Strategies to prevent injury in adolescent sport: a systematic review

Effect of neuromuscular injury prevention strategies on injury rates in adolescent males playing sport: a systematic review protocol

OBJECTIVE

This review will assess the effectiveness of neuromuscular injury prevention strategies on injury rates among adolescent males playing sports.

INTRODUCTION

Adolescent athletes are predisposed to injuries during this period of growth. Growth-related injury risk factors can be mitigated by implementing appropriate neuromuscular injury prevention strategies. This review will include all sporting disciplines in summarizing the components and assessing the effectiveness of injury prevention strategies in the adolescent male population.

INCLUSION CRITERIA

Randomized controlled trials investigating adolescent males, between the ages of 13 and 18 years, participating in organized sports, in any setting and level of participation, will be included. Studies that evaluate neuromuscular injury prevention strategies (eg, balance, proprioceptive, plyometric, agility, strength, weight, conditioning and sport-specific exercises and training, warm up, cool down, stretches, neuromuscular control) vs no intervention or standard training and competition exposure will be included. The outcomes of interest are injury incidence and prevalence rates.

METHODS

Databases searched will include MEDLINE (PubMed), CINAHL Complete (EBSCOhost), ClinicalKey, SPORTDiscus (EBSCOhost), Physiotherapy Evidence Database (PEDro), Scopus, ScienceDirect, MasterFILE Premier (EBSCOhost), Academic Search Complete (EBSCOhost), Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov. Gray literature and unpublished studies will be searched via Health and Medical Complete (ProQuest Dissertations & Theses). Study screening and selection against inclusion criteria will be performed. Data extraction and critical appraisal will be performed using the standardized JBI templates and checklists for qualitative research. All stages will be performed by 2 independent reviewers, with conflicts resolved by a third reviewer.

REVIEW REGISTRATION

PROSPERO CRD42022327047.

Sleep, Nutrition, and Injury Risk in Adolescent Athletes: A Narrative Review

This narrative review explores the impact of sleep and nutrition on injury risk in adolescent athletes. Sleep is viewed as essential to the recuperation process and is distinguished as an active participant in recovery through its involvement in growth, repair, regeneration, and immunity. Furthermore, the literature has shown that the sleep of athletes impacts elements of athletic performance including both physical and cognitive performance, recovery, injury risk, and mental well-being. For sleep to have a restorative effect on the body, it must meet an individual's sleep needs whilst also lasting for an adequate duration and being of adequate quality, which is age-dependent. The literature has suggested that athletes have increased sleep needs compared to those of the general population and thus the standard recommendations may not be sufficient for athletic populations. Therefore, a more individualised approach accounting for overall sleep health may be more appropriate for addressing sleep needs in individuals including athletes. The literature has demonstrated that adolescent athletes achieve, on average, ~6.3 h of sleep, demonstrating a discrepancy between sleep recommendations (8-10 h) and actual sleep achieved. Sleep-wake cycles undergo development during adolescence whereby adaptation occurs in sleep regulation during this phase. These adaptations increase sleep pressure tolerance and are driven by the maturation of physiological, psychological, and cognitive functioning along with delays in circadian rhythmicity, thus creating an environment for inadequate sleep during adolescence. As such, the adolescent period is a phase of rapid growth and maturation that presents multiple challenges to both sleep and nutrition; consequently, this places a significant burden on an adolescent athletes' ability to recover, thus increasing the likelihood of injury. Therefore, this article aims to provide a comprehensive review of the available literature on the importance of sleep and nutrition interactions in injury risk in adolescent athletes. Furthermore, it provides foundations for informing further investigations exploring the relation of sleep and nutrition interactions to recovery during adolescence.

Does injury risk increase when youth athletes start to study at a sports high school?

Background/aim

The injury risk is high in adolescent elite athletes. However, little is known about how the injury risk changes when young talented athletes start studying at a sports high school. The primary aim was therefore to explore the risk of injury when the athlete starts to study at a sports high school. A secondary aim was to identify risk factors for injury.

Methods

A total of 489 athletes (age 15-16 years) were followed for 20 weeks, including 10 weeks before and 10 weeks after the athlete had started to study at a sports high school. Substantial injury was monitored in adolescent elite athletes using the Oslo Sports Trauma Research Centre Questionnaire.

Results

The results showed that the mean difference (md) in injury prevalence was significantly (p=0.001) higher across the 10 weeks after school had started (md 3.6; 95% CI 1.5 to 5.8), compared with the 10 weeks before. Female athletes had significantly (p<0.001) higher injury prevalence (md 6.4%; 95% CI 3.0 to 9.8) across the 10 weeks after school had started, whereas male athletes (md 0.9%; 95% CI -1.8 to 3.6) had not (p=0.530). Three significant (p<0.05) risk factors were identified; previous injury within the past 12 months (OR 3.23), higher training volume (OR 0.97) and lower well-being (OR 0.71).

Conclusions

Our results provide supporting evidence for increased injury risk in female adolescent elite athletes after the athletes had started to study at a sports high school.

Previous Injury and Lower Well-being Increase Injury Risk in Female Adolescent Athletes

Several risk factors for injury have been suggested in female elite athletes. However, there is a lack of prospective studies in young female athletes where multiple risk factors have been studied. The aim of this study was to identify risk factors for injury in female adolescent elite athletes. Substantial injuries were monitored in 222 athletes using the validated Oslo Sports Trauma Research Centre Questionnaire over 20 weeks. Over 20 potential risk factors were explored. Based on a binomial generalized linear mixed model, two significant (p<0.05) risk factors for injury were identified; previous injury within the last 12 months (OR 2.55) and well-being (OR 0.97). An athlete with a previous injury had twice as high a risk of injury (13% vs. 6%) compared to an athlete with no previous injury. Higher perceived well-being was associated with a decreased risk of injury. Based on a prospective design with a large sample of female adolescent elite athletes, investigating over 20 potential risk factors for injury, our results suggest that a previous injury and well-being are risk factors for injury.

Coaches' experiences of injury prevention in youth elite athletes: An interview study of 10 coaches

INTRODUCTION

Injury prevention is important to reduce the high injury risk in youth elite athletes studying at sports high schools. Coaches are considered important in youth elite sports and injury prevention.

OBJECTIVES

The aim was to investigate perceptions and experiences of injury prevention among coaches at sports high schools.

METHODS

A manifest qualitative content analysis with an inductive approach was used based on ten semi-structured interviews with coaches who work at sports high schools.

RESULTS

An overarching theme "Coaches of youth athletes value injury prevention but have limited knowledge and support" was identified and five main categories were formed. Coaches perceived themselves to play an important role in injury prevention, yet they described limited time for knowledge acquisition and highlighted the close collaboration with other professions as a key in injury prevention.

CONCLUSION

A coach's knowledge and support are critical factors in injury prevention of youth elite athletes. Evidence-based as well as non-evidence-based approaches are used, and the biopsychosocial perspective was not always taken into consideration. A need for more interprofessional collaboration and knowledge acquisition regarding injury prevention is warranted.

The association between size and symmetry of the lumbar multifidus muscle, and injuries in adolescent rugby union players

OBJECTIVES

This study aimed to investigate the association between size and symmetry of the lumbar multifidus muscle, and season injuries in adolescent rugby union players.

