (SH1, ATFL injury, osteochondral avulsion) in children and adolescents were included. Exclusion criteria were the following: case reports or articles with less than ten subjects, unspecified imaging modality and articles unrelated to lateral ankle lesions. Thus, 237 titles and abstracts were selected, 25 were analyzed thoroughly, and 11 articles were included for final analysis.

RESULTS

SH1 fractures were found in 0-57.5% of the cases in all series and 0-3% in the most recent series. A diagnosis of an ATFL injury was found in 3.2-80% and an osteochondral avulsion of the distal fibula in 6-28.1%. The most recent series report 76-80% and 62% for ATFL injury and osteochondral avulsion respectively.

CONCLUSIONS

There is a non-negligible incidence of ATFL sprains and fibular tip avulsions in patients with a suspected SH1 fracture of the distal fibula. According to recent evidence and MRI examinations, the most common injuries of the pediatric ankle are ATFL sprain and osteochondral avulsions. This should be taken into consideration in daily practice when ordering radiological examination and deciding on treatment modalities.

Health-Related Outcomes 3-15 Years Following Ankle Sprain Injury in Youth Sport: What Does the Future Hold?

BACKGROUND

This study examined the association between youth sport-related ankle sprain injury and health-related outcomes, 3-15 years postinjury.

METHODS

A historical cohort study in which uninjured controls were cluster-matched with injured cases. The primary outcome was self-reported Foot and Ankle Outcome Score (FAOS). Secondary outcomes included measures of adiposity, validated questionnaires for physical activity, athletic identity, fear of pain, and tests of strength, balance, and function.

RESULTS

We recruited 86 participants (median age of 23 years; 77% female); 50 with a time-loss ankle sprain, median of 8 years postinjury, and 36 uninjured controls cluster-matched by sex and sport. Based on mixed effects multivariable regression models, previously injured participants demonstrated poorer outcomes than controls on all 5 FAOS subscales regardless of sex and time since injury, with the largest differences observed in symptoms (-20.9, 99% CI: -29.5 to -12.3) and ankle-related quality of life (-25.3, 99% CI: -34.7 to -15.9) subscales. Injured participants also had poorer unipedal dynamic balance (-1.9, 99% CI: 3.5 to -0.2) and greater fear of pain (7.2, 99% CI: 0.9-13.4) compared with controls. No statistically significant differences were found for other secondary outcomes.

CONCLUSION

At 3-15 years following time-loss ankle sprain injury in youth sport, previously injured participants had more pain and symptoms, poorer self-reported function, ankle-related quality of life, reduced sport participation, balance, and greater fear of pain than controls. This underlines the need to promote the primary prevention of ankle sprains and secondary prevention of potential health consequences, including posttraumatic osteoarthritis.

LEVEL OF EVIDENCE

Level III, historical cohort study.

ACL injury prevention: Where have we come from and where are we going?

Anterior cruciate ligament (ACL) injuries are one of the most common and severe knee injuries across sports. As such, ACL injury prevention has been a focus of research and sports medicine practice for the past three-plus decades. Examining the current research and identifying both clinical strategies and research gaps, the aim of this review is to empower clinicians and researchers with knowledge of where the ACL injury prevention literature is currently and where it is going in the future. This paper examines the mechanism of ACL injury prevention, screening, implementation, compliance, adherence, coronavirus, and areas of future research. Clinical significance: The time lag between research and practical implementation in general healthcare settings can be as long as 17 years; however, athletes playing sports today are unable to wait that long. With effective programs already established, implementation and adherence to these programs is essential. Strategies such as coaching education, increasing awareness of free programs, identifying barriers, and overcoming implementation obstacles through creative collaboration are just a few ways that could help improve both ACL injury prevention implementation and adherence.

Effects of Hypopressive Exercise on Posterior Back Chain Kinematics and Pulmonary Function in Professional Female Basketball Players

CONTEXT

Hypopressive exercise (HE) has been used as an alternative lumbo-pelvic injury prevention program and claimed to be a means of respiratory and flexibility improvement. However, the possible effects of HE on athletic populations and physical performance remain unclear.

