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Feng P, Li S, Shi X, Mu J, Xu Y, Fan C, Dong J, Li X. Cross-Cultural Adaptation, Feasibility, Reliability, and Validity Tests of the Chinese Version of Ankle Ligament Reconstruction-Return to Sport After Injury Scale. Orthop J Sports Med 2024; 12:23259671241275091. [PMID: 39371572 PMCID: PMC11456205 DOI: 10.1177/23259671241275091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/18/2024] [Indexed: 10/08/2024] Open
Abstract
Background The Ankle Ligament Reconstruction-Return to Sport After Injury (ALR-RSI) scale can be utilized for assessing patients who have previously sustained lateral ankle ligament injury before returning to sport. Given its original development for use in different languages, it is essential to translate and validate this scale for application to the Chinese population. Purposes To translate and culturally adapt the ALR-RSI scale into a Chinese version and assess its reliability and validity. Study Design Cohort study (Diagnosis); Level of evidence, 2. Methods The procedure of translation and cross-cultural adaptation was performed following the recommended guidelines and the Chinese version of ALR-RSI (ALR-RSI-CHN) was conducted in patients with lateral ankle ligament surgery. Feasibility was assessed by floor/ceiling effects. Reliability was assessed by using Cronbach α as a measure to analyze internal consistency, while the intraclass correlation coefficient was utilized to examine test-retest reliability. Validity was assessed by using Spearman coefficients to analyze the correlations between ALR-RSI-CHN, the Karlsson scale, and the American Orthopaedic Foot and Ankle Society (AOFAS) scale. Results A total of 66 participants were included. The ALR-RSI-CHN scale showed good feasibility with no floor/ceiling effects. The internal consistency of the scale was adequate with a Cronbach α of 0.93, and test-retest reliability was excellent with an interclass correlation coefficient of 0.97 (95% CI, 0.92-0.99). The ALR-RSI-CHN scale demonstrated moderate correlation with the Karlsson scale (r = 0.48 [range, 0.26-0.65]) and strong correlation with the AOFAS scale (r = 0.55 [range, 0.35-0.71]). A significant difference in ALR-RSI-CHN scores was observed between patients who returned to sports and those who did not, with respective scores of 53.60 (range, 44.50-62.69) and 42.25 (range, 35.51-49) (P = .04). Conclusion The study demonstrated that the ALR-RSI-CHN scale had satisfactory psychometric properties, rendering it a feasible, reliable, and valid instrument for evaluating patients who have lateral ligament surgery in China.
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Affiliation(s)
- Pengpeng Feng
- Department of Rehabilitation, Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Shuxian Li
- Department of Sport Health, Tianjin University of Sport, Beijing, China
| | - Xiuxiu Shi
- Department of Rehabilitation, Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Jiedan Mu
- Department of Rehabilitation, Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Ying Xu
- Department of Rehabilitation, Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Chen Fan
- Department of Rehabilitation, Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Jige Dong
- Department of Rehabilitation, Wangjing Hospital of China Academy of Chinese Medicine Sciences, Beijing, China
| | - Xiao Li
- Department of Rehabilitation, Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
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Flore Z, Welsch G, Bloch H. Return to Play Assessment After Lateral Ankle Sprains - German Male Elite Youth Football (Soccer) Academy Baseline Data. Int J Sports Phys Ther 2024; 19:976-988. [PMID: 39268225 PMCID: PMC11392466 DOI: 10.26603/001c.120201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 05/10/2024] [Indexed: 09/15/2024] Open
Abstract
Background Lateral ankle sprain (LAS) is one of the most common types of injury in football (soccer). Normative baseline data of performance tests for Return to Play (RTP) decision are still lacking. Purpose The primary aim of this study was to generate baseline values for uninjured elite youth football players for a multifactorial RTP assessment and compare with previously published data. A secondary aim was to investigate the use of the Limb Symmetry Index (LSI) as a method to determine whether an athlete passes a performance test or not. Study Design Observational Cohort study. Methods Baseline data of performance tests (Y-Balance [YBT-LQ], Heel Rise [HRT]; Singe Leg Squat [SLST]; Single Leg Drop Jump [SLDJ]; Side Hop [SHT]; Figure of 8 Hop [F-8]; Modified Agility T-Test [MAT]) were assessed in 20 elite youth football players, aged 16-21 years. Additionally, the traditional LSI (dividing the result of the non-dominant leg by the result of the dominant leg and multiplying by 100) and directionally corrected LSI (the worst value is divided by the better value and multiplied by 100) were calculated. The test values were compared to previously reported study results. LSI and side-to-side comparisons between dominant and non-dominant leg sides were analyzed using the Wilcoxon test. Results Male elite youth football players achieved better results in the dynamic performance tests (SHT, F-8, and MAT) compared to reference values of the cohorts previously described in the literature: YBT-LQ total score (cm) dominant (dom) 99.3±8.3, non-dominant (ND) 99.5±10.4; HRT (average number) dom. 27.1±5.4, ND 25.2±5.1); SLDJ height (cm) dom 15±5, ND 15±5 and contact time (sec) dom 0.29±0.08, ND 0.29±0.07, Reactive Strength Index (RSI) dom 0.52±0.12, ND 0.50±0.13); SHT (sec) dom 7.12±0.73, ND 7.39±0.93; F-8 (sec) dom 10.52±1.02, ND 10.37±1.04; and MAT (sec) 5.82±0.22. Directionally corrected LSI differed significantly from the traditional calculated LSI (p<0.05). Conclusion The findings of this study highlight the need to determine specific baseline data for RTP testing in male elite youth football players after LAS. The traditional LSI should not be used as a "stand alone method" for determining RTP. LSI calculations should consider the direction of asymmetry to determine passing a performance test or not. Level of evidence 3b.
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Affiliation(s)
- Zacharias Flore
- School of Sport and Exercise Sciences University of Kent
- Medical Department 1. FC Magdeburg
| | - Götz Welsch
- UKE-Athleticum University Medical Center Hamburg-Eppendorf
- Department of Trauma and Orthopaedic Surgery University Medical Center Hamburg-Eppendorf
| | - Hendrik Bloch
- Bezirksverwaltung Bielefeld, Verwaltungs-Berufsgenossenschaft (VBG)
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Elsner A, Klemmer K, Vordemvenne T, Wähnert D. [Treatment of acute ankle distortion in footballers : Are we doing it particularly right or particularly wrong?]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:393-403. [PMID: 38787408 DOI: 10.1007/s00132-024-04506-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Despite the high incidence of ankle sprains, the ideal treatment is controversial and a significant percentage of patients who have suffered an ankle sprain never fully recover. Even professional athletes are affected by this post-traumatic complication. There is strong evidence that permanent impairment after an ankle injury is often due to an inadequate rehabilitation and training program and too early return to sport. THERAPY AND REHABILITATION Therefore, athletes should start a criteria-based rehabilitation after ankle sprain and gradually progress through the programmed activities, including e.g. cryotherapy, edema reduction, optimal load management, range of motion exercises to improve ankle dorsiflexion and digital guidance, stretching of the triceps surae with isometric exercises and strengthening of the peroneus muscles, balance and proprioception training, and bracing/taping. The fact that this is professional sport does not exempt it from consistent, stage-appropriate treatment and a cautious increase in load. However, there are a number of measures and tools that can be used in the intensive care of athletes to improve treatment and results.
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Affiliation(s)
- Andreas Elsner
- DIOOS - Deutsches Institut für Orthopädie, Osteopathie und Sportmedizin, Lipper Hellweg 10, 33604, Bielefeld, Deutschland.
- Orthopädische Gemeinschaftspraxis am Bültmannshof, Bielefeld, Deutschland.
| | - Kira Klemmer
- DIOOS - Deutsches Institut für Orthopädie, Osteopathie und Sportmedizin, Lipper Hellweg 10, 33604, Bielefeld, Deutschland
| | - Thomas Vordemvenne
- Medizinische Fakultät und Universitätsklinikum OWL, Evangelisches Klinikum Bethel, Universitätsklinik für Unfallchirurgie und Orthopädie, Universität Bielefeld, Bielefeld, Deutschland
| | - Dirk Wähnert
- Medizinische Fakultät und Universitätsklinikum OWL, Evangelisches Klinikum Bethel, Universitätsklinik für Unfallchirurgie und Orthopädie, Universität Bielefeld, Bielefeld, Deutschland
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Kremen TJ, Wu SY, Upfill-Brown A, Bugarin A, Huang J, Jones KJ, Shi BY. Impact of the COVID-19 Pandemic Hiatus From Sports Activities on Injuries Observed Among Division I NCAA Athletes. Orthop J Sports Med 2023; 11:23259671231169188. [PMID: 37250744 PMCID: PMC10209719 DOI: 10.1177/23259671231169188] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/24/2023] [Indexed: 05/31/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic significantly disrupted athletic activities, including those in the Pacific 12 (Pac-12) Conference of the National Collegiate Athletic Association. It is currently unknown how the disruption in training and competition impacted athletes' risk of injury upon resumption of activities. Purpose To describe and compare the rate, timing, mechanism, and severity of injuries among collegiate athletes across multiple sports in the Pac-12 Conference before and after the COVID-19 pandemic-associated hiatus of intercollegiate athletic activities. Study Design Descriptive epidemiology study. Methods Descriptive and injury data among intercollegiate athletes from both the season before the hiatus and the season after the hiatus were acquired from the Pac-12 Health Analytics Program database. Injury elements (timing of injury onset, injury severity, mechanism, recurrence, outcome, need for procedural intervention, and event segment during which the injury took place) were compared by time using the chi-square test and a multivariate logistic regression model. Subgroup analyses were performed on knee and shoulder injuries among athletes participating in sports with traditionally high rates of knee and shoulder injuries. Results A total of 12,319 sports-related injuries across 23 sports were identified, with 7869 pre-hiatus injuries and 4450 post-hiatus injuries. There was no difference in the overall incidence of injury between the pre-hiatus and post-hiatus seasons. However, the proportion of noncontact injuries was higher in the post-hiatus season for football, baseball, and softball players, and the proportion of nonacute injuries in the post-hiatus season was higher among football, basketball, and rowing athletes. Finally, the overall proportion of injuries sustained by football players in the final 25% of competition or practice was higher in the post-hiatus season. Conclusion Athletes competing in the post-hiatus season were observed to have higher rates of noncontact injuries and injuries sustained in the final 25% of competition. This study demonstrates that the COVID-19 pandemic has had varied effects on athletes from different sports, suggesting that many factors must be considered when designing return-to-sports programs for athletes after an extended absence from organized training.