DESIGN

Prospective longitudinal cohort study.

SETTING

Pre-season assessment of the size (cross-sectional area) of the lumbar multifidus (L2-5) muscles using ultrasound imaging.

PARTICIPANTS

Seventy-one adolescent rugby union players (aged 15-18 years).

MAIN OUTCOME MEASURES

"Time-loss" injuries were recorded during the season and divided into four injury regions (head and neck, upper limb, trunk and lower limb).

RESULTS

Thirty-nine injuries were recorded during the season. Players who sustained an upper limb injury during the season had smaller lumbar multifidus muscles at the L5 vertebral level (effect size = 0.7, p = 0.03) and asymmetry in muscle size at the L2 (p = 0.05) and L5 (p = 0.04) in the pre-season. There was no association between size of the lumbar multifidus muscle and other injuries (p > 0.05).

CONCLUSION

Lumbar multifidus muscle size and symmetry may impact lumbopelvic control which may increase the risk of sustaining an upper limb injury during rugby union. Future research should aim to identify whether lumbar multifidus muscle size is a modifiable risk factor for rugby union injuries to guide future intervention programs.

A qualitative examination of injury prevention strategy and education in Ladies Gaelic football: Understanding the preferences of players and coaches

The high rates of injury in Ladies Gaelic football impact the wellbeing of players and are a major financial burden for the Ladies Gaelic Football Association. Effective injury prevention programmes have been developed for Gaelic games, but these are not currently widely adopted. The aim of this study was to qualitatively investigate adult Ladies Gaelic football players and coaches' preferences for injury prevention strategies and injury prevention education using a constructivist grounded-theory approach. Semi-structured interviews were conducted with 23 currently active Ladies Gaelic football coaches and adult players. The core strategy preferences discussed by participants were the properties of an injury prevention programme, the role of stakeholders, strategy logistics and the need for guidance and support. If the uptake and long-term adoption of an injury prevention programme is to be maximised, the preferences of the players and coaches who will ultimately utilise the programme must be understood and integrated into a wider implementation strategy developed around their needs. For education preferences, the core categories identified were the focus of education, who needs education, the format, educator, roll-out strategy, and time required. Future educational strategies must incorporate the preferences of stakeholders into their design if they are to be successful in spreading injury prevention knowledge and achieving change. To give injury prevention strategies, programmes, and education the best chances at successful adoption, it is crucial that the preferences of end-users are addressed and implemented.

Previous injury, sex and well-being are associated with injury profiles in 422 adolescent elite athletes of age 15-16 years: a 20-week longitudinal study

Background

Adolescent elite athletes have a high injury risk and many risk factors for injury have been suggested. However, there is a lack of prospective studies in adolescent elite athletes of age 15-16 years.

Aim

The aim of the study was to prospectively explore risk factors associated with different injury prevalence profiles in adolescent elite athletes.

Methods

Substantial injury was monitored in adolescent elite athletes (n=422) using the validated Oslo Sports Trauma Research Center Questionnaire over 20 weeks. Athletes were categorised in tertiles based on injury prevalence.

Results

The median substantial injury prevalence for all athletes was 10% (IQR 0%-20%). Compared with the 'no injury' group, previous injury (p<0.001, OR 3.91) and well-being (p<0.001, OR 0.93) were associated with the 'high injury' group, and previous injury (p=0.006, OR 1.96) and being a female athlete (p=0.002, OR 2.08) with the 'low injury' group. A female athlete with a previous injury and low perceived well-being (25th percentile) had a 48% risk (95% CI 36% to 59%) of belonging to the 'high injury' group, compared with 7% (95% CI 4% to 12%) for a male athlete with no previous injury and high well-being (75th percentile).

Conclusion

Medical personnel should be aware of the high injury risk and risk factors for injury in adolescent elite athletes, and closely monitor the rehabilitation post-injury as a previous injury is such a strong risk factor for a new injury.

Epidemiology of Lateral Ligament Complex Tears of the Ankle in National Collegiate Athletic Association (NCAA) Sports: 2014-15 Through 2018-19

BACKGROUND

Epidemiological studies of lateral ankle sprains in NCAA sports are important in appraising the burden of this injury and informing prevention efforts.

PURPOSE

To describe the epidemiology of lateral ankle sprains in NCAA sports during the 2014-15 through 2018-19 seasons.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

Injury and exposure information collected within the NCAA Injury Surveillance Program (ISP) were examined. Counts, rates, and proportions of lateral ankle sprains were used to describe injury incidence by sport, event type (practices, competitions), season segment (preseason, regular season, postseason), injury mechanism (player contact, noncontact, and surface contact, injury history (new, recurrent), and time loss (time loss [≥1 day], non-time loss). Injury rate ratios (IRRs) were used to examine differential injury rates, and injury proportion ratios (IPRs) were used to examine differential distributions.

RESULTS

A total of 3910 lateral ankle sprains were reported (4.61 per 10,000 athlete exposures) during the study period, and the overall rate was highest in men's basketball (11.82 per 10,000 athlete exposures). The competition-related injury rate was higher than the practice-related rate (IRR, 3.24; 95% CI, 3.04-3.45), and across season segments, the overall rate was highest in preseason (4.99 per 10,000 athlete exposures). Lateral ankle sprains were most often attributed to player-contact mechanisms in men's (43.2%) and women's sports (35.1%), although injuries were more prevalently attributed to player contact in men's than in women's sports (IPR, 1.23; 95% CI, 1.13-1.34). Overall, 49.7% of all lateral ankle sprains were time loss injuries.

CONCLUSIONS

The findings of this study are consistent with previous epidemiological investigations of lateral ankle sprains among NCAA athletes. Results offer additional context on differential injury mechanisms between men's and women's sports and on injury risk across the competitive season. Future research may examine the effectiveness of deploying injury prevention programs before the start of a season.

Applying the Principles of Motor Learning in Preventative Programs of Overuse Injuries in Young Athletes: A Scoping Review

This study aimed to review the scope of overuse injury prevention programs in young players through the lens of application of motor learning principles. From 280 studies found in the initial search, 13 studies were selected based on a series of inclusion criteria. The selected studies were categorized based on the type of intervention resulting in multicomponent (two studies), Fédération Internationale de Football Association 11+ (five studies), neuromuscular training (two studies), Fédération Internationale de Football Association Medical Assessment and Research Center (two studies), educational (one study), and stability (one study). The studies that had an effective preventative role to reduce overuse injuries applied some principles of motor learning to their intervention, such as contextual interference, variability of practice, task constraints, the power law of practice, transfer of learning, and explicit methods. There is a gap in the literature related to explicit applications of motor learning principles in the design of preventative interventions for overuse injury.

Characterization of Musculoskeletal Injuries in Gymnastics Participants From 2013 to 2020

BACKGROUND

Many studies have analyzed gymnastics-related injuries in collegiate and elite athletes, but there is minimal literature analyzing the epidemiological characteristics of injuries in the greater gymnastics community.

HYPOTHESIS

A higher incidence of injuries in younger gymnasts between the ages of 6 and 15 years compared with those 16 years and older and a difference in the distribution of injuries between male and female gymnasts.

