Quantifying the risk of sports injury: a systematic review of activity-specific rates for children under 16 years of age

[Groin pain in sports games: a systematic review]

BACKGROUND

In sports games, epidemiological data show that groin pain is relatively common and can lead to repeated loss of time. Consequently, it is essential to be aware of the evidence-based prevention strategies. The aim of this systematic review was to examine risk factors and prevention strategies for groin pain and to rank them based on their evidence in sports games.

METHODS

The review was conducted according to the PRISMA guidelines, using a PICO-scheme in the PubMed, Web of Science and SPOLIT databases. We included all available intervention and observational studies on the influence of risk factors and prevention strategies on groin pain in sports games. The methodological quality and level of evidence was assessed using the PEDro-Scale and OCEBM model, respectively. Finally, the quantity, quality and level of evidence was used to rank each risk factor for its grade.

RESULTS

Moderate evidence was found for four risk factors that significantly influence the risk of groin pain: male sex, previous groin pain, hip adductor strength and not participating in the FIFA 11+ Kids. Moreover, moderate evidence was found for the following non-significant risk factors: older age, body height and weight, higher BMI, body fat percentage, playing position, leg dominance, training exposure, reduced hip abduction, adduction, extension, flexion, and internal rotation-ROM, hip flexor strength, hip abductor, adductor, flexor and core strengthening with balance exercises, clinical hip mobility tests and physical capacities.

CONCLUSION

The identified risk factors can be considered when developing prevention strategies to reduce the risk of groin pain in sports games. Thereby, not only the significant, but also the non-significant risk factors should be considered for prioritisation.

Who Does Not Respond to Injury Prevention Warm-up Programs? A Secondary Analysis of Trial Data From Neuromuscular Training Programs in Youth Basketball, Soccer, and Physical Education

OBJECTIVES: To identify factors associated with nonresponse to neuromuscular training (NMT) warm-up programs among youth exposed to NMT warm-ups. METHODS: This is a secondary analysis of youth (aged 11-18 years) in the intervention groups of 4 randomized controlled trials in high school basketball, youth community soccer, and junior high school physical education. Youth who were exposed to NMT and who sustained an injury during the study were considered nonresponders. Odds ratios (ORs) were based on generalized estimating equations logistic regression controlling for clustering by team/class and adjusted for age, weight, height, balance performance, injury history, sex, and sport (soccer/basketball/physical education). RESULTS: A total of 1793 youth were included. Youth with a history of injury in the previous year had higher odds (OR = 1.64; 95% CI: 1.14, 2.37) of injury during the study, and females were more likely (OR = 1.67; 95% CI: 1.21, 2.31) to sustain an injury than males who were participating in NMT. Age was not associated with the odds of sustaining an injury (OR = 1.10; 95% CI: 0.93, 1.30). Soccer players benefited most from greater adherence, with 81% lower odds of injury (OR = 0.19; 95% CI: 0.06, 0.57) when completing 3 NMT sessions a week compared with 1 session per week. CONCLUSION: Factors associated with nonresponse to an NMT warm-up program were female sex, history of injury during the previous 12 months, and lower weekly NMT session adherence in some sports (soccer). J Orthop Sports Phys Ther 2023;53(2):94-102. Epub: 9 December 2022. doi:10.2519/jospt.2022.11526.

Physical activity and health in Chinese children and adolescents: expert consensus statement (2020)

China is experiencing significant public health challenges related to social and demographic transitions and lifestyle transformations following unprecedented economic reforms four decades ago. Of particular public health concern is the fourfold increase in overweight and obesity rates in the nation's youth population, coupled with the low prevalence of adolescents meeting recommended levels of physical activity. Improving the overall health of China's more than 170 million children and adolescents has become a national priority. However, advancing nationwide health initiatives and physical activity promotion in this population has been hampered by the lack of a population-specific and culturally relevant consensus on recommendations for achieving these ends. To address this deficiency and inform policies to achieve Healthy China 2030 goals, a panel of Chinese experts, complemented by international professionals, developed this consensus statement. The consensus was achieved through an iterative process that began with a literature search from electronic databases; in-depth reviews, conducted by a steering committee, of the resulting articles; and panel group evaluations and discussions in the form of email correspondence, conference calls and written communications. Ultimately, the panel agreed on 10 major themes with strong scientific evidence that, in children and adolescents aged 6-17, participating in moderate to vigorous physical activities led to multiple positive health outcomes. Our consensus statement also (1) highlights major challenges in promoting physical activity, (2) identifies future research that addresses current knowledge gaps, and (3) provides recommendations for teachers, education experts, parents and policymakers for promoting physical activity among Chinese school-aged children and adolescents. This consensus statement aligns with international efforts to develop global physical activity guidelines to promote physical activity and health and prevent lifestyle-related diseases in children and adolescents. More importantly, it provides a foundation for developing culturally appropriate and effective physical activity interventions, health promotion strategies and policy initiatives to improve the health of Chinese children and adolescents.

Lower limb MSK injuries among school-aged rugby and football players: a systematic review

OBJECTIVE

The objective of this systematic review was to explore the incidence of lower limb musculoskeletal (MSK) injuries sustained by rugby union, rugby league, soccer, Australian Rules and Gaelic football players under 18 years. The review sought to identify the mechanisms and types of injury sustained and to compare between sports.

