Sports injuries in adolescents' ball games: soccer, handball and basketball

Sports Injuries in Basketball Players: A Systematic Review

(1) Background: The objective of this systematic review was to collect relevant data in the available contemporary studies about sports injuries of basketball players and explain differences in sports injuries relative to gender, location, sport, and position on the court; (2) Methods: The papers were searched digitally using PubMed, MEDLINE, ERIC, Google Scholar, and ScienceDirect databases, from 1990 to 2024; (3) Results: The most frequent severe injuries for both genders are knee and ankle injuries and the most frequent forms of injury are ankle sprain and ligament strain. The most frequent injuries occur during running and after contact with the ball. Shooting guards sustain the highest injury rate followed by centers and point guards, while guards have the highest rate of adductor muscle injury; and (4) Conclusions: Studies indicate that ankle and knee injuries are prevalent among basketball players, with ankle sprains being particularly prevalent. Knee injuries are more common in female basketball players, including ACL injuries. Various factors contribute to injuries, including the biomechanics of jumping, landing, sudden changes in direction, and the physical demands placed on the body during the game.

Activation Capacity of the Intrinsic Musculature of the Foot in Handball Athletes with Chronic Ankle Instability

Chronic ankle instability (CAI) is a common pathology in handball. The role of the intrinsic musculature of the foot in these players in relation to proprioception and stability has not been stablished. The objective of this study was to compare the ultrasound morphology of the heel fat pad of the foot in professional handball players to CAI in healthy players and establish relationships between CAI and physical and psychological variables. The study has been a descriptive observational case-control study in which 20 professional handball male players over 18 years of age were divided into 8 cases (CAI) and 12 controls (healthy). An ultrasound evaluation, the thickness and/or cross-sectional area at rest and the contraction measurement of the Abductor Digiti Minimi, Abductor Hallucis, Flexor Digitorum Brevis and Quadratus Plantae muscles were analyzed. Moreover, the compressibility index of the heel fat pad and the activation of the abdominal wall musculature (ultrasound), the flexion strength of the hallux and lesser toes (dynamometry), the foot functionality (Bristol Foot Score (BFS) questionnaire) and the psychological variables (self-reported questionnaires) were measured. There were no significant differences between the activation capacity values of the foot muscles of healthy and CAI athletes. Significant differences were found between groups regarding the BFS score (p = 0.007), d = 1.404), and significant correlations were also found between hallux flexion strength and lesser toes flexion strength in the total sample. Although there were no differences between the two groups, the identification of the activation pattern of these muscles in handball athletes is essential to the improvement of performance and preventing injuries such as CAI.

Sport-related injuries in Iranian basketball players: evidence from a retrospective epidemiologic study (2019-20)

OBJECTIVES

Basketball is a contact sport with complex movements that include jumps, turns, and changes in direction, which cause frequent musculoskeletal injuries in all regions of the body. Also, injury patterns among athletes, particularly basketball players, continue to evolve and change. The current retrospective epidemiologic study aimed to investigate the incidence, severity, and sports-related risk factors of injuries in Iranian basketball players from 2019 to 2020.

METHODS

Using the Information Retrospective Injury Questionnaire (online version), data on basketball-related injuries were collected retrospectively for 204 basketball players of the Iranian league (professional super league and first-division league) during the 2019/2020 season.

RESULTS

A total of 628 injuries were reported, which was equivalent to 6.07 injuries/1000 h. The ankle was the location of most injuries (n = 116 or 26.9%; overuse injuries (n = 40 or 20.3%)), followed by lower back/pelvis injuries (acute injury n = 67 (15.5%) and overuse injuries (n = 23; 11.6%)), knee injuries (acute injury n = 62 (15.7%) and overuse injuries (n = 31 (14.3%)), wrist/fingers injuries (acute injury (n = 85 (13.4%)) and overuse injuries (n = 8; 4.0%)), and shin/calf injuries (acute injury (n = 35; 8.1%) and overuse injuries (n = 28; 14.2%)). Mean time loss in first-division league players was much higher than professional super league players (7.84/1000 h exposure vs. 4.30/1000 h exposure), respectively.

CONCLUSION

The ankle sprain was the most common injury in our study. Lower back/pelvis injuries had the longest time loss. Injury was more frequent among first-division league players than those in the professional super league. Injuries during practice were notably more frequent than during competition with different patterns of injuries.

Relationship of Vertical Jump Performance and Ankle Joint Range of Motion: Effect of Knee Joint Angle and Handedness in Young Adult Handball Players

The purpose of the study is to examine the effect of the ankle joint range of motion (ROM) on the vertical jump (VJ) performance of adult handball players. The active (ACT) and passive (PAS) ankle joint ROM of 12 male members of the U21 National Handball Team with the knee joint at 0°, 40°, and 90° flexion (0° = fully extended knee) was evaluated using a video analysis measuring method. Participants also performed maximum VJ with (CMJ) and without (SQJ) countermovement, as well as with (AS) and without (NAS) an arm swing. Statistical analyses included 2 × 2 × 3 MANOVA, 2 × 2 repeated measures ANOVA, and Pearson’s correlation. Results reveal that PAS-ROM was larger (p < 0.05) in all knee joint flexion angles. ROM was smaller (p < 0.05) by approximately 10° at 0° compared to 90° knee flexion. No lateral effects on ROM due to the handedness of the players were observed. AS and CM resulted in increased jump height (p < 0.05). Finally, ACT-ROM when the knee joint was flexed at 40° was highly correlated (r ≥ 0.66, p < 0.05) with VJ performance except for CMJ-AS. In conclusion, the differences in the bi-articular gastrocnemius muscle flexibility due to the alteration of the angular position of the examined joints affected the ability to generate impulse during the VJ tests.

Range of motion and muscle function on shoulder joints of young handball athletes

BACKGROUND

The detection of primary risk factors through the assessment of shoulder range of motion (ROM) and muscle function could prevent injuries in the initial stages of the handball (HB) practice.

OBJECTIVE

To compare shoulder ROM, muscle strength and muscle extensibility between throwing and non-throwing shoulders in young HB athletes and between non-HB athletes.

METHODS

A cross-sectional study was designed. Participants aged between 14-16 years that practice physical activity regularly were included and divided in two groups. The HB group included volunteers who practiced HB, the control group included volunteers who practiced other activities. The variables measured were internal rotation and external rotation ROM, maximum isometric strength, and extensibility of the tissues of the posterior part of the throwing and non-throwing shoulder.

RESULTS

Thirty-seven subjects were included. The HB group (n= 19) showed greater ROM in both shoulders compared to the control group (n= 18) (p< 0.05). The throwing shoulder of the HB group showed less internal rotation ROM, greater external rotation ROM and greater internal rotation strength when compared to the non-throwing shoulder (p< 0.05).

CONCLUSIONS

The results of the study suggest that young HB athletes present differences in shoulder ROM compared to non-HB athletes. Also, HB athletes showed differences in ROM and strength between the TS and non-TS. Hence, the assessment of the shoulder ROM and muscle function should be taken into consideration to avoid injuries in this population.

Hip Abductor Muscle Strength Deficit as a Risk Factor for Inversion Ankle Sprain in Male College Soccer Players: A Prospective Cohort Study

Background:

Previous studies have attempted to determine whether certain risk factors can predict the occurrence of inversion ankle sprains in male collegiate soccer players. However, no consensus has been reached on the predictive risk factors of inversion ankle sprain in this population.