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Affiliation(s)
- Thomas J. Kremen
- Department of Orthopaedic Surgery,
David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Shannon Y. Wu
- David Geffen School of Medicine at
UCLA, Los Angeles, California, USA
| | - Alexander Upfill-Brown
- Department of Orthopaedic Surgery,
David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Amador Bugarin
- David Geffen School of Medicine at
UCLA, Los Angeles, California, USA
| | - Julian Huang
- University of California at Los
Angeles, Los Angeles, California, USA
| | - Kristofer J. Jones
- Department of Orthopaedic Surgery,
David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Brendan Y. Shi
- Department of Orthopaedic Surgery,
David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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5
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Rees H, Persson UM, Delahunt E, Boreham C, Blake C. Winter breaks in field hockey. J Sci Med Sport 2022; 25:911-917. [DOI: 10.1016/j.jsams.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 06/29/2022] [Accepted: 08/08/2022] [Indexed: 10/15/2022]
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Hall EC, Larruskain J, Gil SM, Lekue JA, Baumert P, Rienzi E, Moreno S, Tannure M, Murtagh CF, Ade JD, Squires P, Orme P, Anderson L, Whitworth-Turner CM, Morton JP, Drust B, William AG, Erskine RM. Playing Position is Associated with Injury Incidence Rate in Male Academy Soccer Players. J Athl Train 2022; 57:696-703. [PMID: 35142844 DOI: 10.4085/1062-6050-0346.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT It is unclear whether playing position influences injury in male academy soccer players (ASP). OBJECTIVE To determine if playing position is associated with injury in ASP. DESIGN Descriptive Epidemiology Study. SETTING English, Spanish, Uruguayan and Brazilian soccer academies. PARTICIPANTS 369 ASP from Under 14 (U14) to U23 age groups, classified as 'post-peak height velocity' using maturity offset, and grouped as goalkeepers (GK), lateral defenders (LD), central defenders (CD), lateral midfielders (LM), central midfielders (CM) and forwards (FWD). Additional analysis compared central (CENT) with lateral/forward (LAT/FWD) positions. MAIN OUTCOME MEASURES Injuries were recorded prospectively over one season. Injury prevalence proportion (IPP), days missed and injury incidence rate (IIR, injuries per 1000 training/match hours, n=116) were analysed according to playing position. RESULTS No association with playing position was observed for any injury type/location regarding IPP (P≥0.089) or days missed (P≥0.235). The IIR was higher in CD than LD for general (9.30 vs. 4.18 injuries/1000h, P=0.009), soft-tissue (5.14 vs. 1.95 injuries/1000h, P=0.026) and ligament/tendon injuries (2.69 vs. 0.56 injuries/1000h, P=0.040). Regarding CENT vs. LAT/FWD, there were no associations with IPP (P≥0.051) or days missed (P≥0.083), but general IIR was greater in CENT than LAT/FWD (8.67 vs. 6.12 injuries/1000h, P=0.047). CONCLUSIONS ASP playing position was not associated with IPP or days missed but the higher general, soft-tissue and ligament/tendon IIR in CD suggests this position warrants specific attention regarding injury prevention strategies. These novel findings highlight the importance of including training/match exposure when investigating the influence of playing position on injury in ASP.
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Affiliation(s)
- Elliott Cr Hall
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | | | - Susana M Gil
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | | | - Philipp Baumert
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.,Department of Sport and Health Science, Technical University of Munich, Munich, Germany
| | - Edgardo Rienzi
- Club Atlético Peñarol, Estadio Campeón del Siglo, Montevideo, Uruguay
| | - Sacha Moreno
- Club Atlético Peñarol, Estadio Campeón del Siglo, Montevideo, Uruguay
| | | | - Conall F Murtagh
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.,Liverpool Football Club, Liverpool, UK
| | | | | | | | - Liam Anderson
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
| | | | - James P Morton
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Barry Drust
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
| | - Alun G William
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK.,Institute of Sport, Exercise and Health, University College London, London, UK
| | - Robert M Erskine
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.,Institute of Sport, Exercise and Health, University College London, London, UK
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7
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Wagemans J, Bleakley C, Taeymans J, Schurz AP, Kuppens K, Baur H, Vissers D. Exercise-based rehabilitation reduces reinjury following acute lateral ankle sprain: A systematic review update with meta-analysis. PLoS One 2022; 17:e0262023. [PMID: 35134061 PMCID: PMC8824326 DOI: 10.1371/journal.pone.0262023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 12/15/2021] [Indexed: 12/26/2022] Open
Abstract
Research questions 1) Do exercise-based rehabilitation programs reduce re-injury following acute ankle sprain?; 2) Is rehabilitation effectiveness moderated by the exercise’s therapeutic quality, content and volume? Methods This systematic review with meta-analysis (PROSPERO: CRD42020210858) included randomized controlled trials in which adults who sustained an acute ankle sprain received exercise-based rehabilitation as an intervention. Databases CINAHL, Web of Science, SPORTDiscus, Cochrane Central Register of Controlled Trials, PEDro and Google Scholar were searched for eligible articles (last search: March 2021). ROB II screening tool by Cochrane was used to assess risk of bias and the i-CONTENT tool was used to assess quality of interventions. Both qualitative analysis and quantitative data synthesis were performed. Results Fourteen randomized controlled trials comprising 2182 participants were included. Five studies were judged overall low risk of bias and i-CONTENT assessment showed poor to moderate therapeutic quality of exercise across all included articles. Pooled data found significant reductions in re-injury prevalence at 12 months, in favour of the exercise-based rehabilitation group vs usual care (OR: 0.60; 95%CI: 0.36 to 0.99). Pooled data for re-injury incidence showed not-significant results (MD: 0.027; 95%CI: -2.14 to 2.19). Meta-regression displayed no statistically significant association between training volume and odds of re-injury (r = -0.00086; SD: 0.00057; 95%CI: -0.00197 to 0.00025). Results from patient-reported outcomes and clinical outcomes were inconclusive at 1 month, 3–6 months and 7–12 months of follow up. Conclusion Exercise-based rehabilitation reduces the risk of recurrent ankle sprain compared to usual care, but there is insufficient data to determine the optimal content of exercise-based interventions. Training volume varied considerably across studies but did not affect the odds of sustaining a re-injury. Effects on patient-reported outcomes and clinical outcomes are equivocal. Future research should compare different exercise contents, training volumes and intensities after ankle sprain.
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Affiliation(s)
- Jente Wagemans
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
- * E-mail: ,
| | - Chris Bleakley
- School of Health Science, Ulster University, Newtownabbey, Northern Ireland
| | - Jan Taeymans
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
- Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Kevin Kuppens
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Heiner Baur
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Dirk Vissers
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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8
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Kolodziej M, Nolte K, Schmidt M, Alt T, Jaitner T. 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. Front Sports Act Living 2021; 3:615330. [PMID: 34734178 PMCID: PMC8559431 DOI: 10.3389/fspor.2021.615330] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 09/21/2021] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Mathias Kolodziej
- Department of Strength and Conditioning and Performance, Borussia Dortmund, Dortmund, Germany
- Institute for Sports and Sport Science, Technical University (TU) Dortmund University, Dortmund, Germany
| | - Kevin Nolte
- Institute for Sports and Sport Science, Technical University (TU) Dortmund University, Dortmund, Germany
| | - Marcus Schmidt
- Institute for Sports and Sport Science, Technical University (TU) Dortmund University, Dortmund, Germany
| | - Tobias Alt
- Department of Biomechanics, Performance Analysis and Strength and Conditioning, Olympic Training and Testing Centre Westphalia, Dortmund, Germany
| | - Thomas Jaitner
- Institute for Sports and Sport Science, Technical University (TU) Dortmund University, Dortmund, Germany
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Materne O, Chamari K, Farooq A, Tabben M, Weir A, Holmich P, Bahr R, Greig M, McNaughton LR. Shedding light on incidence and burden of physeal injuries in a youth elite football academy: A 4-season prospective study. Scand J Med Sci Sports 2021; 32:165-176. [PMID: 34551163 DOI: 10.1111/sms.14059] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/21/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Physeal injuries have been overlooked in epidemiological research in youth sports. Our prospective study investigated the incidence, severity, and burden of physeal injuries in a youth elite football academy. METHODS In total, 551 youth male football players from under-9 to under-19 were included and observed over four consecutive seasons. Injuries involving the physis were diagnosed and recorded according to type, location, and diagnosis. Injury incidence (II), severity (days lost), and injury burden (IB) were calculated per squad per season (25 players/squad). RESULTS There were 307 physeal injuries: 262 apophyseal (85%), 26 physeal (9%), 2 epiphyseal (1%), and 17 other physeal injuries (5%) with 80% (n=245) causing time-loss. The overall mean incidence of time-loss physeal injuries was 6 injuries/squad-season, leading to a total of 157 days lost/squad-season. The U-16s had the highest burden with 444 days lost per squad-season [median: 20 (95% CI: 12-30) days; II: 10 (95% CI: 7.3.1-13.4)]. Apophyseal injuries of the hip-pelvis resulted in the greatest burden [median: 13 (95% CI: 10-17); II: 2.5 (95% CI: 2.1-3.0)]. Peak apophyseal injury incidence per body parts occurred in U-11 for foot-ankle (II: 2.4; 95% CI: 1.0-4.9), U-14 for knee (II: 4.5; 95% CI: 2.7-7.1), and U-17 for hip-pelvis (II: 6.4; 95% CI: 4.2-9.3). CONCLUSION Physeal injuries accounted for a quarter of all-time loss with the largest injury burden in U-16. Most physeal injuries involved the lower limb and affected the apophysis. Physeal and apophyseal injuries incidence, burden, and pattern vary substantially depending on age. Hip-pelvic apophyseal injuries accounted for the largest injury burden.