DESIGN

This systematic review focused on the incidence of lower limb injury in adolescent team sports that involved running and kicking a ball. A literature search of studies published prior to January 2020 was conducted using SportDiscus, Medline and PubMed databases. The Standard Quality Assessment Criteria appraisal tool was used to assess the quality of each article included in the review. Two or more authors independently reviewed all papers.

RESULTS

Sixteen papers met the inclusion criteria; prospective cohort (N=14), retrospective (n=1) and longitudinal (n=1). These studies investigated injuries in rugby union and rugby league (n=10), football (soccer) (n=3), Australian Rules (n=2) and Gaelic football (n=1). There were a total of 55 882 participants, aged 7-19 years old, who reported 6525 injuries. The type, site and mechanisms of injury differed across sports.

SUMMARY

Lower limb injuries were common in adolescent rugby, soccer, Gaelic football and Australian Rules football players, however these studies may not fully reflect the true injury burden where recurrent and overuse injuries have not been considered. There were differences between sports in the mechanisms, types and severity of injury.

Knee Kinetics in Baseball Hitting and Return to Play after ACL Reconstruction

The purpose of this study was to describe the knee kinetics of baseball hitting, develop a tool to predict knee kinetics from easily obtainable measures, and to compare knee kinetics to other exercises along the rehabilitation continuum to determine a timeline for when hitting may resume after ACL reconstruction. Nineteen high school baseball athletes (16.3±0.8 yrs, 180.6±5.7 cm, 78.4±10.8 kg) participated. Participants took ten swings off a tee. Kinetic data were recorded using an electromagnetic tracking system. Data from swings with the top three exit velocities were averaged for analysis. Linear regressions were used to determine if predictors of height, mass, age and exit velocity could predict the following torques: bilateral knee net, extension, internal and external rotation, valgus and varus torque; and anterior force. Backwards regression models revealed independent variables could significantly predict front knee net, internal and external rotation, extension, and varus torque, and anterior force; and back knee net and valgus torque. Based on the kinetics of baseball hitting compared to those of rehabilitation exercises, if the involved knee is the front, we suggest tee hitting may be initiated at 13 weeks after ACL reconstruction. If the involved knee is the back, we suggest tee hitting may initiated at 17 weeks after ACL reconstruction.

There Is No Relationship Between Lower Extremity Alignment During Unilateral and Bilateral Drop Jumps and the Risk of Knee or Ankle Injury: A Prospective Study

OBJECTIVE

To investigate the association between lower extremity alignment during unilateral and bilateral drop jump tests and the risk of acute noncontact knee or ankle injuries in young team sport athletes.

DESIGN

Prospective cohort study.

METHODS

A 2-dimensional video analysis was used to measure the frontal plane knee projection angle in the single-leg vertical drop jump (VDJ) and the bilateral VDJ in young team sport athletes. Out of the 364 athletes (187 male, 177 female), 189 played basketball and 175 played floorball.

RESULTS

Six male athletes sustained knee injuries and 23 sustained ankle injuries. Frontal plane knee projection angle in the single-leg VDJ or the bilateral VDJ was not associated with ankle injuries among male athletes. No statistical analysis was performed for the knee injuries. Among female athletes, 28 sustained knee and 41 sustained ankle injuries. Frontal plane knee projection angle during the single-leg VDJ or the bilateral VDJ was not a risk factor for knee or ankle injuries.

CONCLUSION

Lower extremity alignment during unilateral and bilateral drop jump tests was not associated with future noncontact knee or ankle injuries among young team sport athletes. The findings should be interpreted cautiously due to the small number of injuries. J Orthop Sports Phys Ther 2020;50(5):267-274. doi:10.2519/jospt.2020.9247.

Physical Activity-Related Injury and Its Associated Factors among Middle School Students in Southern China

Physical activity (PA) promotion is beneficial to gain and maintain optimal health, but might increase risks for physical activity-related injury (PARI). This cross-sectional study aimed to investigate the incidence rate and identify risk factors of PARI among Chinese middle school students. Selected via the method of cluster random sampling, students graded 7⁻8 (junior) and 10⁻11 (senior) from five middle schools (aged from 10 to 18 years old) in Shantou were invited to participate in the survey. Information on socio-demography, PA involvement, sleep duration, individual safety awareness and exercise behavior, and PARI experiences in the past 12 month was collected. Multivariate logistic regression model was performed to estimate the risk factors of PARI. A total of 3082 participants completed the valid questionnaires, with an overall incidence rate of 25.1%. Boys, junior school students, sports team members, and those with lower safety awareness, living with single parent, and without any chronic conditions were at higher risks for PARI. Moreover, exercising on wet floor or with illness frequently would also be more likely to experience injury, especially those with at least 120 min per day. In conclusion, PARI was prevalent among middle school students in southern China. The above data provide insights that were focused and effective actions should be taken to prevent school-aged adolescents from PARI and maximize the benefits of PA.

Prevalence of adolescent physical activity-related injuries in sports, leisure time, and school: the National Physical Activity Behaviour Study for children and Adolescents

BACKGROUND

The purpose of this study was to investigate the prevalence of adolescent physical activity-related injuries in sports club activities, leisure time physical activity and school-based physical activity. The secondary aim was to investigate the differences in the prevalence of physical activity -related injuries between years 2014 and 2016. In addition, we set out to study the associations between age, sex and the frequency of physical activity and injury prevalence.

