The distribution of injuries in men's Canada West university football. A 5-year analysis

Implementation of Injury and Illness Surveillance Protocols in Varsity Athletes

OBJECTIVE

To develop and implement a prospective varsity athlete surveillance system to identify injury and illness trends in a multisport varsity-level university setting.

DESIGN

Longitudinal prospective surveillance study.

SETTING

Varsity-level sport program at the University of Guelph, Guelph, ON, Canada.

PARTICIPANTS

Athletic therapists (ATs) (n = 35) from 17 varsity sports provided injury and illness information on 624 varsity-level athletes (381 men and 243 women) during the 2016/2017 competitive season.

INTERVENTIONS

Team ATs reported athlete health complaints weekly. Athletes reported additional details on the injury or illness that was reported.

MAIN OUTCOME MEASURES

The outcome measurements included when the injury or illness occurred, anatomical location, diagnosis, cause, perceived severity, treatment, estimated athlete exposure (AE) to training and competition, and time loss from sport. Measures were recorded from the teams' first competition through to the end the season and/or playoffs.

RESULTS

Twenty-nine of 30 varsity sports teams participated in this injury and illness surveillance protocol. The compliance of team ATs and varsity athletes was 89% (men: 94%, women: 82%). The overall injury and illness rates were 5.5 injuries and 1.7 illnesses per 1000 AEs, respectively. Men's injury rates were greater than women's, and injury rates of contact sports were greater than noncontact sports.

CONCLUSIONS

The utilization of a prospective injury and illness surveillance protocol in the Canadian University sport system is feasible with good athlete, AT, and coach acceptance. The surveillance data should inform future injury and illness prevention strategies.

Epidemiology of Head Injuries Focusing on Concussions in Team Contact Sports: A Systematic Review

BACKGROUND

Although injuries to the head represent a small proportion of all sport injuries, they are of great concern due to their potential long-term consequences, which are even suspected in mild traumatic brain injuries.

OBJECTIVE

The aim of this review was to compare the incidence of concussions and other head injuries in elite level football, rugby, ice hockey and American Football.

METHODS

Four electronic databases (CINAHL, PsycINFO, Web of Science, PubMed) were searched. Prospective cohort studies on the incidence of concussion in elite athletes aged 17 years or older that were published in an English-language peer-reviewed journal since 2000 were included. Two authors independently evaluated study eligibility and quality. The extracted data on concussions were pooled in a meta-analysis using an inverse-variance fixed-effects model. The extracted data on head injuries were reported in a narrative and tabular summary.

RESULTS

The search yielded 7673 results of which 70 articles were included in the qualitative and 47 in the quantitative analysis. In our meta-analysis, we found the highest concussion incidences in rugby match play (3.89 and 3.00 concussions per 1000 h and athletic exposures (AEs), respectively), and the lowest in men's football training (0.01 and 0.08 per 1000 h and AEs, respectively). Overall, concussions and all head injuries were rare in training when compared to match play. Female players had an increased concussion risk in football and ice hockey when compared to male players.

CONCLUSION

Future research should focus on concussion in women's contact sports, as there is little evidence available in this area. Methodological deficits are frequent in the current literature, especially regarding sample size and study power, and should be avoided.

Reporting Multiple Individual Injuries in Studies of Team Ball Sports: A Systematic Review of Current Practice

Background

To identify and prioritise targets for injury prevention efforts, injury incidence studies are widely reported. The accuracy and consistency in calculation and reporting of injury incidence is crucial. Many individuals experience more than one injury but multiple injuries are not consistently reported in sport injury incidence studies.

Objective

The aim of this systematic review was to evaluate current practice of how multiple injuries within individuals have been defined and reported in prospective, long-term, injury studies in team ball sports.

Data Sources

A systematic search of three online databases for articles published before 2016.

Study Selection

Publications were included if (1) they collected prospective data on musculoskeletal injuries in individual participants; (2) the study duration was >1 consecutive calendar year/season; and (3) individuals were the unit of analysis.

Data Extraction

Key study features were summarised, including definitions of injury, how multiple individual injuries were reported and results relating to multiple injuries.

Results

Of the 71 publications included, half did not specifically indicate multiple individual injuries; those that did were largely limited to reporting recurrent injuries. Eight studies reported the number/proportion of athletes with more than one injury, and 11 studies presented the mean/number of injuries per athlete.

Conclusions

Despite it being relatively common to collect data on individuals across more than one season, the reporting of multiple injuries within individuals is much more limited. Ultimately, better addressing of multiple injuries will improve the accuracy of injury incidence studies and enable more precise targeting and monitoring of the effectiveness of preventive interventions.

Electronic supplementary material

The online version of this article (doi:10.1007/s40279-016-0637-3) contains supplementary material, which is available to authorized users.