STUDY DESIGN

Retrospective cross-sectional study.

LEVEL OF EVIDENCE

Level 3.

METHODS

The National Electronic Injury Surveillance System (NEISS) was queried for all gymnastics-related musculoskeletal injuries presenting to the emergency department (ED) between 2013 and 2020. Incidence was calculated as per 100,000 person-years using the weighted estimates provided by NEISS and national participation data. Chi-square and column proportion z-testing was used to analyze where appropriate.

RESULTS

The incidence of gymnastics-related musculoskeletal injuries was 480.7 per 100,000 person-years. Most ED visits were children between the ages of 6 and 15 years (84.0%). Younger gymnasts (ages 6 to 10) were most likely to experience a lower arm fracture, while those over the age of 10 years were most likely to experience an ankle sprain (P < 0.01). Men and boys presented with a much greater proportion of shoulder injuries (8.0% vs 3.9%), while women and girls presented with a greater proportion of elbow injuries (9.9 % vs 5.9%) and wrist (10.5% vs 8.3%) injuries (P < 0.01).

CONCLUSION

As hypothesized, most gymnastics-related injuries between 2013 and 2020 were athletes between 6 and 15 years old. Many of these athletes are attempting new, more difficult, skills and are at increased risk of more acute injury when attempting skills they may be unfamiliar with.

CLINICAL RELEVANCE

With increased pressure to specialize at an early age to maintain competitiveness and learn new, higher-level skills compared with their peers, younger athletes are most susceptible to acute injury. New injury prevention strategies could be implemented to help this high-risk population compete and train safely.

A Comprehensive Summary of Systematic Reviews on Sports Injury Prevention Strategies

Background

A large volume of systematic reviews and meta-analyses has been published on the effectiveness of sports injury prevention programs.

Purpose

To provide a qualitative summary of published systematic reviews and meta-analyses that have examined the effectiveness of sports injury prevention programs on reducing musculoskeletal injuries.

Study Design

Systematic review; Level of evidence, 4.

Methods

We searched the PubMed, CINAHL, EMBASE, and the Cochrane databases for systematic reviews and meta-analyses that evaluated the effectiveness of sports injury prevention programs. We excluded published abstracts, narrative reviews, articles not published in English, commentaries, studies that described sports injury prevention strategies but did not assess their effectiveness, studies that did not assess musculoskeletal injuries, and studies that did not assess sports-related injuries. The most relevant results were extracted and summarized. Levels of evidence were determined per the Oxford Centre for Evidence-Based Medicine, and methodological quality was assessed using the AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews, revised version).

Results

A total of 507 articles were retrieved, and 129 were included. Articles pertaining to all injuries were divided into 9 topics: sports and exercise in general (n = 20), soccer (n = 13), ice hockey (n = 1), dance (n = 1), volleyball (n = 1), basketball (n = 1), tackle collision sports (n = 1), climbing (n = 1), and youth athletes (n = 4). Articles on injuries by anatomic site were divided into 11 topics: general knee (n = 8), anterior cruciate ligament (n = 34), ankle (n = 14), hamstring (n = 11), lower extremity (n = 10), foot (n = 6), groin (n = 2), shoulder (n = 1), wrist (n = 2), and elbow (n = 1). Of the 129 studies, 45.7% were ranked as evidence level 1, and 55.0% were evidence level 2. Based on the AMSTAR-2, 58.9% of the reviews reported a priori review methods, 96.1% performed a comprehensive literature search, 47.3% thoroughly described excluded articles, 79.1% assessed risk of bias for individual studies, 48.8% reported a valid method for statistical combination of data (ie, meta-analysis), 45.0% examined the effect of risk of bias on pooled study results, and 19.4% examined the risk for publication bias.

Conclusion

This comprehensive review provides sports medicine providers with a single source of the most up-to-date publications in the literature on sports injury prevention.

Identification of Neuromuscular Performance Parameters as Risk Factors of Non-contact Injuries in Male Elite Youth Soccer Players: A Preliminary Study on 62 Players With 25 Non-contact Injuries

Introduction: Elite youth soccer players suffer increasing numbers of injuries owing to constantly increasing physical demands. Deficits in neuromuscular performance may increase the risk of injury. Injury risk factors need to be identified and practical cut-off scores defined. Therefore, the purpose of the study was to assess neuromuscular performance parameters within a laboratory-based injury risk screening, to investigate their association with the risk of non-contact lower extremity injuries in elite youth soccer players, and to provide practice-relevant cut-off scores.

Methods: Sixty-two elite youth soccer players (age: 17.2 ± 1.1 years) performed unilateral postural control exercises in different conditions, isokinetic tests of concentric and eccentric knee extension and knee flexion (60°/s), isometric tests of hip adduction and abduction, and isometric tests of trunk flexion, extension, lateral flexion and transversal rotation during the preseason period. Non-contact lower extremities injuries were documented throughout 10 months. Risk profiling was assessed using a multivariate approach utilizing a Decision Tree model [Classification and Regression Tree (CART) method].

Results: Twenty-five non-contact injuries were registered. The Decision Tree model selected the COP sway, the peak torque for knee flexion concentric, the functional knee ratio and the path of the platform in that hierarchical order as important neuromuscular performance parameters to discriminate between injured and non-injured players. The classification showed a sensitivity of 0.73 and a specificity of 0.91. The relative risk was calculated at 4.2, meaning that the risk of suffering an injury is four times greater for a player, who has been classified as injured by the Decision Tree model.

Conclusion: Measuring static postural control, postural control under unstable condition and the strength of the thigh seem to enable a good indication of injury risk in elite youth soccer players. However, this finding has to be taken with caution due to a small number of injury cases. Nonetheless, these preliminary results may have practical implications for future directions in injury risk screening and in planning and developing customized training programs to counteract intrinsic injury risk factors in elite youth soccer players.

Association of COMT Polymorphisms with Multiple Physical Activity-Related Injuries among University Students in China

The catechol-O-methyltransferase (COMT) is a candidate gene to provide promising evidence of psychiatric disorders, but there is a knowledge gap between the genetic factor and multiple physical activity-related injuries (PARIs). The aim of this study was to explore the contribution of COMT to the risk of PARIs among university students in the Chinese Han population. We can further search for the intrinsic risk factors for the occurrence of multiple physical activity injuries and provide a scientific basis for early screening and precise intervention for the high-risk group of college students with multiple PARIs. A 1:1 matched case-control study of 61 PARIs cases and 61 healthy controls were carried out. DNA samples of the participants were isolated from saliva and genotyped on eight SNPs of the COMT gene (rs9265, rs4680, rs6269, rs4818, rs4633, rs165655, rs165656, and rs165722) using the MALDI-TOF MS method. We found that rs6269 and rs4818 were significantly associated with PARIs, and rs6269-GG and rs4818-GG contributed to the reduced risk of PARIs. Further haplotype analysis showed a four-marker C-G-C-G haplotype (rs165722-rs6269-rs4633-rs4818) acted with a protective role in the development of PARIs (p = 0.037; OR: 0.474, 95% CI: 0.269 to 0.834). However, the interactions between club membership and rs6269 or rs4818 would significantly increase the risk of PARIs (both p < 0.001, OR: 5.121 and 4.977, respectively). This is the first study to find the contribution of COMT to PARIs occurrence, suggesting that the COMT polymorphisms and the gene-environment interactions may alter the risk of PARIs.