METHODS

This cross-sectional study is based on the National Physical Activity Behaviour Study for Children and Adolescents (LIITU in Finnish) conducted in years 2014 and 2016. The subjects completed an online questionnaire in the classroom during school hours. A total of 8406 subjects participated in the current study. Out of these, 49% were boys and 51% were girls. The proportions of 11-, 13-, and 15-year-olds were 35%, 34% and 31%, respectively.

RESULTS

In the combined data for 2014 and 2016, injury prevalence was higher in sports club activities (46%, 95% CI 44.8-47.8) than in leisure time PA (30%, 95% CI, 28.5-30.5) or school-based PA (18%, 95% CI, 17.4-19.1). In leisure time PA, the injury prevalence was higher than in school-based PA. In all the three settings, injury prevalence was higher in 2016 than in 2014. Frequency of PA was associated with a higher risk for PA-related injuries in sports clubs and leisure time.

CONCLUSIONS

With half of the subjects reporting at least one PA-related injury during the past year, results indicate that adolescent PA-related injuries are a large-scale problem. There is a worrisome rise in injury prevalence in recent years. From a public health standpoint, there is an urgent need to invest in injury prevention to reverse this trend.

Pediatric and adolescent injury in rodeo

High injury potential in rodeo is well recognized but the injury data for pediatric and adolescent rodeo athletes remain sparse. A systematic review of the literature published between 1990 and 2017 was conducted to assess the incidence and determinants of rodeo-related injuries in this population and to suggest injury prevention measures. Three of the 10 included studies reported event frequency and exposure data while the other seven pertained to particular injuries and/or rodeo events. Although each study documented cases of severe injuries, the limited epidemiological data indicated the majority of pediatric and adolescent athletes sustained minor injuries, such as sprains, strains, and contusions. Most injuries resulted from the impact of a fall or animal contact with the head being the most reported injury site. Owing to an unpredictable nature of this sport, injury prevention is challenging but there is evidence that helmets reduce the incidence and severity of head injuries.

Facts and values: on the acceptability of risks in children's sport using the example of rugby - a narrative review

A clash of values has been identified between those who assert that:1. all childhood injuries, regardless of origin, are inherently undesirable and should be prevented and;2. those who believe that some measure of injury to children is an acceptable compromise for the physical benefits associated with physical activity and the development of abilities to appraise and deal with risks.A debate regarding whether the tackles and collisions permitted in schools' rugby represent acceptable risks, and what steps should be taken if they do not, exemplifies the issue.Questions regarding the magnitude of injury risks in sport are issues of fact and can be quantified via the results of injury surveillance studies. Risks are neither high nor low in isolation; they are relatively high or low with reference to other activities or across groups participating in an activity. Issues of the acceptability of a given degree of risk are value dependent. Research regarding perceptions of risk reveals wide variations in the degree of risk people view as acceptable. Factors impacting on risk perception include whether the risks are well known and understood, whether they are 'dread' risks and the degree to which people undertake the risks voluntarily and feel they have control over them.Based on the evidence currently available, the risks to children playing rugby do not appear to be inordinately high compared with those in a range of other childhood sports and activities, but better comparative information is urgently needed. Further evidence, however, should not necessarily be expected to result in the resolution of acceptable risk debates-pre-existing values shape our perspectives on whether new evidence is relevant, valid and reliable.

Evidence in support of the call to ban the tackle and harmful contact in school rugby: a response to World Rugby

In a paper published in BJSM (June 2016), World Rugby employees Ross Tucker and Martin Raftery and a third coauthor Evert Verhagen took issue with the recent call to ban tackling in school rugby in the UK and Ireland. That call (to ban tackling) was supported by a systematic review published in BJSM Tucker et al claim that: (1) the mechanisms and risk factors for injury along with the incidence and severity of injury in youth rugby union have not been thoroughly identified or understood; (2) rugby players are at no greater risk of injury than other sports people, (3) this is particularly the case for children under 15 years and (4) removing the opportunity to learn the tackle from school pupils might increase rates of injuries. They conclude that a ban 'may be unnecessary and may also lead to unintended consequences such as an increase in the risk of injury later in participation.' Here we aim to rebut the case by Tucker et al We share new research that extends the findings of our original systematic review and meta-analysis. A cautionary approach requires the removal of the tackle from school rugby as the quickest and most effective method of reducing high injury rates in youth rugby, a public health priority.

Shoulder pain in adolescent athletes: prevalence, associated factors and its influence on upper limb function

BACKGROUND

Sports that require the constant use of an upper limb demand the maximum kinetic chain efficiency in this segment. Immaturity of the musculoskeletal system, followed by failure in motor skills can expose adolescents to major reports of pain complaints, particularly for the shoulder.

OBJECTIVE

To evaluate the prevalence of shoulder pain in adolescent athletes and identify possible factors associated with the complaint.

METHOD

A total of 310 athletes, of both sexes and aged between 10 and 19 years old participated on this study. The subjects filled out a questionnaire with personal, sports and upper limb function (Quick-DASH) questions. We evaluated the height, body mass, shoulder rotation range and stability of the upper limb using the CKCUES-test. The association between pain and the variables was analyzed using multilevel modeling logistic regression. We used the Mann-Whitney test for comparing between pain and function.