OBJECTIVE

Examine the effects of a HE program on posterior back chain kinematics, thoracic mobility, pulmonary function, and lower lumbar pain in female basketball players over an 8-week training period.

DESIGN

Prospective (1) baseline, (2) midpoint (4 wk), and (3) after 8 weeks.

SETTING

Sports field.

PARTICIPANTS

A total of 17 professional female basketball players (mean age 20.7 y, SD: 3.50; body mass index, 21.71, SD: 1.69).

INTERVENTION

Participants performed 8 HE weekly sessions of 30 minutes.

MAIN OUTCOME MEASURES

Back chain kinematics was assessed with the sit and reach and finger to floor test, and back pain was assessed through numerical rating scale. Respiratory parameters were assessed by spirometry and through thoracic mobility.

RESULTS

The analysis of variance revealed significant differences between the 3 measurement periods for thoracic mobility (P > .01); forced expiratory volume in the first second (P < .05) while no statistical differences were found for the rest of spirometry outcomes. Significant differences were also revealed between baseline and after the intervention for the sit and reach test (P > .01), peak expiratory flow (P = .01), and forced expiratory volume in the first 25 seconds (P = .04). Also, significant differences between weeks were found in levels of lumbar pain (P = .003) and the finger to floor test (P = .002).

CONCLUSIONS

These preliminary findings suggest that a HE program can improve posterior back chain and chest wall kinematics as well as lower lumbar pain levels. However, no gains seem to be observed for the majority of pulmonary variables except for peak expiratory flow and forced expiratory volume in the first seconds.

Sport participation and injury rates in high school students: A Canadian survey of 2029 adolescents

INTRODUCTION

The objective of this study is to examine sport and recreational (S&R) activity participation and injury rates (IR) in high school students (ages 14-19).

METHODS

High school students (N = 24 schools, n = 2,029; 958 male, 1,048 female, 23 identified 'other' or missing; ages 14-19) in Alberta completed a web-based survey during class (October 2018-March 2019). Students identified their top three sports for participation in the past year. Primary outcome measures included IR for (a) any S&R-related injury, (b) most serious S&R-related injury resulting in medical attention, and (c) most serious injury resulting in restriction from S&R for at least one day.

RESULTS

In total, 1763/2029 (86.89%) respondents [861/958 (89.87%) male, 886/1048 (84.54%) female, 16/23 (69.57%) identifying as 'other' or missing] participated in an S&R activity in the past year. Top sports for male participation were basketball (33.08%; 95% CI 27.67-39.00), ice hockey (20.46%; 95% CI 14.87-27.47), and soccer (19.42%; 95% CI 15.67-23.80). Top sports for female participation were dance (22.52%; 95% CI 17.98-27.82), basketball (18.32%; 95% CI 14.32-23.14), and badminton (17.84%; 95% CI 13.35-23.43). Of the 1,971 students completing the S&R injury question, 889 reported at least one injury during the past year [(IR = 45.10 injuries/100 students/year (95% CI 39.72-50.61)]. The medical attention IR was 29.09 injuries/100 students/year (95% CI 24.49-34.17) and time loss IR was 36.00 injuries/100 students/year (95% CI 30.47-41.93).

CONCLUSIONS

High school student S&R IRs are high with 29% of adolescents reporting at least one medical attention injury within the past year. Injury prevention strategies targeting youth are necessary. Practical Application: Participation in S&R activities has multiple physical, psychological, and health benefits for adolescents, but some S&R activities also have greater risks of injury. This study informs the next sports to target for implementation of optimal prospective surveillance and injury prevention strategies among high school aged students.

Neuromuscular training after concussion to improve motor and psychosocial outcomes: A feasibility trial

OBJECTIVE

To determine the feasibility of an 8-week neuromuscular training program initiated upon return-to-play clearance following concussion.

DESIGN

Feasibility trial.

SETTING

A single sports medicine center.

PARTICIPANTS

We approached n = 54 patients; n = 32 agreed to participate (59%). N = 27 participants returned for their second visit at return-to-play clearance (84%) and were randomized to neuromuscular training (n = 13) or standard-of-care (n = 14).