The Effects of Physical Activity on Physeal and Skeletal Development

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There is increasing evidence in the literature regarding the important health impact of and risk factors for injury in youth sport.

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Increasing pediatric and adolescent activity intensity, such as is seen in earlier single-sport focus and specialization, may be associated with morphological changes in the growing skeleton.

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Chronic subacute injury to the developing physes in the active child can lead to stress on the growth plate and surrounding tissues that induces developmental morphological changes in the joint.

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There is evidence to suggest that frequent participation in sports that place particular stress across the physes of the proximal humerus, the proximal femur, and the distal radius can be associated with an increased risk of inducing developmental and morphological changes that could lead to future joint dysfunction and premature degeneration.

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Additional research is necessary to better define the pathoetiology of activity-mediated morphological changes, as well as to create and validate parameters for safe involvement in competitive physical activities.

Examining the Role of Risk Compensation in Extreme Sports

This study explored the relations between sensation seeking, impulsivity, risk compensation, and extreme-sports injury to better understand contributing factors to risk taking in extreme sports and subsequent adverse outcomes. Data included cross-sectional survey responses from 1,107 college students (Mage = 19.47, SD = 2.14). Poisson, logistic, and negative binomial regressions were used to investigate the relations of interest. Results indicate that sensation seeking and impulsivity are significantly associated with both risk compensation and extreme-sports injury. Risk compensation is significantly and positively associated with extreme-sports injury in mountain biking and snowboarding. Risk compensation did not significantly moderate the relation between the personality constructs of interest and extreme-sports injury. These results show that the role of risk compensation in extreme-sports injury is highly sport-specific. These results highlight the importance of considering both personality and risk compensation in prevention and intervention efforts.

Comparison between neurodynamic therapy and foam rolling in cool-down sessions for delayed onset muscle soreness in healthy individuals

BACKGROUND

Delayed onset of muscle soreness (DOMS) is a common finding in trained and untrained individuals post high intensity exercises which can lead to injuries. Foam rolling (FR) and neurodynamic therapy (NDT) are types of active cool-down which provides effective for treatment of DOMS. But their role in reduction of intensity of the same in cool down is not established.

STUDY DESIGN

Crossover study.

METHODOLOGY

Total 60 healthy individuals participated in the study. Pre intervention readings were taken of strength and tightness by Range of motion. Subjects performed both the types of cool-down separated by 4 weeks interval with random allocation. Post intervention readings of hamstring and quadriceps tightness, grade of tenderness and stand to sit VAS score was taken post 24 h and 48 h and strength post 48 h.

RESULTS

Analysis was done for using repeated measures ANOVA and Friedman's test. The difference of values for Straight Leg Raise and Prone knee Flexion between NDT and FR post 24 h were statistically significant (p < 0.05) while that of NDT post 24 h being similar to FR post 48 h (p > 0.05). There was a significant difference between strength, tenderness and VAS in NDT and FR (p < 0.05). With the mean of post 24 h as well as post 48 h being less in the FR intervention.

CONCLUSION

Foam rolling is a better option than Neurodynamic therapy for reduction of intensity of DOMS.

Guidelines for Physical Activity-A Cross-Sectional Study to Assess Their Application in the General Population. Have We Achieved Our Goal?

National and international healthcare organizations propose guidelines for physical activity worldwide, defining its characteristics. These guidelines' practical applications are difficult to estimate, since they are not fully followed. The aim of the present cross-sectional observational study was to assess awareness about guidelines for physical activity and to evaluate their practical applications in a sample of the Italian population. In total, 310 participants completed an online survey (mean age 29.10 ± 4.44), assessing the habits, beliefs and health effects of physical activity. In total, 39.35% of respondents were inactive. In total, 6.91% of active respondents did not perform a warm-up phase at the beginning of each training session and 77.14% did not check their own heart rate during the training session. Approximately half of respondents reported erroneous beliefs about the type, frequency and volume of physical activity, compared to data proposed by the guidelines. The preventive effect of physical activity was clearly perceived for cardiovascular diseases, diabetes, metabolic syndrome and depression. Several subjects misinterpreted the preventive role of physical activity in colon and breast cancers, and in femur and vertebral fractures. Habits and beliefs about physical activity in the general population are far from the guidelines and recommendations. Therefore, it is necessary to strengthen the conscious practice of physical activity further.

Sport injury prevalence and risk by level of play and sports played among a representative population of French adolescents. A school-based study

BACKGROUND

Sports practice has both benefits and physical risks. In France, data related to adolescent sports injury are rare. The main purpose of this article is to study the prevalence and risk of injuries by level of play and sports in the southeast of France.

METHODS

Data collection was conducted in French schools among adolescents in 2015 and 2017 (n=1849; aged 14-19). Only sports players were included (n=1366). Two level of play were created. The low-level group included adolescents playing sport either outside or within a club, at the local level of competition or below. The high-level group included adolescents playing sport within a club at the state (regional) level of competition or higher. Odds-ratios and their 95% confidence intervals adjusted for variables selected using stepwise regression procedures were calculated to determine the injury risk of high-level athletes compared with those at low-level, in each sport. We also calculated the injury risk of each sport compared to all the other sports, by level of play.

RESULTS

In almost all sports activities, the prevalence of injured athletes was higher in the high-level of play than in the low-level of play. The increase in injury risk was the highest in tennis, basketball, dance, athletics and volleyball. When comparing sports, at the lowest level, handball, boxing, soccer and gymnastics practitioners were more at risk than the rest of the sample. At the highest level of play, only basketball players were more at-risk. Dancing is the less dangerous sport in terms of injury outcome, regardless the level.

CONCLUSION

From the state level of competition, injury risk increases significantly across most of the sports. Meanwhile, differences appeared regarding the prevalence, severity and nature of the sustained injuries. It would be useful to perform such analysis on a greater sample size, ideally representative of the national population of adolescents.

Epidemiology of physical activity-related injuries in Chinese university students

Knowledge gaps of the physical activity-related injury (PARI) problem among general undergraduates exist. We conducted a study in four universities, where 1421 students graded 1-3 were interviewed face-to-face during April and May after their completion of the baseline survey in March and April 2017, aiming to describe the incidence and characteristics of PARI. PARI experience and physical activity (PA) participation in the past 12 months were collected. Injury incidence density (IID) and risk, and injury characteristics were evaluated for the overall sample and by gender. Pearson chi-square or Fisher's exact tests and independent-sample t tests were used to test between-group differences. We found that 486 PARIs were reported totally by 289 participants, with an overall IID of 0.57 per 1000 hours of exposure (males: 1.07, females: 0.45) and an injury risk of 0.34 injuries/student/y (males: 0.52; females: 0.28). Higher IIDs were found in roller skating, football, and basketball. The majority of injuries occurred outdoors and involved the lower extremities, with sprain and strain being the primary injury types. Moreover, most injuries were new, acute, and happened in non-contact situations. Of all injuries, 52.1% required medical attention and 64.6% resulted in inactivity of one or more days. Some significant differences were observed between males and females. Our study indicates that PARI is a public health concern among Chinese university students, which can provide direction for targeted prophylactic interventions to underpin the sex-specific injury mechanism to reduce PARI.