RESULTS

The prevalence of shoulder pain was 43.5%. Athletes between 15 and 19 years, handball and judo practitioners, are 1.86, 2.14 and 3.07 more likely to report shoulder pain, respectively, when compared with other sports and ages. Shoulder pain reduced function scores (p<0.001) and increased changes in the range of motion (p<0.04).

CONCLUSION

Shoulder pain is highly prevalent and is associated especially with older adolescent athletes of handball and judo, and affects the levels of function and the range of the shoulder.

Physical Activity-Related Injury Profile in Children and Adolescents According to Their Age, Maturation, and Level of Sports Participation

BACKGROUND

Physical activity (PA) is beneficial, enhancing healthy development. However, one-third of school-age children practicing sports regularly suffer from an injury. These injuries are associated with sex, chronological age, and PA level.

PURPOSE

To identify the importance of age, PA level, and maturity as predictors of injury in Portuguese youth.

STUDY DESIGN

Descriptive epidemiological study.

LEVEL OF EVIDENCE

Level 3.

METHODS

Information about injury and PA level was assessed via 2 questionnaires (LESADO RAPIL II) from 647 subjects aged 10 to 17 years. Maturity offset according to Mirwald (time before or after peak height velocity) and Tanner-Whitehouse III bone age estimates were used to evaluate maturation. Binary logistic regression and gamma regression were used to determine significant predictors of injury and injury rate.

RESULTS

Injury occurrence was higher for both sexes in recreational, school, and federated athletes (athletes engaged in sports that are regulated by their respective federations, with formal competition). These injuries also increased with age in boys and in the higher maturity offset group in girls. Injury rate was higher for both sexes in the no sports participation group. Early-maturing girls, with higher bone age and lower maturity offset, showed higher injury rate.

CONCLUSION

Injuries in Portuguese youth were related to PA level, age, and biological maturation. Recreational, school, and federated athletes had more injury ocurrences while subjects with no sports participation had higher injury risk. Older subjects had more injuries. Early-maturing girls that had just passed peak height velocity may be particularly vulnerable to risk of sports injury because of the growing process.

CLINICAL RELEVANCE

Increased knowledge about injury with specific PA exposure data is important to an overall risk management strategy. This study has deepened the association between injury and biological maturation variables.

Combining statistics from two national complex surveys to estimate injury rates per hour exposed and variance by activity in the USA

BACKGROUND

A common issue in descriptive injury epidemiology is that in order to calculate injury rates that account for the time spent in an activity, both injury cases and exposure time of specific activities need to be collected. In reality, few national surveys have this capacity. To address this issue, we combined statistics from two different national complex surveys as inputs for the numerator and denominator to estimate injury rate, accounting for the time spent in specific activities and included a procedure to estimate variance using the combined surveys.

METHODS

The 2010 National Health Interview Survey (NHIS) was used to quantify injuries, and the 2010 American Time Use Survey (ATUS) was used to quantify time of exposure to specific activities. The injury rate was estimated by dividing the average number of injuries (from NHIS) by average exposure hours (from ATUS), both measured for specific activities. The variance was calculated using the 'delta method', a general method for variance estimation with complex surveys.

RESULTS

Among the five types of injuries examined, 'sport and exercise' had the highest rate (12.64 injuries per 100 000 h), followed by 'working around house/yard' (6.14), driving/riding a motor vehicle (2.98), working (1.45) and sleeping/resting/eating/drinking (0.23). The results show a ranking of injury rate by activity quite different from estimates using population as the denominator.

CONCLUSIONS

Our approach produces an estimate of injury risk which includes activity exposure time and may more reliably reflect the underlying injury risks, offering an alternative method for injury surveillance and research.

Look Before You Leap: What Are the Obstacles to Risk Calculation in the Equestrian Sport of Eventing?

Simple Summary

This paper examines a number of methods for calculating injury risk for riders in the equestrian sport of eventing, and suggests that the primary locus of risk is the action of the horse jumping, and the jump itself. The paper argues that risk calculation should therefore focus first on this locus.

Abstract

All horse-riding is risky. In competitive horse sports, eventing is considered the riskiest, and is often characterised as very dangerous. But based on what data? There has been considerable research on the risks and unwanted outcomes of horse-riding in general, and on particular subsets of horse-riding such as eventing. However, there can be problems in accessing accurate, comprehensive and comparable data on such outcomes, and in using different calculation methods which cannot compare like with like. This paper critically examines a number of risk calculation methods used in estimating risk for riders in eventing, including one method which calculates risk based on hours spent in the activity and in one case concludes that eventing is more dangerous than motorcycle racing. This paper argues that the primary locus of risk for both riders and horses is the jump itself, and the action of the horse jumping. The paper proposes that risk calculation in eventing should therefore concentrate primarily on this locus, and suggests that eventing is unlikely to be more dangerous than motorcycle racing. The paper proposes avenues for further research to reduce the likelihood and consequences of rider and horse falls at jumps.

Injury risk during different physical activity behaviours in children: a systematic review with bias assessment

INTRODUCTION

The current focus on a physically active lifestyle in children puts children at increased physical activity-related injury risk.

