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Hetaimish B, Ahmed H, Otayn A, Alzahrani AM, Almasoudi E, Elaiw M, Alzwaihri AS, Samargandi R. Prevalence, and types of overuse injuries in gym centers: A cross-sectional study in Saudi Arabia. Medicine (Baltimore) 2024; 103:e38830. [PMID: 38996100 PMCID: PMC11245209 DOI: 10.1097/md.0000000000038830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/14/2024] [Indexed: 07/14/2024] Open
Abstract
Physical activity has numerous health benefits, enhancing overall wellbeing. However, it can also lead to injuries, impeding exercise capacity and hindering work. Limited knowledge exists about the prevalence of overuse gym injuries and whether they vary across different gym activities. This study aims to estimate sport injuries at fitness centers in Saudi Arabia, comparing injuries between various activities and session durations. This is a cross-sectional, questionnaire-based study surveyed regular gym-goers in Saudi Arabia with overuse injuries. The online survey, distributed through social media apps, collected data using a validated Google form questionnaire. Questioanire consists of 3 parts. First part of the questionnaire included demographic characteristics of participants. Second part contains characteristics related to gym as gym session's duration, frequency of attending gym per week, sport types, type of injuries and site of injuries. Third part contains Oslo Sports Trauma Research Centre (OSTRC) Overuse injury questionnaire that included 4 questions about difficulties in participation, reduction of training, affection of performance and symptoms. Study included 1012 participants, majority male (76.2%), with age range of 18 to 50 years, and significant proportion falling between 26 and 30 years (52.6%). Majority of participants were from Central Province (42.9%). Gym sessions typically lasted 1 to 2 hours (68.3%), and most common attendance frequency was 4 days/week (39.6%). Common injury sites were shoulder (25.2%), knee (20.2%), and lower back (17.7%). Bodybuilding (50.6%), running (45.8%), and weightlifting/powerlifting (45.1%) were predominant sports. Strain/muscle rupture/tear (35.70%) and muscle cramps/spasm (19.3%) were commonest injury types. Longer gym sessions (>2 hours) were associated with higher prevalence of strain/muscle rupture/tear, dislocation, and subluxation (P < .001). Shorter sessions (<1 hour) had higher prevalence of muscle cramps/spasm and contusion/hematoma/bruise (P < .001). Gym sessions lasting 1 to 2 hours had high prevalence in tendinosis/tendinopathy. Strain/muscle rupture/tear was significantly higher in bodybuilding, weightlifting/powerlifting, swimming, cycling, and running. Tendinosis/tendinopathy was higher in crossfit. (OSTRC) Overuse injury questionnaire revealed decreased participation, training volume, performance, and increased pain with longer gym sessions. In conclusion, gym-related injuries are common, with bodybuilding and running being prevalent activities. Preventative measures should be taken, and individuals are advised to undergo a physical and medical examination before engaging in physical activity at fitness centers.
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Affiliation(s)
- Bandar Hetaimish
- Department of Orthopedic Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Hassan Ahmed
- Pediatric Department, King Salman Medical City-Maternity and Children, Medina, Saudi Arabia
| | - Abdullah Otayn
- Emergency Department, Alhasa Health Cluster, Alhasa, Saudi Arabia
| | | | - Eid Almasoudi
- College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Mohammed Elaiw
- College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | | | - Ramy Samargandi
- Department of Orthopedic Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
- Orthopedic Surgery Department, Centre Hospitalier Régional Universitaire (CHRU) de Tours, Tours, France
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Martin C, Lieb A, Tokish J, Shanely E, Kluzek S, Collins G, Bullock G. Initial versus Subsequent Injury and Illness and Temporal Trends Among Professional Hockey Players. Int J Sports Phys Ther 2024; 19:215-226. [PMID: 38313661 PMCID: PMC10837818 DOI: 10.26603/001c.92309] [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: 06/27/2023] [Accepted: 01/06/2024] [Indexed: 02/06/2024] Open
Abstract
Background Research is limited investigating injuries/illness incidence among National Hockey League (NHL) players. This study sought to establish injury/illness incidence, initial versus subsequent injury risk among NHL players, and determine temporal trends of injury and illness incidence. Hypothesis Variations in injury incidence by body region, and initial versus subsequent injury would be observed among positions. Study Design Retrospective cohort study. Methods Publicly available data were utilized. NHL players 18 years or older between 2007-2008 to 2018-2019 were included. Injury and illness was stratified by position and body segment. Incidence rate (IR), and initial versus subsequent injury and illness risk ratios were calculated. Temporal trends were reported. Results Nine thousand, seven-hundred and thirty four injuries and illnesses were recorded. Centers had the highest overall IR at 15.14 per 1000 athlete game exposures (AGEs) (95%CI:15.12-15.15) and were 1.4 times more likely to sustain a subsequent injury compared to other positions. The groin/hip/thigh was the most commonly injured body region with an IR of 1.14 per 1000 AGEs (95%CI:1.06-1.21), followed by the head/neck (0.72 per 1000 AGEs, 95%CI:0.66-0.78). Combined injury and illness IR peaked in 2009-2010 season at 12.01 (95%CI: 11.22-12.79). The groin/hip/thigh demonstrated peak incidence during the 2007-2008 season (2.53, 95%CI:2.17-2.90); head/neck demonstrated a peak incidence in 2010-2011 season (Overall: 1.03, 95%CI:0.81-1.26). Injuries reported as 'lower body' increased over time. Conclusions Positional differences were observed; centers demonstrated the highest overall IR, and subsequent injury risk. Injury by body region was similar to previous literature. Head/neck and concussion decreased over time supporting rule changes in body checking and visor wear. Clinicians should be aware that 'lower body' injuries increased over time; therefore, injuries to the groin/hip/thigh or knee are likely underreported. Level of Evidence Level 3.
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Affiliation(s)
- Chelsea Martin
- Epidemiology University of North Carolina at Chapel Hill
| | | | | | | | - Stefan Kluzek
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis University of Oxford
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences University of Oxford
- University of Nottingham
| | - Gary Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences University of Oxford
- Oxford University Hospitals NHS Trust
| | - Garrett Bullock
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis University of Oxford
- School of Medicine, Department of Orthopaedic Surgery Wake Forest University
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Stathas I, Kalliakmanis A, Kekelekis A, Danassi Afentaki D, Tsepis E, Fousekis K. Effectiveness of an On-Field Rehabilitation framework for return to sports in injured male professional football players: a single-blinded, prospective, randomised controlled trial. BMJ Open Sport Exerc Med 2024; 10:e001849. [PMID: 38268525 PMCID: PMC10806762 DOI: 10.1136/bmjsem-2023-001849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 01/26/2024] Open
Abstract
Objectives In football, on-field rehabilitation (OFR) is critical during injury recovery for a player's safe return to sports (RTS). The study aimed to evaluate the effectiveness of an OFR framework for RTS in injured male professional football players. Trial design A prospective block-randomised controlled-parallel trial was conducted (level of evidence 1b). Methods Male professional football players (mean age, 26.3±3.6 years) from Greece diagnosed with an acute, lower limb musculoskeletal (MSK) injury (confirmed clinically and through imaging) participated in the study. During rehabilitation, the participants' OFR was guided by either the On-Field Rehabilitation (On FI.RE.) accelerated framework (experimental group) or a traditional OFR framework for a late injury recovery phase (comparison group). Between July 2021 and January 2022, 76 players were randomly allocated to the experimental group (n=38) and the comparison group (n=38). Participants were blinded during the study regarding intervention therapeutic protocols. The primary outcome measure was the effect of On FI.RE. framework on the time needed to return to team training (RTT) participation. The correlation between the time needed to return to on-field activity and RTT was calculated. Subsequent injuries were registered for a 12-month follow-up period. Results The intervention protocol, On FI.RE. framework, had a statistically significant effect on the time needed to RTT (F(1) = 49 626, p<0.001) with a large effect size (ES; η2=0.422) and fewer days (mean=23.8±9.1 days) needed than the comparison group (mean=30.3±9.8 days). There was a strong correlation between return to on-field activity and the time needed to RTT (r(76) = 0.901, p<0001) with a large ES (r>0.5). Six subsequent injuries were registered in the traditional OFR framework group, and one subsequent injury in the On FI.RE. framework group after a follow-up period of 12 months. Conclusion The On FI.RE., an accelerated OFR framework during injury recovery, is more effective than a traditional OFR framework, reducing the time a player needs to RTS. It entails a very low risk of reinjury. Trial registration number NCT05163470.
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Affiliation(s)
- Ioannis Stathas
- Physiotherapy Department, School of Health Rehabilitation Sciences, University of Patras, Patra, Greece
- Head of Physiotherapy and rehabilitation department, OFI Crete FC, Herakleion, Crete, Greece
| | | | - Afxentios Kekelekis
- Laboratory of Neuromechanics, School of Physical Education and Sport Science at Serres, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Elias Tsepis
- Physiotherapy Dept School of Health Rehabilitation Sciences, University of Patras, Patra, Greece
| | - Konstantinos Fousekis
- Physiotherapy Department Therapeutic exercise and Sports Rehabilitation exercise laboratory, University of Patras, Patra, Greece
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Aiello F, McCall A, Brown SJ, Serner A, Fortington LV, Huurman SAE, Lewin C, Nagao M, O'Brien J, Panossian A, Pruna R, Ramos GP, Whalan M, Impellizzeri FM. Development of a Standardised System to Classify Injury-Inciting Circumstances in Football: the Football Injury Inciting Circumstances Classification System (FIICCS). Sports Med 2023; 53:1805-1818. [PMID: 37233947 PMCID: PMC10432371 DOI: 10.1007/s40279-023-01857-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND A comprehensive examination of the sport-specific activities and circumstances being performed at the time of injury is important to hypothesise mechanisms, develop prevention strategies and inform future investigations. Results reported in the literature are inconsistent because inciting activities are reported using different classifications. Hence the aim was to develop a standardised system for the reporting of inciting circumstances. METHODS The system was developed using a modified Nominal Group Technique. The initial panel included 12 sports practitioners and researchers from four continents with respectively ≥ 5 years of experience working in professional football and/or conducting injury research. The process consisted of six phases: idea generation, two surveys, one online meeting and two confirmations. For answers to the closed questions, consensus was deemed achieved if ≥ 70% of respondents agreed. Open-ended answers were qualitatively analysed and then introduced in subsequent phases. RESULTS Ten panellists completed the study. The risk of attrition bias was low. The developed system includes a comprehensive range of inciting circumstances across five domains: contact type, ball situation, physical activity, session details, contextual information. The system also distinguishes between a core set (essential reporting) and an optional set. The panel deemed all the domains to be important and easy to use both in football and in research environments. CONCLUSION A system to classify inciting circumstances in football was developed. Given the extent of reporting inconsistency of inciting circumstances in the available literature, this can be used while further studies evaluate its reliability.
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Affiliation(s)
- Francesco Aiello
- Arsenal Performance and Research Team, Arsenal Football Club, London, UK
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Alan McCall
- Arsenal Performance and Research Team, Arsenal Football Club, London, UK.
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK.
| | - Susan J Brown
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Andreas Serner
- FIFA Medical, Fédération Internationale de Football Association, Zurich, Switzerland
| | - Lauren V Fortington
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Suzanne Afra Elisabeth Huurman
- Medical Department Real Madrid CF, Madrid, Spain
- Sports Medicine Department, St Antonius Hospital, Utrecht, The Netherlands
| | - Colin Lewin
- The Lewin Sports Injury Clinic, East London, UK
| | - Masashi Nagao
- Medical Technology Innovation Center, Juntendo University, Bunkyo-ku, Tokyo, Japan
- Department of Orthopaedic Surgery, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Sports Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - James O'Brien
- Red Bull Athlete Performance Center, Salzburg, Austria
| | | | | | - Guilherme Passos Ramos
- Brazilian Football Confederation (CBF), Rio de Janeiro, RJ, Brazil
- Endocrinology and Metabolism Laboratory, Department of Physiology and Biophysics, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Matthew Whalan
- Centre of Medical and Exercise Physiology, School of Medicine, University of Wollongong, Wollongong, NSW, Australia
- Football Australia, Sydney, Australia
| | - Franco M Impellizzeri
- Faculty of Health, Sport and Exercise Discipline Group, University of Technology Sydney, Sydney, Australia
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Merrick N, Hart NH, Mosler AB, Allen G, Murphy MC. Injury Profiles of Police Recruits Undergoing Basic Physical Training: A Prospective Cohort Study. JOURNAL OF OCCUPATIONAL REHABILITATION 2023; 33:170-178. [PMID: 35917080 PMCID: PMC10025230 DOI: 10.1007/s10926-022-10059-2] [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: 07/08/2022] [Indexed: 06/15/2023]
Abstract
Purpose A lack of published epidemiological data among police recruits presents a major challenge when designing appropriate prevention programs to reduce injury burden. We aimed to report the injury epidemiology of Western Australian (WA) Police Force recruits and examine sex and age as injury risk factors. Methods Retrospective analyses were conducted of prospectively collected injury data from WA Police Force recruits between 2018-2021. Injury was defined as 'time-loss' and injury incidence rate per 1000 training days (Poisson exact 95% confidence intervals) was calculated. For each region and type of injury, the incidence, severity, and burden were calculated. The association between age, sex, and injury occurrence were assessed using Cox regression time-to-event analysis. Results A total of 1316 WA Police Force recruits were included, of whom 264 recruits sustained 304 injuries. Injury prevalence was 20.1% and the incidence rate was 2.00 (95%CI 1.78-2.24) injuries per 1000 training days. Lower limb injuries accounted for most of the injury burden. Ligament/ joint injuries had the highest injury tissue/pathology burden. The most common activity injuring recruits was physical training (31.8% of all injuries). Older age (Hazard Ratio = 1.5, 95%CI = 1.2 to 1.9, p = 0.002) and female sex (Hazard Ratio = 1.4, 95%CI = 1.3 to 1.6, p < 0.001) increased risk of injury. Conclusion Prevention programs targeting muscle/tendon and ligament/joint injuries to the lower limb and shoulder should be prioritised to reduce the WA Police Force injury burden. Injury prevention programs should also prioritise recruits who are over 30 years of age or of female sex, given they are a higher risk population.