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.

Strength and conditioning in adolescent female athletes

Despite evidence that strength and conditioning (S&C) programs decrease injury risk and increase sport performance, young females are rarely offered S&C programs comparable to those of their male counterparts. The purpose of this study was to evaluate the current body of available literature regarding S&C in adolescent female athletes, describe potential benefits, and generate recommendations for S&C programs for female adolescent athletes. This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Systematic searches of the PubMed and Google Scholar databases were conducted using the following keywords: 'female athletes,' 'injury prevention,' 'adolescent,' 'physical fitness,' 'strength,' 'female adolescent,' and 'conditioning.' Studies included in this review evaluated the effectiveness of S&C protocols and/or the habits and attitudes of coaches and athletic trainers working with female adolescent athletes. Seven articles evaluating S&C programs for the adolescent female athlete were used as the basis for this systematic review. These articles described current protocols and/or factors that should be taken into account when designing S&C programs. The identified articles focused on improving the strength of adolescent female athletes, decreasing the risk of injury, and exposing female athletes to the benefits of S&C that are routinely afforded to their male counterparts. Despite the critical potential benefits of S&C training, such as improved landing mechanics, coaches and athletic trainers do not routinely implement S&C programs for female adolescent athletes. The lack of such programs is largely due to misconceptions surrounding female athletes, such as the perception that females fear bulking up. S&C programs for adolescent female athletes should incorporate stretching of the hip adductors, targeted hamstring, gluteal and quadriceps strengthening, and a synergistic adaptation model, which tailors training protocols to an athlete's pubertal stage.

General versus sports-specific injury prevention programs in athletes: A systematic review on the effect on injury rates

Introduction

Annually, 2 million sports-related injuries are reported in Germany of which athletes contribute to a large proportion. Multiple sport injury prevention programs designed to decrease acute and overuse injuries in athletes have been proven effective. Yet, the programs’ components, general or sports-specific, that led to these positive effects are uncertain. Despite not knowing about the superiority of sports-specific injury prevention programs, coaches and athletes alike prefer more specialized rather than generalized exercise programs. Therefore, this systematic review aimed to present the available evidence on how general and sports-specific prevention programs affect injury rates in athletes.

Methods

PubMed and Web of Science were electronically searched throughout April 2018. The inclusion criteria were publication dates Jan 2006–Dec 2017, athletes (11–45 years), exercise-based injury prevention programs and injury incidence. The methodological quality was assessed with the Cochrane Collaboration assessment tools.

Results

Of the initial 6619 findings, 15 studies met the inclusion criteria. In addition, 13 studies were added from reference lists and external sources making a total of 28 studies. Of which, one used sports-specific, seven general and 20 mixed prevention strategies. Twenty-four studies revealed reduced injury rates. Of the four ineffective programs, one was general and three mixed.

Conclusion

The general and mixed programs positively affect injury rates. Sports-specific programs are uninvestigated and despite wide discussion regarding the definition, no consensus was reached. Defining such terminology and investigating the true effectiveness of such IPPs is a potential avenue for future research.

Prevention of musculoskeletal injuries in recreational field hockey: the systematic development of an intervention and its feasibility

Objective

This article describes the systematic development of an intervention for the prevention of lower extremity injuries in field hockey and the assessment of its feasibility.

Methods

The intervention was developed according to the first four steps of the intervention mapping and knowledge transfer scheme processes, mostly based on focus group interviews with experts in field hockey and injury prevention (needs assessment; objective and target groups; content selection; development). Subsequently, a quasi-experimental research (one-group post-test design) was conducted among 35 young field hockey players and 7 coaches. Participants were asked to use the intervention for 3 weeks, and the degrees of relevancy, suitability, satisfaction and usability of the intervention were assessed by means of a questionnaire and a group interview.

Results

First, the needs assessment conducted among the main actors within recreational field hockey revealed that an injury prevention intervention was needed, ideally delivered through videos via an application for smartphone/tablet or website. Second, the objective and target groups of the intervention were defined, namely to prevent or reduce the occurrence of lower extremity injuries among both young and adult recreational field hockey players. Third, warming-up exercises were selected as preventive measures and strategies (eg, core stability, strength, coordination). Last, the 'Warming-Up Hockey' intervention was developed, consisting of a warm-up programme (delivered by coaches including more than 50 unique exercises). The relevancy, satisfaction and usability of 'Warming-Up Hockey' were positively evaluated, but two main alterations were made: the duration of the 'Warming-up Hockey' was reduced from 16 to 12  min and a match-specific warm-up was added.

Conclusion

The feasibility of 'Warming-Up Hockey' was positively assessed by players and coaches. Prior to its nationwide implementation, the effectiveness of the intervention on injury reduction among field hockey players should be conducted.

Functional Performance Measures Used for Return-to-Sport Criteria in Youth Following Lower-Extremity Injury

CONTEXT

As sport participation increases globally, so will injury-related risks. The process used to determine return-to-sport following injury is vital to future sport participation and injury prevention. Early specialization along with poor management of sport participation causes an increase in injury risk and potential long-term health consequences for youth athletes.

OBJECTIVES

Previous injury is a common intrinsic risk factor for new injuries. Identifying functional performance deficits, defined by return-to-sport criteria, minimizes these risk factors and provides athletes with guidelines to return safely to sport. The purposes of this clinical commentary and literature review are to provide a summary of current concepts and clinical practices and to identify functional performance measures as clinical assessment tools for return-to-play criteria in the youth population.

EVIDENCE

A literature review was completed using numerous databases, where 154 relevant articles were reviewed and 22 articles were included in this commentary. Of the 22 articles using functional performance measures for return-to-sport criteria, 6 were specific to youth, 12 had mixed populations of adults and youth, and 4 were normative samples for specific youth populations. Acquisition: The gaps in the literature pertaining to functional performance measures in the youth population are addressed, and future research needs for return-to-sport criteria are identified.

EVIDENCE SYNTHESIS

This descriptive literature review identifies 22 articles that meet the search criteria for the youth population discussing the use of clinical functional performance measures in order to identify return-to-sport criteria for lower-extremity injuries.

CONCLUSIONS

Due to the inconsistencies in terminology, definitions, and standardization of clinical assessment tools, it seems necessary to create a comprehensive functional performance test battery for the lower extremity that can be used as return-to-sport criteria.

Effects of the '11+ Kids' injury prevention programme on severe injuries in children's football: a secondary analysis of data from a multicentre cluster-randomised controlled trial

BACKGROUND

To assess the effects of the injury prevention programme '11+ Kids' on reducing severe injuries in 7 to 13 year old football (soccer) players.