Purpose:

To identify risk factors for inversion ankle sprains among male collegiate soccer players.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

Included were 145 male collegiate soccer players in Japan who were assessed during a preseason medical checkup for potential risk factors of inversion ankle sprain. The preseason assessment included anthropometric measurements, joint laxity and flexibility, muscle flexibility, muscle strength, and balance ability, with a total of 33 variables. The participants were monitored during the 2019 season for inversion ankle sprains as diagnosed by physicians.

Results:

A total of 31 inversion ankle sprains in 31 players (21.4%) occurred during the season. Only the measured isometric hip abductor strength was significantly lower in injured players as compared with uninjured players. Logistic regression analysis revealed measured hip abductor muscle strength deficit as a significant risk factor for inversion ankle sprain (odds ratio, 0.978 [95% CI, 0.976-0.999]; P = .05).

Conclusion:

Hip abductor strength deficit was a risk factor for inversion ankle sprain in the study population. This finding could be useful for the prevention of inversion ankle sprains in male collegiate soccer players.

Influence of Size and Maturity on Injury in Young Elite Soccer Players

The involvement of pre-adolescents in soccer is becoming more and more frequent, and this growing participation generates some concerns about the potential factors for sports injuries. The purpose of this study was to investigate sports injuries in younger (U9–U11) and older (U12–U13) children playing soccer at an elite level, analyzing potential anthropometric and maturity risk factors. A total of 88 elite soccer players aged 9–13 years were investigated. Weight, stature, and sitting height were measured at the start and at the end of the competitive season, computing the relative growth velocities. Additional body composition parameters were taken during a second survey. Maturity offset was calculated using predictive equations based on anthropometric traits such as years from age at peak height velocity (YPHV). Injuries suffered during the competitive season were recorded. Maturity and some anthropometric characteristics were significantly different according to the presence or absence of injuries among the players. Multiple logistic regression revealed that YPHV, body mass index (BMI), and calf muscle area were the factors most significantly correlated with injuries. Players with increased BMI, with decreased calf muscle area, and who were closer to their peak height velocity, were at a higher risk of injury. Findings showed that a monitoring program of anthropometric characteristics taking into account the maturational stage needs to be developed to prevent injuries.

Determinants of lower-extremity injury severity and recovery in U.S. High School Soccer Players

Lower-extremity injuries are common among soccer players, yet few studies have attempted to identify determinants of lower-extremity injury severity and recovery within this group. We aim to identify determinants of lower-extremity injury severity and recovery among high school (HS) soccer players in the US. We used soccer-related injury observations recorded within the NATION-SP during 2011/12-2013/14. Odds of a season-ending game-related injury were higher than a season-ending practice-related injury (Adj. OR = 2.64, 95% CI = [1.39, 5.01]). Gender, setting, and playing surface emerged as significant determinants of any time loss following lower-extremity injuries in multivariable logistic regression models, and multivariable random effects Poisson regression models also revealed significant differences in recovery durations across levels of these variables for "similarly severe" injuries. Findings suggest that gender, injury setting, playing surface contribute to injury corollaries differently. Similar multi-method approaches are needed to identify determinants of injury severity and recovery in this group.

Proximal Interphalangeal Hyperextension Injuries in Children: The Development of a Clinical Decision Guide

OBJECTIVE

To develop a clinical decision guide for the diagnosis and treatment of hyperextension injuries of long fingers.

STUDY DESIGN

Consecutive patients age <16 years (n = 300) with an acute proximal interphalangeal (PIP) joint hyperextension injury were included. High-risk and low-risk measures for severe injury were established with a standardized clinical examination and anteroposterior and lateral radiographs of the injured finger. Four clinical variables were assessed: location of pain; swelling and bruising, stability, and mobility. Pathological radiographic findings were compiled, and the risk of late complications was analyzed. The predictive value of the clinical examination in the identification of low-risk injuries was assessed.

RESULTS

The majority (67%) of children consulting for a hyperextension finger trauma did not have a fracture. No child with a low-risk clinical examination had a subsequent high-risk diagnosis (eg, relevant intra-articular fracture, dislocation). Among 64 clinical high-risk diagnoses only 12 significant fractures were found.

CONCLUSION

Treatment decisions after PIP hyperextension injuries can be based on a clinical examination using a standardized evaluation protocol. Application of the clinical decision guide presented here has a sensitivity of 100% to rule out a significant injury. Present results showed that the majority of radiographs currently performed are avoidable. Once the decision rule is validated, its clinical application will improve patient care, reduce waiting times in emergency departments, avoid unnecessary radiation exposure, and possibly reduce costs.

Epidemiology of injuries in elite Korean handball athletes: a prospective cohort study

BACKGROUND

To report injury patterns associated with training activities of South Korean elite handball athletes.

METHODS

We prospectively collected data (stratified by sex, handball position, and injury location) on site from elite handball athletes between January and December 2019 at the Korea Training Center, South Korea. We used χ2 tests and one-way analysis of variance to compare groups. Simple linear regression was conducted to determine associations between pain score and recovery time.

RESULTS

We included 188 (96 male and 92 female) athletes who sustained 767 injuries (annual average, 4.08 injuries/athlete) during the study. Female athletes had a higher (p<0.001) injury incidence rate (6.21/1000 h) than male athletes (4.39/1000 h). Most injuries occurred in the lower extremities (50.2%). The injured body areas differed by handball position (p<0.001), and injury severity differed according to sex (p<0.001), with injuries in men typically resulting in a longer recovery time. Pain score and recovery time differed (both p<0.001) depending on the injured tissue type. Pain score was the highest and recovery time longest for ligament injuries; muscle injuries resulted in a high pain score but a relatively short recovery time. An increase in pain score of 1 was associated with an increase in recovery time of approximately 1.59 days.

CONCLUSIONS

We believe that our data increase the understanding of the types and severity of injuries sustained by elite Korean handball athletes. These data should be incorporated into programs that aim to reduce the incidence of sports injuries and enhance athletic performance.

Warm-Ups and Coaches' Perceptions: Searching for Clues to Improve Injury Prevention in Youth Basketball

Introduction: Regular use of neuromuscular training (NMT) warm-up programs improves performance and prevents injuries. However, low level of adoption of these programs remains a problem. Understanding the current warm-ups in youth basketball and coaches' perceptions on injury prevention can guide the design of superior implementation strategies. This study describes warm-ups in youth basketball and coaches' injury prevention-related knowledge, attitudes, beliefs, and information sources.

Methods: Youth basketball coaches (n = 50) completed a preseason questionnaire. The questionnaire covered warm-up length, use of aerobic/agility/balance/strength/other exercises in the warm-up, injury-related knowledge, attitudes, beliefs, and sources of information.

Results: Typical warm-up duration was ≤ 10 min (48.0% of coaches, 95% CI: ±13.8%). All coaches included aerobic exercises in their warm-up. Agility, strength, and balance exercises were utilized by 80.0% (95% CI: ±11.7%), 70.7% (95% CI: ±13.6%), and 26.8% (95% CI: ±13.6%) of coaches, respectively. Most coaches agreed to some extent that basketball injuries are preventable (94%) and that participating in a NMT warm-up program would reduce player's risk of injury (92%). Other coaches were identified as the most common source of information on warm-ups and injury prevention.

Discussion: Coaches use parts of effective NMT warm-up programs, but balance exercises are not well adopted. Considering the level of evidence supporting the importance of balance exercises in injury prevention, it is crucial to improve the implementation of NMT warm-up programs in youth basketball, for example, through educational courses. As fellow coaches were identified as the most important source of information, coaches' role in knowledge translation should be emphasized.