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Affiliation(s)
- Nicole Merrick
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Nicolas H Hart
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, SA, Australia
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Andrea B Mosler
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Garth Allen
- Western Australian Police Academy, Western Australian Police Force, Joondalup, Western Australia, Australia
| | - Myles C Murphy
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.
- School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.
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High revision arthroscopy rate after ACL reconstruction in men's professional team sports. Knee Surg Sports Traumatol Arthrosc 2023; 31:142-151. [PMID: 35976389 DOI: 10.1007/s00167-022-07105-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/03/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE The study analysed unique data on anterior cruciate ligament (ACL) injuries among German professional male team sports over five consecutive seasons with the aim of improving medical outcomes in the future. Sport-specific differences in injury occurrence, concomitant injuries, timing of ACL reconstruction, graft type selection and short-term complications were examined. METHODS This retrospective study analysed trauma insurance data on all complete ACL tears from players with at least one competitive match appearance in the two highest divisions of German male basketball, ice hockey, football and handball. Each complete ACL tear registered by clubs or physicians between the 2014/15 and 2018/19 seasons with the German statutory accidental insurance for professional athletes (VBG) as part of occupational accident reporting was included. RESULTS In total, 189 out of 7517 players (2.5%) sustained an ACL injury, mainly in handball (n = 82; 43.4%) and football (n = 72; 38.1%) followed by ice hockey (n = 20; 10.6%) and basketball (n = 15; 7.9%).Seventeen players (9.0%) also sustained a second ACL injury. Thus, 206 ACL injuries were included in the analysis. The overall match incidence of ACL injuries was 0.5 per 1000 h and was highest in handballs (1.1 injuries per 1000 h). A total of 70.4% of ACL injuries involved concomitant injury to other knee structures, and 29.6% were isolated ACL injuries. The highest rate of isolated ACL injuries was seen in ice hockey (42.9%). All ACL injuries, except for one career-ending injury, required surgery. In the four analysed team sports, hamstring tendons (71.4%) were the most commonly used grafts for ACL reconstruction; football had the highest percentage of alternative grafts (48.7%). During rehabilitation, 22.9% of all surgically treated ACL injuries (n = 205) required at least two surgical interventions, and 15.6% required revision arthroscopy. The main cause of revision arthroscopy (n = 32; 50.0%) was range-of-motion deficit due to arthrofibrosis or cyclops formation. CONCLUSION The present study shows an overall high rate of revision arthroscopy after ACLR (15.6%), which should encourage surgeons and therapists to evaluate their treatment and rehabilitation strategies in this specific subpopulation. Hamstring tendon grafts are most commonly used for ACL reconstruction but have the highest revision and infection rates. Handball shows the highest ACL injury risk of the four evaluated professional team sports. Concomitant injuries occur in the majority of cases, with the highest share of isolated ACL injuries occurring in ice hockey. LEVEL OF EVIDENCE Level III.
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Gijon-Nogueron G, Ortega-Avila AB, Kaldau NC, Fahlstrom M, Felder H, Kerr S, King M, McCaig S, Marchena-Rodriguez A, Cabello-Manrique D. Data Collection Procedures and Injury Definitions in Badminton: A Consensus Statement According to the Delphi Approach. Clin J Sport Med 2022; 32:e444-e450. [PMID: 35588081 DOI: 10.1097/jsm.0000000000001048] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/12/2022] [Indexed: 02/04/2023]
Abstract
ABSTRACT Previous studies involving injury surveillance in badminton players have used nonstandardized injury definitions and data collection methodologies. The purpose of this study was to apply a Delphi method to (1) reach a consensus on an injury definition in badminton and (2) develop a standardized badminton injury report form. An Injury Consensus Group was established under the auspices of the Badminton World Federation, and initial injury definitions and injury report form were developed. An internal panel was formed from the Injury Consensus Group, and an external panel was selected based on a combination of profession, experience in the field, sport-specific knowledge/expertise, and geographical location to obtain a widely representative sample. Through 2 rounds of voting by the external panel, consensus was reached on both the definition of an injury in badminton and a standardized injury report form. The agreed injury definition was "Any physical injury sustained by a player during a match or training regardless if further diagnostic tests were done or if playing time was lost" and the injury report form contained the following 7 sections: Injury record, Diagnosis, Injury mechanism, Regarding pain, Pain and return to play/training after injury, Grade of severity, and Recurrence. We recommend the use of the definitions and methods presented in this consensus statement for the reporting of injury in all international and domestic badminton players. This should make future injury surveillance reports directly comparable and hence more informative in recognizing trends over time and differences between countries.
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Affiliation(s)
- Gabriel Gijon-Nogueron
- Department of Nursing and Podiatry, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Ana Belen Ortega-Avila
- Department of Nursing and Podiatry, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Niels Christian Kaldau
- Sports Orthopedic Research Center-Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager & Hvidovre Hospital, Hvidovre, Denmark
| | - Martin Fahlstrom
- Department of Clinical Science, Professional Development, Umeå University, Umeå, Sweden
| | - Hanno Felder
- Department of Biomechanics, Olympic Training Center, Saarbrücken, Germany
| | - Stewart Kerr
- Life Fit Wellness, Healthcare & Exercise Centre, Falkirk, Scotland, United Kingdom
| | - Mark King
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Steve McCaig
- English Institute of Sport, EIS/L'Boro Performance Centre, Loughborough University, Loughborough, United Kingdom
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Bullock GS, Thigpen CA, Noonan TK, Kissenberth MJ, Shanley E. Initial kinematic chain injuries increase hazard of subsequent arm injuries in professional baseball pitchers. J Shoulder Elbow Surg 2022; 31:1773-1781. [PMID: 35598837 DOI: 10.1016/j.jse.2022.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Currently, there are few studies that have evaluated the relationship between a lower extremity or trunk injury (kinematic chain) and subsequent arm injury. The purpose of this study was (1) to investigate the relationship between initial kinematic chain (lower extremity or trunk) injury and subsequent arm injury; and (2) to investigate the relationship between initial shoulder or elbow injury and subsequent arm injury. METHODS A 7-year prospective injury risk study was conducted with Minor League Baseball pitchers. Pitches, pitching appearances, athlete exposures (AEs), and arm injuries (≥1-day time loss) were documented throughout the season. Cox survival analyses with 95% confidence intervals (95% CIs) were performed. Confounders controlled for included age, body mass index, arm dominance, pitching role, previous arm injury, number of pitching appearances, and seasonal pitch load. RESULTS A total of 297 pitchers participated (total player days = 85,270). Arm injury incidence was 11.4 arm injuries/10,000 AEs, and kinematic chain incidence was 5.2 injuries/10,000 AEs. Pitchers who sustained a kinematic chain injury demonstrated a greater hazard (2.6 [95% CI: 1.2, 5.6], P = .019) of sustaining an arm injury. Pitchers who sustained an initial shoulder injury demonstrated a greater hazard (9.3 [95% CI: 1.1, 83], P = .047) of sustaining a subsequent shoulder or elbow injury compared with pitchers who sustained an initial elbow injury. CONCLUSIONS Pitchers who sustained an initial lower extremity or trunk injury demonstrated an increased subsequent arm injury hazard compared with pitchers who did not. Pitchers who sustained an initial shoulder injury demonstrated a greater hazard of sustaining a subsequent arm injury compared with pitchers who sustained an initial elbow injury. However, this secondary analysis should be interpreted with caution. Clinicians should monitor risk with workload accumulation, which may be related to pitching compensatory strategies in a fatigued state. Pitchers who sustain a shoulder injury should be evaluated and perform both shoulder and elbow rehabilitation strategies before return to sport.
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Affiliation(s)
- Garrett S Bullock
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford, Oxford, UK.
| | - Charles A Thigpen
- Department of Observational Clinical Research, ATI Physical Therapy, Greenville, SC, USA; University of South Carolina Center for Rehabilitation and Reconstruction Sciences, Greenville, SC, USA
| | - Thomas K Noonan
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Denver, CO, USA; Steadman Hawkins Clinic, University of Colorado Health, Englewood, CO, USA
| | | | - Ellen Shanley
- Department of Observational Clinical Research, ATI Physical Therapy, Greenville, SC, USA; University of South Carolina Center for Rehabilitation and Reconstruction Sciences, Greenville, SC, USA
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Subsequent Musculoskeletal Injury Incidence Are Similar Between General Infection and COVID-19 Among High School Athletes in the Unites States Despite Higher Illness Incidence During Academic Years 2019-2020 and 2020-2021. J Orthop Sports Phys Ther 2022; 52:546-553. [PMID: 35722758 DOI: 10.2519/jospt.2022.11200] [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: 02/07/2023]
Abstract
OBJECTIVES To describe overall illness and COVID-19- specific illness in high school athletes in the 2019-2020 and 2020-2021 academic school years, and to describe and assess the risk of musculoskeletal injury following general infection and after COVID-19. DESIGN Ecological study. METHODS High schools (6 states; 176 high schools) were matched between the 2019-2020 and 2020-2021 academic school years, based on 2020-2021 high school sport participation. Illness and injury data were collected from the high school athletic trainers. Illness was stratified by overall illness, general infection, and COVID-19. Injuries following moderate or severe infections or COVID-19 were recorded. Illness and injury incidence rate per 100 athletes per year, with 95% confidence intervals (95% CIs), were calculated. Negative binomial models comparing injury following general infections and COVID-19 infections were calculated. RESULTS A total of 98 487 and 72 521 athletes participated in the 2019-2020 and 2020-2021 years. Illness incidence rate was less in the 2019-2020 academic school year [0.30 (95% CI: 0.27, 0.34)] than the 2020-2021 academic school year [1.1 (1.0-1.2)], resulting in a difference of 0.8 (95% CI: 0.7, 0.9). COVID-19 incidence rate was 0.52 (0.47-0.58) in the 2020-2021 year. Injury following general infection incidence rate was 27.9 injuries (21.4-34.5) per 100 athletes in 2019-2020, and 22.5 injuries (19.3-25.7) per 100 athletes in 2020-2021. There was no difference in injury risk following general infection and COVID-19 [rate ratio: 1.2 (95% CI: 0.7, 2.4)]. CONCLUSIONS The incidence rate for all illnesses in high school athletes was slightly (0.8) greater in the 2020-2021 academic compared to the 2019-2020 year. Most of the incidence increase was due to infections and COVID-19. Subsequent injury incidence following moderate and severe infections were similar between years and between general infections and COVID-19. J Orthop Sports Phys Ther 2022;52(8):546-553. Epub: 19 June 2022. doi:10.2519/jospt.2022.11200.
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Kawaguchi K, Taketomi S, Mizutani Y, Inui H, Yamagami R, Kono K, Kage T, Takei S, Fujiwara S, Ogata T, Tanaka S. Dynamic Postural Stability Is Decreased During the Single-Leg Drop Landing Task in Male Collegiate Soccer Players With Chronic Ankle Instability. Orthop J Sports Med 2022; 10:23259671221107343. [PMID: 35912384 PMCID: PMC9326837 DOI: 10.1177/23259671221107343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 03/31/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Chronic ankle instability (CAI) is commonly encountered in soccer players. The feelings of instability and anxiety caused by CAI can lead to poor performance, such as difficulty in sharp change of direction during soccer play. The single-leg drop landing (SLDL) task is often used to evaluate dynamic postural stability. Purpose/Hypothesis: The purpose of this study was to clarify whether dynamic stability measured during SLDL is altered in male collegiate soccer players with CAI. The hypothesis was that athletes with CAI would show poor dynamic postural stability. Study Design: Controlled laboratory study. Methods: A total of 103 male collegiate soccer players were recruited, and their limbs were classified based on the new international CAI criteria. All players performed three 5-second SLDL trials on a force plate. The main outcome measures included time to stabilization of the horizontal ground-reaction force (GRF); peak GRF in the vertical, horizontal, and sagittal directions; and trajectory length of the center of pressure during SLDL. Results: Data from 59 CAI limbs and 147 non-CAI limbs were collected in this study. Time to stabilization of horizontal GRF was significantly longer in the CAI limbs (P < .001), and the peak GRFs in all directions were significantly lower in the CAI limbs (vertical, P < .001; horizontal, P < .001; sagittal, P = .001). Additionally, the trajectory length of the center of pressure was significantly greater in the CAI limbs (P = .004). Conclusion: Soccer players with CAI had decreased dynamic postural stability that led them to land softly when performing the SLDL task. Measurement of dynamic postural stability may be useful in the evaluation of CAI. Clinical Relevance: Our findings may be useful for strategies of daily training or as an evaluation tool.