METHODS

Football clubs (under-9, under-11 and under-13 age groups) from the Czech Republic, Germany, the Netherlands and Switzerland were cluster-randomised (clubs) into an intervention (INT) and a control group (CON). INT replaced their usual warm-up by '11+ Kids' two times a week. CON followed their regular training regime. Match and training exposure and injury characteristics were recorded and injury incidence rates (IRs) and 95% CIs calculated. For the present analysis, only severe injuries (absence from training/match ≥28 days) were considered. Hazard ratios (HR) were calculated using extended Cox models.

RESULTS

The overall IR of severe injuries per 1000 football hours was 0.33 (95% CI 0.25 to 0.43) in CON and 0.15 (95% CI 0.10 to 0.23) in INT. There was a reduction of severe overall (HR 0.42, 95% CI 0.24 to 0.72), match (0.41, 0.17 to 0.95) and training injuries (0.42, 0.21 to 0.86) in INT. The injury types that were prevented the most were: other bone injuries 66%, fractures 49% and sprains and ligament injuries 37%. Severe injuries located at the knee (82%), hip/groin (81%), the foot/toe (80%) and the ankle (65%) were reduced tremendously.

CONCLUSIONS

'11+ Kids' has a large preventive effect on severe injuries by investing only 15 to 20 min per training session. The present results should motivate coaches to implement effective injury prevention programmes such as the '11+ Kids' in children's football.

TRIAL REGISTRATION NUMBER

NCT02222025.

Meta-analysis of meta-analyses of anterior cruciate ligament injury reduction training programs

Several meta-analyses have been published on the effectiveness of anterior cruciate ligament (ACL) injury prevention training programs to reduce ACL injury risk, with various degrees of risk reduction reported. The purpose of this research was to perform a systematic review and meta-analysis of overlapping meta-analyses evaluating the effectiveness of ACL injury prevention training programs so as to summarize the amount of reduction in risk for all ACL and non-contact ACL injuries into a single source, and determine if there were sex differences in the relative efficacy of ACL injury prevention training programs. Five databases (Medline, PubMed, Embase, CINAHL, and Cochrane) were searched to identify meta-analyses that evaluated the effectiveness of ACL injury prevention training programs on ACL injury risk. ACL injury data were extracted and the results from each meta-analysis were combined using a summary meta-analysis based on odds ratios (OR). Eight meta-analyses met eligibility criteria. Six of the eight only included data for female athletes. Summary meta-analysis showed an overall 50% reduction (OR = 0.5 [0.41-0.59]; I²  = 15%) in the risk of all ACL injuries in all athletes and a 67% reduction (OR = 0.33 [0.27-0.41]; I²  = 15%) for non-contact ACL injuries in females. This paper combines all previous meta-analyses into a single source and shows conclusive evidence that ACL injury prevention programs reduce the risk of all ACL injuries by half in all athletes and non-contact ACL injuries by two-thirds in female athletes. There is insufficient data to make conclusions as to the effectiveness of ACL injury prevention programs in male athletes. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2696-2708, 2018.

Effectiveness of multicomponent lower extremity injury prevention programmes in team-sport athletes: an umbrella review

OBJECTIVE

To identify which exercise combinations are most effective as part of a lower extremity injury prevention programme for team-sport athletes.

DESIGN

Umbrella review.

DATA SOURCES

A comprehensive literature search was performed in PubMed, Scopus, Cochrane Library and PEDro databases. Studies published between January 2000 and March 2017 were included in this umbrella review.

STUDY ELIGIBILITY CRITERIA

Moderate to high-quality systematic reviews that investigated the effectiveness of a combination of two or more exercise components, that is, strength, agility, plyometrics, balance, stretching, technique, warm-up and functional activity, regarding injury incidence/rate of lower extremity injuries in team-sport athletes. The methodological quality of the included systematic reviews was independently assessed by two reviewers using the Assessing the Methodological Quality of Systematic Reviews measurement tool and the Grading of Recommendations Assessment, Development and Evaluation guidelines were used to assess the overall quality of evidence for particular outcomes.

RESULTS

Twenty-four systematic reviews met the inclusion criteria. Multicomponent exercise interventions were effective in reducing the injury incidence/rate of lower extremity, knee, ACL and ankle injuries, but not groin injuries. Strength and balance exercise components were included in 10 of 11 effective injury prevention programmes for the lower extremity, knee, ACL and ankle injuries.

SUMMARY/CONCLUSION

Lower extremity injury prevention programmes in team sports are effective in preventing lower extremity, knee, ACL and ankle injuries. Lower extremity muscle strength and balance exercises should be prioritised in lower extremity injury prevention programmes for team-sport athletes.

Young, talented and injured: Injury perceptions, experiences and consequences in adolescent elite athletes

Even though injury is common in elite sports, there is still a lack of knowledge of young athletes' injury perception both during and after injury. The aim of this mixed-method study was, therefore, to explore, in-depth, data on injury consequences and adolescent elite athletes' perceptions and experience of injury. Three hundred and forty adolescent elite athletes (age range 15-19), from 16 different sports, were bi-weekly monitored over 52 weeks using a valid questionnaire. Twenty athletes from the same cohort were interviewed in focus groups about injury experience and perceptions. The results show that the average bi-weekly prevalence of injury was 38.7% (95% CI 37.3-40.1), with 30.0% (n = 102) of the athletes injured for more than half of all reporting times. An overarching theme from the focus groups highlighted the risk among young athletes of a loss of identity while injured. The findings support several suggestions that may improve the rehabilitation process and enhance rehabilitation outcomes: (a) provide clear pathways to the medical team, (b) recognize the identity loss, (c) involve the injured athletes with the rest of the teammates and (d) educate athletes about how to interpret pain signals. Future research should explore and evaluate the effectiveness and generalization of such interventions.

From which level of competition in clubs are adolescents at greater risk of injury compared with outside-of-clubs athletes? A school-based study

OBJECTIVES

Sport practice is a key factor in a person's physical and mental health but, for adolescent athletes, some injuries lead to health problems in the long term. The literature provides multiple factors for understanding injury but does not give information about injury risk related to each level of play in a large sample of multisport athletes. This study investigates this relationship in 14- to 19-year-old adolescents.

METHODS

The survey on adolescents and health was conducted in classrooms of France, from February to March 2015. Only sports players were included in the analyses (n = 986). The levels of play were divided into five categories: outside of a club/no competition, club player/no competition, club player/local level, club player/state level and club player/national and higher level. A three-step binary logistic regression analysis with age, sex, type of sport, weekly hours of exposure, and level of play was used.

RESULTS

During the past year, 48.1% of the adolescents were injured. Age and sex were not risk factors. The injury risk associated with the increases in level of play is higher than those related to the hours of exposure per week or the type of sport. In clubs, adolescents who do not compete or play at a local level showed no evidence of greater injury risk whereas state-level and national- and higher-level athletes were at greater risk than outside-of-club players (OR = 2.18, 95%CI = 1.13-3.94 and OR = 3.89, 95%CI = 2.07-7.31, respectively).

CONCLUSION

Adolescents who play sports in clubs are clearly more exposed to injury than those who play outside of a club, mainly from state level. Age and sex are not related to injury. Future epidemiological studies should control adolescents' level of play. Special attention should be accorded to the injury risk of athletes playing at these levels of competition.