Epidemiology of injuries in female and male senior Slovenian handball leagues

BACKGROUND

Handball is associated with a high frequency of injuries due to unexpected situations, external disturbances of movement and extreme positions of body segments. The purpose of this study was to identify and analyze injuries among female and male players from all five senior Slovenian handball leagues in the season 2010/2011.

METHODS

We conducted a retrospective epidemiological study using a questionnaire. Data were collected between February and May 2012. Descriptive analysis is provided.

RESULTS

Forty-five percent of all the players were injured, reporting 92 injuries. 0.58 injuries/player occurred, 57 (62%) in females and 35 (38%) in males. Injury incidence in females (27.7 injuries/1000 hours match, 0.97 injuries/1000 hours training) was higher than in men (10.6 injuries/1000 hours match, 0.5 injuries/1000 hours training), respectively. The left- and right-back players were injured most often (41%). Sprain was the most common injury type (55%). Most injuries were severe (29%). The lower limb was injured most frequently (62%). Ankle was injured the most commonly (35%), but ankle injuries were in most cases moderate (38%). More than 70% of knee injuries and 50% of shoulder injuries were severe. In 33%, cause of injury was contact with an opponent/teammate. Thirty-six percent of players reported shoulder and 36% ankle overuse syndromes.

CONCLUSIONS

Present findings showed a higher incidence of injuries in female than in male senior Slovenian handball players in the 2010/2011 season. Preventive programs should focus not only on the acute ankle and knee injuries, but also on overuse syndromes of the shoulder and ankle.

Identification of Ankle Injury Risk Factors in Professional Soccer Players Through a Preseason Functional Assessment

Background

Etiologically, the risk of an ankle injury depends on extrinsic and intrinsic factors, such as muscle strength asymmetry, decreased flexibility, and decreased proprioception, as well as patient age and history of injuries.

Purpose/Hypothesis

The purpose of this study was to identify risk factors present in the preseason assessment that may predispose professional soccer players to ankle injuries. We hypothesized that analysis of these parameters could relate the incidence of injuries to the deficits found during the preseason period, enabling the identification of risk factors to predict the occurrence of injuries.

Study Design

Cohort study; Level of evidence, 2.

Methods

A total of 89 professional soccer athletes were evaluated in the preseason period; the evaluation included athlete history and anthropometric data collection, an isokinetic ankle evaluation, and functional tests: the Dorsiflexion Lunge Test and Y-Balance Test (YBT). The athletes were monitored during the competitive period, and the incidence of injuries was surveyed. The association of quantitative variables and injury outcomes was analyzed using the Student t test for independent samples, with P < .05. For the association of categorical variables and injury outcomes, the chi-square test was performed, with P < .05.

Results

A higher incidence of ankle injuries was associated with lower YBT scores in the dominant (P = .04) and nondominant (P = .01) limbs. A higher body mass index was also associated with a higher injury occurrence (P = .01).

Conclusion

Functional tests, such as the YBT, are indicated tools for assessing the physical capacities and possible risks of ankle sprains, as they can evaluate the ankle functional capacity in a complex way, identifying athletes more prone to ankle injuries. Athletes' body mass index should also be taken into account to prevent such injuries.

Weight, BMI and stability are risk factors associated with lateral ankle sprains and chronic ankle instability: a meta-analysis

IMPORTANCE

Lateral ankle sprains (LAS) are common in the general population and may lead to chronic ankle instability (CAI). If patients at risk could be identified, they could receive adequate and on-time treatment.

OBJECTIVE

The purpose of the current review was to identify all reported intrinsic factors associated with sustaining a LAS or progressing to CAI after an initial sprain.

EVIDENCE REVIEW

PubMed, Embase, MEDline, Cochrane and PEDro were searched for studies published until July 2019. Articles were selected if they included intrinsic factors related to LAS or CAI, subjects of at least 16 years old, and contained a minimum of 10 patients and 10 controls. Studies were excluded if they concerned reviews or case reports, included patients with previous surgical interventions, concomitant injuries or joint pathology other than ankle instability. Quality of included studies was assessed using the Quality in Prognostic Studies tool and quality of evidence was assessed using the GRADEpro tool. In case outcomes were described by at least three studies, data were pooled and assessed by performing a meta-analysis. Based on the pooled data, either a fixed-effects model or random-effects model was selected to correct for the degree of heterogeneity.

FINDINGS

The search resulted in a total of 4154 studies. After title and abstract screening and subsequent full-text screening, 80 relevant studies were included. Results of the meta-analyses indicated that, compared with healthy controls, patients with LAS had a higher mean body mass index (BMI). In patients with CAI, a higher weight and a longer time to stabilise after performing a task (eg, jumping) were found compared with healthy controls. Other outcomes could not be compared using a meta-analysis due to heterogeneity in outcome measurement and the great number of different outcomes reported. Identification of the risk factors when patients present themselves after a LAS may help to determine which patients are at risk of recurrent sprains or developing CAI.

CONCLUSIONS AND RELEVANCE

Based on the findings in this review, a higher BMI, and a higher weight and neuromuscular stability deficits may be regarded risk factors for sustaining a LAS or developing CAI, respectively.

LEVEL OF EVIDENCE

III.

Epidemiology of Secondary School Boys' and Girls' Basketball Injuries: National Athletic Treatment, Injury and Outcomes Network

CONTEXT

Little is known about non-time-loss (NTL) injury patterns in basketball athletes. Knowledge of these patterns may aid in the development of prevention and management strategies for patients with these injuries.

OBJECTIVE

To describe the epidemiology of time-loss (TL) and NTL injuries sustained by secondary school boys' and girls' basketball athletes.

DESIGN

Descriptive epidemiology study.

SETTING

Eighty-six unique schools provided data, with 84 and 83 contributing to boys' and girls' basketball, respectively.

PATIENTS OR OTHER PARTICIPANTS

Athletes participating in secondary school-sponsored boys' and girls' basketball.

MAIN OUTCOME MEASURE(S)

Boys' and girls' basketball data from the National Athletic Treatment, Injury and Outcomes Network (NATION) injury-surveillance program (2011-2012 through 2013-2014 years) were analyzed. Injury counts, rates, and rate ratios (IRRs) were reported with 95% confidence intervals (CIs).

RESULTS

The NATION captured 2653 injuries over 364 355 athlete-exposures (AEs) for boys' basketball and 2394 injuries over 288 286 AE for girls' basketball, producing rates of 7.28/1000 AEs (95% CI = 7.00, 7.56) for boys and 8.30/1000 AEs (95% CI = 7.97, 8.64) for girls. The overall injury rates were slightly lower for boys (IRR = 0.88; 95% CI = 0.83, 0.93). For boys, 559 (21.1%) injuries were TL and 2094 (78.9%) were NTL, producing a TL injury rate of 1.53/1000 AEs (95% CI = 1.40, 1.66) and an NTL injury rate of 5.75/1000 AEs (95% CI = 5.50, 5.99). For girls, 499 (20.8%) injuries were TL and 1895 (79.2%) were NTL, producing a TL injury rate of 1.73/1000 AEs (95% CI = 1.58, 1.88) and an NTL injury rate of 6.57/1000 AEs (95% CI = 6.28, 6.87). Rates of TL injuries were similar between boys' and girls' basketball (IRR = 0.89; 95% CI = 0.79, 1.00); NTL injury rates were lower for boys (IRR = 0.87; 95% CI = 0.82, 0.93).