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Affiliation(s)
- Kohei Kawaguchi
- The University of Tokyo Sports Science Institute, Tokyo, Japan.,Department of Orthopaedic Surgery Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shuji Taketomi
- The University of Tokyo Sports Science Institute, Tokyo, Japan.,Department of Orthopaedic Surgery Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuri Mizutani
- The University of Tokyo Sports Science Institute, Tokyo, Japan
| | - Hiroshi Inui
- Department of Orthopaedic Surgery Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryota Yamagami
- Department of Orthopaedic Surgery Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenichi Kono
- Department of Orthopaedic Surgery Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomofumi Kage
- Department of Orthopaedic Surgery Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Seira Takei
- Department of Orthopaedic Surgery Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sayaka Fujiwara
- Department of Rehabilitation Medicine, The University of Tokyo, Tokyo, Japan
| | - Toru Ogata
- Department of Rehabilitation Medicine, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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11
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Visentini PJ, McDowell AH, Pizzari T. Factors associated with overuse injury in cyclists: A systematic review. J Sci Med Sport 2021; 25:391-398. [DOI: 10.1016/j.jsams.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 12/05/2021] [Accepted: 12/21/2021] [Indexed: 10/19/2022]
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12
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Sheehy DJ, Toohey LA, Panagodage Perera NK, Drew MK. Despite maintaining a high daily training availability, a quarter of athletes start the season injured and three quarters experience injury in an Australian State Academy of Sport. J Sci Med Sport 2021; 25:139-145. [PMID: 34556402 DOI: 10.1016/j.jsams.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/03/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To 1) investigate the incidence, prevalence, burden and characteristics of injuries; and 2) explore the frequency of physiotherapy and medical servicing for elite sports academy athletes over a 12-month season. DESIGN Prospective cohort study. METHODS Medical attention and time-loss injuries were prospectively recorded by Physiotherapy and Medical (Sports Physician) staff for 94 athletes (72.3% females). The number of linked physiotherapy and medical servicing appointments was also recorded. Injury incidence rates (IIR), point and period prevalence, and injury burden were calculated and compared by athlete gender, sport, and categorisation (performance level) using incidence rate ratios (IRR). RESULTS The number of injuries reported was 193 in 71 (75.5%) athletes. The IIR was 2.1 (95%CI: 1.8 to 2.4) injuries per 365 days, with no gender difference observed (IRR: 1.1, 0.8 to 1.4). The injury burden was 43.5 (95%CI: 37.8 to 50.1) days absent per 365 days. More than one-quarter (point prevalence, 26.6%) of athletes commenced the season with an injury. In-season injury risk was 2.5 fold greater in athletes who started the season with an injury compared to athletes who started the season without an injury (IRR: 2.5, 1.9 to 3.4). The majority (81.2%) of the 1164 appointments recorded were physiotherapy, with an overall 4.3:1.0 physiotherapy to medical appointment ratio. CONCLUSIONS One in four athletes began the elite pathway season with a pre-existing injury, while also demonstrating a 2.5 fold greater risk of subsequent injury in the scholarship period. Sports should not assume their athletes are uninjured at the beginning of their scholarship. Injury profiles, and physiotherapy and medical servicing varied across sports. To reduce health as a barrier in the successful transition of talented young athletes to elite athletes, injury management strategies at the commencement of recruitment and throughout the scholarship should be prioritised in the development pathway.
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Affiliation(s)
- Daniel J Sheehy
- ACT Academy of Sport, Australia; Sports Medicine, Australian Institute of Sport, Australia.
| | - Liam A Toohey
- Athlete Availability Program, Australian Institute of Sport, Australia
| | | | - Michael K Drew
- Athlete Availability Program, Australian Institute of Sport, Australia
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13
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Clark NC, Campbell SD. Preseason weight-bearing ankle dorsiflexion in male professional football players with and without a history of severe ankle injury: A novel analysis in an English Premier League club. Phys Ther Sport 2021; 52:21-29. [PMID: 34365086 DOI: 10.1016/j.ptsp.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Ankle injuries are common in professional football and have profound player/team/club consequences. The weight-bearing lunge-test (WBLT) assesses ankle dorsiflexion range-of-motion in football primary/secondary injury prevention and performance contexts. Data for uninjured and previously ankle-injured players in the English Premier League (EPL) is not available. This study analysed WBLT measurements (cm) within and between uninjured and previously severe ankle-injured players (injured-stiff group, injured-lax group) in one EPL club. DESIGN Cross-sectional. SETTING Preseason. PARTICIPANTS Forty-nine players (age 22.9 ± 4.6 yr; height 181.6 ± 5.2 cm; mass 77.7 ± 7.6 kg). MAIN OUTCOME MEASURES Prevalence (%) of previous unilateral severe ankle injury (USAI). Side-to-side (right/left, dominant/nondominant, injured/uninjured) WBLT comparisons at group-level (t-test [within-group]; Welch's ANOVA [between-group]; effect sizes [within-/between-group]) and individual-level (limb symmetry index [%]; absolute-asymmetry [%]). RESULTS Prevalence of USAI was 38.7%. There were no statistically-significant side-to-side differences for within-/between-group comparisons. Effect sizes: just-below-large (injured-stiff) and extremely-large (injured-lax) for within-group injured-side/uninjured-side comparisons; just-below-medium (injured-lax) to just-above-medium (injured-stiff) for injured-side comparisons to uninjured players. Absolute-asymmetries: uninjured players, 15.4±13.2%; injured-stiff, 21.8±33.6%; injured-lax 20.4±13.6%. CONCLUSIONS Over one-third of players had previous USAI. Effect sizes indicate substantial within-group side-to-side differences and less substantial between-group differences. Across groups, some players had absolute-asymmetries that may elicit concern in ankle primary/secondary injury prevention and performance contexts.
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Affiliation(s)
- Nicholas C Clark
- School of Sport, Rehabilitation, and Exercise Sciences. University of Essex. Wivenhoe Park, Colchester, Essex, CO4 3SQ, UK.
| | - Stuart D Campbell
- Tottenham Hotspur Football Club. Hotspur Way, Enfield, Middlesex, EN2 9AP, UK.
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14
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Archbold P, Rankin AT, Webb M, Davies R, Nicholas R, Eames NWA, Wilson RK, Vincent J, McKeever D, Duddy K, Matthews M, Bleakley C. Injury patterns in U15 rugby players in Ulster schools: A Rugby Injury Surveillance (RISUS) Study. TRANSLATIONAL SPORTS MEDICINE 2021. [DOI: 10.1002/tsm2.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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15
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Beas-Jiménez JDD, Garrigosa AL, Cuevas PD, Riaza LM, Terés XP, Alonso JM, Recio MIÁ, Bolados CC. Translation Into Spanish and Proposal to Modify the Orchard Sports Injury Classification System (OSICS) Version 12. Orthop J Sports Med 2021; 9:2325967121993814. [PMID: 33954218 PMCID: PMC8044570 DOI: 10.1177/2325967121993814] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 02/02/2023] Open
Abstract
Purpose To publish the Spanish translation of Version 12 of the sports injury classification system called Orchard Sports Injury Classification System and propose a modification to include a numerical code that reflects the impact of the injury on sports functionality. Methods The members of the working group on the epidemiology of sports injury, of the Group for the Study of the Muscle-Tendon System (GESMUTE), and of the Spanish Society of Sports Traumatology (SETRADE), carried out a bibliographical review on the epidemiological classification systems of injuries, 3 face-to-face consensus meetings, and various online pieces of work, following the Delphi work methodology. Results The Spanish translation of Version 12 of the Orchard Sports Injury Classification System is fully accessible and free of charge at https://gesmute.es/traduccion-espanola-osics-12/. The current project proposes to add, at the end of the current coding system of Version 12, a numerical code (0: No Functional impairment; 1: Limits Sports Activity; 2: Prevents Sports Activity; 3: Limits Daily Life Activities), to indicate any functional repercussions caused by the injury. Conclusion We present the Spanish translation of Version 12 of the Orchard Sports Injury Classification System. We propose as an improvement the inclusion of functionality criteria in sports injury classifications; more specifically, our proposal could be an improvement to the Orchard Sports Injury Classification System Version 12.
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Affiliation(s)
| | | | | | | | - Xavier Peirau Terés
- National Institute of Physical Education of Catalonia (INEFC), Lleida, Spain
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16
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Wang C, Vargas JT, Stokes T, Steele R, Shrier I. Analyzing Activity and Injury: Lessons Learned from the Acute:Chronic Workload Ratio. Sports Med 2021; 50:1243-1254. [PMID: 32125672 DOI: 10.1007/s40279-020-01280-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Injuries occur when an athlete performs a greater amount of activity than what their body can withstand. To maximize the positive effects of training while avoiding injuries, athletes and coaches need to determine safe activity levels. The International Olympic Committee has recommended using the acute:chronic workload ratio (ACWR) to monitor injury risk and has provided thresholds to minimize risk when designing training programs. However, there are several limitations to the ACWR and how it has been analyzed which impact the validity of current recommendations and should discourage its use. This review aims to discuss previously published and novel challenges with the ACWR, and strategies to improve current analytical methods. In the first part of this review, we discuss challenges inherent to the ACWR. We explain why using a ratio to represent changes in activity may not always be appropriate. We also show that using exponentially weighted moving averages to calculate the ACWR results in an initial load problem, and discuss their inapplicability to sports where athletes taper their activity. In the second part, we discuss challenges with how the ACWR has been implemented. We cover problems with discretization, sparse data, bias in injured athletes, unmeasured and time-varying confounding, and application to subsequent injuries. In the third part, conditional on well-conceived study design, we discuss alternative causal-inference based analytical strategies that may avoid major flaws in studies on changes in activity and injury occurrence.
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Affiliation(s)
- Chinchin Wang
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, 3755 Côte Ste-Catherine Road, Montreal, QC, H3T 1E2, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada
| | - Jorge Trejo Vargas
- Department of Mathematics and Statistics, McGill University, 805 Sherbrooke Street West, Montreal, QC, H3A 0B9, Canada
| | - Tyrel Stokes
- Department of Mathematics and Statistics, McGill University, 805 Sherbrooke Street West, Montreal, QC, H3A 0B9, Canada
| | - Russell Steele
- Department of Mathematics and Statistics, McGill University, 805 Sherbrooke Street West, Montreal, QC, H3A 0B9, Canada
| | - Ian Shrier
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, 3755 Côte Ste-Catherine Road, Montreal, QC, H3T 1E2, Canada.
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17
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Lee YS, Park DS, Oh JK, Kim SY. Sports injury type and psychological factors affect treatment period and willingness-to-pay: Cross-sectional study. Medicine (Baltimore) 2020; 99:e23647. [PMID: 33327346 PMCID: PMC7738063 DOI: 10.1097/md.0000000000023647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aimed to describe the sport injuries of elite collegiate athletes, and to examine the influence of career length, past injuries, and psychological factors on the treatment period and willingness to pay (WTP) for treatment.A survey was conducted among students of the Department of Physical Education, Korea National Sport University. Results were interpreted through frequency analysis and multiple linear regression analysis.All students currently in training (n = 624, mean age 21 ± 2 years) participated in this study. 12-month prevalence of sports injuries was 56%. The locations of the most common and severe injuries were the knee, ankle, and back. The most frequent types of common injury were sprain, ruptured ligament, and bruising. The location of injuries varied according to the sports discipline. The treatment period was influenced by sports discipline, career length, location, and type of injury, and fear of further injuries. Treatment period was associated with the reason for fear of injuries, and WTP was influenced by fear of further injuries.Our study suggests that specific management plans for athletes based on disciplines, past injuries, and their emotional responses to previous injuries are required for rehabilitation and return to sports following treatment.
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Affiliation(s)
- Ye-Seul Lee
- Department of Anatomy and Acupoint, College of Korean Medicine, Gachon University
| | | | - Jae Keun Oh
- Department of Health and Exercise Science, Korea National Sport University, South Korea
| | - Song-Yi Kim
- Department of Anatomy and Acupoint, College of Korean Medicine, Gachon University
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18
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De Blaiser C, Roosen P, Willems T, De Bleecker C, Vermeulen S, Danneels L, De Ridder R. The role of core stability in the development of non-contact acute lower extremity injuries in an athletic population: A prospective study. Phys Ther Sport 2020; 47:165-172. [PMID: 33302113 DOI: 10.1016/j.ptsp.2020.11.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 11/21/2020] [Accepted: 11/24/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Stability of the core is associated with lower extremity functioning. Consequently, impaired core stability might play a role in developing non-contact acute lower extremity sports injuries. The objective was to investigate components of core stability as potential risk factors for acute lower extremity injuries. DESIGN A cohort study was set up with a follow-up and injury registration period of 1.5 years. PARTICIPANTS 142 male and female physical education students were included. MAIN OUTCOME MEASURES Measures of isometric hip and core muscular strength, endurance, proprioception and neuromuscular control of the core, and postural control were taken at the start of the study. Sports-related injury occurrence was registered during follow-up. RESULTS 27 (19%) injuries of interest occurred during follow-up. After multivariate model building, a significant predictive effect was found for side-to-side hip abduction strength asymmetry (p = .007). The hazard of developing an acute lower extremity injury increased with 6.2% with a 1 unit increase in side-to-side strength imbalance, regardless of gender. CONCLUSION Hip abduction strength imbalance was determined as a risk factor for the development of non-contact, acute lower extremity injuries. Normalizing hip strength imbalances might be beneficial for injury prevention. However, further research is needed to support this claim.