OBJECTIVE

To summarise, in a systematic review, the evidence for the injury risk of several physical activity behaviours in 6- to 12-year-old children.

METHODS

An electronic search was performed in three databases (Embase, PubMed and SPORTDiscus). Inclusion criteria were: age 6-12 years; report on injuries related to overall physical activity, active commuting, unorganised leisure time physical activity, physical education and/or organised sports; incidence rates expressed as injuries per hours of physical activity; and published after January 1st 2000. Risk of bias was assessed for all studies included.

RESULTS

Eight studies were included. The risk of bias assessment resulted in two studies with a score that was higher than 75 %; risk bias of those two studies was considered low. The medically treated, injury incidence rate was reported to be between 0.15 and 0.27 injuries per 1,000 h of physical activity. The absolute number of injuries related to unorganised leisure time physical activity was higher than the absolute number of injuries reported in organised sports. The respective injury incidence rate expressed per 1,000 h exposure was, however, generally lower during unorganised leisure time than during organised sports. Reported injury incidence rates related to active commuting were comparable to those for unorganised leisure time physical activity. Conflicting injury incidence rates were reported for physical education. Subgroup analysis suggested that girls and children with low habitual levels of physical activity are at increased injury risk. A limitation of the review is that no standard bias assessment was available for this specific context.

CONCLUSIONS

Children are at an inherent injury risk while participating in physical activities. Most injury prevention efforts have focussed on the sports setting, but our results suggest that many children sustain an injury during unorganised leisure time physical activities.

Child development and pediatric sport and recreational injuries by age

CONTEXT

In 2010, 8.6 million children were treated for unintentional injuries in American emergency departments. Child engagement in sports and recreation offers many health benefits but also exposure to injury risks. In this analysis, we consider possible developmental risk factors in a review of age, sex, and incidence of 39 sport and recreational injuries.

OBJECTIVE

To assess (1) how the incidence of 39 sport and recreational injuries changed through each year of child and adolescent development, ages 1 to 18 years, and (2) sex differences. Design : Descriptive epidemiology study.

SETTING

Emergency department visits across the United States, as reported in the 2001-2008 National Electronic Injury Surveillance System database.

PATIENTS OR OTHER PARTICIPANTS

Data represent population-wide emergency department visits in the United States. Main Outcome Measure(s) : Pediatric sport- and recreation-related injuries requiring treatment in hospital emergency departments.

RESULTS

Almost 37 pediatric sport or recreational injuries are treated hourly in the United States. The incidence of sport- and recreation-related injuries peaks at widely different ages. Team-sport injuries tend to peak in the middle teen years, playground injuries peak in the early elementary ages and then drop off slowly, and bicycling injuries peak in the preteen years but are a common cause of injury throughout childhood and adolescence. Bowling injuries peaked at the earliest age (4 years), and injuries linked to camping and personal watercraft peaked at the oldest age (18 years). The 5 most common causes of sport and recreational injuries across development, in order, were basketball, football, bicycling, playgrounds, and soccer. Sex disparities were common in the incidence of pediatric sport and recreational injuries.

CONCLUSIONS

Both biological and sociocultural factors likely influence the developmental aspects of pediatric sport and recreational injury risk. Biologically, changes in perception, cognition, and motor control might influence injury risk. Socioculturally, decisions must be made about which sport and recreational activities to engage in and how much risk taking occurs while engaging in those activities. Understanding the developmental aspects of injury data trends allows preventionists to target education at specific groups.

Back injuries in a cohort of schoolchildren aged 6-12: A 2.5-year prospective study

The aims of this prospective school cohort study were to describe the epidemiology of diagnosed back pain in childhood, classified as either nontraumatic or traumatic back injury, and to estimate the association with physical activity in different settings. Over 2.5 years, 1240 children aged 6-12 years were surveyed weekly using mobile text messages to ask about the presence or absence of back pain. Pain was clinically diagnosed and injuries were classified using the International Classification of Diseases version 10. Physical activity data were obtained from text messages and accelerometers. Of the 315 back injuries diagnosed, 186 injuries were nontraumatic and 129 were traumatic. The incidence rate ratio was 1.5 for a nontraumatic back injury compared with a traumatic injury. The overall estimated back injury incidence rate was 0.20 per 1000 physical activity units (95% confidence interval 0.18-0.23). The back injury incidence rates were higher for sports when exposure per 1000 physical activity units was taken into consideration and especially children horse-riding had a 40 times higher risk of sustaining a traumatic back injury compared to the risk during non-organized leisure time physical activity. However, the reasonably low injury incidence rates support the recommendations of children continuously being physically active.

Risk factors for acute and overuse sport injuries in Swedish children 11 to 15 years old: What about resistance training with weights?