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Affiliation(s)
- Olivier Materne
- ASPETAR, Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Aspire Health Centre, Aspire Academy, Doha, Qatar.,Rangers Football Club, Glasgow, Scotland
| | - Karim Chamari
- ASPETAR, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | | | | | - Adam Weir
- ASPETAR, Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.,Sport Medicine and Exercise Clinic Haarlem (SBK), Haarlem, The Netherlands
| | - Per Holmich
- ASPETAR, Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Sports Orthopaedic Research Center - Copenhagen (SORC-C), Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Roald Bahr
- ASPETAR, Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Matt Greig
- Department of Sport and Physical Activity, Edge Hill University, Ormskirk, UK
| | - Lars R McNaughton
- Department of Sport and Physical Activity, Edge Hill University, Ormskirk, UK.,Department of Sport and Movement Studies, Faculty of Health Science, University of Johannesburg, Auckland Park, South Africa
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10
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The dominant leg is more likely to get injured in soccer players: systematic review and meta-analysis. Biol Sport 2021; 38:397-435. [PMID: 34475623 PMCID: PMC8329968 DOI: 10.5114/biolsport.2021.100265] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 08/31/2020] [Accepted: 09/03/2020] [Indexed: 12/26/2022] Open
Abstract
In soccer (football), dominant limb kicking produces higher ball velocity and is used with greater frequency than the non-dominant limb. It is unclear whether limb dominance has an effect on injury incidence. The purpose of this systematic review with meta-analysis is to examine the relationship between limb dominance and soccer injuries. Studies were identified from four online databases according to PRISMA guidelines to identify studies of soccer players that reported lower extremity injuries by limb dominance. Relevant studies were assessed for inclusion and retained. Data from retained studies underwent meta-analyses to determine relative risk of dominant versus non-dominant limb injuries using random-effects models. Seventy-four studies were included, with 36 of them eligible for meta-analysis. For prospective lower extremity injury studies, soccer players demonstrated a 1.6 times greater risk of injury to the dominant limb (95% CI [1.3-1.8]). Grouped by injury location, hamstring (RR 1.3 [95% CI 1.1-1.4]) and hip/groin (RR 1.9 [95% CI 1.3-2.7]) injuries were more likely to occur to the dominant limb. Greater risk of injury was present in the dominant limb across playing levels (amateurs RR 2.6 [95% CI 2.1-3.2]; youths RR 1.5 [95% CI 1.26-1.67]; professionals RR 1.3 [95% CI 1.14-1.46]). Both males (RR 1.5 [95% CI 1.33-1.68)] and females (RR 1.5 [95% CI 1.14-1.89]) were more likely to sustain injuries to the dominant limb. Future studies investigating soccer injury should adjust for this confounding factor by using consistent methods for assigning limb dominance and tracking use of the dominant versus non-dominant limb.
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Plisky PJ, Bullock GS, Garner MB, Ricard R, Hayden J, Huebner B, Schwartzkopf-Phifer K, Kiesel K. The Dorsiflexion Range of Motion Screen: A Validation Study. Int J Sports Phys Ther 2021; 16:306-311. [PMID: 33842026 PMCID: PMC8016445 DOI: 10.26603/001c.21253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/10/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Limited ankle dorsiflexion (DF) is associated with ankle sprains and other lower extremity injuries. Current ankle measurements can be laborious to perform in an athletic environment. PURPOSE The purpose of this study was to determine the reliability and discriminant validity of a novel closed-chain ankle DF ROM test, the standing ankle dorsiflexion screen (SADS). STUDY DESIGN Reliability and validity study. METHODS Thirty-seven healthy subjects participated in the study. Two raters measured closed-chain ankle DF range of motion (ROM) using a modified lunge position with an electronic inclinometer. Four raters measured ankle DF using the SADS. Reliability was calculated using intraclass correlation coefficients (ICC) and kappa coefficients for the raters using an electronic inclinometer and the SADS scale, respectively. An independent t-test compared the SADS categories of "behind" and "beyond" to the modified lunge test ROM (p<0.05). RESULTS Excellent ICC values (0.95 [95% CI (0.92,0.97)]) and high kappa values were observed (0.61-0.81), with high percent agreement (86-94%). There was a significant difference in ankle DF ROM between the nominally scored "behind" and "beyond" categories, regardless of rater or trial analyzed (behind: 41.3° ± 4.7°; beyond: 51.8°± SD 6.1°, p <0.001). CONCLUSIONS The SADS was observed to have excellent interrater reliability and high discriminant validity. Furthermore, there was a distinct closed chain ankle DF ROM difference between the "behind" and "beyond" SADS nominal scores. CLINICAL RELEVANCE The SADS can be used as a quick and efficient closed chain ankle DF ROM screen. LEVEL OF EVIDENCE 2b.
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J H, K P, M L, K S, P K, A H, Vm M, J P. Association between lower extremity muscle strength and acute ankle injury in youth team-sports athletes. Phys Ther Sport 2021; 48:188-195. [PMID: 33508694 DOI: 10.1016/j.ptsp.2021.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/12/2021] [Accepted: 01/16/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To investigate lower extremity muscle strength as risk factor for an acute ankle injury in youth athletes. DESIGN Cohort study. SETTING Basketball and floorball clubs. PARTICIPANTS 188 youth (≤21) male and 174 female athletes. MAIN OUTCOME MEASURES 1RM leg press, maximal concentric isokinetic quadriceps and hamstrings as well as maximal isometric hip abductor strength were measured and athletes were followed for an acute ankle injury up to three years. Cox regression models were used in statistical analyses. RESULTS In males, greater 1RM leg press and maximal quadriceps strength increased the risk of any type of acute ankle injury (Hazard ratio [HR] for 1 SD increase, 1.63 [95% CI, 1.12-2.39] and 1.43 [95% CI, 1.01-2.01], respectively). In females, greater 1RM leg press and difference between legs in hip abduction strength increased the risk of acute non-contact ankle injury (HR for 1 SD increase, 1.44 [95% CI, 1.03-2.02] and 1.44 [95% CI, 1.03-2.00], respectively). However, ROC curve analyses showed AUC:s of 0.57-0.64 indicating "fail" to "poor" combined sensitivity and specifity of these tests. CONCLUSION Greater strength in both sexes along with asymmetry in hip abductor strength in females increased the risk of acute ankle injury.
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Affiliation(s)
- Hietamo J
- Tampere Research Center of Sport Medicine, UKK Institute for Health Promotion Research, Tampere, Finland; KHKS, Hämeenlinna, Finland.
| | - Pasanen K
- Tampere Research Center of Sport Medicine, UKK Institute for Health Promotion Research, Tampere, Finland; Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Leppänen M
- Tampere Research Center of Sport Medicine, UKK Institute for Health Promotion Research, Tampere, Finland
| | - Steffen K
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Kannus P
- Tampere Research Center of Sport Medicine, UKK Institute for Health Promotion Research, Tampere, Finland; Departement of Orthopedics and Traumatology, Tampere University Hospital, and Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Heinonen A
- University of Jyväskylä, Jyväskylä, Finland
| | - Mattila Vm
- Departement of Orthopedics and Traumatology, Tampere University Hospital, and Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Parkkari J
- Tampere Research Center of Sport Medicine, UKK Institute for Health Promotion Research, Tampere, Finland; Departement of Orthopedics and Traumatology, Tampere University Hospital, and Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
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Huang Z, Shan W, Ding J, Sun W, Fong DTP. Peroneal reaction time delayed but dynamic single-legged stability retained in collegiate footballers during a simulated prolonged football protocol. Res Sports Med 2020; 29:557-570. [PMID: 33297786 DOI: 10.1080/15438627.2020.1857251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Delayed peroneal reaction time and impaired single-legged dynamic stability were risk factors of lateral ankle sprain (LAS), yet no study explored the change of them during a football match. The aim is to explore the change of peroneal reaction time and single-legged dynamic stability during a football simulation protocol. Twelve collegiate football players voluntarily completed a 105-min football match simulation protocol in which peroneal reaction time, root-mean-square of mediolateral ground reaction force in first 0.4 s (RMS ML 0.4), and the mean mediolateral ground reaction force in the late stage (late dynamic MLGRF), were measured for both legs at 15-min intervals during the protocol. Peroneal reaction time was tested using an electromyography (EMG) system. The ground reaction force variables were measured from GRF data after a single-legged drop-jump landing. Repeated measures one-way MANOVA was conducted to evaluate variables over time and leg dominance. Statistical significance was set at p < 0.05 level. Peroneal reaction time significantly increased for both legs at 45 minutes and after 60 minutes. RMS ML 0.4 of both legs and late dynamic MLGRF for dominant leg remained unchanged throughout the protocol and late dynamic MLGRF for non-dominant leg significantly reduced at the 90th minute.
