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Hides JA, Brown DA, Anning LN, Blanch PD, Leung FT. Decreased isometric neck strength is a risk factor for head, neck and face injuries in professional rugby league players. J Sports Sci 2024:1-7. [PMID: 39632417 DOI: 10.1080/02640414.2024.2432793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Accepted: 11/14/2024] [Indexed: 12/07/2024]
Abstract
Head, neck and face injuries are a concern in contact sports. This exploratory study aimed to establish 1) injury risk factors for head, neck and face injuries and 2) clinical cut-off values related to strength, endurance and proprioception of the cervical spine in a team of professional rugby league players. Pre-season assessments of isometric strength of the flexor, extensor and lateral flexor muscles, endurance of the flexor muscles and joint position error were conducted. Injuries resulting in games missed were recorded. Cross-tabulations were used to determine the unadjusted odds ratios for the measures as risk factors for playing season injuries. The unadjusted odds ratio (OR) values indicated that if a player had weaker extensors of the neck (<36.4 kg, p = 0.014; <3.4N/kg, p = 0.014) or asymmetry of isometric strength of their lateral flexor muscles (left-to-right ratio <0.91, p = 0.005), their odds of games missed due to season head, neck and face injuries was increased (OR extensors = 8; 95% CI = 1.5-42.5 OR asymmetry of lateral flexor muscles OR = 12.6; 95% CI = 2.0-79.4). As muscle strength is modifiable, the clinical application of this study would involve targeting players in the team beneath the clinical cut-off value.
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Affiliation(s)
- Julie A Hides
- School of Health Sciences and Social Work, Griffith University, Nathan Campus, Nathan, Australia
- Mater Back Stability Research Clinic, Mater Health, South Brisbane, Australia
| | - Daniel A Brown
- School of Health Sciences and Social Work, Griffith University, Nathan Campus, Nathan, Australia
| | - Luke N Anning
- School of Health Sciences and Social Work, Griffith University, Nathan Campus, Nathan, Australia
- Brisbane Broncos Rugby League, Clive Berghofer Centre, Red Hill, Australia
| | - Peter D Blanch
- School of Health Sciences and Social Work, Griffith University, Nathan Campus, Nathan, Australia
- Brisbane Broncos Rugby League, Clive Berghofer Centre, Red Hill, Australia
| | - Felix T Leung
- School of Health Sciences and Social Work, Griffith University, Nathan Campus, Nathan, Australia
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Barcelos G, Miranda de Oliveira JG, Melo R, Norte CE, Filgueiras A. Concussion and executive functions in combat sports: A systematic review. J Sports Sci 2024:1-10. [PMID: 39589220 DOI: 10.1080/02640414.2024.2433902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 11/18/2024] [Indexed: 11/27/2024]
Abstract
Concussion is a diagnosis given due to trauma caused by abrupt acceleration and deceleration of the brain. The consequences involve, among others, impairments in executive functions. Considering the high incidence of concussions in combat sports, this study investigated the impacts of this trauma on core executive functions. A systematic search was carried out until November 2023, using the PRISMA method on the Virtual Health Library (BVS), PubMed, Science Direct and Scielo platforms. 11 studies, including case studies and quantitative empirical studies, met the eligibility criteria. Risk of bias was assessed using the Cochrane Collaboration risk of bias measurement tool. The results produced high and low bias studies, evaluated by three independent evaluators. Of the 11 studies selected, 91% included samples of boxers and 27.3% included mixed samples (men and women). The total sample was 1,130, aged between 15 and 68 years. 81.9% indicate impairment of executive functions in fighters, with impacts most frequently reported on memory (36.5%) and inhibitory control (27.5%). The results suggest that concussion impairs executive functions in boxing and MMA. However, more studies are needed to relate the diagnosis of concussion to possible deficits in executive functions in combat sports.