To determine the 1-year self-reported incidence of overuse and traumatic sport injuries and risk factors for injuries in children participating in a summer sports camp representing seven different sports. 4363 children, 11 to 15 years old participating in a summer camp in seven different sports answered a questionnaire. Injury in this cross-sectional study was defined as a sport-related trauma or overload leading to pain and dysfunction preventing the person from participation in training or competition for at least 1 week. A number of risk factors for injury were investigated such as sex, age, number of hours spent on training in general, and on resistance training with weights. Nearly half [49%, 95% confidence interval (CI) 48-51%] of the participants had been injured as a result of participation in a sport during the preceding year, significantly more boys than girls (53%, 95% CI 50-55% vs 46%, 95% CI 43-48%; P < 0.001). Three factors contributed to increased incidence of sport injuries: age, sex, and resistance training with weights. Time spent on resistance training with weights was significantly associated with sport injuries in a logistic regression analysis. In children age 11 to 15 years, the risk of having a sport-related injury increased with age and occurred more often in boys than in girls. Weight training was the only modifiable risk factor that contributed to a significant increase in the incidence of sport injuries.

A systematic review on the effectiveness of school and community-based injury prevention programmes on risk behaviour and injury risk in 8-12 year old children

OBJECTIVES

To review existing literature on the effectiveness of community-based and school-based physical activity related injury prevention programmes implemented to increase safety behaviour and decrease injury risk in 8-12 year old children, considering the methodological quality of the studies.

DESIGN

A systematic review with quality assessment.

METHODS

A systematic search was performed using the CINAHL, Cochrane, EMBASE, PubMed and Sportdiscus databases. Inclusion criteria included the following: children aged 8-12 years; school- or community-based injury prevention programmes; an outcome defined as number of injuries, injury incidence or safety behaviour; published in an English language journal. Methodological quality was assessed for all included studies.

RESULTS

The search yielded 5377 records, of which 11 were included in the review; four studies were considered as being of high quality. The focus of studies that were included was on the use of safety devices (8), pedestrian safety (2) and physical activity-related injury prevention (1). For safety device use, short term effects of school- and community-based interventions are promising for 8-12 year olds. Results regarding sustainability of the effect are inconsistent. A mediating effect on the distribution of safety devices was observed. Both financial and non-financial barriers seemed to prevent participants from purchasing a safety device.

CONCLUSIONS

The short term effects for school- and community-based interventions using safety devices for 8-12 year olds are promising. More high quality research is, however warranted, preferably shifting focus from safety behaviour change to actual physical activity injury reduction.

Fractures in children: epidemiology and activity-specific fracture rates

BACKGROUND

Approximately one-third of pediatric fractures occur during sport or recreational activity. In this paper, we investigate the incidence and causes of pediatric fractures in our region and quantify the fracture rate per exposure time for the most common sport and recreational activities.

METHODS

We prospectively evaluated all children younger than sixteen years who presented to our institution with a new fracture within a twelve-month period. Exposure time to the most common childhood activities was measured by means of interviewing random parents from the study population. The main outcome measures were the annual fracture incidence in the population and fracture rates per 10,000 hours of exposure to various sports and recreational activities.

RESULTS

A total of 1403 fractures were included. The overall annual incidence was 180.1 fractures per 10,000 children younger than sixteen years. The distal part of the radius was most often fractured (436 fractures, 31.1%). Snowboarding was associated with the highest activity-specific fracture rate, estimated to be 1.9 (95% confidence interval [CI], 1.16 to 2.60) fractures per 10,000 hours of exposure. In comparison, the fracture rate per 10,000 hours of exposure was 0.79 (CI, 0.42 to 1.09) for handball, 0.44 (CI, 0.35 to 0.52) for soccer, and 0.35 (CI, 0.23 to 0.47) for trampolining.

CONCLUSIONS

The distal part of the radius is the most common fracture site in childhood. Fracture rates differ between various physical activities. The fracture rate for snowboarding was four times higher compared with that for other common childhood sport and recreational activities in our region.

Simple strategy to prevent severe head trauma in Judo

To determine whether the use of an under-mat has an effect on impact forces to the head in Judo, a Judo expert threw an anthropomorphic test device using the Osoto-gari and Ouchi-gari techniques onto a tatami (judo mat) with and without an under-mat. Head acceleration was measured and the head injury criterion (HIC) values with or without under-mat were compared. The use of an under-mat significantly decreased (p = 0.021) the HIC values from 1174.7 ± 246.7 (without under-mat) to 539.3 ± 43.5 in Ouchi-gari and from 330.0 ± 78.3 (without under-mat) to 156.1 ± 30.4 in Osoto-gari. The use of an under-mat simply reduces impact forces to the head in Judo. Rule changes are not necessary and the enjoyment and health benefits of Judo are maintained.

Sports injuries among adolescents: incidence, causes and consequences

AIM

The purpose of this study was to evaluate the 1-year incidence, location, type, mechanism and severity of sports injuries for adolescents in Germany.

METHODS

Data were from the 'German Health Interview and Examination Survey for Children and Adolescents', a nationwide study of n = 17 641 children and adolescents. Analyses were based on a weighted total sample size of n(w) = 7451 adolescents between 11 and 17 years of age, 51% of them boys.

RESULTS

A total of 577 adolescents (8%) reported having experienced a sports injury during the past year. Collisions and falls were reported as being the most important causes. The most frequent diagnoses were contusions, dislocations, strains and sprains (60%), followed by fractures (26%). Most injuries (88%) were treated on an outpatient basis with only 12% resulting in hospitalisation. Gender-specific analyses showed that 9% of the boys and 7% of the girls suffered from a sports injury during the past year. After adjusting for the level of physical activity, these gender differences disappeared (OR(girls) 0.94; 95% confidence intervals: 0.74-1.18). Excluding injuries incurred from falls while horse riding, there were no gender differences in the mechanism of injury. Among boys, 30% of all injuries were fractures, among girls 20% (P < 0.05). Apart from fractures, no further differences between the sexes in the range of diagnoses were identified.