MAIN OUTCOME MEASURES

Participants completed three assessments: within 14 days post-concussion, immediately after return-to-play clearance, and 8-weeks following return-to-play clearance. The intervention aimed to achieve positive neuromuscular adaptations and occurred 2x/week for 8 weeks under supervision.

RESULTS

N = 2 participants randomized to the intervention elected not to participate, both due to schedule conflicts (e.g., time required to meet with the study team). Participants began the intervention an average of 11 days after return-to-play clearance, the majority (91%) completed >75% of training sessions, and training sessions lasted an average of 18.2 ± 4.8 min. One participant stopped the intervention after 7 training sessions due to time availability.

CONCLUSION

It is feasible to initiate a neuromuscular training program for most athletes shortly after returning to play following concussion. Clinicians and researchers may consider this approach to mitigate the increased musculoskeletal injury risk for concussion patients returning to sports.

The epidemiology of chronic ankle instability with perceived ankle instability- a systematic review

Background

Chronic ankle instability, developing from ankle sprain, is one of the most common sports injuries. Besides it being an ankle issue, chronic ankle instability can also cause additional injuries. Investigating the epidemiology of chronic ankle instability is an essential step to develop an adequate injury prevention strategy. However, the epidemiology of chronic ankle instability remains unknown. Therefore, the purpose of this study was to investigate the epidemiology of chronic ankle instability through valid and reliable self-reported tools in active populations.

Methods

An electronic search was performed on PubMed and Web of Science in July 2020. The inclusion criteria for articles were peer-reviewed, published between 2006 and 2020, using one of the valid and reliable tools to evaluate ankle instability, determining chronic ankle instability based on the criteria of the International Ankle Consortium, and including the outcome of epidemiology of chronic ankle instability. The risk of bias of the included studies was evaluated with an adapted tool for the sports injury review method.

Results

After removing duplicated studies, 593 articles were screened for eligibility. Twenty full-texts were screened and finally nine studies were included, assessing 3804 participants in total. The participants were between 15 and 32 years old and represented soldiers, students, athletes and active individuals with a history of ankle sprain. The prevalence of chronic ankle instability was 25%, ranging between 7 and 53%. The prevalence of chronic ankle instability within participants with a history of ankle sprains was 46%, ranging between 9 and 76%. Five included studies identified chronic ankle instability based on the standard criteria, and four studies applied adapted exclusion criteria to conduct the study. Five out of nine included studies showed a low risk of bias.

Conclusions

The prevalence of chronic ankle instability shows a wide range. This could be due to the different exclusion criteria, age, sports discipline, or other factors among the included studies. For future studies, standardized criteria to investigate the epidemiology of chronic ankle instability are required. The epidemiology of CAI should be prospective. Factors affecting the prevalence of chronic ankle instability should be investigated and clearly described.

Comparison of the Effect of Resistance and Balance Training on Isokinetic Eversion Strength, Dynamic Balance, Hop Test, and Ankle Score in Ankle Sprain

Ankle sprain is a commonly recurring sports injury. This study aimed to compare the rehabilitation effects of resistance and balance training programs in patients with recurrent ankle sprain. Patients with recurrent lateral ankle sprain completed a home-based rehabilitation program comprising resistance training (RT; n = 27) or balance training (BT; n = 27). RT consisted of exercises using elastic tube bands, and BT consisted mainly of exercises performed using a variety of balance tools. Exercises were performed for 6 weeks, twice a day for 20 min, 5 days per week. Isokinetic eversion strength, Y-Balance test and hop tests, and foot and ankle outcome score (FAOS) were evaluated. Both RT and BT significantly improved strength and dynamic balance (p < 0.05). Compared to RT, BT also significantly improved the outcome of the crossover hop test (p = 0.008). The changes reflected group and time in pain (p = 0.022), sports (p = 0.027), and quality of life (p = 0.033) of FAOS were significantly greater in BT than RT.