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Affiliation(s)
- Zhanyu Huang
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Wei Shan
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.,China Institute of Sport and Health Science, Beijing Sport University, Beijing, China
| | - Junyuan Ding
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Wei Sun
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Daniel T P Fong
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Materne O, Chamari K, Farooq A, Weir A, Hölmich P, Bahr R, Greig M, McNaughton LR. Injury incidence and burden in a youth elite football academy: a four-season prospective study of 551 players aged from under 9 to under 19 years. Br J Sports Med 2020; 55:493-500. [PMID: 33199359 DOI: 10.1136/bjsports-2020-102859] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Investigate the incidence and burden of injuries by age group in youth football (soccer) academy players during four consecutive seasons. METHODS All injuries that caused time-loss or required medical attention (as per consensus definitions) were prospectively recorded in 551 youth football players from under 9 years to under 19 years. Injury incidence (II) and burden (IB) were calculated as number of injuries per squad season (s-s), as well as for type, location and age groups. RESULTS A total of 2204 injuries were recorded. 40% (n=882) required medical attention and 60% (n=1322) caused time-loss. The total time-loss was 25 034 days. A squad of 25 players sustained an average of 30 time-loss injuries (TLI) per s-s with an IB of 574 days lost per s-s. Compared with the other age groups, U-16 players had the highest TLI incidence per s-s (95% CI lower-upper): II= 59 (52 to 67); IB=992 days; (963 to 1022) and U-18 players had the greatest burden per s-s: II= 42.1 (36.1 to 49.1); IB= 1408 days (1373 to 1444). Across the cohort of players, contusions (II=7.7/s-s), sprains (II=4.9/s-s) and growth-related injuries (II=4.3/s-s) were the most common TLI. Meniscus/cartilage injuries had the greatest injury severity (95% CI lower-upper): II= 0.4 (0.3 to 0.7), IB= 73 days (22 to 181). The burden (95% CI lower-upper) of physeal fractures (II= 0.8; 0.6 to 1.2; IB= 58 days; 33 to 78) was double than non-physeal fractures. SUMMARY At this youth football academy, each squad of 25 players averaged 30 injuries per season which resulted in 574 days lost. The highest incidence of TLI occurred in under-16 players, while the highest IB occurred in under-18 players.
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Affiliation(s)
- Olivier Materne
- ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar .,Aspire Health Centre, Aspire Academy, Doha, Qatar
| | - Karim Chamari
- ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Abdulaziz Farooq
- ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Adam Weir
- ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Sport medicine and exercise, clinic Haarlem (SBK), Haarlem, The Netherlands.,Erasmus MC, Department of Orthopaedics, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Per Hölmich
- ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Sports Orthopaedic Research Center, Copenhagen (SORC-C) - Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Roald Bahr
- ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
| | - Matt Greig
- Department of Sport and Physical Activity, Edge Hill University, Ormskirk, UK
| | - Lars R McNaughton
- Department of Sport and Physical Activity, Edge Hill University, Ormskirk, UK.,Department of Sport and Movement Studies, Faculty of Health Science, University of Johannesburg, Auckland Park, South Africa
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Madić D, Obradović B, Golik-Perić D, Marinković D, Trajković N, Gojković Z. The isokinetic strength profile of semi-professional soccer players according to low back pain. J Back Musculoskelet Rehabil 2020; 33:501-506. [PMID: 31524139 DOI: 10.3233/bmr-171109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Soccer as a sport has a very high injury rate and low back pain (LBP) is considered to be the most common overuse injury typically occurring in the back and spine in elite soccer players. OBJECTIVE This study aimed to investigate differences in knee muscle strength and muscle imbalances in soccer players according to lower back pain. METHODS One hundred and thirty-six male professional soccer players (20.49 ± 3.73 years, 76.57 ± 8.24 kg, 182.63 ± 6.73 cm) volunteered for the study. The isokinetic dynamometer PrimaDOC (EASYTECH, Italy) was used to assess the hamstring and quadriceps strength at the selected speeds of 60∘/s, whereas the Roland-Morris Disability Questionnaire (RDQ) was used as a health status measure to assess physical disability caused by low back pain. RESULTS A univariate analysis of variance has shown that there is a statistically significant difference among the groups divided into Absolute peak torque right knee flexors, Absolute peak torque left knee flexors, Ratio between hamstrings and quadriceps strength right leg, and Ratio between hamstrings and quadriceps strength left leg based on the RDQ scores. On the other hand, no other significant differences among the groups were found in other parametersCONCLUSION: The current study indicates that knee muscle strength variables, resulting from an isokinetic testing, have the potential to discriminate between soccer players with and without a history of low back pain. However, low back pain is a multidimensional phenomenon and knee muscle strength or imbalance alone cannot be expected to explain low back pain.
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Affiliation(s)
- Dejan Madić
- University of Novi Sad, Faculty of Sport and Physical Education, Novi Sad, Serbia
| | - Borislav Obradović
- University of Novi Sad, Faculty of Sport and Physical Education, Novi Sad, Serbia
| | - Dragana Golik-Perić
- University of Novi Sad, Faculty of Sport and Physical Education, Novi Sad, Serbia
| | - Dragan Marinković
- University of Novi Sad, Faculty of Sport and Physical Education, Novi Sad, Serbia
| | - Nebojša Trajković
- University of Novi Sad, Faculty of Sport and Physical Education, Novi Sad, Serbia
| | - Zoran Gojković
- Government of the Autonomous Province of Vojvodina, Provincial Secretariat for Health Care, Novi Sad, Serbia
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Abstract
Purpose of Review The purpose of this review is to describe the current evidence on the most common sports-related ankle injuries. Joint anatomy, epidemiology, clinical findings, diagnostic approach, and treatment are presented with a specific focus on the available evidence towards return to play. Recent Findings Recent findings show that ankle sprain is the most common injury in the world of sports. Bony fractures, cartilage defects, and syndesmotic lesions are frequently seen in association with the more severe type of ankle sprains. Summary In summary, the majority of the athletes’ ankle sprains are managed conservatively with excellent outcomes and full return to their pre-injury level of play. However, it is essential to differentiate the single ligament sprain from a more complex injury to the ankle joint. The evidence-based treatment and rehabilitation programmes are associated with a better prognosis and a faster time to return to sport participation.
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Affiliation(s)
- P D'Hooghe
- Department of Orthopaedic Surgery, Aspetar Sports Medicine and Orthopedic Surgery Hospital, Sports City Street 1, Aspire Zone, P.O. Box: 29222, Doha, Qatar.
| | - F Cruz
- Department of Orthopaedic Surgery, Aspetar Sports Medicine and Orthopedic Surgery Hospital, Sports City Street 1, Aspire Zone, P.O. Box: 29222, Doha, Qatar
| | - K Alkhelaifi
- Department of Orthopaedic Surgery, Aspetar Sports Medicine and Orthopedic Surgery Hospital, Sports City Street 1, Aspire Zone, P.O. Box: 29222, Doha, Qatar
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Lloyd RS, Oliver JL, Myer GD, De Ste Croix M, Read PJ. Seasonal variation in neuromuscular control in young male soccer players. Phys Ther Sport 2020; 42:33-39. [PMID: 31869753 PMCID: PMC9892782 DOI: 10.1016/j.ptsp.2019.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/13/2019] [Accepted: 12/14/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Determine how lower limb neuromuscular control changes over the course of a competitive soccer season. DESIGN Repeated measures. SETTING Academy soccer club. PARTICIPANTS 43 male youth soccer players (age 13.1 ± 2.2 yr; height 160.1 ± 15.7 cm; body mass 49.4 ± 14.3 kg; maturity offset 0.2 ± 1.9 yr). MAIN OUTCOME MEASURES Pre-, mid- and end of season assessments of peak landing forces during single leg 75% horizontal hop and stick (75%HOP) and a single leg countermovement jump (SLCMJ), single leg hop for distance (SLHD), knee valgus during the tuck jump assessment (TJA) and inter-limb symmetries. RESULTS Hop distance increased significantly. Absolute peak landing forces in the left leg during the SLCMJ and 75%HOP increased significantly, with significant increases also present in the same leg for SLCMJ relative peak landing force. TJA knee valgus score was reduced in the right leg, but remained at a 'moderate' level in the left knee. CONCLUSION Neuromuscular control, as evidenced by increased absolute and relative peak landing forces, appears to reduce over the course of a competitive season. Young soccer players should engage in neuromuscular training throughout the season to offset any decrements in neuromuscular control and to facilitate appropriate landing strategies.
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Affiliation(s)
- Rhodri S Lloyd
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK; Sport Performance Research Institute, New Zealand (SPRINZ), AUT University, Auckland, New Zealand; Centre for Sport Science and Human Performance, Waikato Institute of Technology, Hamilton, New Zealand.
| | - Jon L Oliver
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK; Sport Performance Research Institute, New Zealand (SPRINZ), AUT University, Auckland, New Zealand
| | - Gregory D Myer
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics and Orthopaedic Surgery, College of Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, USA; The Micheli Center for Sports Injury Prevention, Boston, MA, USA
| | - Mark De Ste Croix
- School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
| | - Paul J Read
- School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK; Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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Rhodes D, Maden-Wilkinson J, Jeffrey J, Birdsall D, Alexander J. Measures of PHV and the effect on directional dynamic stability to identify risk factors for injury in elite football. J Sports Med Phys Fitness 2020; 60:568-573. [PMID: 32043345 DOI: 10.23736/s0022-4707.20.10352-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study is to analyze the relationship between peak height velocity (PHV) and dynamic balance (Y-Balance) versus non-peak growth to identify risk factors for non-contact lower limb injuries using a retrospective study design in elite youth footballers. METHODS Ninety-three elite category 1 academy football players completed Y-Balance assessment during the preseason screening assessment. Data in relation to Y-Balance and Peak Height Velocity measures was than analyzed retrospectively and correlated against injury audit data to identify relationships between the variables. RESULTS A significant correlation was identified between PHV and measures of directional dynamic stability utilizing Y-Balance assessment (P≤0.001). No significant correlations were identified between PHV and injury or injury and dynamic stability scores (P>0.05). Injury occurrence for players within predicted periods of PHV was represented as 45%, within the cohort contained within the study. CONCLUSIONS Evidently periods of growth and maturation within elite academy footballers has a detrimental effect on directional dynamic stability performance. However, caution must be taken with interpreting the significance of this relationship and the effect it has on injury occurrence. Consideration must be given to quantifying key etiological factors associated with injury during adolescence and refrain from reliance on measures of PHV.