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Affiliation(s)
- Cedric De Blaiser
- Department of Rehabilitation Sciences, Ghent University, 9000, Ghent, Belgium.
| | - Philip Roosen
- Department of Rehabilitation Sciences, Ghent University, 9000, Ghent, Belgium
| | - Tine Willems
- Department of Rehabilitation Sciences, Ghent University, 9000, Ghent, Belgium
| | - Camilla De Bleecker
- Department of Rehabilitation Sciences, Ghent University, 9000, Ghent, Belgium
| | - Stefan Vermeulen
- Department of Rehabilitation Sciences, Ghent University, 9000, Ghent, Belgium
| | - Lieven Danneels
- Department of Rehabilitation Sciences, Ghent University, 9000, Ghent, Belgium
| | - Roel De Ridder
- Department of Rehabilitation Sciences, Ghent University, 9000, Ghent, Belgium
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19
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Bitchell CL, Varley-Campbell J, Robinson G, Stiles V, Mathema P, Moore IS. Recurrent and Subsequent Injuries in Professional and Elite Sport: a Systematic Review. SPORTS MEDICINE-OPEN 2020; 6:58. [PMID: 33270184 PMCID: PMC7714809 DOI: 10.1186/s40798-020-00286-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 11/24/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Injury surveillance in professional sport categorises injuries as either "new" or "recurrent". In an attempt to make categorisation more specific, subsequent injury categorisation models have been developed, but it is not known how often these models are used. The aim was to assess how recurrent and subsequent injuries are reported within professional and elite sport. METHODS Online databases were searched using a search strategy. Studies needed to prospectively report injury rates within professional or elite sports that have published consensus statements for injury surveillance. RESULTS A total of 1322 titles and abstract were identified and screened. One hundred and ninety-nine studies were screened at full text resulting in 81 eligible studies. Thirty studies did not report recurrent injuries and were excluded from data extraction. Within the studies that reported recurrent injuries, 21 reported the number and percentage; 13 reported only the proportion within all injuries; three reported only the number; five reported the number, percentage and incidence; and two only reported the incidence. Seven studies used subsequent injury terminology, with three reporting subsequent injury following concussion, one using an amended subsequent injury model and three using specific subsequent injury categorisation models. The majority of subsequent injuries (ranging from 51 to 80%) were categorised as different and unrelated to the index injury. The proportion of recurrent injuries (exact same body area and nature related to index injury) ranged from 5 to 21%. CONCLUSIONS Reporting recurrent or subsequent injuries remains inconsistent, and few studies have utilised subsequent injury models. There is limited understanding of subsequent injury risk, which may affect the development of injury prevention strategies. TRIAL REGISTRATION CRD42019119264.
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Affiliation(s)
| | | | - Gemma Robinson
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | | | - Prabhat Mathema
- Welsh Rugby Union Group, WRU National Centre of Excellence, Vale of Glamorgan, UK
| | - Isabel Sarah Moore
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
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20
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Everhart JS, Kirven JC, France TJ, Hidden K, Vasileff WK. Independent risk factors for recurrent or multiple new injuries in CrossFit athletes. J Sports Med Phys Fitness 2020; 60:1470-1476. [DOI: 10.23736/s0022-4707.20.11040-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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21
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Green B, Lin M, McClelland JA, Semciw AI, Schache AG, Rotstein AH, Cook J, Pizzari T. Return to Play and Recurrence After Calf Muscle Strain Injuries in Elite Australian Football Players. Am J Sports Med 2020; 48:3306-3315. [PMID: 33030961 DOI: 10.1177/0363546520959327] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Calf muscle strain injuries (CMSI) are prevalent in sport, but information about factors associated with time to return to play (RTP) and recurrence is limited. PURPOSE To determine whether clinical and magnetic resonance imaging (MRI) data are associated with RTP and recurrence after CMSI. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Data of 149 CMSI reported to the Soft Tissue injury Registry of the Australian Football League were explored to evaluate the impact of clinical data and index injury MRI findings on RTP and recurrence. Clinical data included age, previous injury history, ethnicity, and the mechanism of injury. RESULTS Irrespective of the anatomical location, players with CMSI with severe aponeurotic disruption (AD) took longer to RTP than players with CMSI with no AD: 31.3 ± 12.6 days vs 19.4 ± 10.8 days (mean ± SD; P = .003). A running-related mechanism of injury was associated with a longer RTP period for CMSI overall (adjusted hazard ratio [AHR], 0.59; P = .02). The presence of AD was associated with a longer RTP period for soleus injuries (AHR, 0.6; P = .025). Early recurrence (ie, ≤2 months of the index injury) was associated with older age (AHR, 1.3; P = .001) and a history of ankle injury (AHR, 3.9; P = .032). Older age (AHR, 1.1; P = .013) and a history of CMSI (AHR, 6.7; P = .002) increased the risk of recurrence within 2 seasons. The index injury MRI findings were not associated with risk of recurrence. CONCLUSION A running-related mechanism of injury and the presence of AD on MRI were associated with a longer RTP period. Clinical rather than MRI data best indicate the risk of recurrent CMSI.
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Affiliation(s)
- Brady Green
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Monica Lin
- Victoria House Medical Imaging, Melbourne, Australia
| | - Jodie A McClelland
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Adam I Semciw
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia.,Northern Centre for Health Education and Research, Northern Health, Victoria, Australia
| | - Anthony G Schache
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | | | - Jill Cook
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
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22
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Anderson DS, Cathcart J, Wilson I, Hides J, Leung F, Kerr D. Lower limb MSK injuries among school-aged rugby and football players: a systematic review. BMJ Open Sport Exerc Med 2020; 6:e000806. [PMID: 33178442 PMCID: PMC7642221 DOI: 10.1136/bmjsem-2020-000806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2020] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE The objective of this systematic review was to explore the incidence of lower limb musculoskeletal (MSK) injuries sustained by rugby union, rugby league, soccer, Australian Rules and Gaelic football players under 18 years. The review sought to identify the mechanisms and types of injury sustained and to compare between sports. DESIGN This systematic review focused on the incidence of lower limb injury in adolescent team sports that involved running and kicking a ball. A literature search of studies published prior to January 2020 was conducted using SportDiscus, Medline and PubMed databases. The Standard Quality Assessment Criteria appraisal tool was used to assess the quality of each article included in the review. Two or more authors independently reviewed all papers. RESULTS Sixteen papers met the inclusion criteria; prospective cohort (N=14), retrospective (n=1) and longitudinal (n=1). These studies investigated injuries in rugby union and rugby league (n=10), football (soccer) (n=3), Australian Rules (n=2) and Gaelic football (n=1). There were a total of 55 882 participants, aged 7-19 years old, who reported 6525 injuries. The type, site and mechanisms of injury differed across sports. SUMMARY Lower limb injuries were common in adolescent rugby, soccer, Gaelic football and Australian Rules football players, however these studies may not fully reflect the true injury burden where recurrent and overuse injuries have not been considered. There were differences between sports in the mechanisms, types and severity of injury.
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Affiliation(s)
| | - John Cathcart
- Institute of Nursing and Health Research, School of Health Sciences, Ulster University - Jordanstown Campus, Newtownabbey, UK
| | - Iseult Wilson
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - Julie Hides
- School of Allied Health Sciences, Griffith University, Nathan, Australia
| | - Felix Leung
- School of Allied Health Sciences, Griffith University, Nathan, Australia
| | - Daniel Kerr
- Institute of Nursing and Health Research, School of Health Sciences, Ulster University - Jordanstown Campus, Newtownabbey, UK
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23
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Owoeye OBA, Ghali B, Befus K, Stilling C, Hogg A, Choi J, Palacios‐Derflingher L, Pasanen K, Emery CA. Epidemiology of all‐complaint injuries in youth basketball. Scand J Med Sci Sports 2020; 30:2466-2476. [DOI: 10.1111/sms.13813] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/13/2020] [Accepted: 08/17/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Oluwatoyosi B. A. Owoeye
- Department of Physical Therapy and Athletic Training Doisy College of Health Sciences Saint Louis University St. Louis MO USA
- Sport Injury Prevention Research Centre Faculty of Kinesiology University of Calgary Calgary AB Canada
- Alberta Children’s Hospital Research Institute University of Calgary Calgary AB Canada
| | - Brianna Ghali
- Sport Injury Prevention Research Centre Faculty of Kinesiology University of Calgary Calgary AB Canada
| | - Kimberley Befus
- Sport Injury Prevention Research Centre Faculty of Kinesiology University of Calgary Calgary AB Canada
| | - Carlyn Stilling
- Sport Injury Prevention Research Centre Faculty of Kinesiology University of Calgary Calgary AB Canada
| | - Abigail Hogg
- Sport Injury Prevention Research Centre Faculty of Kinesiology University of Calgary Calgary AB Canada
| | - John Choi
- Sport Injury Prevention Research Centre Faculty of Kinesiology University of Calgary Calgary AB Canada
| | - Luz Palacios‐Derflingher
- Sport Injury Prevention Research Centre Faculty of Kinesiology University of Calgary Calgary AB Canada
- Alberta Children’s Hospital Research Institute University of Calgary Calgary AB Canada
| | - Kati Pasanen
- Sport Injury Prevention Research Centre Faculty of Kinesiology University of Calgary Calgary AB Canada
- Alberta Children’s Hospital Research Institute University of Calgary Calgary AB Canada
- Tampere Research Center of Sport Medicine UKK Institute Tampere Finland
- McCaig Institute for Bone and Joint Health University of Calgary Calgary AB Canada
| | - Carolyn A. Emery
- Sport Injury Prevention Research Centre Faculty of Kinesiology University of Calgary Calgary AB Canada
- Alberta Children’s Hospital Research Institute University of Calgary Calgary AB Canada
- Department of Community Health Sciences Cumming School of Medicine University of Calgary Calgary AB Canada
- Department of Pediatrics Cumming School of Medicine University of Calgary Calgary AB Canada
- O’Brien Institute for Public Health University of Calgary Calgary AB Canada
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Injuries across a pre-professional ballet and contemporary dance tertiary training program: A retrospective cohort study. J Sci Med Sport 2020; 23:1166-1171. [PMID: 32703722 DOI: 10.1016/j.jsams.2020.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/15/2020] [Accepted: 06/14/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The study aims to analyse the incidence of medical attention injuries, subsequent injuries, and the median time to injury, across tertiary ballet and contemporary dance training programs. DESIGN Retrospective cohort. METHODS Consenting ballet and contemporary dance students completing the third/final year of two tertiary programs were included. The three-year programs consisted of six semesters. Access was granted to onsite physiotherapy notes, timetables, and academic enrolment. Injury was defined as requiring medical attention. Injury and exposure data were extracted, injuries coded for location and tissue, and subsequent injuries, occurring after an initial index injury, categorised. Mean, standard deviation, range, injury incidence, risk and rate ratios, proportions and Kaplan-Meier curves were calculated to report participant characteristics, and injury patterns across three years of the dance program. RESULTS All 17 students (mean age=20.7 years; standard deviation=1.32) from one program consented to participate, of which all were injured across the three-year program, with 2.71 (95% confidence interval: 2.22, 3.20) injury incidence rate per 1000h, and increasing injury incidences seen across the program. The most injured site and tissue were the ankle (17.65%) and muscle (23.53%) respectively. 74.86% of subsequent injuries were different (affecting a different location and tissue), and 4.88% reinjuries (affecting the same location, tissue, and structure after recovery). The median time to the first injury was seven weeks in the first semester, and later in subsequent year levels. CONCLUSIONS Increasing injury incidences were seen across the program. Most subsequent injuries were different from previous injuries in this cohort. Future research should use exposure measures beyond hours (i.e. intensity) and consider subsequent injuries.
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Translation into Spanish and proposal to modify the Orchard Sports Injury Classification System (OSICS) version 12. APUNTS SPORTS MEDICINE 2020. [DOI: 10.1016/j.apunsm.2020.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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26
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Green B, Bourne MN, van Dyk N, Pizzari T. Recalibrating the risk of hamstring strain injury (HSI): A 2020 systematic review and meta-analysis of risk factors for index and recurrent hamstring strain injury in sport. Br J Sports Med 2020; 54:1081-1088. [PMID: 32299793 DOI: 10.1136/bjsports-2019-100983] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To systematically review risk factors for hamstring strain injury (HSI). DESIGN Systematic review update. DATA SOURCES Database searches: (1) inception to 2011 (original), and (2) 2011 to December 2018 (update). Citation tracking, manual reference and ahead of press searches. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies presenting prospective data evaluating factors associated with the risk of index and/or recurrent HSI. METHOD Search result screening and risk of bias assessment. A best evidence synthesis for each factor and meta-analysis, where possible, to determine the association with risk of HSI. RESULTS The 78 studies captured 8,319 total HSIs, including 967 recurrences, in 71,324 athletes. Older age (standardised mean difference=1.6, p=0.002), any history of HSI (risk ratio (RR)=2.7, p<0.001), a recent HSI (RR=4.8, p<0.001), previous anterior cruciate ligament (ACL) injury (RR=1.7, p=0.002) and previous calf strain injury (RR=1.5, p<0.001) were significant risk factors for HSI. From the best evidence synthesis, factors relating to sports performance and match play, running and hamstring strength were most consistently associated with HSI risk. The risk of recurrent HSI is best evaluated using clinical data and not the MRI characteristics of the index injury. SUMMARY/CONCLUSION Older age and a history of HSI are the strongest risk factors for HSI. Future research may be directed towards exploring the interaction of risk factors and how these relationships fluctuate over time given the occurrence of index and recurrent HSI in sport is multifactorial.