CONCLUSIONS

When NTL injuries were included, the rates of injury in boys' and girls' secondary school basketball were higher than previously reported.

Injury Pattern in Icelandic Elite Male Handball Players

OBJECTIVE

To examine the incidence, type, location, and severity of injuries in Icelandic elite male handball players and compare across factors like physical characteristics and playing position.

DESIGN

Prospective cohort study.

SETTING

The latter part of the preseason and the competitive season of Icelandic male handball.

PARTICIPANTS

Eleven handball teams (185 players) from the 2 highest divisions in Iceland participated in the study. Six teams (109 players) completed the study.

VARIABLES MEASURED

Injuries were recorded by the players under supervision from their team physiotherapists or coaches. Coaches recorded training exposure, and match exposure was obtained from the Icelandic and European Handball Federations. The players directly recorded potential risk factors, such as age, height, weight, previous injuries, and player position.

MAIN OUTCOME MEASURES

Injury incidence and injury location and number of injury days.

RESULTS

Recorded time-loss injuries were 86, of which 53 (62%) were acute and 33 (38%) were due to overuse. The incidence of acute injuries was 15.0 injuries/1000 hours during games and 1.1 injuries/1000 hours during training sessions. No significant difference was found in injury incidence between teams, but number of injury days did differ between teams (P = 0.0006). Acute injuries were most common in knees (26%), ankles (19%), and feet/toes (17%), but overuse injuries occurred in low back/pelvic region (39%), shoulders (21%), and knees (21%). Previous knee injuries were the only potential risk factor found for knee injury.

CONCLUSIONS

The results indicate a higher rate of overuse injuries in low back/pelvic region and shoulders than in comparable studies.

Injury incidence and injury patterns by category, player position, and maturation in elite male handball elite players

The aim of this cohort study is to estimate the influence of position, category, and maturity status on the incidence and pattern of injury in handball players, across two seasons. Injury registration from 164 players-season (12-27 years) was conducted, and players were categorized into youth (133) and adults (31), and per position: 27 goalkeepers, 67 backs, 70 wings and pivots. Maturity status in youth players was also measured by testicular volume on clinical examination (32 immature, 101 mature). 190 injuries occurred during 34 221 hours of exposure. Injury incidence in youth was 6.0 per 1000 total hours [CI 95%, 4.8-7.2] (14.9 match [9.7-20.1] and 3.7 training hours [2.7-4.6]; n= 142 injuries), and in adults 6.5 per 1000 total hours [4.4-8.6] (22.2 match [8.8-35.6] and 3.0 training hours [1.3-4.6]; n=48 injuries). There were significant differences in knee (P=0.01) and cartilage injury (P=0.05) according to playing position. There were significant differences according to age category in ankle (P=0.03), head (P=0.01), thigh (P=0.05) and muscular injury (P= 0.02), and apophysitis (P=0.04) for biological maturity state. Adult handball players had more ankle and muscle injuries than youths. Pivot and wings (2^nd line) had more knee and cartilage problems. A higher incidence of apophysitis was found in immature youth players.

The 'Sequence of Prevention' for musculoskeletal injuries among recreational basketballers: a systematic review of the scientific literature

OBJECTIVE

Currently, there is no overview of the incidence and (basketball-specific) risk factors of musculoskeletal injuries among recreational basketball players, nor any insight into the effect of preventive measures on the incidence of basketball injuries. This study aimed to gather systematically the scientific evidence on the incidence, prevalence, aetiology and preventive measures for musculoskeletal injuries among recreational basketball players.

METHODS

Highly sensitive search strategies were built based on three groups of keywords (and related search terms). Two electronic databases were searched, namely Medline (biomedical literature) via Pubmed, and SPORTDiscus (sports and sports medicine literature) via EBSCOhost.

RESULTS

The incidence of musculoskeletal injuries among recreational basketball players ranged from 0.0047 injuries per 1,000 athlete-exposures (AE) for dental injuries to 10.1 injuries per 1000 AE for overall injuries during match play. Significant risk factors for injuries were defending, postural sway, high vertical ground reaction force during jumping and weight >75 kg. All prevention studies have shown to have a significant effect on reducing the risk of injury ranging from an odds ratio (95% confidence interval (CI)) of 0.175 (0.049-0.626) for training injuries and a relative risk (95% CI) of 0.83 (0.57-1.19) achieved with FIFA 11+ prevention exercises and sport-specific balance training, relatively.

CONCLUSION

In order to gain insight in the aetiology of basketball-specific injuries and consequently facilitate the development of preventive strategies, more high quality basketball-specific and injury-specific studies among recreational basketball players are needed.

Comparative Evaluation Between Anatomic and Nonanatomic Lateral Ligament Reconstruction Techniques in the Ankle Joint: A Computational Study

Biomechanical studies have indicated that the conventional nonanatomic reconstruction techniques for lateral ankle sprain (LAS) tend to restrict subtalar joint motion compared to intact ankle joints. Excessive restriction in subtalar motion may lead to chronic pain, functional difficulties, and development of osteoarthritis (OA). Therefore, various anatomic surgical techniques to reconstruct both the anterior talofibular and calcaneofibular ligaments (CaFL) have been introduced. In this study, ankle joint stability was evaluated using multibody computational ankle joint model to assess two new anatomic reconstruction and three popular nonanatomic reconstruction techniques. An LAS injury, three popular nonanatomic reconstruction models (Watson-Jones, Evans, and Chrisman–Snook) and two common types of anatomic reconstruction models were developed based on the intact ankle model. The stability of ankle in both talocrural and subtalar joint were evaluated under anterior drawer test (150 N anterior force), inversion test (3 N·m inversion moment), internal rotational test (3 N·m internal rotation moment), and the combined loading test (9 N·m inversion and internal moment as well as 1800 N compressive force). Our overall results show that the two anatomic reconstruction techniques were superior to the nonanatomic reconstruction techniques in stabilizing both talocrural and subtalar joints. Restricted subtalar joint motion, which is mainly observed in Watson-Jones and Chrisman–Snook techniques, was not shown in the anatomical reconstructions. Evans technique was beneficial for subtalar joint as it does not restrict subtalar motion, though Evans technique was insufficient for restoring talocrural joint inversion. The anatomical reconstruction techniques best recovered ankle stability.

Fractures in German elite male soccer players

BACKGROUND

Aim of this retrospective cohort study was to identify fracture epidemiology and off times after different types of fractures in German male elite soccer players from the first division Bundesliga based on information from the public media.

METHODS

Exposure and fracture data over 7.5 consecutive seasons (2009/10 until the first half of 2016/17) were collected from two media-based register (transfermarkt.de® and kicker.de®).

RESULTS

Overall, 357 fractures from 290 different players were recorded with an incidence of 0.19/1000 hours of exposure (95% CI: 0.14-0.24). Most fractures in German elite soccer players involved the lower extremities (35.3%), the head/face (30.3%) and the upper extremities (24.9%). The median off time after a fracture in German elite male professional soccer in 7.5 Season was 51.1 days (range 0-144). The number of fractures per 100 players per season decreased between 2009 and 2016. There was no significant difference in overall fracture incidence when comparing players at different position (P=0.11). Goalkeepers have a significantly (P<0.02) higher likelihood of suffering hand and finger fractures and they are significantly (P<0.03) less prone of suffering foot fractures, cranial and maxillofacial fractures (P<0.04). compared to outfield players.