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Affiliation(s)
- David Rhodes
- Institute of Coaching and Performance, School of Sport and Health Sciences, University of Central Lancashire, Preston, UK
| | - Joe Maden-Wilkinson
- Everton Football Club, Finch Farm Training Complex, Finch Lane, Halewood, Liverpool, UK
| | - Josh Jeffrey
- Everton Football Club, Finch Farm Training Complex, Finch Lane, Halewood, Liverpool, UK
| | - Daniel Birdsall
- Sport, Nutrition and Clinical Sciences, School of Sport and Health Sciences, University of Central Lancashire, Preston, UK
| | - Jill Alexander
- Sport, Nutrition and Clinical Sciences, School of Sport and Health Sciences, University of Central Lancashire, Preston, UK -
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Prevention of Ankle Sprain Injuries in Youth Soccer and Basketball: Effectiveness of a Neuromuscular Training Program and Examining Risk Factors. Clin J Sport Med 2018; 28:325-331. [PMID: 29864071 DOI: 10.1097/jsm.0000000000000462] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The primary objective of this study was to examine the effectiveness of a neuromuscular training (NMT) warm-up program in reducing the risk of ankle sprain injury (ASI) in youth soccer and basketball. The secondary objective included the evaluation of risk factors for ASI. STUDY DESIGN Secondary analysis of pooled data from 5 studies. PARTICIPANTS Male and female youth (11-18 years) soccer and basketball players (n = 2265) in Alberta, Canada. OUTCOME MEASURES Ankle sprain injury was the primary outcome and was recorded using a validated prospective injury surveillance system consistent in all studies. The primary exposure of interest was NMT warm-up, which included aerobic, strength, agility, and balance components. Multivariable Poisson regression, controlling for clustering by team and offset for exposure hours, was used to estimate incidence rate ratios (IRRs) with 95% confidence intervals (CIs), with considerations for confounding and effect modification and evaluating all covariates as potential risk factors. RESULTS A total of 188 ASIs were reported in 171 players. Neuromuscular training significantly reduced the risk of ASI [IRR = 0.68 (95% CI; 0.46-0.99)]. Independent risk factors for ASI included previous ASI [IRR = 1.98 (95% CI; 1.38-2.81)] and participation in basketball versus soccer [IRR = 1.83 (95% CI; 1.18-2.85)]. Sex, age, body mass index, and previous lower extremity injury (without previous ASI) did not predict ASI (P > 0.05). CONCLUSIONS Exposure to an NMT program is significantly protective for ASI in youth soccer and basketball. Risk of ASI in youth basketball is greater than soccer, and players with a history of ASI are at greater risk.
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Covassin T, Petit KM, Savage JL, Bretzin AC, Fox ME, Walker LF, Gould D. Sports-Related Concussion Occurrence at Various Time Points During High School Athletic Events: Part 2. Am J Sports Med 2018; 46:2270-2276. [PMID: 29927307 DOI: 10.1177/0363546518780225] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Sports-related concussion (SRC) injury rates, and identifying those athletes at the highest risk, have been a primary research focus. However, no studies have evaluated at which time point during an athletic event athletes are most susceptible to SRCs. PURPOSE To determine the clinical incidence of SRCs during the start, middle, and end of practice and competition among high school male and female athletes in the state of Michigan. STUDY DESIGN Descriptive epidemiological study. METHODS There were 110,774 male and 71,945 female student-athletes in grades 9 through 12 (mean time in high school, 2.32 ± 1.1 years) who participated in sponsored athletic activities (13 sports) during the 2015-2016 academic year. An SRC was diagnosed and managed by a medical professional (ie, MD, DO, PA, NP). SRC injuries were reported by certified athletic trainers, athletic administrators, and coaches using the Michigan High School Athletic Association Head Injury Reporting System. Time of SRC was defined as the beginning, middle, or end of practice/competition. Clinical incidence was calculated by dividing the number of SRCs in a time point (eg, beginning) by the total number of participants in a sport per 100 student-athletes (95% CI). Risk ratios were calculated by dividing one time point by another time point. RESULTS There were 4314 SRCs reported, with the highest in football, women's basketball, and women's soccer. The total clinical incidence for all sports was 2.36 (95% CI, 2.29-2.43) per 100 student-athletes. The most common time for SRCs was the middle, followed by the end of all events. Athletes had a 4.90 (95% CI, 4.44-5.41) and 1.50 (95% CI, 1.40-1.60) times greater risk during the middle of all events when compared with the beginning and end, respectively. There was a 3.28 (95% CI, 2.96-3.63) times greater risk at the end of all events when compared with the beginning. CONCLUSION Athletes were at the greatest risk for SRCs at the middle of practice and competition when compared with the beginning and end. CLINICAL RELEVANCE The current study suggests that medical attention is particularly important during the middle of all athletic events. Intervention measures to limit SRCs may be most beneficial during the middle of athletic events.
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Affiliation(s)
| | - Kyle M Petit
- Michigan State University, East Lansing, Michigan, USA
| | | | | | - Meghan E Fox
- Grand Valley State University, Allendale, Michigan, USA
| | | | - Daniel Gould
- Michigan State University, East Lansing, Michigan, USA
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Al Bimani SA, Gates LS, Warner M, Ewings S, Crouch R, Bowen C. Characteristics of patients with ankle sprain presenting to an emergency department in the south of England (UK): A seven-month review. Int Emerg Nurs 2018; 41:38-44. [PMID: 29885906 DOI: 10.1016/j.ienj.2018.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 04/30/2018] [Accepted: 05/31/2018] [Indexed: 12/26/2022]
Abstract
INTRODUCTION There is lack of evidence about ankle sprain patients presenting to emergency department (ED) in the UK. The study aim was to determine prevalence, demographic and clinical characteristics of patients attending to one ED. Knowing those characteristics may help setting prevention strategies and inform effective clinical practice. METHODS A retrospective review of records from patients' database system was conducted between May and November 2015 (inclusive). RESULTS 909 new patients with ankle sprain were recorded during the study period. Patients had a median age of 27 years (IQR 20). Men aged between 14 and 37 years had higher percentage of injuries compared to women of a similar age. Overall prevalence of injury was equally distributed between men and women. Most patients were sent to radiography department for ankle/foot X-ray (89%). Over half of patients (58%) were sent home with no follow-up treatment. A subsample (n = 106) from the original sample (n = 909) showed a variety of causes of injury such as tripping (29%), non-specific injury (26.4%), sports (26%), walking (12.2%) and other accidental causes (6%). Football was the most prevalent sport (13%). CONCLUSIONS Prevention strategies, appropriate assessment tools and tailored rehabilitation programs are warranted to reduce number of patients and potential chronic symptoms.
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Affiliation(s)
- Saed A Al Bimani
- Faculty of Health Sciences, University of Southampton, Southampton, UK.
| | - Lucy S Gates
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Martin Warner
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Sean Ewings
- Statistical Sciences Research Institute, University of Southampton, Southampton, UK
| | - Robert Crouch
- Emergency Department, Southampton General Hospital, Southampton, UK
| | - Catherine Bowen
- Faculty of Health Sciences, University of Southampton, Southampton, UK
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Read PJ, Oliver JL, De Ste Croix MBA, Myer GD, Lloyd RS. A prospective investigation to evaluate risk factors for lower extremity injury risk in male youth soccer players. Scand J Med Sci Sports 2018; 28:1244-1251. [PMID: 29130575 PMCID: PMC6556769 DOI: 10.1111/sms.13013] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2017] [Indexed: 11/27/2022]
Abstract
There is an inherent risk of injury in male youth football; however, pertinent risk factors for injury have yet to be examined. This study used a prospective cohort design with 357 elite male youth football players (aged 10-18 years) assessed during the preseason period and then monitored during the season recording all non-contact lower extremity injuries. Screening tests included single leg hop for distance (SLHD); 75% of maximum hop and stick (75%Hop); single leg countermovement jump (SLCMJ); and the tuck jump assessment (TJ). Players were divided into subgroups based on chronological age. SLCMJ peak landing vertical ground reaction force (pVGRF) asymmetry was the most prominent risk factor (U11-U12s, OR 0.90, P = .04; and U15-U16s, OR 0.91, P < .001). Maturational offset (OR 0.58, P = .04), lower right leg SLCMJ pVGRF relative to body weight (OR 0.36, P = .03), and advanced chronological age (OR 3.62, P = .04) were also significantly associated with heightened injury risk in the U13-U14s, U15-U16s, and U18s, respectively. Univariate analyses showed combinations of anthropometric and movement screening risk factors were associated with heightened risk of lower extremity injury; however, there was variability across the different chronological age groups. Greater SLCMJ pVGRF asymmetry, lower right leg SLCMJ pVGRF %BW, later maturation, and advanced chronological age are potential risk factors for injury in elite male youth football players, although the strength of these relationships was often low to moderate. In addition, risk factors are likely to change at different stages of development.