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Affiliation(s)
- Brady Green
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Matthew N Bourne
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia.,School of Allied Health Sciences, Griffith University, Gold Coast Campus, Queensland, Australia
| | - Nicol van Dyk
- High Performance Unit, Irish Rugby Football Union, Dublin, Ireland
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
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Bahr R, Clarsen B, Derman W, Dvorak J, Emery CA, Finch CF, Hägglund M, Junge A, Kemp S, Khan KM, Marshall SW, Meeuwisse W, Mountjoy M, Orchard JW, Pluim B, Quarrie KL, Reider B, Schwellnus M, Soligard T, Stokes KA, Timpka T, Verhagen E, Bindra A, Budgett R, Engebretsen L, Erdener U, Chamari K. International Olympic Committee consensus statement: methods for recording and reporting of epidemiological data on injury and illness in sport 2020 (including STROBE Extension for Sport Injury and Illness Surveillance (STROBE-SIIS)). Br J Sports Med 2020; 54:372-389. [PMID: 32071062 PMCID: PMC7146946 DOI: 10.1136/bjsports-2019-101969] [Citation(s) in RCA: 406] [Impact Index Per Article: 101.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2020] [Indexed: 12/16/2022]
Abstract
Injury and illness surveillance, and epidemiological studies, are fundamental elements of concerted efforts to protect the health of the athlete. To encourage consistency in the definitions and methodology used, and to enable data across studies to be compared, research groups have published 11 sport-specific or setting-specific consensus statements on sports injury (and, eventually, illness) epidemiology to date. Our objective was to further strengthen consistency in data collection, injury definitions and research reporting through an updated set of recommendations for sports injury and illness studies, including a new Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist extension. The IOC invited a working group of international experts to review relevant literature and provide recommendations. The procedure included an open online survey, several stages of text drafting and consultation by working groups and a 3-day consensus meeting in October 2019. This statement includes recommendations for data collection and research reporting covering key components: defining and classifying health problems; severity of health problems; capturing and reporting athlete exposure; expressing risk; burden of health problems; study population characteristics and data collection methods. Based on these, we also developed a new reporting guideline as a STROBE Extension-the STROBE Sports Injury and Illness Surveillance (STROBE-SIIS). The IOC encourages ongoing in- and out-of-competition surveillance programmes and studies to describe injury and illness trends and patterns, understand their causes and develop measures to protect the health of the athlete. Implementation of the methods outlined in this statement will advance consistency in data collection and research reporting.
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Affiliation(s)
- Roald Bahr
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Ben Clarsen
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Division of Orthopaedic Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Jiri Dvorak
- Spine Unit, Swiss Concussion Center and Swiss Golf Medical Center, Schulthess Clinic, Zurich, Switzerland
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Caroline F Finch
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Martin Hägglund
- Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden
| | - Astrid Junge
- Medical School Hamburg, Hamburg, Germany
- Swiss Concussion Centre, Schulthess Clinic, Zurich, Switzerland
| | - Simon Kemp
- Rugby Football Union, London, UK
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Karim M Khan
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
- British Journal of Sports Medicine, London, UK
| | - Stephen W Marshall
- Injury Prevention Research Center and Department of Epidemiology at the Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Willem Meeuwisse
- Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada
- National Hockey League, Calgary, Alberta, Canada
| | - Margo Mountjoy
- Department of Family Medicine (Sport Medicine), McMaster University, Hamilton, Ontario, Canada
- FINA Bureau (Sport Medicine), Lausanne, Switzerland
| | - John W Orchard
- School of Public Health, University of Sydney, New South Wales, Sydney, Australia
| | - Babette Pluim
- Department of Sports Medicine, Royal Netherlands Lawn Tennis Association, Amstelveen, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research Center of Excellence, Amsterdam, The Netherlands
- Faculty of Health Sciences, University of Pretoria, Hatfield, South Africa
| | - Kenneth L Quarrie
- New Zealand Rugby, Wellington, New Zealand
- Sports Performance Research Institute New Zealand, AUT University, Auckland, New Zealand
| | - Bruce Reider
- Department of Orthopaedic Surgery and Rehabilitation, University of Chicago, Chicago, Illinois, USA
| | - Martin Schwellnus
- Sport, Exercise Medicine and Lifestyle Research Institute (SEMLI), University of Pretoria, Hatfield, South Africa
| | - Torbjørn Soligard
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, Calgary, Alberta, Canada
| | - Keith A Stokes
- Department for Health, University of Bath, Bath, UK
- Rugby Football Union, Twickenham, UK
| | - Toomas Timpka
- Athletics Research Center, Linköping University, Linköping, Sweden
- Centre for Healthcare Development, Region Östergötland, Linköping, Sweden
| | - Evert Verhagen
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
| | - Abhinav Bindra
- Athlete Commission, International Olympic Committee, Lausanne, Switzerland
| | - Richard Budgett
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Lars Engebretsen
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Uğur Erdener
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Karim Chamari
- Aspetar Sports Medicine and Orthopedic Hospital, Doha, Qatar
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Lathlean TJH, Gastin PB, Newstead SV, Finch CF. Absolute and Relative Load and Injury in Elite Junior Australian Football Players Over 1 Season. Int J Sports Physiol Perform 2020; 15:511-519. [PMID: 31569071 DOI: 10.1123/ijspp.2019-0100] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 07/11/2019] [Accepted: 07/15/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE To investigate the association between training and match loads and injury in elite junior Australian football players over 1 competitive season. METHODS Elite junior Australian football players (n = 290, age 17.7 [0.3] y, range 16-18 y) were recruited from the under-18 state league competition in Victoria to report load and injury information. One-week load (session rating of perceived exertion multiplied by duration) and all time-loss injuries were reported using an online sport-injury surveillance system. Absolute load measures (weekly sums) enabled the calculation of relative measures such as the acute:chronic workload ratio. Load measures were modeled against injury outcome (yes/no) using a generalized estimating equation approach, with a 1-wk lag for injury. RESULTS Low (<300 arbitrary units [au]) and high (>4650 au) 1-wk loads were associated with significantly higher risk of injury. Furthermore, low (<100 au) and high (>850 au) session loads were associated with a higher risk of injury. High strain values (>13,000) were associated with up to a 5-fold increase in the odds of injury. There was a relatively flat-line association between the acute:chronic workload ratio and injury. CONCLUSIONS This study is the first investigation of elite junior athletes demonstrating linear and nonlinear relationships between absolute and relative load measures and injury. Coaches should focus player loads on, or at least close to, the point at which injury risk starts to increase again (2214 au for 1-wk load and 458 au for session load) and use evidence-based strategies across the week and month to help reduce the risk of injury.
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Bahr R, Clarsen B, Derman W, Dvorak J, Emery CA, Finch CF, Hägglund M, Junge A, Kemp S, Khan KM, Marshall SW, Meeuwisse W, Mountjoy M, Orchard JW, Pluim B, Quarrie KL, Reider B, Schwellnus M, Soligard T, Stokes KA, Timpka T, Verhagen E, Bindra A, Budgett R, Engebretsen L, Erdener U, Chamari K. International Olympic Committee Consensus Statement: Methods for Recording and Reporting of Epidemiological Data on Injury and Illness in Sports 2020 (Including the STROBE Extension for Sports Injury and Illness Surveillance (STROBE-SIIS)). Orthop J Sports Med 2020; 8:2325967120902908. [PMID: 32118084 PMCID: PMC7029549 DOI: 10.1177/2325967120902908] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 01/03/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Injury and illness surveillance, and epidemiological studies, are fundamental elements of concerted efforts to protect the health of the athlete. To encourage consistency in the definitions and methodology used, and to enable data across studies to be compared, research groups have published 11 sport- or setting-specific consensus statements on sports injury (and, eventually, illnesses) epidemiology to date. OBJECTIVE To further strengthen consistency in data collection, injury definitions, and research reporting through an updated set of recommendations for sports injury and illness studies, including a new Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist extension. STUDY DESIGN Consensus statement of the International Olympic Committee (IOC). METHODS The IOC invited a working group of international experts to review relevant literature and provide recommendations. The procedure included an open online survey, several stages of text drafting and consultation by working groups, and a 3-day consensus meeting in October 2019. RESULTS This statement includes recommendations for data collection and research reporting covering key components: defining and classifying health problems, severity of health problems, capturing and reporting athlete exposure, expressing risk, burden of health problems, study population characteristics, and data collection methods. Based on these, we also developed a new reporting guideline as a STROBE extension-the STROBE Sports Injury and Illness Surveillance (STROBE-SIIS). CONCLUSION The IOC encourages ongoing in- and out-of-competition surveillance programs and studies to describe injury and illness trends and patterns, understand their causes, and develop measures to protect the health of the athlete. The implementation of the methods outlined in this statement will advance consistency in data collection and research reporting.
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Affiliation(s)
| | - Roald Bahr
- Roald Bahr, MD, PhD, Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, PB 4014 Ullevål Stadion, 0806 Oslo, Norway ()
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Serner A, Weir A, Tol JL, Thorborg K, Lanzinger S, Otten R, Hölmich P. Return to Sport After Criteria-Based Rehabilitation of Acute Adductor Injuries in Male Athletes: A Prospective Cohort Study. Orthop J Sports Med 2020; 8:2325967119897247. [PMID: 32064292 PMCID: PMC6990618 DOI: 10.1177/2325967119897247] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 11/24/2019] [Indexed: 11/17/2022] Open
Abstract
Background: Despite being one of the most common sports injuries, there are no criteria-based rehabilitation programs published for acute adductor injuries. Purpose: To evaluate return-to-sport (RTS) outcomes and reinjuries after criteria-based rehabilitation for athletes with acute adductor injuries. Study Design: Cohort study; Level of evidence, 2. Methods: Male adult athletes with an acute adductor injury underwent a supervised, standardized criteria-based exercise rehabilitation program. Magnetic resonance imaging (MRI) was used to grade the injury extent from 0 (negative finding) to 3 (complete tear/avulsion). There were 3 milestones used to evaluate the RTS continuum: (1) clinically pain-free, (2) completion of controlled sports training, and (3) return to full team training. Subsequent injuries were registered within the first year. Results: We included 81 athletes with an acute adductor injury (MRI grade 0: n = 14; grade 1: n = 20; grade 2: n = 30; grade 3: n = 17). Of these, 61 (75%) athletes achieved RTS milestone 1, 50 (62%) achieved RTS milestone 2, and 75 (93%) achieved RTS milestone 3. There were no statistical differences in the RTS duration between MRI grade 0, 1, and 2 at any RTS milestone; thus, these were grouped together as grade 0-2. The median time (interquartile range [IQR]) for athletes with grade 0-2 injuries to become clinically pain-free was 13 days (IQR, 11-21 days), to complete controlled sports training was 17 days (IQR, 15-27 days), and to return to full team training was 18 days (IQR, 14-27 days). For athletes with a grade 3 injury, median times were 55 days (IQR, 31-75 days), 68 days (IQR, 51-84 days), and 78 days (IQR, 68-98 days), respectively. The overall 1-year reinjury rate was 8%. Athletes who achieved RTS milestone 1 had a statistically significantly lower reinjury rate than athletes who did not (5% vs 21%, respectively; ϕ = –0.233; P = .048). Athletes who achieved RTS milestone 2 had a nonstatistically significantly lower reinjury rate than athletes who did not (6% vs 13%, respectively; ϕ = –0.107; P = .366). Conclusion: We analyzed the results of a criteria-based rehabilitation protocol for athletes with acute adductor injuries. Athletes with an MRI grade 0-2 adductor injury were clinically pain-free after approximately 2 weeks and returned to full team training after approximately 3 weeks. Most athletes with an MRI grade 3 adductor injury were pain-free and returned to full team training within 3 months. Meeting the clinically pain-free criteria resulted in fewer reinjuries compared with not meeting the criteria.
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Affiliation(s)
- Andreas Serner
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Adam Weir
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Center for Groin Injuries, Department of Orthopaedics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Johannes L Tol
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Amsterdam Movement Sciences, Academic Center for Evidence-Based Sports Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Kristian Thorborg
- Sports Orthopedic Research Center-Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Sean Lanzinger
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Roald Otten
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Roald Otten Sportsrehab, J&C Sportsrehab, Amstelveen, the Netherlands
| | - Per Hölmich
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Sports Orthopedic Research Center-Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
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Hess MC, Swedler DI, Collins CS, Ponce BA, Brabston EW. Descriptive Epidemiology of Injuries in Professional Ultimate Frisbee Athletes. J Athl Train 2020; 55:195-204. [PMID: 31895593 DOI: 10.4085/1062-6050-269-18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONTEXT Injuries in professional ultimate Frisbee (ultimate) athletes have never been described. OBJECTIVE To determine injury rates, profiles, and associated factors using the first injury-surveillance program for professional ultimate. DESIGN Descriptive epidemiology study. SETTING American Ultimate Disc League professional ultimate teams during the 2017 season. PATIENTS OR OTHER PARTICIPANTS Sixteen all-male teams. MAIN OUTCOME MEASURE(S) Injury incidence rates (IRs) were calculated as injuries per 1000 athlete-exposures (AEs). Incidence rate ratios were determined to compare IRs with 95% confidence intervals, which were used to calculate differences. RESULTS We observed 299 injuries over 8963 AEs for a total IR of 33.36 per 1000 AEs. Most injuries affected the lower extremity (72%). The most common injuries were thigh-muscle strains (12.7%) and ankle-ligament sprains (11.4%). Running was the most frequent injury mechanism (32%). Twenty-nine percent of injuries involved collisions; however, the concussion rate was low (IR = 0.22 per 1000 AEs). Injuries were more likely to occur during competition and in the second half of games. An artificial turf playing surface did not affect overall injury rates (Mantel-Haenszel incidence rate ratio = 1.28; 95% confidence interval = 0.99, 1.67). CONCLUSIONS To our knowledge, this is the first epidemiologic study of professional ultimate injuries. Injury rates were comparable with those of similar collegiate- and professional-level sports.