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Affiliation(s)
- Gabrielle Barcelos
- Instituto de Psicologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Raquel Melo
- Departamento de Psicologia, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Carlos Eduardo Norte
- Instituto de Psicologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Alberto Filgueiras
- School of Education and Applied Sciences, University of Gloucestershire, Cheltenham, UK
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Eastwood D, Owen C, Phillips G, Williams S, Brown J, Gardner AJ, Hendricks S, Johnston RD, Stokes K, Tadmor D, Till K, Whitehead S, Jones B. Incidence of concussion in men's Super League, Championship, and Academy rugby league matches between 2016 and 2022. J Sci Med Sport 2023; 26:539-544. [PMID: 37718192 DOI: 10.1016/j.jsams.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/09/2023] [Accepted: 09/01/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVES To quantify the incidence of concussion and compare between playing levels in male rugby league. DESIGN Retrospective cohort. METHODS Between 2016 and 2022, medically diagnosed concussions in Super League, Championship, and Academy competitions were reported to the Rugby Football League via club medical staff. Anonymised data were analysed using generalised linear mixed-effects models by season, month, and between competitions. RESULTS Overall, 1403 concussions were identified from 104,209 player-match hours. Concussion incidence for Super League, Championship, and Academy was 15.5, 10.5, and 14.3 per 1000 player-match hours, respectively. Championship concussion incidence was significantly lower than the Super League (p < 0.001) and Academy (p < 0.001). No significant differences were identified between years for Super League (range: 13.3 to 18.8 per 1000 player-match hours) and Championship (range: 8.4 to 12.1 per 1000 player-match hours). In Academy (range: 9.6 to 20.5 per 1000 player-match hours), concussion incidence was significantly greater in 2021 compared to earlier years (2016, p = 0.01 and 2017, p = 0.03). No significant differences were identified between months for any competition. CONCLUSIONS The incidence of concussion is greater in Super League and Academy compared to the Championship. Academy concussion incidence has increased over time. Different factors between and within competitions, such as changes to medical standards and knowledge, could have influenced the identification and diagnosis of concussion.
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Affiliation(s)
- David Eastwood
- Centre for Health and Injury and Illness Prevention in Sport, University of Bath, United Kingdom; Wakefield Trinity Rugby League Club, United Kingdom
| | - Cameron Owen
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, United Kingdom; England Performance Unit, Rugby Football League, United Kingdom
| | - Gemma Phillips
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, United Kingdom; England Performance Unit, Rugby Football League, United Kingdom; Hull Kingston Rovers, United Kingdom
| | - Sean Williams
- Centre for Health and Injury and Illness Prevention in Sport, University of Bath, United Kingdom; UK Collaborating Centre on Injury and Illness Prevention in Sport (UKCCIIS), University of Bath, United Kingdom
| | - James Brown
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, United Kingdom; Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Institute of Sport and Exercise Medicine, Stellenbosch University, South Africa; Division of Physiological Sciences and Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Andrew J Gardner
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, United Kingdom; Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Sharief Hendricks
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, United Kingdom; Division of Physiological Sciences and Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Rich D Johnston
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, United Kingdom; School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Australia; Sport Performance Recovery Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Australia
| | - Keith Stokes
- Centre for Health and Injury and Illness Prevention in Sport, University of Bath, United Kingdom; Rugby Football Union, United Kingdom; UK Collaborating Centre on Injury and Illness Prevention in Sport (UKCCIIS), University of Bath, United Kingdom
| | - Daniel Tadmor
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, United Kingdom; Leeds Rhinos Rugby League Club, United Kingdom
| | - Kevin Till
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, United Kingdom; Leeds Rhinos Rugby League Club, United Kingdom
| | - Sarah Whitehead
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, United Kingdom
| | - Ben Jones
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, United Kingdom; England Performance Unit, Rugby Football League, United Kingdom; Division of Physiological Sciences and Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, South Africa; School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Australia; Premiership Rugby, United Kingdom.