CONCLUSIONS

This study can confirm that male professional soccer teams experience 1-2 fractures per season in German elite soccer. The incidence of fractures in elite German soccer players decreased between 2009 and 2016. The most fractures occur in the lower extremities and there is no difference in overall fracture risk for players at different playing positions. The information from our study might be of a great importance to medical practitioners, soccer coaches and soccer manager.

Does Intensive Soccer Playing During the Growth Period Lead to Leg Length Discrepancies?

Leg length discrepancies (LLD) are a common reason for podiatry consultations and can affect up to 90% of the overall population. Furthermore, it is widely recognized that intensive participation in certain sports can alter bone development. The aim of this study is to explore any possible relation between playing soccer and the appearance or evolution of LLD, by means of a retrospective study based on the analysis of case reports of patients followed for foot or plantar troubles. Case reports were selected in the archives of a podiatric clinic for the period between 2002 and 2016 among patients who declared regular to intensive soccer playing, aged 13 years or more. LLD was detected in the vast majority of cases (95 cases out of 104). Pearson correlation coefficients were computed and revealed a strong correlation between the laterality of the kicking limb and that of the shorter leg. The shorter limb was on the side of the kicking leg in 96% of the cases when considering the players who began practice before the age of 13, and only 53% of the cases for others. Intensive soccer playing at a young age may encourage the appearance and evolution of a real LLD.

High ankle injury rate in adolescent basketball: A 3-year prospective follow-up study

This prospective study investigated the incidence and pattern of acute time-loss injuries in young female and male basketball players. Eight basketball teams (n=201; mean age 14.85±1.5) participated in the follow-up study (2011-2014). The coaches recorded player participation in practices and games on a team diary. A study physician contacted the teams once a week to check new injuries and interviewed the injured players. In total, 158 injuries occurred. The overall rate of injury (per 1000 hours) was 2.64 (95% CI 2.23-3.05). Injury rate was 34.47 (95% CI 26.59-42.34) in basketball games and 1.51 (95% CI 1.19-1.82) in team practices. Incidence rate ratio (IRR) between game and practice was 22.87 (95% CI 16.71-31.29). Seventy-eight percent of the injuries affected the lower limbs. The ankle (48%) and knee (15%) were the most commonly injured body sites. The majority of injuries involved joint or ligaments (67%). Twenty-three percent of the injuries were severe causing more than 28 days absence from sports. Number of recurrent injuries was high (28% of all injuries), and most of them were ankle sprains (35 of 44, 79%). No significant differences were found in injury rates between females and males during games (IRR 0.88, 0.55, to 1.40) and practices (IRR 1.06, 0.69, to 1.62). In conclusion, ankle and knee ligament injuries were the most common injuries in this study. Moreover, the rate of recurrent ankle sprains was alarming.

Risk Factors for Noncontact Ankle Injuries in Amateur Male Soccer Players: A Prospective Cohort Study

OBJECTIVE

To determine whether nonmodifiable and modifiable risk factors [ankle dorsiflexion range of motion (ROM), lower limb power output, and balance], as identified in preseason screening, predict the risk of sustaining a noncontact ankle injury in amateur male soccer players during the training and competitive season.

DESIGN

Prospective cohort study.

SETTING

Amateur soccer competition (club and area representative teams).

PARTICIPANTS

Amateur soccer players (n = 210) aged ≥15 years.

ASSESSMENT OF RISK FACTORS (INDEPENDENT VARIABLES)

Height, weight, ankle dorsiflexion ROM, power (vertical jump) and balance (time of double-leg balanced stance on an electronic wobble board, maximum 20 seconds) measured in preseason screening.

MAIN OUTCOME MEASURES (DEPENDENT VARIABLE)

Incidence of noncontact ankle injury and exposure to both training and games, monitored during the competitive season following baseline measurement. Noncontact ankle injury was defined as any ankle injury not caused by a collision (with another player or object) resulting in a participant missing at least 1 game or training session.

RESULTS

Fourteen of the 210 participants (6.7%) sustained a noncontact ankle injury yielding an injury rate of 0.484 injuries per 1000 player hours. Lower limb power output scores <30 W/kg [odds ratio (OR), 9.20, 95% confidence interval (CI), 1.13-75.09, P = 0.038] and poorer balance scores (OR, 0.43, 95% CI, 0.21-0.89, P = 0.024) were associated with higher odds of injury.

CONCLUSIONS

Poorer lower limb power output and balance are risk factors for noncontact ankle injury among amateur soccer players. These deficits can potentially be identified by screening, providing opportunities to investigate prevention strategies.

Quality of functional movement patterns and injury examination in elite-level male professional football players

The purpose of this study is to examine the quality of functional movement patterns among one of Hungary's first league soccer clubs, where the elite male football players (N = 20) utilize the well-established Functional Movement Screen™ (FMS) system; a comprehensive functional program designed to determine and identify the quality of movement and the greatest risk factors for non-contact injuries. Furthermore, an additional purpose of this program is to examine injuries over the course of 6 competitive months. Focusing on the mechanisms of injuries and their causes in the lower extremities during this period is one of the key objectives. Over the course of 6 months we found significant differences between ankle injuries and the FMS Hurdle Step exercise (p < 0.05), and the FMS Deep Squat exercise and knee and hip injuries (p < 0.05). The FMS pre-screening system found lower limb asymmetry present in 40% of the participants. The authors believe that the importance of preventative measures and structural sport specific pre-screening cannot be overemphasized, and that there is a growing need for further transparent research in this field in order to be more effective with regard to programs dedicated to injury prevention and the enhancement players' physical performance.

Epidemiology of injury in male adolescent Gaelic games

OBJECTIVES

There is a lack of epidemiological research in adolescent Gaelic games, with previous research primarily focusing on elite adult males. This study aimed to prospectively capture the epidemiology of injury in male adolescent Gaelic games over one year.

DESIGN

Prospective cohort study.

METHODS

Two hundred and ninety two (15.7±0.8 years) male adolescent Gaelic footballers and hurlers took part in a one year prospective epidemiological study. Injuries were assessed weekly by a certified Athletic Rehabilitation Therapist and an injury was defined as any injury sustained during training or competition resulting in restricted performance or time lost from play. An injury report form was utilised to standardise injury information.

RESULTS

Match injuries were more frequent in Gaelic footballers (9.26 per 1000h) and hurlers (11.11 per 1000h) than training injuries (2.69 and 3.01 per 1000h, respectively). Over a quarter of injuries in adolescent Gaelic footballers (26.7%) and hurlers (26.5%) were overuse in nature. Recurrent injuries were also frequent, particularly in adolescent Gaelic footballers (47.3%). Lower limb injuries predominated (football 74.7%, hurling 58%), particularly in the knee (18.7%, 20.0%) and ankle (12.0%, 10.0%). Hamstring injuries were more frequent in footballers (13.3%), with lower back injuries more common in hurlers (22.0%). Minor injuries were common in hurling (61.7%), with moderate (20.8%) and severe (37.5%) injuries predominant in Gaelic football.

CONCLUSIONS

Injuries are frequent in adolescent Gaelic games and this study sets the scene for the establishment of injury prevention strategies for this at risk population.

The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies

BACKGROUND

Ankle sprain is one of the most common musculoskeletal injuries, yet a contemporary review and meta-analysis of prospective epidemiological studies investigating ankle sprain does not exist.

OBJECTIVE

Our aim is to provide an up-to-date account of the incidence rate and prevalence period of ankle sprain injury unlimited by timeframe or context activity.