Epidemiology of Injuries in First Division Spanish Women's Soccer Players

The epidemiology of injuries in female soccer has been studied extensively in several national leagues. Even so, data on the first division Spanish league are limited. The objective of this study was to describe the epidemiology of the first division of the Spanish Women’s Soccer League and to analyze data in relation to game position, circumstance, or the moment of injury. Fifteen teams and 123 players participated in the study. Players’ characteristics and their injuries (location, type, diagnosis, circumstance, and moment) were collected. Injuries were described by their frequencies (number and percentage) and incidence rates (IR) with 95% confidence intervals (CIs). Lower limb injuries accounted for 86.8% of total injuries. Anterior cruciate ligament (ACL) and meniscus injuries occurred in totality in non-contact circumstance (0.35/1000 h; 95% CI, 0.18 to 0.62 and 0.23/1000 h; 95% CI, 0.10 to 0.45, respectively). Match injury IRs (19.02/1000 h; 95% CI, 14.89 to 23.97) were significantly higher than training (1.70/1000 h; 95% CI, 1.27 to 2.22). As a conclusion, structures such as the ACL or meniscus are most commonly injured in the non-contact circumstance in the first division of the Spanish Women’s Soccer League. In addition, match situations involve a greater risk of injury than training, increasing the risk to the ankle and knee injuries as the season progresses.

Dissemination and implementation research in sports and exercise medicine and sports physical therapy: translating evidence to practice and policy

Knowledge from research evidence is wasted unless it is applied. While the scientific evidence base for many sports and exercise medicine and sports physical therapy interventions is robust, real-world implementation and evolution to scale remains an ongoing challenge. Dissemination and implementation research is important to generate evidence-informed, cost-effective and context-specific strategies for implementation partners and stakeholders to effectively apply and sustain the best research evidence in public health and clinical practice. However, this field of inquiry remains underexplored in sports and exercise medicine and sports physical therapy. Most intervention studies in sports and exercise medicine and sports physical therapy are terminated at the efficacy trial stage without considerations for best practices for translation to community and clinical settings. Lack of context-specific dissemination and implementation strategies to drive the translation of evidence-based interventions results in poor execution of, and attrition from, interventions, and this is associated with suboptimal outcomes and increased healthcare costs. Theory-driven quality research informing the successful dissemination and implementation of evidence-based interventions is needed to address lingering evidence-to-practice gaps. Dissemination and implementation research completes the final stage in the research-to-practice pipeline. It seeks to close evidence-to-practice gaps, thereby ensuring speedy application of research evidence to achieve desired public health outcomes while making more efficient use of limited resources. This review introduces sports and exercise medicine and sports physical therapy researchers and stakeholders to key concepts and principles in dissemination and implementation research.

Reducing Injuries in Soccer (Football): an Umbrella Review of Best Evidence Across the Epidemiological Framework for Prevention

Soccer is the most popular sport in the world. Expectedly, the incidence of soccer-related injuries is high and these injuries exert a significant burden on individuals and families, including health and financial burdens, and on the socioeconomic and healthcare systems. Using established injury prevention frameworks, we present a concise synthesis of the most recent scientific evidence regarding injury rates, characteristics, mechanisms, risk and protective factors, interventions for prevention, and implementation of interventions in soccer. In this umbrella review, we elucidate the most recent available evidence gleaned primarily from systematic reviews and meta-analyses. Further, we express the exigent need to move current soccer injury prevention research evidence into action for improved player outcomes and widespread impact through increased attention to dissemination and implementation research. Additionally, we highlight the importance of an enabling context and effective implementation strategies for the successful integration of evidence-based injury prevention programs into real-world soccer settings. This narrative umbrella review provides guidance to inform future research, practice, and policy towards reducing injuries among soccer players.

Low Energy, Lateral Ankle Injuries in Pediatric and Adolescent Patients: A Systematic Review of Ankle Sprains and Nondisplaced Distal Fibula Fractures

BACKGROUND

Lateral ankle injuries are one of the most common musculoskeletal injuries sustained by pediatric and adolescent athletes. These injuries can result in significant time lost from competition, affect performance when returning to play, and represent a significant burden on the health care system as a whole. The purpose of this study was to systematically review the literature on the diagnosis, treatment, and prevention of acute lateral ankle injuries and their chronic effects in pediatric and adolescent athletes (younger than 19 y).

METHODS

This systematic review was conducted according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) guidelines between September and December 2018. PubMed and Google Scholar were systematically searched using the search terms: ("distal fibula fracture" OR "ankle sprain") AND ("youth" OR "pediatric" OR "adolescent"). All authors participated in article review (N=172) for relevance and age restrictions in which 30 met the inclusion criteria.