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Dunne LAM, Cole MH, Cormack SJ, Howell DR, Johnston RD. Validity and Reliability of Methods to Assess Movement Deficiencies Following Concussion: A COSMIN Systematic Review. SPORTS MEDICINE - OPEN 2023; 9:76. [PMID: 37578611 PMCID: PMC10425315 DOI: 10.1186/s40798-023-00625-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 08/02/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND There is an increased risk of subsequent concussion and musculoskeletal injury upon return to play following a sports-related concussion. Whilst there are numerous assessments available for clinicians for diagnosis and during return to play following concussion, many may lack the ability to detect these subclinical changes in function. Currently, there is no consensus or collated sources on the reliability, validity and feasibility of these assessments, which makes it difficult for clinicians and practitioners to select the most appropriate assessment for their needs. OBJECTIVES This systematic review aims to (1) consolidate the reliability and validity of motor function assessments across the time course of concussion management and (2) summarise their feasibility for clinicians and other end-users. METHODS A systematic search of five databases was conducted. Eligible studies were: (1) original research; (2) full-text English language; (3) peer-reviewed with level III evidence or higher; (4) assessed the validity of lower-limb motor assessments used to diagnose or determine readiness for athletes or military personnel who had sustained a concussion or; (5) assessed the test-retest reliability of lower-limb motor assessments used for concussion management amongst healthy athletes. Acceptable lower-limb motor assessments were dichotomised into instrumented and non-instrumented and then classified into static (stable around a fixed point), dynamic (movement around a fixed point), gait, and other categories. Each study was assessed using the COSMIN checklist to establish methodological and measurement quality. RESULTS A total of 1270 records were identified, with 637 duplicates removed. Titles and abstracts of 633 records were analysed, with 158 being retained for full-text review. A total of 67 records were included in this review; 37 records assessed reliability, and 35 records assessed the validity of lower-limb motor assessments. There were 42 different assessments included in the review, with 43% being non-instrumented, subjective assessments. Consistent evidence supported the use of instrumented assessments over non-instrumented, with gait-based assessments demonstrating sufficient reliability and validity compared to static or dynamic assessments. CONCLUSION These findings suggest that instrumented, gait-based assessments should be prioritised over static or dynamic balance assessments. The use of laboratory equipment (i.e. 3D motion capture, pressure sensitive walkways) on average exhibited sufficient reliability and validity, yet demonstrate poor feasibility. Further high-quality studies evaluating the reliability and validity of more readily available devices (i.e. inertial measurement units) are needed to fill the gap in current concussion management protocols. Practitioners can use this resource to understand the accuracy and precision of the assessments they have at their disposal to make informed decisions regarding the management of concussion. TRAIL REGISTRATION This systematic review was registered on PROSPERO (reg no. CRD42021256298).
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Affiliation(s)
- Laura A M Dunne
- School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Australia.
- SPRINT Research Centre, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia.
| | - Michael H Cole
- School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Australia
- Healthy Brain and Mind Research Centre, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Stuart J Cormack
- SPRINT Research Centre, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - David R Howell
- Sports Medicine Center, Children's Hospital Colorado, Aurora, CO, USA
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Rich D Johnston
- School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Australia
- SPRINT Research Centre, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia
- Carnegie Applied Rugby Research Centre, School of Sport, Leeds Beckett University, Leeds, UK
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Heron N, Jones N, Cardwell C, Gomes C. 'If in Doubt, Sit Them Out': How Long to Return to Elite Cycling Competition following a Sports-Related Concussion (SRC)? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085449. [PMID: 37107731 PMCID: PMC10138273 DOI: 10.3390/ijerph20085449] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 05/11/2023]
Abstract
INTRODUCTION A concussion or sports-related concussion (SRC) is a traumatic brain injury induced by biomechanical forces. After a SRC diagnosis is made, a concussed individual must undergo a period away from competition while they return to their baseline level of functioning. The Union Cycliste Internationale (UCI) currently recommend a minimum of 6 days restriction from competitive cycling following a SRC but there is a growing feeling amongst those involved in brain injury research that this period is too short. Therefore, how much time should cyclists be removed from competitive sporting action following a SRC? AIMS To review the time out of competition following the diagnosis of a SRC for elite cyclists within British Cycling (BC). METHODS All medical records for elite cyclists within BC were audited for diagnoses of "concussion" or "sports-related concussions" from January 2017 until September 2022. The days out of competition following the concussion until ready to compete again (that is, returned to full training) was then calculated. All diagnoses and management of SRC were undertaken by the medical team at BC and in-keeping with current international guidelines. RESULTS Between January 2017 and September 2022, there were 88 concussions diagnosed, 54 being males and 8 in para-athletes. The median duration for time out of competition for all concussions was 16 days. There was no statistical difference between males (median 15.5 days) and females (median 17.5 days) for time out of competition (p-value 0.25). The median duration out of competition following a concussion for able-bodied athletes was 16 (80 athletes) compared to 51 days (8 athletes) in para-cyclists, which was not statistically different (p-value 0.39). CONCLUSIONS This is the first study to report SRC concussion recovery times in elite cycling, including para-athletes. Between January 2017 and September 2022, there were 88 concussions diagnosed at BC and the median duration for time out of competition for all concussions was 16 days. There was no statistically significant difference in recovery times between male and females and para- and able-bodied athletes. This data should be used to help establish minimum withdrawal times post-SRC for elite cycling participation and we call on the UCI to review this data when establishing SRC protocols for cycling, with further research required in para-cyclists.