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Affiliation(s)
- P J Read
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Youth Physical Development Centre, School of Sport, Cardiff Metropolitan University, Cardiff, UK
| | - J L Oliver
- Youth Physical Development Centre, School of Sport, Cardiff Metropolitan University, Cardiff, UK
- Sport Performance Research Institute, New Zealand (SPRINZ), AUT University, Auckland, New Zealand
| | - M B A De Ste Croix
- School of Sport and Exercise, University of Gloucestershire, Gloucestershire, UK
| | - G D Myer
- Division of Sports Medicine, Cincinnati Children's Hospital, Cincinnati, OH, USA
- Department of Pediatrics and Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- The Micheli Center for Sports Injury Prevention, Boston, MA, USA
- Department of Orthopaedics, University of Pennsylvania, Philadelphia, PA, USA
| | - R S Lloyd
- Youth Physical Development Centre, School of Sport, Cardiff Metropolitan University, Cardiff, UK
- Sport Performance Research Institute, New Zealand (SPRINZ), AUT University, Auckland, New Zealand
- Centre for Sport Science and Human Performance, Waikato Institute of Technology, Hamilton, New Zealand
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Malliaropoulos N, Bikos G, Meke M, Vasileios K, Valle X, Lohrer H, Maffulli N, Padhiar N. Higher frequency of hamstring injuries in elite track and field athletes who had a previous injury to the ankle - a 17 years observational cohort study. J Foot Ankle Res 2018; 11:7. [PMID: 29492109 PMCID: PMC5828071 DOI: 10.1186/s13047-018-0247-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 01/22/2018] [Indexed: 12/26/2022] Open
Abstract
Background Inversion injury to the ankle and hamstring injuries are common problems in most sports. It is not known whether these injuries constitute a predisposing factor or a precursor of injury or re-injury of these anatomical locations. Therefore, we wished to test the hypothesis that a previous inversion ankle injury exerted a significant effect on the chance of an athlete suffering from a subsequent ipsilateral hamstring injury and vice versa. Methods In an observational cohort study over 17 years (1998–2015), 367 elite track and field athletes, were grouped according to their first traumatic isolated ankle or hamstring injury. Fifty athletes experienced both injuries. The Mann-Whitney U and Chi-square tests (p < 0.05) were performed to test possible associations of ankle and hamstring injury with age, gender, athletics discipline, grade, and type of antecedent injury. Results Athletes with a preceding ankle injury had a statistically significantly higher chance of experiencing a subsequent hamstring injury compared with athletes who had experienced a hamstring injury as their first traumatic event (x2 = 4.245, p = 0.039). The proportion of both ankle and hamstring injury events was not statistically different between female (18%) and male (11%) athletes. Age and grade of injury did not influence the proportion of ankle and/or hamstring injury events. Conclusion There is a statistically significantly higher frequency of hamstring injuries in elite track and field athletes having experienced a previous ankle ligament injury.
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Affiliation(s)
- Nikolaos Malliaropoulos
- Sports and Exercise Medicine Clinic, Thessaloniki, Greece.,National Track & Field Centre, Sports Medicine Clinic, Thessaloniki, Greece.,European Sports Care, London, UK.,Sports Clinic, Rheumatology Department, Barts Health Trust, London, UK.,5William Harvey Research Institute, Centre for Sports and Exercise, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
| | - Georgios Bikos
- National Track & Field Centre, Sports Medicine Clinic, Thessaloniki, Greece.,Euromedica Arogi Rehabilitation Clinic, Thessaloniki, Greece
| | - Maria Meke
- Sports and Exercise Medicine Clinic, Thessaloniki, Greece
| | - Korakakis Vasileios
- 7Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Hellenic Orthopaedic Manipulative Therapy Diploma, Athens, Greece
| | - Xavier Valle
- Football Club Barcelona, Medical Department, Barcelona, Spain.,10Sports Medicine School (Universitat de Barcelona), Barcelona, Spain.,Mapfre Centre for Tennis Medicine, Barcelona, Spain.,12Department de Cirurgia de la Facultat de Medicina at the Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Heinz Lohrer
- European SportsCare Network, Frankfurt am Main, Germany.,Department of Sport and Sport Science, University of Freiburg, Freiburg im Breisgau, Germany
| | - Nicola Maffulli
- 5William Harvey Research Institute, Centre for Sports and Exercise, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK.,15Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Nat Padhiar
- European Sports Care, London, UK.,Sports Clinic, Rheumatology Department, Barts Health Trust, London, UK.,5William Harvey Research Institute, Centre for Sports and Exercise, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
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Read PJ, Oliver JL, De Ste Croix MBA, Myer GD, Lloyd RS. An audit of injuries in six english professional soccer academies. J Sports Sci 2017; 36:1542-1548. [DOI: 10.1080/02640414.2017.1402535] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Paul J. Read
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Youth Physical Development Unit, School of Sport, Cardiff Metropolitan University, Cardiff, UK
| | - Jon L. Oliver
- Youth Physical Development Unit, School of Sport, Cardiff Metropolitan University, Cardiff, UK
- Sport Performance Research Institute, New Zealand (SPRINZ), AUT University, Auckland, New Zealand
| | | | - Gregory D. Myer
- Division of Sports Medicine, Cincinnati Children’s Hospital, Cincinnati, OH, USA
- Department of Pediatrics and Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- The Micheli Center for Sports Injury Prevention, Boston, MA, USA
- Department of Orthopaedics, University of Pennsylvania, Philadelphia, PA, USA
| | - Rhodri S. Lloyd
- Youth Physical Development Unit, School of Sport, Cardiff Metropolitan University, Cardiff, UK
- Sport Performance Research Institute, New Zealand (SPRINZ), AUT University, Auckland, New Zealand
- Centre for Sport Science and Human Performance, Waikato Institute of Technology, Hamilton, New Zealand
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Neuromuscular Risk Factors for Knee and Ankle Ligament Injuries in Male Youth Soccer Players. Sports Med 2017; 46:1059-66. [PMID: 26856339 DOI: 10.1007/s40279-016-0479-z] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Injuries reported in male youth soccer players most commonly occur in the lower extremities, and include a high proportion of ligament sprains at the ankle and knee with a lower proportion of overuse injuries. There is currently a paucity of available literature that examines age- and sex-specific injury risk factors for such injuries within youth soccer players. Epidemiological data have reported movements that lead to non-contact ligament injury include running, twisting and turning, over-reaching and landing. Altered neuromuscular control during these actions has been suggested as a key mechanism in females and adult populations; however, data available in male soccer players is sparse. The focus of this article is to review the available literature and elucidate prevalent risk factors pertaining to male youth soccer players which may contribute to their relative risk of injury.
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27
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Does kinesiology taping of the ankles affect proprioceptive control in professional football (soccer) players? Phys Ther Sport 2017; 25:94-98. [DOI: 10.1016/j.ptsp.2016.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 08/31/2016] [Accepted: 09/02/2016] [Indexed: 11/21/2022]
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De Ridder R, Witvrouw E, Dolphens M, Roosen P, Van Ginckel A. Hip Strength as an Intrinsic Risk Factor for Lateral Ankle Sprains in Youth Soccer Players: A 3-Season Prospective Study. Am J Sports Med 2017; 45:410-416. [PMID: 27852594 DOI: 10.1177/0363546516672650] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Numerous epidemiological studies have emphasized the burden of lateral ankle sprains in youth soccer players. However, no prospective study has identified intrinsic physical and modifiable risk factors for these injuries in this particular population. Although injury prevention programs in soccer incorporate proximal hip and core stability exercises, it is striking that the relationship between impaired proximal hip function and ankle sprains has not yet been prospectively investigated in youth soccer players. HYPOTHESIS This prospective study aimed to examine whether hip muscle strength is a risk factor for sustaining a lateral ankle sprain in youth soccer players. We hypothesized that decreased hip muscle strength would predispose youth soccer players to an increased risk of lateral ankle sprains. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS This study included a total of 133 male youth soccer players (age divisions U11-U17) for analysis. At the beginning of the season, anthropometric characteristics were collected and hip muscle strength was assessed using a handheld dynamometer. Injury registration was performed by the team medical staff during 3 consecutive seasons. A principal-component, multivariate Cox regression analysis was performed to identify potential risk factors for sustaining a lateral ankle sprain. RESULTS Twelve participants (18% of all reported injuries) sustained a lateral ankle sprain (0.36 per 1000 athletic-exposure hours). After adjustment for body size dependencies and other hip muscle forces, an increase in hip muscle extension force was associated with a significant decrease in the hazard of the injury (hazard ratio, 0.3; 95% confidence interval, 0.1-0.9; P = .028). No other study variable could be identified as a risk factor for lateral ankle sprains. CONCLUSION Reduced hip extension muscle strength is an independent risk factor for lateral ankle sprains in male youth soccer players. Other hip muscle strength outcomes were not identified as risk factors. Replication in larger samples with more injured cases is warranted to further ascertain the importance of this risk factor.
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Affiliation(s)
- Roel De Ridder
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Erik Witvrouw
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Physiotherapy, Aspetar Hospital, Aspetar, Doha, Qatar
| | - Mieke Dolphens
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Philip Roosen
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Ans Van Ginckel
- Faculty of Medicine, Dentistry and Health Sciences, Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia
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29
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Nagle K, Johnson B, Brou L, Landman T, Sochanska A, Comstock RD. Timing of Lower Extremity Injuries in Competition and Practice in High School Sports. Sports Health 2017; 9:238-246. [PMID: 28146414 PMCID: PMC5435151 DOI: 10.1177/1941738116685704] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Laboratory-based experiments demonstrate that fatigue may contribute to lower extremity injury (LEI). Few studies have examined the timing of LEIs during competition and practice, specifically in high school athletes across multiple sports, to consider the possible relationship between fatigue and LEIs during sport events. Hypothesis: The purpose of this study was to describe the timing of LEIs in high school athletes within games and practices across multiple sports, with a hypothesis that more and severe injuries occur later in games and practices. Study Design: Descriptive epidemiologic study. Level of Evidence: Level 4. Methods: Using the National High School RIO (Reporting Information Online) sport injury surveillance system, LEI severity and time of occurrence data during practice and competition were extracted for 9 high school sports. Results: During the school years 2005-2006 through 2013-2014, 16,967,702 athlete exposures and 19,676 total LEIs were examined. In all sports surveyed, there was a higher LEI rate, relative risk for LEI, and LEI requiring surgery during competition than practice. During practice, the majority of LEIs occurred over an hour into practice in all sports. In quarter-based competition, more LEIs occurred in the second (31% to 32%) and third quarters (30% to 35%) than in the first (11% to 15%) and fourth quarters (22% to 26%). In games with halves, the majority (53% to 66%) of LEIs occurred in the second half. The greater severity LEIs tended to occur earlier in games. Conclusion: Fatigue may play a role in the predominance of injuries in the second half of games, though various factors may be involved. Greater severity of injuries earlier in games may be because of higher energy injuries when athletes are not fatigued. Clinical Relevance: These findings can help prepare sports medicine personnel and guide further related research to prevent LEIs.