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Affiliation(s)
- Matthew C Hess
- School of Medicine, Department of Orthopaedic Surgery, University of Alabama at Birmingham
| | - David I Swedler
- Pacific Institute for Research and Evaluation, Calverton, MD
| | - Christine S Collins
- School of Medicine, Department of Orthopaedic Surgery, University of Alabama at Birmingham
| | - Brent A Ponce
- School of Medicine, Department of Orthopaedic Surgery, University of Alabama at Birmingham
| | - Eugene W Brabston
- School of Medicine, Department of Orthopaedic Surgery, University of Alabama at Birmingham
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Green B, Lin M, Schache AG, McClelland JA, Semciw AI, Rotstein A, Cook J, Pizzari T. Calf muscle strain injuries in elite Australian Football players: A descriptive epidemiological evaluation. Scand J Med Sci Sports 2020; 30:174-184. [PMID: 31494970 DOI: 10.1111/sms.13552] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 08/23/2019] [Accepted: 09/02/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Calf muscle strain injuries (CMSI) show consistent rates of prevalence and re-injury in elite Australian Football players. An epidemiological evaluation is warranted to better understand the clinical presentation and recovery of CMSI. PURPOSE First, to describe the epidemiology of CMSI in elite Australian Football players. Second, to determine if recovery following injury is different according to: (a) injury type (index vs re-injury); (b) muscle injured (soleus vs gastrocnemius); and (c) mechanism of injury (running-related activity vs non running-related activity). STUDY DESIGN Descriptive epidemiological. METHODS Data retrieved from the Soft Tissue injury Registry of the Australian Football League were analyzed. Sixteen clubs submitted data on CMSI from 2014 to 2017. Data included: player characteristics, training and match history at the time of injury, MRI, and the time to reach recovery milestones. RESULTS One hundred and eighty-four CMSI were included (149 index injuries; 35 re-injuries). Soleus injuries were most prevalent (84.6%). Soleus injuries took 25.4 ± 16.2 days to return to play, whereas gastrocnemius injuries took 19.1 ± 14.1 days (P = .097). CMSI sustained during running-related activities took approximately 12 days longer to recover than injuries sustained during non running-related activities (P = .001). Compared to index injuries, re-injuries involved older players (P = .03) and significantly more time was taken to run at >90% of maximum speed, return to full training, and return to play (P ≤ .001). Almost all of the observed re-injuries involved soleus (91.4%). CONCLUSION Soleus injuries are more prevalent than gastrocnemius injuries in elite Australian Football players. Prognosis appears to be influenced by clinical factors, with CMSI sustained during running-related activities and re-injuries needing more time to recover.
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Affiliation(s)
- Brady Green
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Monica Lin
- Victoria House Imaging, Melbourne, Australia
| | - Anthony G Schache
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Jodie A McClelland
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Adam I Semciw
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | | | - Jill Cook
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
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Nielsen RØ, Bertelsen ML, Ramskov D, Damsted C, Brund RK, Parner ET, Sørensen H, Rasmussen S, Kjærgaard S. The Garmin-RUNSAFE Running Health Study on the aetiology of running-related injuries: rationale and design of an 18-month prospective cohort study including runners worldwide. BMJ Open 2019; 9:e032627. [PMID: 31494626 PMCID: PMC6731941 DOI: 10.1136/bmjopen-2019-032627] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Running injuries affect millions of persons every year and have become a substantial public health issue owing to the popularity of running. To ensure adherence to running, it is important to prevent injuries and to have an in-depth understanding of the aetiology of running injuries. The main purpose of the present paper was to describe the design of a future prospective cohort study exploring if a dose-response relationship exists between changes in training load and running injury occurrence, and how this association is modified by other variables. METHODS AND ANALYSIS In this protocol, the design of an 18-month observational prospective cohort study is described that will include a minimum of 20 000 consenting runners who upload their running data to Garmin Connect and volunteer to be a part of the study. The primary outcome is running-related injuries categorised into the following states: (1) no injury; (2) a problem; and (3) injury. The primary exposure is change in training load (eg, running distance and the cumulative training load based on the number of strides, ground contact time, vertical oscillation and body weight). The change in training load is a time-dependent exposure in the sense that progression or regression can change many times during follow-up. Effect-measure modifiers include, but is not limited to, other types of sports activity, activity of daily living and demographics, and are assessed through questionnaires and/or by Garmin devices. ETHICS AND DISSEMINATION The study design, procedures and informed consent have been evaluated by the Ethics Committee of the Central Denmark Region (Request number: 227/2016 - Record number: 1-10-72-189-16).
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Affiliation(s)
| | | | - Daniel Ramskov
- Section for Sports Science, Department of Public Health, Aarhus Universitet, Aarhus, Denmark
| | - Camma Damsted
- Section for Sports Science, Department of Public Health, Aarhus Universitet, Aarhus, Denmark
| | | | - Erik Thorlund Parner
- Department of Public Health, Aarhus University, Section for Biostatistics, Aarhus, Denmark
| | - Henrik Sørensen
- Section of Sports, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Sten Rasmussen
- Orthopaedic Surgery Research Unit, Aarhus University Hospital - Aalborg Hospital, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Søren Kjærgaard
- Section for Environment, Occupation and Health, Department of Public Health, Aarhus Universitet, Aarhus, Denmark
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Using causal energy categories to report the distribution of injuries in an active population: An approach used by the U.S. Army. J Sci Med Sport 2019; 22:997-1003. [DOI: 10.1016/j.jsams.2019.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/28/2019] [Accepted: 04/01/2019] [Indexed: 12/31/2022]
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Abstract
Special Operations Combat Personnel (SOCP) face significant challenges and occupational demands that put them at significant risk for musculoskeletal injury. Musculoskeletal injury leads to lost-duty days, medical disqualification, and compromises operational readiness and mission success. Optimizing human performance and developing injury prevention strategies can position SOCP for success, but human performance optimization is a complex process that demands the integration of multiple disciplines to address a broad range of capabilities necessary for this success. The Warrior Model for Human Performance Optimization outlines a step-by-step approach to human performance optimization embedded within a scientific, evidenced-based approach to injury prevention and performance optimization that includes a step to ensure specificity of training and interventions. This evidence-based approach can insure that SOCP capabilities match the demands of occupation enabling them to successfully execute their occupation tasks without risk of injury. While the focus of this review is on military personnel, the same principles have application to nonmilitary high-performance athletes.
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Toohey LA, Drew MK, Bullock N, Caling B, Fortington LV, Finch CF, Cook JL. Epidemiology of elite sprint kayak injuries: A 3-year prospective study. J Sci Med Sport 2019; 22:1108-1113. [PMID: 31239203 DOI: 10.1016/j.jsams.2019.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To analyse the characteristics of injuries sustained by elite sprint kayak athletes, to investigate relationships between initial and subsequent injuries, and to examine injury differences between male and female athletes. DESIGN Descriptive epidemiology study. METHODS Data from 63 athletes (37 male, 26 female) of the Australian national sprint kayak squad were prospectively collected over three continuous years (September 2014-August 2017). All medical attention injuries were recorded irrespective of time-loss and modality of training. Descriptive analyses were performed, and frequency comparisons across genders assessed with chi squared tests. RESULTS Forty-nine athletes (78%) sustained 146 injuries (median=2, interquartile range=1-4, range=0-12). Most injuries were to the upper limb (48%), with the shoulder being the most common body site injured (27%). Thirty-one athletes (49%) sustained at least one subsequent injury, equating to 97 subsequent injuries. The majority (68%) of subsequent injuries occurred at a different site and nature to previous injuries. Male athletes were more likely to sustain an injury than remain injury free compared to female athletes (Chi2(1)=6.75, p=0.009), but there was no difference between males and females who thereafter sustained a subsequent injury (Chi2(1)=0.84, p=0.359). CONCLUSIONS Injury occurrence is common in sprint kayak, with many athletes experiencing more than one injury. Small variations in injury characteristics exist between male and female athletes in sprint kayak. This study identifies upper limb and trunk, and joint and muscle injuries as the most prevalent sprint kayak injuries, providing a focus for the development of future injury prevention strategies.
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Affiliation(s)
- Liam A Toohey
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australia; Athlete Availability Program, Australian Institute of Sport, Australia.
| | - Michael K Drew
- Athlete Availability Program, Australian Institute of Sport, Australia
| | - Nicola Bullock
- Paddle Australia, Australia; Physiology, Australian Institute of Sport, Australia; Bond Institute of Health and Sport, Bond University, Australia
| | | | - Lauren V Fortington
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australia; Exercise Medicine Research Institute, School of Medical and Health Sciences, Edith Cowan University, Australia
| | - Caroline F Finch
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australia; Exercise Medicine Research Institute, School of Medical and Health Sciences, Edith Cowan University, Australia
| | - Jill L Cook
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australia
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Toohey LA, Drew MK, Finch CF, Cook JL, Fortington LV. A 2-Year Prospective Study of Injury Epidemiology in Elite Australian Rugby Sevens: Exploration of Incidence Rates, Severity, Injury Type, and Subsequent Injury in Men and Women. Am J Sports Med 2019; 47:1302-1311. [PMID: 30779880 DOI: 10.1177/0363546518825380] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Injuries are common in rugby sevens, but studies to date have been limited to short, noncontinuous periods and reporting of match injuries only. PURPOSE To report the injury incidence rate (IIR), severity, and burden of injuries sustained by men and women in the Australian rugby sevens program and to provide the first longitudinal investigation of subsequent injury occurrence in rugby sevens looking beyond tournament injuries only. STUDY DESIGN Descriptive epidemiology study. METHODS Ninety international rugby sevens players (55 men and 35 women) were prospectively followed over 2 consecutive seasons (2015-2016 and 2016-2017). All medical attention injuries were reported irrespective of time loss. Individual exposure in terms of minutes, distance, and high-speed distance was captured for each player for matches and on-field training, with the use of global positioning system devices. The IIR and injury burden (IIR × days lost to injury) were calculated per 1000 player-hours, and descriptive analyses were performed. RESULTS Seventy-three players (81.1%) sustained 365 injuries at an IIR of 43.2 per 1000 player-hours (95% CI, 43.0-43.3). As compared with male players, female players experienced a lower IIR (incidence rate ratio, 0.91; 95% CI, 0.90-0.91). Female players also sustained a higher proportion of injuries to the trunk region (relative risk, 1.75; 95% CI, 1.28-2.40) but a lower number to the head/neck region (relative risk, 0.58; 95% CI, 0.37-0.93; P = .011). The majority (80.7%) of subsequent injuries were of a different site and nature than previous injuries. A trend toward a reduced number of days, participation time, distance, and high-speed distance completed before the next injury was observed after successive injury occurrence. CONCLUSION Female players have a lower IIR than male players, with variation of injury profiles observed between sexes. With a surveillance period of 2 years, subsequent injuries account for the majority of injuries sustained in rugby sevens, and they are typically different from previous types of sustained injuries. After each successive injury, the risk profile for future injury occurrence appears to be altered, which warrants further investigation to inform injury prevention strategies in rugby sevens.
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Affiliation(s)
- Liam A Toohey
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia.,Athlete Availability Program, Australian Institute of Sport, Bruce, Australia
| | - Michael K Drew
- Athlete Availability Program, Australian Institute of Sport, Bruce, Australia
| | - Caroline F Finch
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Jill L Cook
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia
| | - Lauren V Fortington
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,Federation University Australia, Ballarat, Australia
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Hoffman DT, Dwyer DB, Tran J, Clifton P, Gastin PB. Australian Football League Injury Characteristics Differ Between Matches and Training: A Longitudinal Analysis of Changes in the Setting, Site, and Time Span From 1997 to 2016. Orthop J Sports Med 2019; 7:2325967119837641. [PMID: 31041327 PMCID: PMC6477771 DOI: 10.1177/2325967119837641] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Injury surveillance has been used to quantify the scope of the injury burden
in Australian football. However, deeper statistical analyses are required to
identify major factors that contribute to the injury risk and to understand
how these injury patterns change over time. Purpose: To compare Australian Football League (AFL) injury incidence, severity,
prevalence, and recurrence by setting, site, and time span from 1997 to
2016. Study Design: Descriptive epidemiology study. Methods: A total of 15,911 injuries and medical illnesses recorded by team medical
staff at each club were obtained from the AFL’s injury surveillance system
and analyzed using linear mixed models with 3 fixed effects (setting, time
span, site) and 1 random effect (club). All types of injuries and medical
illnesses were included for analysis, provided that they caused the player
to miss at least 1 match during the regular season or finals. Five-season
time spans (1997-2001, 2002-2006, 2007-2011, and 2012-2016) were used for
comparisons. Incidence rates were expressed at the player level. Recurrences
were recoded to quantify recurrent injuries across multiple seasons. Results: Compared with training injuries, match injuries had a 2.8 times higher
incidence per season per club per player (matches: 0.070 ± 0.093; training:
0.025 ± 0.043; P < .001). Match injuries resulted in 1.9
times more missed matches per club per season (matches: 17.2 ± 17.0;
training: 9.1 ± 10.5; P < .001). and were more likely to
be recurrences (matches: 11.6% ± 20.0%; training: 8.6% ± 21.8%;
P < .001). From the 1997-2001 to 2007-2011 time
spans, overall injury severity increased from a mean of 3.2 to 3.7 missed
matches (P ≤ .01). For the most recent 2012-2016 time span,
injuries resulted in 3.6 missed matches, on average. Hip/groin/thigh
injuries had the highest incidence (0.125 ± 0.120) and prevalence (19.2 ±
16.4) rates, and recurrences (29.3% ± 27.9%) were 15% more likely at this
site than any other injury site. Conclusion: The risks of match injuries are significantly higher than those of training
injuries in the AFL. Compared with the 1997-2001 time span, injuries became
more severe during the 2007-2011 time span.