RESULTS

Thirty articles met inclusion criteria [Levels of Evidence I to IV (I: n=4, II: n=16, III: n=9, and IV: n=1)] including distal fibula fracture diagnosis and treatment, and risk factors, prevention, and chronic sequela of lateral ankle injuries in pediatric and adolescent patients.

CONCLUSIONS

Low-energy, lateral ankle injuries are common in pediatric and adolescent patients, yet underrepresented in the medical literature. There is a lack of high-quality literature on diagnosis, treatment, and outcomes after Salter-Harris I distal fibula fractures. Available literature, however, suggests that there remains over diagnosis and over treatment of presumed Salter-Harris I distal fibula fractures. Adolescent ankle sprains dominate the available literature likely due to the high recurrence rate. Youth athletes and coaches should address risk factors and engage in injury prevention programs to prevent and minimize the effect of acute lateral ankle injuries.

LEVELS OF EVIDENCE

Level III-Systematic review.

How much, how often, how well? Adherence to a neuromuscular training warm-up injury prevention program in youth basketball

Adherence is a key implementation outcome that determines the effectiveness of an intervention. This study, an observational design involving coaches and players from 33 high school basketball teams, evaluated the dimensions of adherence to a basketball-specific neuromuscular training (NMT) warm-up program in youth basketball. Coach adherence (daily report of team adherence) was collected prospectively. Adherence measures: cumulative utilization (proportion of total sessions possible), utilization fidelity (average # of exercises completed per NMT session), utilization frequency (average # of NMT sessions completed per week) were calculated and further evaluated for optimal adherence (≥80%, ≥10.4 exercises/session and ≥2 sessions/week, respectively) per coach. Additionally, exercise fidelity (proportion of players performing individual exercises correctly) was assessed. Coach (n = 31; 27-59 years) median cumulative utilization was 80%, utilization fidelity was 12 (of a possible 13 exercises per session) and utilization frequency was 2.3 sessions per week. Optimal adherence ranged from 52% to 71% across measures of adherence. Player exercise fidelity was 48%. Time constraint (47%) was the most frequently reported adherence barrier. While coach adherence to the NMT warm-up program was reasonably high across measures of adherence, a considerable proportion of coaches did not attain optimal adherence levels and player exercise fidelity was low.

Effects of Vibration Rolling with and without Dynamic Muscle Contraction on Ankle Range of Motion, Proprioception, Muscle Strength and Agility in Young Adults: A Crossover Study

Vibration rolling (VR) has emerged as a self-myofascial release (SMR) tool to aid exercise performance when warming up. However, the benefits of VR on exercise performance when combined with dynamic muscle contraction are unclear. The purpose of this study was to investigate the immediate effects of the combination of VR with dynamic muscle contraction (DVR), VR, and static stretching (SS) during warm-up on range of motion (ROM), proprioception, muscle strength of the ankle, and agility in young adults. In this crossover design study, 20 recreationally active adults without musculoskeletal disorders completed three test sessions in a randomized order, with 48 h of rest between each session. Participants completed one warm-up intervention and its measurements on the same day; different warm-up interventions and measurements were performed on each of the three days. The measurements included ankle dorsiflexion and plantarflexion ROM, ankle joint proprioception, muscle strength, and agility. After DVR and VR intervention, ankle dorsiflexion ROM (both DVR and VR, p < 0.001), plantarflexion ROM (both DVR and VR, p < 0.001), plantar flexor muscle strength (DVR, p = 0.007; VR, p < 0.001), and agility (DVR, p = 0.016; VR, p = 0.007) significantly improved; after SS intervention, ankle dorsiflexion and plantar flexion ROM (dorsiflexion, p < 0.001; plantar flexion, p = 0.009) significantly improved, but muscle strength and agility were not enhanced. Compared with SS, DVR and VR significantly improved ankle plantar flexor muscle strength (p = 0.008 and p = 0.001, respectively). Furthermore, DVR significantly improved ankle dorsiflexion compared with VR (p < 0.001) and SS (p < 0.001). In conclusion, either DVR, VR, or SS increased ankle ROM, but only DVR and VR increased muscle strength and agility. In addition, DVR produced considerable increases in ankle dorsiflexion. These findings may have implications for warm-up prescription and implementation in both rehabilitative and athletic practice settings.