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Affiliation(s)
- Kyle Nagle
- University of Colorado Anschutz, Aurora, Colorado.,Musculoskeletal Research Center, Children's Hospital, Aurora, Colorado
| | | | - Lina Brou
- University of Colorado Anschutz, Aurora, Colorado
| | - Tyler Landman
- Musculoskeletal Research Center, Children's Hospital, Aurora, Colorado
| | - Ada Sochanska
- Musculoskeletal Research Center, Children's Hospital, Aurora, Colorado
| | - R Dawn Comstock
- University of Colorado Anschutz, Aurora, Colorado.,Colorado School of Public Health, Aurora, Colorado
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30
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Read PJ, Oliver JL, de Ste Croix MBA, Myer GD, Lloyd RS. Reliability of the Tuck Jump Injury Risk Screening Assessment in Elite Male Youth Soccer Players. J Strength Cond Res 2016; 30:1510-6. [PMID: 26562715 DOI: 10.1519/jsc.0000000000001260] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Read, PJ, Oliver, JL, de Ste Croix, MBA, Myer, GD, and Lloyd, RS. Reliability of the tuck jump injury risk screening assessment in elite male youth soccer players. J Strength Cond Res 30(6): 1510-1516, 2016-Altered neuromuscular control has been suggested as a mechanism for injury in soccer players. Ligamentous injuries most often occur during dynamic movements, such as decelerations from jump-landing maneuvers where high-risk movement patterns are present. The assessment of kinematic variables during jump-landing tasks as part of a preparticipation screen is useful in the identification of injury risk. An example of a field-based screening tool is the repeated tuck jump assessment. The purpose of this study was to analyze the within-subject variation of the tuck jump screening assessment in elite male youth soccer players. Twenty-five pre-peak height velocity (PHV) and 25 post-PHV elite male youth soccer players from the academy of a professional English soccer club completed the assessment. A test-retest design was used to explore the within-subject intersession reliability. Technique was graded retrospectively against the 10-point criteria set out in the screening protocol using two-dimensional video cameras. The typical error range reported for tuck jump total score (0.90-1.01 in pre-PHV and post-PHV players respectively) was considered acceptable. When each criteria was analyzed individually, kappa coefficient determined that knee valgus was the only criterion to reach substantial agreement across the two test sessions for both groups. The results of this study suggest that although tuck jump total score may be reliably assessed in elite male youth soccer players, caution should be applied in solely interpreting the composite score due to the high within-subject variation in a number of the individual criteria. Knee valgus may be reliably used to screen elite youth male soccer players for this plyometric technique error and for test-retest comparison.
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Affiliation(s)
- Paul J Read
- 1School of Sport, Health and Applied Science, St Mary's University, London, United Kingdom; 2Youth Physical Development Unit, School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom; 3Exercise and Sport Research Centre, School of Sport and Exercise, University of Gloucestershire, Gloucester United Kingdom; 4Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; 5Department of Pediatrics and Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio; 6The Micheli Center for Sports Injury Prevention, Boston, Massachusetts; 7Sport Performance Research Institute, New Zealand (SPRINZ), AUT University, Auckland, New Zealand; and 8Department of Orthopaedics, University of Pennsylvania, Philadelphia, Pennsylvania
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31
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Renshaw A, Goodwin PC. Injury incidence in a Premier League youth soccer academy using the consensus statement: a prospective cohort study. BMJ Open Sport Exerc Med 2016; 2:e000132. [PMID: 27900186 PMCID: PMC5125417 DOI: 10.1136/bmjsem-2016-000132] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2016] [Indexed: 11/18/2022] Open
Abstract
Background There is an established risk of injury to young athletes exposed to high training loads. Identifying and monitoring injury risk is essential to aid prevention. The aim of this study was to use the consensus statement to determine the incidence and pattern of injury in 1 English Premier League soccer academy during 1 season. Methods A prospective cohort study included 181 elite academy soccer players during the 2012–2013 season. Players were divided into 5 age groups between 9 and 18 years. The number, type and incidence of injuries were recorded during matches and training. Incidence was calculated per 1000 hours of exposure. Results 127 injuries occurred during 29 346 hours of soccer exposure. 72% of injuries were non-contact related. Under (U)18 players sustained the highest number of match injuries. U12–14 players sustained the highest number of training injuries and injuries overall. U16 players sustained the highest number of severe injuries, and U18 players sustained the highest number of moderate injuries. U18 players sustained the highest number of injuries/1000 hours of training and overall. U15 players sustained the highest number of injuries/1000 hours of matches, the highest number of recurrent injuries and the highest incidence of recurrence. The most common injuries were muscle injuries in U15 and U18 players. The most common injury location was the anterior thigh, with the majority of these occurring in training. Conclusions Using the consensus statement, this study used a repeatable method to identify the injury profile of elite academy-level soccer players.
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Affiliation(s)
| | - Peter C Goodwin
- Department of Health Professions , Manchester Metropolitan University , Manchester , UK
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32
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Read P, Oliver JL, De Ste Croix MBA, Myer GD, Lloyd RS. Injury Risk Factors in Male Youth Soccer Players. Strength Cond J 2015. [DOI: 10.1519/ssc.0000000000000171] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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34
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Greig M, McNaughton L. Soccer-specific Fatigue Decreases Reactive Postural Control with Implications for Ankle Sprain Injury. Res Sports Med 2014; 22:368-79. [DOI: 10.1080/15438627.2014.944300] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Matt Greig
- Department of Sport & Physical Activity, Edge Hill University, Ormskirk, Lancashire, UK
| | - Lars McNaughton
- Department of Sport & Physical Activity, Edge Hill University, Ormskirk, Lancashire, UK
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35
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Attenborough AS, Hiller CE, Smith RM, Stuelcken M, Greene A, Sinclair PJ. Chronic ankle instability in sporting populations. SPORTS MEDICINE (AUCKLAND, N.Z.) 2014. [PMID: 24981244 DOI: 10.1007/s40279-014-0218-2.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chronic ankle instability (CAI) is a term used to identify certain insufficiencies of the ankle joint complex following an acute ankle injury. Acute ankle injuries are often associated with sporting mishaps; however, this review was the first to identify the aspects of CAI (perceived instability, mechanical instability and recurrent sprain), and persisting symptoms following an ankle sprain, that have been reported within sporting cohorts. OBJECTIVE To determine the presence of common aspects of CAI within individual sports. METHODS A systematic search of the MEDLINE, Web of Science, CINAHL, SPORTDiscus and AMED databases up until 1 October, 2013 produced 88 studies appropriate for review. A calculated weighted percentage of the outcome data allowed the comparison of figures across a range of sports. RESULTS Soccer, basketball and volleyball were the most represented sports and recurrent ankle injury/sprain was the most reported aspect of CAI. Soccer had the highest percentage of participants with recurrent sprain (61%) and mechanical instability (38%), whilst track and field had the highest percentage of participants with perceived instability (41%). Gymnasts had the highest percentage of ankles with persisting symptoms following an initial ankle sprain. CONCLUSION This review was the first to assess aspects of CAI within sporting cohorts and has identified limitations to the research reporting these data. The problem of CAI across a range of sports remains unclear and thus advocates the need for further controlled research in the area to ascertain the true extent of CAI within sporting populations.
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Affiliation(s)
- Alison Suzanne Attenborough
- Discipline of Exercise and Sport Science, Faculty of Health Sciences, University of Sydney, PO Box 170, Lidcombe, NSW, 1825, Australia,
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36
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Attenborough AS, Hiller CE, Smith RM, Stuelcken M, Greene A, Sinclair PJ. Chronic Ankle Instability in Sporting Populations. Sports Med 2014; 44:1545-56. [PMID: 24981244 DOI: 10.1007/s40279-014-0218-2] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Alison Suzanne Attenborough
- Discipline of Exercise and Sport Science, Faculty of Health Sciences, University of Sydney, PO Box 170, Lidcombe, NSW, 1825, Australia,
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37
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Shah T, Cloke DJ, Rushton S, Shirley MDF, Deehan DJ. Lower Back Symptoms in Adolescent Soccer Players: Predictors of Functional Recovery. Orthop J Sports Med 2014; 2:2325967114529703. [PMID: 26535318 PMCID: PMC4555597 DOI: 10.1177/2325967114529703] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: There are little published data on factors relating to low back pain in the younger athletic population. Hypothesis: Independent predictors of recovery and return to participation in sports could be determined by event analysis, which investigates the impacts of covariates, including age, position, and injury type, on the risk of delayed recovery after injury. Study Design: Descriptive epidemiology study. Methods: This study examined 41 English Premiership soccer academy squads consisting of 12,306 player seasons for the incidence of lower back injury, injury severity, and investigated time to recovery in relation to potential risk factors. Injury risk was assessed for different times in a match and season, mechanism of injury, player position, player age, and competitive compared with noncompetitive play. Results: A total of 310 (3.0% of all injuries sustained in the population) lumbar spine injuries were recorded. Overall, 10,265 training days (median, 14 days; interquartile range, 8-30 days) were lost. The risk of injury increased as the first half progressed and was maintained throughout the second half with a contact mechanism and with increasing age. Neither competitive play compared with noncompetitive play nor player position had an effect on injury incidence. Prognostic factors for poor recovery were bony injuries and increasing age. Conclusion: These findings indicate that prolonged absence from training after a back injury is seen, especially in bony injuries and in older adolescents. It is suggested that there should be a low threshold for investigation of adolescent patients with back pain in the hope of early appropriate management of more severe diagnoses.