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Affiliation(s)
- Neil Heron
- Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK
- Medical Department, British Cycling, Manchester M11 4DQ, UK
- School of Medicine, Keele University, Staffordshire ST5 5BG, UK
- Correspondence:
| | - Nigel Jones
- Medical Department, British Cycling, Manchester M11 4DQ, UK
| | | | - Clint Gomes
- Medical Department, British Cycling, Manchester M11 4DQ, UK
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Wait TJ, Eck AG, Loose T, Drumm A, Kolaczko JG, Stevanovic O, Boublik M. Median Time to Return to Sports After Concussion Is Within 21 Days in 80% of Published Studies. Arthroscopy 2023; 39:887-901. [PMID: 36574536 DOI: 10.1016/j.arthro.2022.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/17/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To perform a systematic review of the literature and evaluate the return to play (RTP) time frame after a concussion diagnosis. Our secondary purpose was to analyze and compare different prognostic variables affecting concussions, time to return to school, time to symptom resolution of concussive symptoms, and time each patient spent in the RTP protocol. METHODS A PubMed, Scopus, Medline, Embase, and Cochrane Library database literature review was performed in August 2022. The studies needed to report, in days, the length of time a patient/athlete was removed from play due to concussion management. The Risk of Bias in Non-Randomized Studies of Interventions tool was used for risk of bias for each study, and Methodological Index for Non-Randomized Studies criteria were used for quality assessment. RESULTS There were 65 studies included in the systematic review and a total of 21,966 patients evaluated. The RTP time intervals ranged from 1 to 1,820 days, with 80.7% of the median RTP time frames for each study within 21 days. Preconcussion risk factors for prolonged RTP included female sex, younger age, presence of psychiatric disorders, and history of previous concussion. Postconcussion risk factors included severe symptom scores at initial clinic visit, loss of consciousness, nonelite athletes, and delayed removal from competition. The most common sports resulting in concussion were contact sports, most commonly football and soccer. Median time to return to school was 3 to 23 days. Median time to symptom resolution ranged from 2 to 11 days. Median time in RTP protocol was 1 to 6 days. CONCLUSIONS Median time to return to sports after concussion is within 21 days in 80% of published studies. LEVEL OF EVIDENCE IV, systematic review of Level I to IV studies.
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Affiliation(s)
- Trevor J Wait
- University of Colorado - Steadman Hawkins Clinic of Denver, Englewood, Colorado, U.S.A..
| | - Andrew G Eck
- Department of Orthopaedics, UT Health San Antonio, San Antonio, Texas, U.S.A
| | - Tyler Loose
- University of Washington School of Medicine, Seattle, Washington, U.S.A
| | - Amelia Drumm
- University of Colorado School of Medicine, Englewood, Colorado, U.S.A
| | - Jensen G Kolaczko
- University of Colorado - Steadman Hawkins Clinic of Denver, Englewood, Colorado, U.S.A
| | - Ognjen Stevanovic
- University of Colorado - Steadman Hawkins Clinic of Denver, Englewood, Colorado, U.S.A
| | - Martin Boublik
- University of Colorado - Steadman Hawkins Clinic of Denver, Englewood, Colorado, U.S.A
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