METHODS

We conducted a systematic review and meta-analyses of English articles using relevant computerised databases. Search terms included Medical Search Headings for the ankle joint, injury and epidemiology. The following inclusion criteria were used: the study must report epidemiology findings of injuries sustained in an observed sample; the study must report ankle sprain injury with either incidence rate or prevalence period among the surveyed sample, or provide sufficient data from which these figures could be calculated; the study design must be prospective. Independent extraction of articles was performed by two authors using pre-determined data fields.

RESULTS

One-hundred and eighty-one prospective epidemiology studies from 144 separate papers were included. The average rating of all the included studies was 6.67/11, based on an adapted version of the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) guidelines for rating observational studies. 116 studies were considered high quality and 65 were considered low quality. The main findings of the meta-analysis demonstrated a higher incidence of ankle sprain in females compared with males (13.6 vs 6.94 per 1,000 exposures), in children compared with adolescents (2.85 vs 1.94 per 1,000 exposures) and adolescents compared with adults (1.94 vs 0.72 per 1,000 exposures). The sport category with the highest incidence of ankle sprain was indoor/court sports, with a cumulative incidence rate of 7 per 1,000 exposures or 1.37 per 1,000 athlete exposures and 4.9 per 1,000 h. Low-quality studies tended to underestimate the incidence of ankle sprain when compared with high-quality studies (0.54 vs 11.55 per 1,000 exposures). Ankle sprain prevalence period estimates were similar across sub-groups. Lateral ankle sprain was the most commonly observed type of ankle sprain.

CONCLUSIONS

Females were at a higher risk of sustaining an ankle sprain compared with males and children compared with adolescents and adults, with indoor and court sports the highest risk activity. Studies at a greater risk of bias were more likely to underestimate the risk of ankle sprain. Participants were at a significantly higher risk of sustaining a lateral ankle sprain compared with syndesmotic and medial ankle sprains.

Football injuries in children and adolescent players: are there clues for prevention?

Football (soccer) is the world's most popular sport with most players being younger than 18 years. Playing football can induce beneficial health effects, but there is also a high risk of injury. Therefore, it is necessary to implement measures for preventing injuries. The present review analyzes and summarizes published scientific information on the incidence and characteristics of football injuries in children and adolescent players to arrive at sound conclusions and valid considerations for the development of injury-prevention programs. A literature search was conducted up to November 2012. Fifty-three relevant scientific publications were detected. Thirty-two studies fulfilled the inclusion criteria for pooled analysis. Additional information from the remaining 21 studies was considered where appropriate to obtain a broader perspective on the injury problem in children and youth football. Training injury incidence was nearly constant for players aged 13-19 years, ranging from 1 to 5 injuries per 1,000 h training. Match injury incidence tended to increase with age through all age groups, with an average incidence of about 15 to 20 injuries per 1,000 match hours in players older than 15 years. Between 60 and 90 % of all football injuries were classified as traumatic and about 10-40 % were overuse injuries. Most injuries (60-90 %) were located at the lower extremities with the ankle, knee, and thigh being mostly affected. The frequency of upper-extremity and head/face injuries was higher in those studies that analyzed match injuries only. The most common injury types were strains, sprains, and contusions (10 up to 40 % each). There is some evidence that the risk of traumatic injuries and, in particular, of sustaining a fracture, contusion, or concussion was higher during match play than in practice sessions. Fractures were more frequent in children younger than 15 years than in older players. About half of all time-loss injuries led to an absence from sport of less than 1 week, one third resulted in an absence between 1 and 4 weeks, and 10 to 15 % of all injuries were severe. Separate data for players under the age of 11 years are almost absent. Maturation status seems to have an influence on injury characteristics, although evidence is not conclusive at this time. Three main areas seem to be of particular relevance for future prevention research in young football players: (1) the substantial number of severe contact injuries during matches, (2) the high number of fractures in younger players, and (3) the influence of maturation status and growth spurts.

Jump landing characteristics in elite soccer players with cerebral palsy

The aim of the present study was to analyse the parameters that characterize the vertical ground reaction force during the landing phase of a jump, and to determine the relationship among these parameters in elite soccer players with cerebral palsy (CP). Thirteen male members of the Spanish national soccer team for people with CP (mean age: 27.1 ± 4.7 years) volunteered for the study. Each participant performed three counter movement jumps. The characteristics of the first peak of the vertical ground reaction force during the landing phase of a jump, which corresponds to the forefoot contact with the ground, were similar to the results obtained in previous studies. However, a higher magnitude of rearfoot contact with the ground (F2) was observed in participants with CP than in participants without CP. Furthermore, a significant correlation between F2 magnitude and the elapsed time until its production (T2) was not observed (r = -0.474 for p = 0.102). This result implies that a landing technique based on a delay in the production of F2 might not be effective to reduce its magnitude, contrary to what has been observed in participants without CP. The absence of a significant correlation between these two parameters in the present study, and the high magnitude of F2, suggest that elite soccer players with CP should use footwear with proper cushioning characteristics.

Incidence and prevention of traumatic injuries in paediatric handball players in Istanbul, Turkey

AIM

To investigate the frequency of dental injuries in paediatric handball players. In addition, the players' habits with regard to mouthguard usage, as well as their general knowledge of the prevention of traumatic dental injuries (TDIs) were investigated. Data were collected by structured one-to-one interviews with children of 14 randomly selected handball teams in the amateur national league.

METHODS

The questionnaire consisted of 15 questions. The age, gender, trauma experience and league status of each interviewee was recorded. The interviews took place mainly at national championships or tournaments.

RESULTS

A total of 212 individuals, 74 girls and 138 boys, were interviewed. Forty-one of the 212 participants (19.3 %) had sustained a dental injury. The mean age of participants was 12 ± 1.6 years. Concussion was the most frequent finding and the cause of injury was a blow from another player. The number of individuals that were aware of mouthguards was only 15.6 % and surprisingly no players used mouthguards.

CONCLUSIONS

The results show that handball players need more knowledge and education considering the prevention of TDIs from their sports clubs and dentists. The importance of adequate facial protection in contact sports should be endorsed by all sports clubs, and parents advised accordingly.

Sports injuries among professional male athletes in Kuwait: prevalence and associated factors

OBJECTIVES

To assess a 12-month period and the lifetime prevalence of sports injuries among male athletes according to type of sport, type of injury and its seriousness, and to examine the association of injuries with sociodemographic, lifestyle and preventive factors.

SUBJECTS AND METHODS

In this cross-sectional study, we approached 475 professional athletes participating in ball sports, aged 15 years and older, from 5 sports clubs in Kuwait. Of them, 452 responded. Four ball games--football (soccer), basketball, handball and volleyball--were included. Data were collected through a self-administered questionnaire. Bivariate and multivariate relationships between associated factors and experience of injury were tested by using χ(2) and logistic regression.

RESULTS

The overall 12-month and lifetime prevalence of sports injuries were 73.8 and 89.8%, respectively. Prevalence was highest among volleyball athletes (79%) and lowest among football (soccer) athletes (69%). Lower limbs (73.1%) were the most common site of injuries and joint injuries (43.6%) were the most common type. For the most recent injury, 138 (42%) of athletes took more than 10 days off practice. Compared to volleyball, football (soccer) and handball athletes were 2.9 times (95% CI: 1.3-6.3) and 3.4 times (95% CI: 1.5-7.8) more likely to take more than 10 days off practice. Athletes who sometimes wore protective gears were 3.1 times (95% CI: 1.7-5.8) more likely to report an injury compared with those who never wore protective gears (p < 0.001).