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Affiliation(s)
- Talib Shah
- Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Mark D F Shirley
- Newcastle University, Newcastle upon Tyne, UK. ; The English Football Association at Wembley Stadium, North London, UK
| | - David J Deehan
- Newcastle University, Newcastle upon Tyne, UK. ; Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK. ; Freeman Hospital, High Heaton, Newcastle upon Tyne, UK
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Six-week combined vibration and wobble board training on balance and stability in footballers with functional ankle instability. Clin J Sport Med 2013; 23:384-91. [PMID: 23657122 DOI: 10.1097/jsm.0b013e318291d22d] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the effectiveness of a combination of vibration and wobble board training against wobble board training alone in footballers suffering from functional ankle instability (FAI). DESIGN A 2 × 3 prefactorial-postfactorial design. SETTING University research laboratory. PARTICIPANTS Thirty-three male semiprofessional footballers with self-reported unilateral FAI were randomly assigned in 3 groups: vibration and wobble board (mean age 22.2 years), wobble board (mean age 22.7 years), and control (mean age 23.1 years). INTERVENTIONS Participants in each intervention group performed a 6-week progressive rehabilitation program using a wobble board, either with or without the addition of vibration stimulus. MAIN OUTCOME MEASURES Absolute center of mass (COM) distribution during single-leg stance, modified star excursion balance test (SEBT) reach distances, and single-leg triple hop for distance (SLTHD) were measured before and after 6-week intervention. RESULTS Combined vibration and wobble board training resulted in reduced COM distribution [P ≤ 0.001, effect size (ES) = 0.66], increased SEBT reach distances (P ≤ 0.01 and P ≤ 0.002, ES = 0.19 and 0.29, respectively), and increased SLTHD (P ≤ 0.001, ES = 0.33) compared with wobble board training alone during the course of the 6-week training intervention. CONCLUSIONS Combined vibration and wobble board training improves COM distribution, modified SEBT scores, and SLTHD among footballers suffering FAI compared with wobble board training alone.
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39
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O'Connor AM, James IT. Association of lower limb injury with boot cleat design and playing surface in elite soccer. Foot Ankle Clin 2013; 18:369-80. [PMID: 23707183 DOI: 10.1016/j.fcl.2013.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Reducing external injury risk factors associated with the boot-surface interaction is important in reducing the incidence and severity of foot and ankle injury. A review of prospective football (soccer) injury epidemiology studies determined that the incidence of noncontact ankle sprain injury is relatively high. Research on the impact of cleat shape and configuration and boot design on the boot-surface interaction is providing new understanding of the impact on player biomechanics and injury risk but is not keeping pace with commercial advances in boot design and innovation in natural and synthetic turf surface technology.
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Sobhani S, Dekker R, Postema K, Dijkstra PU. Epidemiology of ankle and foot overuse injuries in sports: A systematic review. Scand J Med Sci Sports 2012; 23:669-86. [PMID: 22846101 DOI: 10.1111/j.1600-0838.2012.01509.x] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2012] [Indexed: 11/28/2022]
Abstract
Studies regarding ankle and foot overuse injuries are quite diverse in research methodology, data reporting, and outcomes. The aims of this systematic review were to analyze the methodology of published studies regarding ankle and foot overuse injuries in different sports disciplines and to summarize epidemiological data of ankle and foot overuse injuries. Four electronic databases, PubMed (MEDLINE), EMBASE, CINAHL, and SPORTDiscus(®) were systematically searched up to June 2011. A total of 89 articles on 23 sports disciplines were included in this review. Soccer, running, and gymnastics were the most frequently studied sports. Achilles tendinopathy, plantar fasciitis, and stress fracture were the most frequently studied injuries. Study design and reporting methods were heterogeneous. Most studies suffered from a weak methodology and poor reporting. The most common weaknesses were lack of a clear case definition, describing assessment procedures and reporting sample characteristics. Due to methodological heterogeneity of studies, inter-sports and intra-sports comparisons and meta-analysis were not possible. Methodology of most studies on incidence and prevalence of ankle and foot overuse injuries is insufficient. Based on the results, we recommend authors to clearly define cases, describe assessment procedures and report sample characteristics adequately.
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Affiliation(s)
- S Sobhani
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Cloke D, Moore O, Shah T, Rushton S, Shirley MDF, Deehan DJ. Thigh muscle injuries in youth soccer: predictors of recovery. Am J Sports Med 2012; 40:433-9. [PMID: 22223714 DOI: 10.1177/0363546511428800] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Participation in soccer at younger ages with attendant risk of muscle injury is increasing. PURPOSE To delineate patterns of thigh muscle injury and predictors of recovery in male youth soccer academy players. STUDY DESIGN Cohort study (prognosis); Level of evidence, 2. METHODS Forty-one English Premiership soccer academy squads (all male, aged 8-16 years) over a 5-year period comprising 12 306 player seasons were studied prospectively for pattern, mechanism, and outcome after thigh muscle injury. Event analysis was used to identify independent predictors of slow recovery. RESULTS A total of 1288 injuries were recorded representing an incidence (mean [SD]) of 0.42 (0.24) per thousand hours of training with a mean annual incidence of 0.52. Midfield players received the most injuries, followed by defense and attack positions. The quadriceps muscle group was most likely to be injured. There were 345 reinjuries (27%). Median time off for a primary injury was 13 days (interquartile range, 7-22 days) and 12 days (7-21 days) following a reinjury. Risk of such injury increased as the game progressed toward the end of the first half period (P = .028), and this risk persisted throughout the entire second half. There were 2 peaks of incidence (January and September). The percentage of the total for hamstring, adductor, and quadriceps injuries did not significantly change with player age. However, the proportion of injuries that were severe increased with age of player (t = 3.72, P = .010). Poor prognostic factors for recovery were hamstring injuries (z = 2.182, P = .029), contact injury (z = -3.137, P = .002), and older age (z = -2.2298, P = .022). CONCLUSION The risk for prolonged recovery from thigh muscle injury was found to increase with age of the player and contact mechanism. The risk of injury increased toward the end of the first half, and this risk persisted throughout the second half. Delayed recovery was significantly associated with a hamstring muscle injury, first injury, and contact mechanism. This study, for the first time, allows identification of youth male soccer players at high-risk for prolonged symptoms after thigh muscle injury.
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Affiliation(s)
- David Cloke
- Newcastle University, Newcastle upon Tyne, United Kingdom
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Moore O, Cloke DJ, Avery PJ, Beasley I, Deehan DJ. English Premiership Academy knee injuries: lessons from a 5 year study. J Sports Sci 2011; 29:1535-44. [PMID: 21988085 DOI: 10.1080/02640414.2011.605162] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This study addresses the epidemiology of knee injuries in adolescent males. Data were collected prospectively from 41 Premiership soccer academies over a 5 year period from July 2000 to June 2005. A total of 12,306 player seasons were registered in the U9 to the U16 age categories with a total of 1750 recordable injuries specific to the knee joint. There was a mean incidence of 0.71 (95% confidence interval ± 0.05) knee injuries per player per year, and a median of 17 (inter-quartile range 9-38) training days and 2 (inter-quartile range 1-4) matches missed per knee injury. Knee injuries were found to be most common in the 14-16 year age group. Six hundred and nine (35% of total) injuries were classed as severe resulting in more than 28 days' absence. Injuries were more likely to be sustained in a competitive or match-play environment (862 or 52%) than in training (796 or 48%), and a non-contact mechanism was implicated in 823 (55%) of recorded cases. Peaks in injury numbers were seen in early season and subsequent to the winter break. Sprain was the most common diagnosis recorded, with the medial collateral ligament affected in 23% of all knee injuries. Knee injuries are common in elite youth footballers. In this uninsured age group, it could be argued that earlier medical intervention may reduce long-term damage to the immature skeleton.
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Affiliation(s)
- Oliver Moore
- Newcastle Medical School, Newcastle-upon-Tyne, UK
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Soubeyrand M, Vincent-Mansour C, Guidon J, Asselineau A, Ducharnes G, Molina V. Severe open ankle sprain (SOAS): a lesion presenting as a penetrating soft tissue injury. J Foot Ankle Surg 2010; 49:253-8. [PMID: 20605561 DOI: 10.1053/j.jfas.2010.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Indexed: 02/03/2023]
Abstract
The objective of this retrospective case study was to describe the incidence and clinical features of severe open ankle sprain (SOAS), defined as a tear of the lateral or medial collateral ligaments with an associated transverse tear of the skin over the corresponding malleolus. To this end, we reviewed the medical records of patients with SOAS managed between January 2005 and January 2009, using the databases of 3 different orthopedic trauma centers. Our review revealed 9 patients with SOAS, 7 (77.77%) of which involved the lateral ligaments and 2 (22.22%) of which involved the medial ligaments. The median age was 32 (range 21 to 45) years, and the injury occurred as a result of a motor vehicle accident in 6 (66.67%) patients, and as a result of a fall from a height in 3 (33.33%) patients. Two tendons were damaged in 2 (22.22%) patients, the deep fibular nerve (deep peroneal nerve) in 2 (22.22%) patients, and the anterior tibial artery in 1 (11.11%) patient. The only abnormality on plain radiographs was pneumarthrosis, which was present in 5 (55.56%) patients. The incidence of SOAS is rare, accounting for 0.002% (9/438,000) of all trauma cases and 0.22% (9/4142) of all cases of ankle trauma. The diagnosis was confirmed by intraoperative stress-maneuvers in all 9 patients. In conclusion, SOAS should be suspected in patients who present with a traumatic skin wound over the malleolus.
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Affiliation(s)
- Marc Soubeyrand
- Hôpital Universitaire de Bicetre, AP-HP, Univ Paris-Sud, Department of Orthopedic Surgery, 94270 Le Kremlin-Bicetre, France.
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