Implementing a junior high school-based programme to reduce sports injuries through neuromuscular training (iSPRINT): a cluster randomised controlled trial (RCT)

Objective

To evaluate the effectiveness of a junior high school-based sports injury prevention programme to reduce injuries through neuromuscular training (NMT).

Methods

This was a cluster randomised controlled trial. Students were recruited from 12 Calgary junior high schools (2014–2017). iSPRINT is a 15 min NMT warm-up including aerobic, agility, strength and balance exercises. Following a workshop, teachers delivered a 12-week iSPRINT NMT (six schools) or a standard-of-practice warm-up (six schools) in physical education classes. The definition of all recorded injuries included injuries that resulted in participants being unable to complete a sport and recreation (S&R) session, lost time from sport and/or seek medical attention. Incidence rate ratios (IRRs) were estimated based on multiple multilevel Poisson regression analyses (adjusting for sex (considering effect modification) and previous injury, offset by S&R participation hours, and school-level and class-level random effects were examined) for intent-to-treat analyses.

Results

1067 students (aged 11–16) were recruited across 12 schools (6 intervention schools (22 classes), 6 control schools (27 classes); 53.7% female, 46.3% male). The iSPRINT programme was protective of all recorded S&R injuries for girls (IRR=0.543, 95% CI 0.295 to 0.998), but not for boys (IRR=0.866, 95% CI 0.425 to 1.766). The iSPRINT programme was also protective of each of lower extremity injuries (IRR=0.357, 95% CI 0.159 to 0.799) and medical attention injuries (IRR=0.289, 95% CI 0.135 to 0.619) for girls, but not for boys (IRR=1.055, 95% CI 0.404 to 2.753 and IRR=0.639, 95% CI 0.266 to 1.532, respectively).

Conclusion

The iSPRINT NMT warm-up was effective in preventing each of all recorded injuries, lower extremity injuries and medically treated S&R injuries in female junior high school students.

Trial registration number

NCT03312504

Current trends in sport injury prevention

Participation in sport and recreation has important positive implications for public health across the lifespan; however, the burden of sport-related musculoskeletal injury is significant, with the greatest risk being in youth and young adults. Moving upstream to primary prevention of injury is a public health priority that will have significant implications for reducing the long-term consequences of musculoskeletal injury including early post-traumatic osteoarthritis. The primary targets for the prevention of musculoskeletal injury in sport include neuromuscular training (NMT), rule modification, and equipment recommendations. Currently, there is significant high-quality evidence to support the widespread use of NMT warm up programs in team and youth sport, with an expected significant impact of reducing the risk of musculoskeletal injury by over 35%. Policy disallowing body checking in youth ice hockey has led to a >50% reduction in injuries, and rules limiting contact practice in youth American football has significant potential for injury prevention. There is evidence to support the use of bracing and taping in elite sport to reduce the risk of recurrent ankle sprain injury but not for use to prevent the primary injury, and wrist guards are protective of sprain injuries in snowboarding. Future research examining the maintenance of NMT programs across real-world sport and school settings, optimization of adherence, additional benefit of workload modification, and evaluation of rule changes in other sports is needed.

Injury prevention in kids' adventure and extreme sports: future directions

Youth have very high participation and injury rates across sport and recreational activities, including in adventure and extreme sports. Sport and recreation is the leading cause of injury in youth and may lead to lower levels of physical activity, higher adiposity, and long-term consequences such as overweight/obesity, post-traumatic osteoarthritis, and post-concussion syndrome which can adversely affect future health. Injuries are predictable and preventable in youth sport, including adventure and extreme sport. However, injury prevention strategies can have a significant impact in reducing the number and severity of injuries in many sports. This article provides an evidence-informed overview on what is known about injury prevention strategies which have been evaluated in youth adventure and extreme sports. Recommendations to contribute to effective and sustainable injury prevention in youth adventure and extreme sports have been summarized.