CONCLUSIONS

Although these results suggest that the risk of sports injuries does not differ significantly based on adolescents' gender, the incidence rate of adolescent sports injuries within Germany is relatively high.

Risk groups for sports injuries among adolescents--representative German national data

BACKGROUND

Physical activity during childhood and adolescence is of major importance with regard to an individual's engagement with sports in later life. Apart from the physical trauma, sports injuries often have negative effects on the motivation to remain physically active. This study evaluates data to gain detailed knowledge on 1-year incidence and risk groups with the aim of providing information for the development of preventive measures.

METHODS

Our data analysis is based on a net sample from a national study in Germany including 7697 children and adolescents aged 11 to 17 years. Within the statistical analyses, we developed weighting factors and calculated group differences as well as regression models for sports injury incidence.

RESULTS

A total of 7.7% of the children and adolescents reported a sport injury during the last 12 months. Bivariate analyses showed significant associations between sports injuries and several social and lifestyle-related covariates. After adjustment for participation in leisure time physical activity, age, non-migrant status and residence in a large city remained positively associated with the incidence of sports injuries.

CONCLUSIONS

In comparison with other results for developed countries, the incidence seems rather high. It remains to be clarified whether this is because of our use of more accurate population-based data. The results suggest that while developing preventive measures, the interaction between preferences for high-risk sports and physical as well as psychological development has to be considered.

Rodeo catastrophic injuries and registry: initial retrospective and prospective report

OBJECTIVE

To introduce the Rodeo Catastrophic Injury Registry (RCIR) and quantify the nature and incidence of catastrophic injury and fatality in rodeo participants across North America.

DESIGN

Retrospective and prospective collection of catastrophic and fatal injury data in rodeo using an online registry (RCIR).

SETTING

Canada and the United States.

PARTICIPANTS

North American rodeo competitors.

ASSESSMENT OF RISK FACTORS

Age, gender, level of competition, rodeo event, mechanism of injury, and use of protective equipment.

MAIN OUTCOME MEASURES

Frequency, incidence, and nature of catastrophic injuries and fatalities among rodeo participants.

RESULTS

The incidence rate of catastrophic injury from 1989 to 2009 was 9.45 per 100 000 (49/518 286). The incidence rate of catastrophic injury during the 2007-2009 study period was 19.81 per 100 000 (19/95 892). The incidence rate of fatality from 1989 to 2009 was 4.05 per 100 000 (21/518 286). The incidence rate of fatality for the 2007-2009 study period was 7.29 per 100 000 (7/95 892).

CONCLUSIONS

Thoracic compression mechanisms of injury are most pervasive and likely to be fatal in rodeo and bull riding. It is unknown whether rodeo protective vests have a protective effect in reducing catastrophic and fatal injuries. On the contrary, helmet use in bull riding and rodeo events seems to have a protective effect in reducing both catastrophic injury and fatality.

Evaluation of injury and fatality risk in rock and ice climbing

Rock and ice climbing are widely considered to be 'high-risk' sporting activities that are associated with a high incidence of severe injury and even death, compared with more mainstream sports. However, objective scientific data to support this perception are questionable. Accordingly, >400 sport-specific injury studies were analysed and compared by quantifying the injury incidence and objectively grading the injury severity (using the National Advisory Committee for Aeronautics score) per 1000 hours of sporting participation. Fatalities were also analysed. The analysis revealed that fatalities occurred in all sports, but it was not always clear whether the sport itself or pre-existing health conditions contributed or caused the deaths. Bouldering (ropeless climbing to low heights), sport climbing (mostly bolt protected lead climbing with little objective danger) and indoor climbing (climbing indoors on artificial rock structures), showed a small injury rate, minor injury severity and few fatalities. As more objective/external dangers exist for alpine and ice climbing, the injury rate, injury severity and fatality were all higher. Overall, climbing sports had a lower injury incidence and severity score than many popular sports, including basketball, sailing or soccer; indoor climbing ranked the lowest in terms of injuries of all sports assessed. Nevertheless, a fatality risk remains, especially in alpine and ice climbing. In the absence of a standard definition for a 'high-risk' sport, categorizing climbing as a high-risk sport was found to be either subjective or dependent on the definition used. In conclusion, this analysis showed that retrospective data on sport-specific injuries and fatalities are not reported in a standardized manner. To improve preventative injury measures for climbing sports, it is recommended that a standardized, robust and comprehensive sport-specific scoring model should be developed to report and fully evaluate the injury risk, severity of injuries and fatality risk in climbing sports.

Clinical management of musculoskeletal injuries in active children and youth

OBJECTIVE

To describe how different health care specialists manage musculoskeletal injury in children and examine factors influencing return to play decisions.

DESIGN

National survey.

SETTING

Secure Web site hosting online questionnaire.

PARTICIPANTS

Medical doctors, physical therapists, and athletic therapists who were members of their respective sport medicine specialty organizations.