Neuromuscular Adaptations to Multimodal Injury Prevention Programs in Youth Sports: A Systematic Review with Meta-Analysis of Randomized Controlled Trials

Objective: Neuromuscular injury prevention programs (IPP) can reduce injury rate by about 40% in youth sport. Multimodal IPP include, for instance, balance, strength, power, and agility exercises. Our systematic review and meta-analysis aimed to evaluate the effects of multimodal IPP on neuromuscular performance in youth sports.

Methods: We conducted a systematic literature search including selected search terms related to youth sports, injury prevention, and neuromuscular performance. Inclusion criteria were: (i) the study was a (cluster-)randomized controlled trial (RCT), and (ii) investigated healthy participants, up to 20 years of age and involved in organized sport, (iii) an intervention arm performing a multimodal IPP was compared to a control arm following a common training regime, and (iv) neuromuscular performance parameters (e.g., balance, power, strength, sprint) were assessed. Furthermore, we evaluated IPP effects on sport-specific skills.

Results: Fourteen RCTs (comprising 704 participants) were analyzed. Eight studies included only males, and five only females. Seventy-one percent of all studies investigated soccer players with basketball, field hockey, futsal, Gaelic football, and hurling being the remaining sports. The average age of the participants ranged from 10 years up to 19 years and the level of play from recreational to professional. Intervention durations ranged from 4 weeks to 4.5 months with a total of 12 to 57 training sessions. We observed a small overall effect in favor of IPP for balance/stability (Hedges' g = 0.37; 95%CI 0.17, 0.58), leg power (g = 0.22; 95%CI 0.07, 0.38), and isokinetic hamstring and quadriceps strength as well as hamstrings-to-quadriceps ratio (g = 0.38; 95%CI 0.21, 0.55). We found a large overall effect for sprint abilities (g = 0.80; 95%CI 0.50, 1.09) and sport-specific skills (g = 0.83; 95%CI 0.34, 1.32). Subgroup analyses revealed larger effects in high-level (g = 0.34–1.18) compared to low-level athletes (g = 0.22–0.75), in boys (g = 0.27–1.02) compared to girls (g = 0.09–0.38), in older (g = 0.32–1.16) compared to younger athletes (g = 0.18–0.51), and in studies with high (g = 0.35–1.16) compared to low (g = 0.12–0.38) overall number of training sessions.

Conclusion: Multimodal IPP beneficially affect neuromuscular performance. These improvements may substantiate the preventative efficacy of IPP and may support the wide-spread implementation and dissemination of IPP. The study has been a priori registered in PROSPERO (CRD42016053407).

Resistance Training in Youth: Laying the Foundation for Injury Prevention and Physical Literacy

CONTEXT

The rising incidence of physical activity- and sports-related injuries has prompted the present-day investigation of resistance training as a potential means of injury prevention and physical literacy development among youth.

EVIDENCE ACQUISITION

Relevant studies on the topics of athlete development, physical literacy, resistance training, and injury prevention in children and adolescents were reviewed (PubMed and Sports Discus, 1982-2016). Recommendations from consensus guidelines and position statements applicable to resistance training and injury prevention in youth, in addition to young athlete development, were reviewed. Additionally, hand searches, expert requests, article reference lists, and gray literature were utilized and reviewed for pertinent content.

STUDY DESIGN

Clinical review.

LEVEL OF EVIDENCE

Level 4.

RESULTS

Youth throughout the physical activity spectrum are at risk for physical activity- and sports-related injury. Of highest priority are early specializers, physically inactive youth, and young girls, owing to increased injury rates. Resistance training among these at-risk populations has been shown to reduce injury risk by up to 68% and improve sports performance and health measures, in addition to accelerating the development of physical literacy. Recent recommendations, position statements, and national initiatives advocate for the incorporation of resistance training with qualified instruction among these groups.

CONCLUSION

Resistance training in addition to free play and other structured physical activity training can serve as a protective means against injury and a positive catalyst for the development of physical literacy to offset the impact of diminishing physical activity and early sport specialization in today's youth.

Predictors of FIFA 11+ Implementation Intention in Female Adolescent Soccer: An Application of the Health Action Process Approach (HAPA) Model

The Fédération Internationale de Football (FIFA) 11+ warm-up program is efficacious at preventing lower limb injury in youth soccer; however, there has been poor adoption of the program in the community. The purpose of this study was to determine the utility of the Health Action Process Approach (HAPA) behavior change model in predicting intention to use the FIFA 11+ in a sample of 12 youth soccer teams (coaches n = 10; 12–16 year old female players n = 200). A bespoke cross-sectional questionnaire measured pre-season risk perceptions, outcome expectancies, task self-efficacy, facilitators, barriers, and FIFA 11+ implementation intention. Most coaches (90.0%) and players (80.0%) expected the program to reduce injury risk but reported limited intention to use it. Player data demonstrated an acceptable fit to the hypothesized model (standardized root mean square residual (SRMR) = 0.08; root mean square of error of approximation (RMSEA) = 0.06 (0.047–0.080); comparative fit index (CFI) = 0.93; Tucker Lewis index (TLI) = 0.91) Task self-efficacy (β = 0.53, p ≤ 0.01) and outcome expectancies (β = 0.13 p ≤ 0.05) were positively associated with intention, but risk perceptions were not (β = −0.02). The findings suggest that the HAPA model is appropriate for use in this context, and highlight the need to target task self-efficacy and outcome expectancies in FIFA 11+ implementation strategies.

Exercise-based injury prevention in child and adolescent sport: a systematic review and meta-analysis

BACKGROUND

The promotion of sport and physical activity (PA) for children is widely recommended to support a healthy lifestyle, but being engaged in sport bears the risk of sustaining injuries. Injuries, in turn, can lead to a reduction in current and future involvement in PA and, therefore, may negatively affect future health as well as quality of life. Thus, sports injury prevention is of particular importance in youth.

OBJECTIVE

The aim of this systematic review was to quantify the effectiveness of exercise-based injury prevention programs in child and adolescent sport in general, and with respect to different characteristics of the target group, injury prevention program, and outcome variables.

DATA SOURCES

An Internet-based literature search was conducted in six databases (CINAHL, Cochrane, EMBASE, ISI Web of Science, PubMed, SPORTDiscus) using the following search terms with Boolean conjunction: (sport injur* OR athletic injur* OR sport accident*) AND (prevent* OR prophylaxis OR avoidance) AND (child* OR adolescent OR youth).

STUDY SELECTION

Randomized controlled trials and controlled intervention studies in organized sport, published in English in a peer-reviewed journal, analyzing the effects of an exercise-based injury prevention program in athletes younger than 19 years of age.

DATA EXTRACTION

Two reviewers evaluated eligibility and methodological quality. Main outcome extracted was the rate ratio (RR). Statistical analyses were conducted using the inverse-variance random effects model.

RESULTS

Twenty-one trials, conducted on a total of 27,561 athletes (median age 16.7 years [range 10.7-17.8]), were included. The overall RR was 0.54 (95% CI 0.45-0.67) [p < 0.001]. Girls profited more from injury prevention than boys (p = 0.05). Both prevention programs with a focus on specific injuries (RR 0.48 [95% CI 0.37-0.63]) and those aiming at all injuries (RR 0.62 [95% CI 0.48-0.81]) showed significant reduction effects. Pre-season and in-season interventions were similarly beneficial (p = 0.93). Studies on programs that include jumping/plyometric exercises showed a significant better (p = 0.002) injury preventive effect (RR 0.45 [95% CI 0.35-0.57], Z = 6.35, p < 0.001) than studies without such exercises (RR 0.74 [95% CI 0.61-0.90], Z = 3.03, p = 0.002).