CONCLUSIONS

Sports injuries are highly prevalent among professional athletes in Kuwait. Future studies are needed to provide guidelines for interventions that may reduce such injuries.

Epidemiology of player--player contact injuries among US high school athletes, 2005-2009

OBJECTIVE

To investigate the epidemiology of player-player contact injuries in a nationally representative sample of US high school student-athletes.

METHODS

Data from the National High School Sports-Related Injury Surveillance Study were analyzed to calculate rates, describe patterns, and evaluate potential risk factors for player-player contact injuries.

RESULTS

Player-player contact injuries represented 46.4% of all high school sports injuries and occurred at a rate of 11.6 per 10,000 athlete exposures (AEs). Player-player contact injury rates (per 10 000 AEs) were highest in football (26.0), wrestling (10.8), and girls' soccer (9.8). Body sites most commonly injured were the ankle/foot (21.9%), head/face (18.9%), and knee (16.9%). Most common diagnoses were ligament sprains (32.5%).

CONCLUSIONS

Player-player contact is the most common mechanism of injury among high school athletes. The epidemiology of such injuries varies by gender and sport. Developing effective preventive measures depends on increasing our knowledge of player-player contact injury rates, patterns, and risk factors.

Basketball-related injuries in school-aged children and adolescents in 1997-2007

OBJECTIVE

The objective was to determine national patterns of basketball-related injuries treated in emergency departments in the United States among children and adolescents <20 years of age.

METHODS

A retrospective analysis was conducted with data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission, from 1997 to 2007. Sample weights provided by the Consumer Product Safety Commission were used to calculate national estimates of basketball-related injuries. Trend significance of the numbers and rates of basketball-related injuries over time was analyzed by using linear regression.

RESULTS

An estimated 4 128 852 pediatric basketball-related injuries were treated in emergency departments. Although the total number of injuries decreased during the study period, the number of traumatic brain injuries (TBIs) increased by 70%. The most common injury was a strain or sprain to the lower extremities (30.3%), especially the ankle (23.8%). Boys were more likely to sustain lacerations and fractures or dislocations. Girls were more likely to sustain TBIs and to injure the knee. Older children (15-19 years of age) were 3 times more likely to injure the lower extremities. Younger children (5-10 years of age) were more likely to injure the upper extremities and to sustain TBIs and fractures or dislocations.

CONCLUSIONS

Although the total number of basketball-related injuries decreased during the 11-year study period, the large number of injuries in this popular sport is cause for concern.

Low risk of injuries among children playing organized soccer: a prospective cohort study

BACKGROUND

The injury rate in soccer is high, and studies have shown that the injury rate among players aged 16 years or older approaches that of adult players. However, little is known about the injury risk among the youngest players, that is, players between 6 and 12 years.

PURPOSE

To examine the risk of injuries in children 6 to 16 years old playing organized soccer.

STUDY DESIGN

Descriptive epidemiological study.

METHODS

Injuries were recorded prospectively throughout 1 season among 121 soccer teams (1879 players, aged 6-16 years) from 2 communities in the southeastern part of Norway.

RESULTS

A total of 159 players sustained 200 injuries, corresponding to an overall injury incidence of 2.2 per 1000 playing hours (95% confidence interval, 1.8-2.6) among boys and 2.0 injuries per 1000 hours (95% confidence interval, 1.4-2.5) among girls. The overall injury incidence was significantly higher (relative risk, 1.7; 95% confidence interval, 1.3-2.2) among older players (13-16 years; 2.6 injuries per 1000 hours, 95% confidence interval, 2.2-3.0) than among younger players (6-12 years; 1.6 injuries per 1000 hours, 95% confidence interval, 1.2-1.9). The injuries recorded in the youngest group were few and mainly mild.

CONCLUSION

The injury risk among young players (6-12 years) playing organized 5- or 7-a-side soccer is low, lower than that of adolescents and much lower than at the elite level. Soccer is a safe sport for children.

Foot and ankle injuries during the Athens 2004 Olympic Games

Background

Major, rare and complex incidents can occur at any mass-gathering sporting event and team medical staff should be appropriately prepared for these. One such event, the Athens Olympic Games in 2004, presented a significant sporting and medical challenge. This study concerns an epidemiological analysis of foot and ankle injuries during the Games.

Methods

An observational, epidemiological survey was used to analyse injuries in all sport tournaments (men's and women's) over the period of the Games.

Results

A total of 624 injuries (525 soft tissue injuries and 99 bony injuries) were reported. The most frequent diagnoses were contusions, sprains, fractures, dislocations and lacerations. Significantly more injuries in male (58%) versus female athletes (42%) were recorded. The incidence, diagnosis and cause of injuries differed substantially between the team sports.

Conclusion

Our experience from the Athens Olympic Games will inform the development of public health surveillance systems for future Olympic Games, as well as other similar mass events.

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

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

Injury risk from popular childhood physical activities: results from an Australian primary school cohort

BACKGROUND

Children engage in various physical activities that pose different injury risks. However, the lack of adequate data on exposure has meant that these risks have not been quantified or compared in young children aged 5-12 years.

OBJECTIVES

To measure exposure to popular activities among Australian primary school children and to quantify the associated injury risks.

METHOD

The Childhood Injury Prevention Study prospectively followed up a cohort of randomly selected Australian primary and preschool children aged 5-12 years. Time (min) engaged in various physical activities was measured using a parent-completed 7-day diary. All injuries over 12 months were reported to the study. All data on exposure and injuries were coded using the International classification of external causes of injury. Injury rates per 1000 h of exposure were calculated for the most popular activities.

RESULTS

Complete diaries and data on injuries were available for 744 children. Over 12 months, 314 injuries relating to physical activity outside of school were reported. The highest injury risks per exposure time occurred for tackle-style football (2.18/1000 h), wheeled activities (1.72/1000 h) and tennis (1.19/1000 h). Overall, boys were injured more often than girls; however, the differences were non-significant or reversed for some activities including soccer, trampolining and team ball sports.

CONCLUSION

Although the overall injury rate was low in this prospective cohort, the safety of some popular childhood activities can be improved so that the benefits may be enjoyed with fewer negative consequences.

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

Injuries caused by sports and other forms of physical activity in young children constitute a significant public health burden. It is important to quantify this risk to ensure that the benefits of sport participation are not outweighed by the potential harms. This review summarises the literature reporting exposure-based injury rates for various forms of physical activity in children aged 15 years and younger. Forty eight studies were found, of which 27 reported injury rates per hourly based exposure measured and 21 reported injury rates according to some other measure. Fourteen different sports and activities were covered, mostly team ball sports, with soccer being the most widely studied. Injury definition and the method of ascertaining and measuring injuries differed between studies, which created a large variation in reported injury rates that did not necessarily represent actual differences in injury risk between activities. The highest hourly based injury rates were reported for ice hockey, and the lowest were for soccer, although the range of injury rates for both of these activities was wide. Very few studies have investigated sports-related injuries in children younger than 8 years or in unorganised sports situations.

Ankle sprain injuries: a 2-year prospective cohort study in female Greek professional basketball players

CONTEXT

Ankle sprains are a common basketball injury. Therefore, examination of risk factors for injury in female professional basketball players is worthwhile.

OBJECTIVE

To examine rates of ankle sprains, associated time missed from participation, and risk factors for injury during 2 consecutive seasons.