INDEPENDENT VARIABLES

Professional affiliation and the effect of the following factors were examined: pushy parent, cautious parent, protective equipment, previous injury, musculoskeletal maturity, game importance, position played, team versus individual sport, and time since injury.

MAIN OUTCOME MEASURES

Recommendation of return to activity after common injuries seen in children and adolescents as described in 5 vignettes; consistency of responses across vignettes.

RESULTS

The survey was completed by 464 respondents (34%). There were several differences between the professional groups in their recommendations to return to activity. Most factors studied did not tend to influence the decision to return to activity, although protective equipment often increased the response to return sooner. The number of participants who would return a child to activity sooner or later for each factor varied greatly across the 5 vignettes, except for pushy parent or cautious parent.

CONCLUSIONS

Management practices of sport medicine clinicians vary according to profession, child, clinical factors, and sport-related factors. Decisions regarding return to play vary according to 5 specific characteristics of each clinical case. These findings help establish areas of consensus and disagreement in the management of children with injuries and safe return to physical activity.

Children as hematopoietic stem cell donors

In the past half-century, hematopoietic stem cell transplantation has become standard treatment for a variety of diseases in children and adults, including selected hematologic malignancies, immunodeficiencies, hemoglobinopathies, bone marrow failure syndromes, and congenital metabolic disorders. There are 3 sources of allogeneic hematopoietic stem cells: bone marrow, peripheral blood, and umbilical cord blood; each has its own benefits and risks. Children often serve as hematopoietic stem cell donors, most commonly for their siblings. HLA-matched biological siblings are generally preferred as donors because of reduced risks of transplant-related complications as compared with unrelated donors. This statement includes a discussion of the ethical considerations regarding minors serving as stem cell donors, using the traditional benefit/burden calculation from the perspectives of both the donor and the recipient. The statement also includes an examination of the circumstances under which a minor may ethically participate as a hematopoietic stem cell donor, how the risks can be minimized, what the informed-consent process should entail, the role for a donor advocate (or some similar mechanism), and other ethical concerns. The American Academy of Pediatrics holds that minors can ethically serve as stem cell donors when specific criteria are fulfilled.

Youth sports in the heat: recovery and scheduling considerations for tournament play

One of the biggest challenges facing numerous young athletes is attempting to perform safely and effectively in the heat. An even greater performance challenge and risk for incurring exertional heat injury is encountered when a young athlete has to compete multiple times on the same day, with only a short rest period between rounds of play, during a hot-weather tournament. Within the scope of the rules, tournament directors frequently provide athletes with only the minimum allowable time between same-day matches or games. Notably, prior same-day exercise has been shown to increase cardiovascular and thermal strain and perception of effort in subsequent activity bouts, and the extent of earlier exercise-heat exposure can affect performance and competition outcome. Incurred water and other nutrient deficits are often too great to offset during short recovery periods between competition bouts, and the athletes are sometimes 'forced' to compete again not sufficiently replenished. Providing longer rest periods between matches and games can significantly improve athlete safety and performance, by enhancing recovery and minimizing the 'carryover' effects from previous competition-related physical activity and heat exposure that can negatively affect performance and safety. Governing bodies of youth sports need to address this issue and provide more specific, appropriate and evidence-based guidelines for minimum rest periods between same-day contests for all levels of tournament play in the heat. Youth athletes are capable of tolerating the heat and performing reasonably well and safely in a range of hot environments if they prepare well, manage hydration sufficiently, and are provided the opportunity to recover adequately between contests.

Suitability of FIFA's "The 11" Training Programme for Young Football Players - Impact on Physical Performance

There is a paucity of evidence regarding the use of injury prevention programmes for preadolescents participating in sport. "The 11 "injury prevention programme was developed by FIFA's medical research centre (F-MARC) to help reduce the risk of injury in football players aged 14 years and over. The aim of this study was to determine the suitability and effectiveness of "The 11 "for younger football players. Twenty-four [12 experimental (EXP), 12 control (CON)] young football players (age 10.4 ± 1.4 yr) participated. The EXP group followed "The 11 "training programme 5 days per week, for 6 weeks, completing all but one of the 10 exercises. Prior to, and after the intervention, both EXP and CON groups performed a battery of football-specific physical tests. Changes in performance scores within each group were compared using independent t-tests (p ≤ 0.05). Feedback was also gathered on the young players' perceptions of "The 11". No injuries occurred during the study in either group. Compliance to the intervention was 72%. Measures of leg power (3 step jump and counter-movement jump) increased significantly (3.4 and 6.0% respectively, p < 0.05). Speed over 20 m improved by 2% (p < 0.05). Most players considered "The 11 "beneficial but not enjoyable in the prescribed format. Given the observed improvements in the physical abilities and the perceived benefits of "The 11", it would appear that a modified version of the programme is appropriate and should be included in the training of young football players, for both physical development and potential injury prevention purposes, as well as to promote fair play. To further engage young football players in such a programme, some modification to "The 11 "should be considered. Key pointsChildren who participate in recreational and competitive sports, especially football, are susceptible to injury.There is a need for the design and assessment of injury prevention programmes for children.The 11 "improves essential physical performance characteristics and has the potential to reduce the risk of injury.It may be prudent to implement a 'child-friendly' version of "The 11", to enhance long-term programme adherence and to ensure progressive physical development of players.