CONCLUSIONS

The results provide good evidence and clearly demonstrate beneficial effects of exercise-based injury prevention programs in youth sports as they can result in statistically significant and practically relevant injury reduction. In particular, multimodal programs including jumping/plyometric exercises can be recommended. However, there is a considerable lack of data for children (under 14 years of age) and for individual sports in general. Future research should include these groups and focus on the effect of specific exercises and compliance.

OARSI Clinical Trials Recommendations: Design and conduct of clinical trials for primary prevention of osteoarthritis by joint injury prevention in sport and recreation

The risk of post-traumatic osteoarthritis (PTOA) substantially increases following joint injury. Research efforts should focus on investigating the efficacy of preventative strategies in high quality randomized controlled trials (RCT). The objective of these OARSI RCT recommendations is to inform the design, conduct and analytical approaches to RCTs evaluating the preventative effect of joint injury prevention strategies. Recommendations regarding the design, conduct, and reporting of RCTs evaluating injury prevention interventions were established based on the consensus of nine researchers internationally with expertise in epidemiology, injury prevention and/or osteoarthritis (OA). Input and resultant consensus was established through teleconference, face to face and email correspondence over a 1 year period. Recommendations for injury prevention RCTs include context specific considerations regarding the research question, research design, study participants, randomization, baseline characteristics, intervention, outcome measurement, analysis, implementation, cost evaluation, reporting and future considerations including the impact on development of PTOA. Methodological recommendations for injury prevention RCTs are critical to informing evidence-based practice and policy decisions in health care, public health and the community. Recommendations regarding the interpretation and conduct of injury prevention RCTs will inform the highest level of evidence in the field. These recommendations will facilitate between study comparisons to inform best practice in injury prevention that will have the greatest public health impact.

Concussion symptoms in youth motocross riders: a prospective, observational study

OBJECT

Action motorsports, including motocross, have been gaining popularity among children and adolescents, raising concerns for increased risk of concussions in participating youth. The authors undertook this study to test the following hypotheses: 1) that there is a high rate of concussion symptoms associated with a number of preventable or adjustable risk factors, and 2) that a high percentage of these symptoms are not be reported to adults and medical personnel.

METHODS

The authors identified all motocross riders under the age of 18 at a regional racetrack during the riding season between May and October 2010. The participants completed questionnaires pertaining to demographic characteristics and variables associated with motocross. The questionnaire results were compared with the incidence of self-reported concussion symptoms.

RESULTS

Two hundred two riders were identified who met the criteria for participation in the study, and 139 of them completed the study questionnaire. Of these 139 riders, 67 (48%) reported at least 1 concussion symptom during the season. The majority of riders (98%) reported "always" wearing a helmet, and 72% received professional help with fitting of their helmets. Proper helmet fitting was associated with a 41% decreased risk of concussion symptoms (RR 0.59, 95% CI 0.44-0.81, p < 0.01). Sixty-six riders (47%) reported having received sponsor support for motocross participation. Sponsor support conferred a relative risk for concussion symptoms of 1.48 (95% CI 1.05-2.08, p = 0.02).

CONCLUSIONS

Nearly half of all motocross competitors under the age of 18 reported concussion symptoms. Preventive measures are necessary to limit the negative impact from concussions. The risk of concussive injury can be decreased for pediatric motocross riders if they receive professional help with proper helmet fitting and through implementation of stricter guidelines regarding sponsorship.

Interventions to prevent sports related injuries: a systematic review and meta-analysis of randomised controlled trials

BACKGROUND

The effects of methods to prevent injuries have been studied in several systematic reviews. However, no meta-analysis taking into account all randomised controlled intervention trials aiming at the prevention of sports injuries has been published.

OBJECTIVE

To summarise the effects of sports injury prevention interventions.

DESIGN

Systematic review and meta-analysis of randomised controlled trials.

DATA SOURCES

PubMed, MEDLINE, SPORTDiscus, the Cochrane Central Register of Controlled Trials, CINAHL, PEDro, and Web of Science, searched in September 2013. The reference lists of retrieved articles and reviews were hand searched.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

To be selected articles had to examine the effects of any preventive intervention on sports injuries, be randomised/quasi-randomised and controlled trials, published in a peer-reviewed journal. The outcome of the trial had to be injury rate or the number of injured individuals.

RESULTS

Of the 5580 articles retrieved after a search of databases and the relevant bibliography, 68 randomised controlled trials were included in the systematic review and 60 trials were included in the meta-analysis. Insoles (OR 0.51, 95% CI 0.32-0.81), external joint supports (OR 0.40, 95% CI 0.30-0.53), and specific training programmes (OR 0.55, 95% CI 0.46-0.66) appeared to be effective in reducing the risk of sports injuries. Stretching (OR 0.92, 95% CI 0.80-1.06), modified shoes (OR 1.23, 95% CI 0.81-1.87), and preventive videos (OR 0.86, 95% CI 0.44-1.68) seemed not to be effective.

CONCLUSIONS

This meta-analysis showed that certain interventions can reduce the risk of sports injuries. There were limitations regarding the quality of the trials, generalisability of the results, and heterogeneity of the study designs. In future, the mechanisms behind effective methods and the most beneficial elements of preventive training programmes need to be clarified.

Trends in moderate to severe paediatric trauma in Central Netherlands

INTRODUCTION

Trend analyses of hospital discharge data can raise signals for prevention policies, but are often flawed by changes in health care consumption. This is a trend analysis of the clinical incidence of paediatric trauma that used international criteria to overcome this bias. The objective is to describe trends in clinical incidence of moderate to severe paediatric trauma, and to identify target groups for prevention activities.

PATIENTS AND METHODS

Included were all paediatric trauma patients (0-18 years) that were discharged from the hospitals of trauma care region Central Netherlands from 1996 to 2009. Selection was made on ISS ≥ 4, and on trauma related International Classification of Diseases diagnostic codes, and trauma related external causes of injury and poisoning codes. Trend analyses were performed using Poisson loglinear regression with correction for age and gender.

RESULTS

23,682 Patients were included, the mean incidence rate was 477/100,000 person-years. Since 2001 the incidence rate of moderate to severe trauma increased with 1.1% annually (95% confidence interval (CI) 0.7-1.5), caused by an increase of falls (3.9%, 95% CI 3.3-4.5), sport injuries (5.4%, 95% CI 4.3-6.5), and bicycle injuries (3.8%, 95% CI 2.8-4.8). The incidence of falls and sport injuries peaked in young children (0-9) and older boys (10-18) respectively. Bicycle injuries affected all children between 5 and 18.

CONCLUSIONS

The incidence of paediatric trauma in the centre of the Netherlands increased since 2001. Trend analyses on moderate and severe injuries may identify target groups for prevention in a trauma region.

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

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