DESIGN

Prospective cohort study.

SETTING

Eighteen professional basketball facilities.

PATIENTS OR OTHER PARTICIPANTS

We observed 204 players from 18 female professional basketball teams for 2 consecutive seasons during a 2-year period.

MAIN OUTCOME MEASURE(S)

Using questionnaires, we recorded the incidence of ankle sprains, participation time missed, and mechanisms of injury in games and practice sessions. Potential risk factors, such as age, body mass, height, training experience, and history of ankle sprain, were examined using multivariate logistic regression.

RESULTS

Fifty of the 204 participants sustained ankle injuries; injuries included 32 ankle sprains, which translated to an ankle sprain rate of 1.12 per 1000 hours of exposure to injury. The 32 players missed 224.4 training and game sessions and an average of 7.01 sessions per injury. Most injuries occurred in the key area of the basketball court and were the result of contact. Injury rates during games were higher than injury rates during practice sessions. Centers, followed by guards and forwards, had the highest rate of injury. Players who did not wear an external ankle support had an odds ratio of 2.481 for sustaining an ankle sprain.

CONCLUSIONS

Female professional basketball athletes who did not wear an external ankle support, who played in the key area, or who functioned as centers had a higher risk for ankle sprain than did other players.

Prospective epidemiological study of basketball injuries during one competitive season: ankle sprains and overuse knee injuries

This prospective cohort study aims to assess the overall incidence of acute and overuse basketball injuries and identifies risk factors associated with ankle sprains and knee overuse injuries. In total, 164 senior players (23.7 years ± 7.0) of all levels of play, and including both men and women, participated voluntarily during one season. A total of 139 acute and 87 overuse injuries were reported, resulting in an overall injury incidence of 9.8 (8.5 to 11.1) per 1,000 hours. The incidence of acute injuries was 6.0/1,000 hours. Ankle sprains (n = 34) accounted for most acute injuries, and 52.9% of all players with ankle sprains reported a previous ankle sprain. Relative Risks (RR) and Odds Ratio (OR) with their 95% Confidence Intervals (CI) were calculated to determine significant differences. Landing on an opponent's foot was the major inciting event, significantly more so than non contact mechanisms (RR=2.1 [95% CI: 1.0-4.2]). Acute knee injuries resulted in the highest playing absence (7 weeks 2 days ± 9 weeks 1 day). Overuse injury incidence was 3.8/1,000 hours. The knee (1.5/1,000 hours) was the most common site. Forward players sustained less knee overuse injuries than players of all other playing positions, and significantly less than center players (OR=0.5 [95% CI: 0.2-0.9]). This study showed that ankle sprains and overuse knee injuries are the most common injuries in basketball, both accounting for 14.8%. Injury prevention programmes however should not concentrate on those injuries only, but might one to consider that acute knee injuries, in spite of the fact that they occur less frequently, also merit further research. Key pointsAnkle sprains are the most common acute injuries in basketball with the inciting event being landing on an opponent's foot or changing direction.Anterior knee pain is the most common overuse injury. Etiologic factors are well described in literature, but prevention strategies are lacking.Acute knee injuries account for the highest inactivity and should therefore also be prevented.Most of the injuries are due to contact mechanisms and therefore the definition of basketball as a non contact sport is questionable.Highest injury risks are found in women and in the lower levels.

Comparison of 3 preventive methods to reduce the recurrence of ankle inversion sprains in male soccer players

BACKGROUND

Ankle sprains are frequent injuries in soccer. Several strategies can be used to prevent further ankle sprains in athletes: the most common are proprioceptive training, strength training, and orthoses.

OBJECTIVE

To investigate which of these 3 interventions is the most effective in preventing ankle sprains in athletes with previous ankle inversion sprain.

STUDY DESIGN

Randomized controlled trial; Level of evidence, 1.

METHODS AND MEASURES

Eighty male soccer players (age, 24.6 +/- 2.63 years; height, 175.60 +/- 4.36 cm; weight, 64.26 +/- 8.37 kg) in the first division of a men's league who had experienced previous ankle inversion sprain were randomly selected from an original population of 120 players. The subjects were individually and randomly assigned to 4 study groups: group 1 (n = 20) followed the proprioceptive program, group 2 (n = 20) followed the strength program, group 3 (n = 20) used orthoses, and group 4 (n = 20) was the control group. Data on the frequency of ankle sprain reinjury were collected at the end of the session.

RESULTS

There were no significant differences among the groups in the number of exposures. The incidence of ankle sprains in players in the proprioception training group was significantly lower than in the control group (relative risk of injury, 0.13; 95% confidence interval, 0.003-0.93; P = .02). The findings with respect to the strength and orthotic groups in comparison with the control group were not significant (relative risk of injury, 0.5; 95% confidence interval, 0.11-1.87; P = .27 for strength; relative risk of injury, 0.25; 95% confidence interval, 0.03-1.25; P = .06 for orthotic group).

CONCLUSION

Proprioceptive training, compared with no intervention, was an effective strategy to reduce the rate of ankle sprains among male soccer players who suffered ankle sprain.

A systematic review on ankle injury and ankle sprain in sports

This article systematically reviews epidemiological studies on sports injury from 1977 to 2005 in which ankle injury was included. A total of 227 studies reporting injury pattern in 70 sports from 38 countries were included. A total of 201,600 patients were included, with 32,509 ankle injuries. Ankle injury information was available from 14,098 patients, with 11 847 ankle sprains. Results show that the ankle was the most common injured body site in 24 of 70 included sports, especially in aeroball, wall climbing, indoor volleyball, mountaineering, netball and field events in track and field. Ankle sprain was the major ankle injury in 33 of 43 sports, especially in Australian football, field hockey, handball, orienteering, scooter and squash. In sports injuries throughout the countries studied, the ankle was the second most common injured body site after the knee, and ankle sprain was the most common type of ankle injury. The incidence of ankle injury and ankle sprain was high in court games and team sports, such as rugby, soccer, volleyball, handball and basketball. This systematic review provides a summary of the epidemiology of ankle injury in sports.

Ankle sprain injuries and risk factors in amateur soccer players during a 2-year period

BACKGROUND

Although ankle sprains are common in soccer, the role of various risk factors in amateur soccer players is unclear.

PURPOSE

To identify the incidence of ankle sprain injuries, associated time loss of participation, and risk factors during two consecutive seasons in amateur players.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

Of 336 athletes enrolled in the study, 312 male amateur soccer players were observed during a 2-year period. Ankle sprain injury incidents, participation time loss, injury mechanisms, ankle region injured, and other risk factors were recorded in games and practice sessions using questionnaires.

RESULTS

During the study 208 ankle injuries were recorded, of which 139 were ankle sprains. These led to 975 sessions lost (on average, 7 lost sessions per injury). Most incidents (80.6%) were contact injuries, occurring mostly in defenders. Injury rates were equal between games and practice, while 61.1% of injuries were observed toward the end of each half of the game (P < .05). The injury incidence rate was higher during the first 2 months of the season as opposed to the last month (P < .05). Multinomial logistic regression showed that previous ankle sprain (P < .05) is a significant predictor of ankle sprain injury.

CONCLUSION

Ankle sprain injuries in amateur soccer players are primarily contact injuries, occurring mainly in defenders and during both games and practice. It appears that more injuries occur in players with previous ankle injury. Injury rates are higher toward the end of a game and chiefly occur during the first 2 months of the season.