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Affiliation(s)
- Daniel T Hoffman
- Centre for Sport Research, Deakin University, Geelong, Australia
| | - Dan B Dwyer
- Centre for Sport Research, Deakin University, Geelong, Australia
| | - Jacqueline Tran
- Centre for Sport Research, Deakin University, Geelong, Australia.,Football Department, Geelong Cats Football Club, Geelong, Australia
| | | | - Paul B Gastin
- Centre for Sport Research, Deakin University, Geelong, Australia
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Toohey LA, Drew MK, Fortington LV, Menaspa MJ, Finch CF, Cook JL. Comparison of subsequent injury categorisation (SIC) models and their application in a sporting population. Inj Epidemiol 2019; 6:9. [PMID: 31245258 PMCID: PMC6582673 DOI: 10.1186/s40621-019-0183-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 02/01/2019] [Indexed: 11/28/2022] Open
Abstract
Background The original subsequent injury categorisation (SIC-1.0) model aimed to classify relationships between chronological injury sequences to provide insight into the complexity and causation of subsequent injury occurrence. An updated model has recently been published. Comparison of the data coded according to the original and revised subsequent injury categorisation (SIC-1.0 and SIC-2.0) models has yet been formally compared. Methods Medical attention injury data was prospectively collected for 42 elite water polo players over an 8 month surveillance period. The SIC-1.0 and SIC-2.0 models were retrospectively applied to the injury data. The injury categorisation from the two models was compared using descriptive statistics. Results Seventy-four injuries were sustained by the 42 players (median = 2, range = 0–5), of which 32 injuries (43.2%) occurred subsequent to a previous injury. The majority of subsequent injuries were coded as occurring at a different site and being of a different nature, while also being considered clinically unrelated to the previous injury (SIC-1.0 category 10 = 57.9%; SIC-2.0 clinical category 16 = 54.4%). Application of the SIC-2.0 model resulted in a greater distribution of category allocation compared to the SIC-1.0 model that reflects a greater precision in the SIC-2.0 model. Conclusions Subsequent injury categorisation of sport injury data can be undertaken using either the original (SIC-1.0) or the revised (SIC-2.0) model to obtain similar results. However, the SIC-2.0 model offers the ability to identify a larger number of mutually exclusive categories, while not relying on clinical adjudication for category allocation. The increased precision of SIC-2.0 is advantageous for clinical application and consideration of injury relationships. Electronic supplementary material The online version of this article (10.1186/s40621-019-0183-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Liam A Toohey
- 1La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, School of Allied Health (Physiotherapy), Bundoora, VIC 3086 Australia.,2Athlete Availability Program, Applied Technology and Innovation, Australian Institute of Sport, Leverrier Street, Bruce, ACT 2617 Australia
| | - Michael K Drew
- 2Athlete Availability Program, Applied Technology and Innovation, Australian Institute of Sport, Leverrier Street, Bruce, ACT 2617 Australia
| | - Lauren V Fortington
- 1La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, School of Allied Health (Physiotherapy), Bundoora, VIC 3086 Australia.,4School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA Australia.,5Federation University Australia, Ballarat, Australia
| | - Miranda J Menaspa
- 3Physical Therapies, Australian Institute of Sport, Bruce, ACT Australia
| | - Caroline F Finch
- 1La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, School of Allied Health (Physiotherapy), Bundoora, VIC 3086 Australia.,4School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA Australia
| | - Jill L Cook
- 1La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, School of Allied Health (Physiotherapy), Bundoora, VIC 3086 Australia
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Moita JP, Gomes A, Xarez L, Coelho C. The role of prediagnostic data in injury epidemiology in preprofessional dancers. Scand J Med Sci Sports 2019; 29:606-614. [PMID: 30634200 DOI: 10.1111/sms.13382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 10/31/2018] [Accepted: 12/31/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION preprofessional dance training starts at very early ages, on a highly demanding environment placing students at significant risk for injury. Injury management and prevention are a matter of concern. Given the constant interchangeability of risk factors, identifying injury patterns may prove to be equally as important. Data looking back from the time of injury through context-specific approaches are missing. OBJECTIVES To identify activity-related injury patterns based on prediagnostic data. METHODS Prospective, non-randomized, observational study, over a 3 years period on a full-time preprofessional dance school featuring both gender students aged 9-21 years old. Non-parametric statistics were used. RESULTS A total of 625 dance injury records from 209 students, n = 68 males and n = 141 females, were analyzed. Season injury risk probability was identified, proving different for each skill level (SkL). Multiple individual injuries revealed a trend toward prevalence rates in advanced level, while index injuries incidence becomes more noticeable in entry level students. Overall incidence rates had no significant differences within SkL. Anatomical location was in line with previous research, although differences were found between gender and SkL. Most injuries occurred in classes, with jumps standing out as the main motor action associated with injury symptoms of gradual onset mechanism. CONCLUSION Dance injuries happen because of dance practice. Knowing the context of injury history from the injured dancer perspective is determinant for management and prevention. prediagnostic data are an umbrella term encompassing several aspects of injury background and represents fertile ground for research. Context-specific methodological approaches are recommended.
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Affiliation(s)
- João Paulo Moita
- Escola Superior de Saúde Atlântica, Barcarena, Portugal.,Escola de Dança do Conservatório Nacional, Lisboa, Portugal
| | - António Gomes
- Departamento de Cirurgia, Hospital Prof. Dr. Fernando Fonseca, Amadora, Portugal
| | - Luís Xarez
- Faculdade de Motricidade Humana, Laboratório do Comportamento Motor, Universidade de Lisboa, Cruz Quebrada, Portugal
| | - Constança Coelho
- Universidade de Lisboa, Faculdade de Medicina de Lisboa, Laboratório de Genética, Instituto de Saúde Ambiental, Lisboa, Portugal
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Fransz DP, Huurnink A, Kingma I, de Boode VA, Heyligers IC, van Dieën JH. Performance on a Single-Legged Drop-Jump Landing Test Is Related to Increased Risk of Lateral Ankle Sprains Among Male Elite Soccer Players: A 3-Year Prospective Cohort Study. Am J Sports Med 2018; 46:3454-3462. [PMID: 30419177 PMCID: PMC6282159 DOI: 10.1177/0363546518808027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Soccer has a high injury rate, with lateral ankle sprains being a common injury. Therefore, an approach to prevent or at least reduce the occurrence is warranted. Injury prevention can be improved by identifying specific risk factors and individuals at risk. PURPOSE To assess drop-jump landing performance as a potential predictor of lateral ankle sprain within 3-year follow-up. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Single-legged drop-jump landing tests were performed by 190 elite soccer players. Based on ground-reaction forces, 6 outcome measures were calculated that aim to reflect the impact and stabilization phase. Lateral ankle sprains were registered during up to 3 years of follow-up. Following a z score correction for age, a multivariate regression analysis was performed. RESULTS During follow-up, 45 players (23.7%) suffered a primary lateral ankle sprain. Of those, 34 were regarded as severe (absence >7 days). Performance was related to increased risk of ankle sprain ( P = .005 for all sprains and P = .001 for severe sprains). Low mediolateral stability for the first 0.4 seconds after landing (a larger value indicates more force exerted in the mediolateral direction, resulting in rapid lateral stabilization) and high horizontal ground-reaction force between 3.0 and 5.0 seconds (a smaller value indicates less sway in the stabilization phase) were identified as risk factors. A player that scored 2 SD below average for both risk factors had a 4.4-times-higher chance of sustaining an ankle sprain than a player who scored average. CONCLUSION The current study showed that following a single-legged drop-jump landing, mediolateral force over 0 to 0.4 seconds and/or mean resultant horizontal ground-reaction force over 3 to 5 seconds has predictive value with regard to the occurrence of an ankle sprain among male elite soccer players within 3 years.
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Affiliation(s)
- Duncan P. Fransz
- Department of Human Movement Sciences,
Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the
Netherlands,Department of Orthopaedic Surgery,
Maastricht University Medical Center, Maastricht, the Netherlands,Duncan P. Fransz, MD, MSc,
Department of Human Movement Sciences, Amsterdam Movement Science, Van der
Boechorststraat 9, 1081 BT Amsterdam, the Netherlands (
)
| | - Arnold Huurnink
- Department of Human Movement Sciences,
Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the
Netherlands,Department of Nuclear Medicine, Academic
Medical Center, Amsterdam, the Netherlands
| | - Idsart Kingma
- Department of Human Movement Sciences,
Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the
Netherlands
| | - Vosse A. de Boode
- adidas miCoach Performance Centre, AFC
Ajax, Amsterdam, the Netherlands
| | - Ide C. Heyligers
- Department of Orthopaedic Surgery,
Zuyderland Medical Center, Heerlen, the Netherlands,School of Health Profession Education,
Maastricht University, Maastricht, the Netherlands
| | - Jaap H. van Dieën
- Department of Human Movement Sciences,
Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the
Netherlands
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Panagodage Perera NK, Joseph C, Kemp JL, Finch CF. Epidemiology of Injuries in Women Playing Competitive Team Bat-or-Stick Sports: A Systematic Review and a Meta-Analysis. Sports Med 2018; 48:617-640. [PMID: 29249082 DOI: 10.1007/s40279-017-0815-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Team bat-or-stick sports, including cricket, softball and hockey, are popular among women. However, little is known about the injury profile in this population. OBJECTIVE The aim was to describe the incidence, nature and anatomical location of injuries in bat-or-stick sports played by women in a competitive league. METHODS This review was prospectively registered (PROSPERO CRD42015026715). CINAHL, MEDLINE, PsycINFO, PubMed, SPORTDiscus were systematically searched from January 2000 to September 2016, inclusive. Peer-reviewed original research articles reporting the incidence, nature and anatomical location of injuries sustained by women aged 18 + years in competitive bat-or-stick sports were included. Two meta-analyses based on injury incidence proportions (injury IP) and injury rates per 1000 person-days of athletic exposure (AE) were performed. RESULTS A total of 37 studies satisfied the inclusion criteria, and five had low risk of bias. The weighted injury IP was 0.42 [95% confidence interval (CI) 0.39-0.45]. The weighted injury rate was 6.12 (95% CI 6.05-6.18) overall, and greater in games [15.79 (95% CI 15.65-15.93)] than in practice [3.07 (95% CI 2.99-3.15)]. The ankle was the most commonly injured anatomical location, followed by the hand (including wrist and fingers), knee and head. Soft tissue and ligament injuries were most common types of injuries. CONCLUSION Injury prevention in women's sports is a novel and emerging field of research interest. This review highlights that injury incidence is high among female bat-or-stick players, but little information is known about direct causal mechanisms. This review clearly establishes the need for enhancements to injury data collection. Without this information, it will not be possible to develop evidence-based injury prevention interventions.
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Affiliation(s)
- Nirmala Kanthi Panagodage Perera
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), SMB Campus, Federation University Australia, Lydiard Street South, Ballarat, VIC, 3350, Australia.
| | - Corey Joseph
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), SMB Campus, Federation University Australia, Lydiard Street South, Ballarat, VIC, 3350, Australia.,Monash Health, 246 Clayton Rd, Clayton, VIC, 3168, Australia
| | - Joanne Lyn Kemp
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), SMB Campus, Federation University Australia, Lydiard Street South, Ballarat, VIC, 3350, Australia.,Latrobe Sports and Exercise Medicine Research Centre, College of Science, Health and Engineering, Latrobe University, Bundoora, VIC, 3086, Australia
| | - Caroline Frances Finch
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), SMB Campus, Federation University Australia, Lydiard Street South, Ballarat, VIC, 3350, Australia
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Toohey LA, Drew MK, Fortington LV, Finch CF, Cook JL. An Updated Subsequent Injury Categorisation Model (SIC-2.0): Data-Driven Categorisation of Subsequent Injuries in Sport. Sports Med 2018; 48:2199-2210. [PMID: 29500797 DOI: 10.1007/s40279-018-0879-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Accounting for subsequent injuries is critical for sports injury epidemiology. The subsequent injury categorisation (SIC-1.0) model was developed to create a framework for accurate categorisation of subsequent injuries but its operationalisation has been challenging. OBJECTIVES The objective of this study was to update the subsequent injury categorisation (SIC-1.0 to SIC-2.0) model to improve its utility and application to sports injury datasets, and to test its applicability to a sports injury dataset. METHODS The SIC-1.0 model was expanded to include two levels of categorisation describing how previous injuries relate to subsequent events. A data-driven classification level was established containing eight discrete injury categories identifiable without clinical input. A sequential classification level that sub-categorised the data-driven categories according to their level of clinical relatedness has 16 distinct subsequent injury types. Manual and automated SIC-2.0 model categorisation were applied to a prospective injury dataset collected for elite rugby sevens players over a 2-year period. Absolute agreement between the two coding methods was assessed. RESULTS An automated script for automatic data-driven categorisation and a flowchart for manual coding were developed for the SIC-2.0 model. The SIC-2.0 model was applied to 246 injuries sustained by 55 players (median four injuries, range 1-12), 46 (83.6%) of whom experienced more than one injury. The majority of subsequent injuries (78.7%) were sustained to a different site and were of a different nature. Absolute agreement between the manual coding and automated statistical script category allocation was 100%. CONCLUSIONS The updated SIC-2.0 model provides a simple flowchart and automated electronic script to allow both an accurate and efficient method of categorising subsequent injury data in sport.
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Affiliation(s)
- Liam A Toohey
- Department of Physical Therapies, c/o AIS Physical Therapies, Australian Institute of Sport, Leverrier Street, Bruce, ACT, 2617, Australia.
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, VIC, Australia.
- School of Allied Health (Physiotherapy), Sport and Exercise Medicine Department, La Trobe University, Bundoora, VIC, 3086, Australia.
| | - Michael K Drew
- Department of Physical Therapies, c/o AIS Physical Therapies, Australian Institute of Sport, Leverrier Street, Bruce, ACT, 2617, Australia
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, VIC, Australia
| | - Lauren V Fortington
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, VIC, Australia
| | - Caroline F Finch
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, VIC, Australia
- School of Allied Health (Physiotherapy), Sport and Exercise Medicine Department, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Jill L Cook
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, VIC, Australia
- School of Allied Health (Physiotherapy), Sport and Exercise Medicine Department, La Trobe University, Bundoora, VIC, 3086, Australia
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Leppe J, Besomi M. Recent Versus Old Previous Injury and Its Association with Running-Related Injuries During Competition by SeRUN® Running Profiles: a Cross-sectional Study. SPORTS MEDICINE-OPEN 2018; 4:49. [PMID: 30421313 PMCID: PMC6232187 DOI: 10.1186/s40798-018-0164-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 10/24/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Previous injury in the last 12 months is the main risk factor for future running-related injuries (RRI) during training and competition environments. However, the relationship between a recent versus old previous injury and a new RRI has not been established yet, nor a separate analysis by different types of runners. METHODS An online questionnaire was sent to 6000 participants of a running event (10 km, 21 km and 42 km), 10 days following the event. The questionnaire included the following information: the presence and topography of new RRIs during the race, old previous injury (from 12-4 months before the race), recent previous injury (from 3-0 months before the race), running experience, training factors and socio-demographic characteristics. Univariate binomial regression analysis was applied to assess different associated factors, and multivariable binomial backward regression (p < 0.05) was used to analyse the relationship between the new and previous injury. RESULTS A total of 868 surveys were analysed (10 km, 32.6%; 21 km, 52%; 42 km, 15.4%). The median age was 38 years (IQR 31-46), and 63.5% were males. Previous injury was reported by 30.3% and 27.6% for old and recent, respectively. The majority of runners were categorised into the advanced group (42.9%), having more than 5 years of running experience. During the race, 7.0% reported a RRI, with 36.1% located at the knee. The multivariable analysis showed an association only between new injury and recent injury. CONCLUSION The delineation of recent and old previous injuries should be considered in running epidemiological research.
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Affiliation(s)
- Jaime Leppe
- School of Physical Therapy, Universidad del Desarrollo, Avenida La Plaza 680, Las Condes, Santiago, Chile
| | - Manuela Besomi
- School of Physical Therapy, Universidad del Desarrollo, Avenida La Plaza 680, Las Condes, Santiago, Chile.
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45
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Nielsen RO, Bertelsen ML, Ramskov D, Møller M, Hulme A, Theisen D, Finch CF, Fortington LV, Mansournia MA, Parner ET. Time-to-event analysis for sports injury research part 2: time-varying outcomes. Br J Sports Med 2018; 53:70-78. [PMID: 30413427 PMCID: PMC6317441 DOI: 10.1136/bjsports-2018-100000] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Time-to-event modelling is underutilised in sports injury research. Still, sports injury researchers have been encouraged to consider time-to-event analyses as a powerful alternative to other statistical methods. Therefore, it is important to shed light on statistical approaches suitable for analysing training load related key-questions within the sports injury domain. CONTENT In the present article, we illuminate: (i) the possibilities of including time-varying outcomes in time-to-event analyses, (ii) how to deal with a situation where different types of sports injuries are included in the analyses (ie, competing risks), and (iii) how to deal with the situation where multiple subsequent injuries occur in the same athlete. CONCLUSION Time-to-event analyses can handle time-varying outcomes, competing risk and multiple subsequent injuries. Although powerful, time-to-event has important requirements: researchers are encouraged to carefully consider prior to any data collection that five injuries per exposure state or transition is needed to avoid conducting statistical analyses on time-to-event data leading to biased results. This requirement becomes particularly difficult to accommodate when a stratified analysis is required as the number of variables increases exponentially for each additional strata included. In future sports injury research, we need stratified analyses if the target of our research is to respond to the question: 'how much change in training load is too much before injury is sustained, among athletes with different characteristics?' Responding to this question using multiple time-varying exposures (and outcomes) requires millions of injuries. This should not be a barrier for future research, but collaborations across borders to collecting the amount of data needed seems to be an important step forward.
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Affiliation(s)
| | | | - Daniel Ramskov
- Department of Public Health, Section for Sports Science, Aarhus University, Aarhus, Denmark.,Department of Physiotherapy, University College Northern Denmark, Aalborg, Denmark
| | - Merete Møller
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Adam Hulme
- Centre for Human Factors and Sociotechnical Systems, Faculty of Arts, Business and Law, University of the Sunshine Coast, Maroochydore DC, Queensland, Australia
| | - Daniel Theisen
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Caroline F Finch
- Australian Centre for Research into Injury in Sport and its Prevention, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Lauren Victoria Fortington
- Australian Centre for Research into Injury in Sport and its Prevention, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia.,Faculty of Science and Technology, Federation University Australia, Ballarat, Victoria, Australia
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.,Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Erik Thorlund Parner
- Department of Public Health, Section for Biostatistics, Aarhus University, Aarhus, Denmark
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46
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Windt J, Ardern CL, Gabbett TJ, Khan KM, Cook CE, Sporer BC, Zumbo BD. Getting the most out of intensive longitudinal data: a methodological review of workload-injury studies. BMJ Open 2018; 8:e022626. [PMID: 30282683 PMCID: PMC6169745 DOI: 10.1136/bmjopen-2018-022626] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/24/2018] [Accepted: 09/04/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To systematically identify and qualitatively review the statistical approaches used in prospective cohort studies of team sports that reported intensive longitudinal data (ILD) (>20 observations per athlete) and examined the relationship between athletic workloads and injuries. Since longitudinal research can be improved by aligning the (1) theoretical model, (2) temporal design and (3) statistical approach, we reviewed the statistical approaches used in these studies to evaluate how closely they aligned these three components. DESIGN Methodological review. METHODS After finding 6 systematic reviews and 1 consensus statement in our systematic search, we extracted 34 original prospective cohort studies of team sports that reported ILD (>20 observations per athlete) and examined the relationship between athletic workloads and injuries. Using Professor Linda Collins' three-part framework of aligning the theoretical model, temporal design and statistical approach, we qualitatively assessed how well the statistical approaches aligned with the intensive longitudinal nature of the data, and with the underlying theoretical model. Finally, we discussed the implications of each statistical approach and provide recommendations for future research. RESULTS Statistical methods such as correlations, t-tests and simple linear/logistic regression were commonly used. However, these methods did not adequately address the (1) themes of theoretical models underlying workloads and injury, nor the (2) temporal design challenges (ILD). Although time-to-event analyses (eg, Cox proportional hazards and frailty models) and multilevel modelling are better-suited for ILD, these were used in fewer than a 10% of the studies (n=3). CONCLUSIONS Rapidly accelerating availability of ILD is the norm in many fields of healthcare delivery and thus health research. These data present an opportunity to better address research questions, especially when appropriate statistical analyses are chosen.
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Affiliation(s)
- Johann Windt
- Experimental Medicine Program, University of British Columbia, Vancouver, British Columbia, Canada
- United States Olympic Committee, Colorado Springs, Colorado, USA
- United States Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs, Colorado, USA
| | - Clare L Ardern
- Division of Physiotherapy, Linköping University, Linköping, Sweden
- School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Tim J Gabbett
- Gabbett Performance Solutions, Brisbane, Queensland, Australia
- Institute for Resilient Regions, University of Southern Queensland, Ipswich, Queensland, Australia
| | - Karim M Khan
- Experimental Medicine Program, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chad E Cook
- Department of Orthopaedics, Duke University, Durham, North Carolina, USA
| | - Ben C Sporer
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
- Vancouver Whitecaps Football Club, Vancouver, British Columbia, Canada
| | - Bruno D Zumbo
- Measurement, Evaluation, and Research Methodology Program, University of British Columbia, Vancouver, British Columbia, Canada
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47
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Stares J, Dawson B, Peeling P, Drew M, Heasman J, Rogalski B, Colby M. How much is enough in rehabilitation? High running workloads following lower limb muscle injury delay return to play but protect against subsequent injury. J Sci Med Sport 2018; 21:1019-1024. [DOI: 10.1016/j.jsams.2018.03.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 03/10/2018] [Accepted: 03/20/2018] [Indexed: 11/25/2022]
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48
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The incidence, prevalence, severity, mechanism and body region of injury in elite junior Australian football players: A prospective cohort study over one season. J Sci Med Sport 2018; 21:1013-1018. [DOI: 10.1016/j.jsams.2018.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 02/25/2018] [Accepted: 03/07/2018] [Indexed: 11/23/2022]
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49
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Esmaeili A, Hopkins WG, Stewart AM, Elias GP, Lazarus BH, Aughey RJ. The Individual and Combined Effects of Multiple Factors on the Risk of Soft Tissue Non-contact Injuries in Elite Team Sport Athletes. Front Physiol 2018; 9:1280. [PMID: 30333756 PMCID: PMC6176657 DOI: 10.3389/fphys.2018.01280] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 08/24/2018] [Indexed: 11/26/2022] Open
Abstract
Aim: Relationships between athlete monitoring-derived variables and injury risk have been investigated predominantly in isolation. The aim of this study was to evaluate the individual and combined effects of multiple factors on the risk of soft-tissue non-contact injuries in elite team sport athletes. Methods: Fifty-five elite Australian footballers were prospectively monitored over two consecutive seasons. Internal and external training load was quantified using the session rating of perceived exertion and GPS/accelerometry, respectively. Cumulative load and acute-to-chronic workload ratios were derived using rolling averages and exponentially weighted moving averages. History of injuries in the current and previous seasons was recorded along with professional experience, weekly musculoskeletal screening, and subjective wellness scores for individual athletes. Individual and combined effects of these variables on injury risk were evaluated with generalized linear mixed models. Results: High cumulative loads and acute-to-chronic workload ratios were associated with increased risk of injuries. The effects for measures derived using exponentially weighted moving averages were greater than those for rolling averages. History of a recent injury, long-term experience at professional level, and substantial reductions in a selection of musculoskeletal screening and subjective wellness scores were associated with increased risk. The effects of high cumulative loads were underestimated by ~20% before adjusting for previous injuries, whereas the effects of high acute-to-chronic workload ratios were overestimated by 10-15%. Injury-prone players, identified via player identity in the mixed model, were at > 5 times higher risk of injuries compared to robust players (hazard ratio 5.4, 90% confidence limits 3.6-12) despite adjusting for training load and previous injuries. Combinations of multiple risk factors were associated with extremely large increases in risk; for example, a hazard ratio of 22 (9.7-52) was observed for the combination of high acute load, recent history of a leg injury, and a substantial reduction in the adductor squeeze test score. Conclusion: On the basis of our findings with an elite team of Australian footballers, the information from athlete monitoring practices in team sports should be interpreted collectively and used as a part of the injury prevention decision-making process along with consideration of individual differences in risk.
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Affiliation(s)
| | | | | | | | | | - Robert J. Aughey
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, VIC, Australia
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50
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Risk Factors for Groin Injury and Groin Symptoms in Elite-Level Soccer Players: A Cohort Study in the Dutch Professional Leagues. J Orthop Sports Phys Ther 2018; 48:704-712. [PMID: 29792105 DOI: 10.2519/jospt.2018.7990] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Groin injury and groin symptoms are common in soccer players. The relationship of groin injury and groin symptoms to reduced hip range of motion (ROM) and previous injury is unclear. Objectives To conduct a retrospective assessment of associations between previous injury and preseason hip ROM and preseason prevalence of severe groin symptoms, and to prospectively identify risk factors for within-season groin injury. Methods During the period of 2015 to 2016, 190 players from 9 Dutch professional soccer clubs participated in this cohort study with prospective and retrospective elements. Univariate and multivariate logistic regressions were used to predict preseason severe groin symptoms, identified using the Copenhagen Hip and Groin Outcome Score, from a history of previous groin injury, general injury (minimum of 1 week in duration) in the previous season, and hip ROM. Cox regression was used to predict within-season groin injury. Results Point prevalence of severe groin symptoms was 24% and within-season incidence of groin injury was 11%. Total, training, and match groin injury incidences were 0.5, 0.2, and 2.6 injuries per 1000 playing hours, respectively. A history of more than 1 previous groin injury was associated with current severe groin symptoms (odds ratio = 3.0; 95% confidence interval: 1.0, 8.3; P = .038). General injury sustained in the previous season (ankle, knee, thigh, shoulder; median, 9 weeks of time loss) was a risk factor for groin injury (hazard ratio = 5.1; 95% confidence interval: 1.8, 14.6; P = .003). Conclusion Severe injuries in the previous season to locations other than the groin increase the risk of groin injury the next season. A history of groin injury is associated with current severe groin symptoms. Preseason hip ROM does not identify players at risk for groin injury. Level of Evidence Prevention, level 2b. J Orthop Sports Phys Ther 2018;48(9):704-712. Epub 23 May 2018. doi:10.2519/jospt.2018.7990.
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