The Epidemiology of Concussions: Number and Nature of Concussions and Time to Recovery Among Female and Male Canadian Varsity Athletes 2008 to 2011

OBJECTIVE

To provide incidence rates and days to symptom resolution and cognitive recovery stratified by sex and sport at a Canadian institution.

STUDY DESIGN

A retrospective chart analysis.

SUBJECTS

Seven hundred fifty-nine varsity level athletes competing in men's football, men's and women's soccer, men's and women's volleyball, men's and women's basketball, men's and women's ice hockey, women's field hockey, women's rugby, men's and women's tennis, men's and women's water polo, men's and women's swimming, badminton, cross-country, and track and field in the 2008 to 2009 season through the 2010 to 2011 season.

MAIN OUTCOME MEASURES

Incidence of concussion, days to symptom recovery, and days to cognitive recovery as measured by clinical interpretation using the sports concussion assessment tool (SCAT)/SCAT2 and Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) with baseline and follow-up data.

RESULTS

A total of 81 concussions were reported and diagnosed among 759 athletes. Significantly, more female athletes were concussed than male athletes (13.08%-7.53%, respectively; P = 0.014) with the highest rates in women's rugby [incidence density (ID) = 20.00 concussions per athlete-season], women's ice hockey (ID = 18.67 per athlete-season), and men's basketball (ID = 20.00 per athlete-season). Sex differences in symptom recovery and cognitive recovery were not significant.

CONCLUSIONS

The incidence of concussion across multiple sports in a Canadian varsity athlete population is of concern. There are inconsistencies found between the time an athlete claims to have no symptoms and the time of neurocognitive recovery as measured by computerized neurocognitive testing. Therefore, objective computerized testing is recommended to ensure that athletes are functionally recovered before return to play.

Severe Brachial Plexus Injuries in American Football

This article reports a series of severe permanent brachial plexus injuries in American football players. The authors describe the mechanisms of injury and outcomes from a more contemporary treatment approach in the form of nerve transfer tailored to the specific injuries sustained. Three cases of nerve transfer for brachial plexus injury in American football players are discussed in detail. Two of these patients regained functional use of the extremity, but 1 patient with a particularly severe injury did not regain significant function. Brachial plexus injuries are found along a spectrum of brachial plexus stretch or contusion that includes the injuries known as "stingers." Early identification of these severe brachial plexus injuries allows for optimal outcomes with timely treatment. Diagnosis of the place of a given injury along this spectrum is difficult and requires a combination of imaging studies, nerve conduction studies, and close monitoring of physical examination findings over time. Although certain patients may be at higher risk for stingers, there is no evidence to suggest that this correlates with a higher risk of severe brachial plexus injury. Unfortunately, no equipment or strengthening program has been shown to provide a protective effect against these severe injuries. Patients with more severe injuries likely have less likelihood of functional recovery. In these patients, nerve transfer for brachial plexus injury offers the best possibility of meaningful recovery without significant morbidity. [ Orthopedics. 2016; 39(6):e1188-e1192.].

Wearing American Football helmets increases cervicocephalic kinaesthetic awareness in "elite" American Football players but not controls

Background

While there have been investigations into the reduced neck injury rate of wearing protective helmets, there is little information on its effects on normal kinaesthetic neck function. This study aims to quantify the kinaesthetic and movement effects of the American football helmet.

Methods

Fifteen British Collegiate American football players (mean age 22.2, SD 1.9; BMI kg.m² 26.3, SD 3.7) were age and size matched to 11 non-American football playing university students (mean age 22.5, SD 3.6; BMI 24.3, SD 3.3 kg.m²). Both groups had their active cervical range of motion and head repositioning accuracy measured during neck flexion/extension using a modified cervical range of motion device and a similarly modified football helmet.

Results

Wearing helmets significantly reduced active cervical range of motion in extension in both groups (P = 0.007 and P = 0.001 Controls and American Footballers respectively). While both groups had similar repositioning when not wearing a helmet (flexion P = 0.99; extension P = 0.52), when wearing helmets, American football players appeared to be more accurate in relation to cervical kinaesthetic repositioning (ANOVA: P = 0.077: flexion effect size =0.84; extension effect size =0.38).

Conclusions

Wearing American football helmets significantly reduces the active cervical range of motion in extension, along with a change in the neutral head position. American footballers have a greater accuracy in repositioning their head from flexion (potentially enhanced proprioception) when wearing a helmet. This finding might allow development of a simple objective test to help discern presence of minor concussive or cervical musculoskeletal injury on or off the field.

Brachial neuropraxia in Canadian Atlantic University sport football players: what is the incidence of "stingers"?

OBJECTIVES

The objectives of this study were (1) to determine the incidence of brachial neuropraxia (stingers) among varsity football players during the 2010 season; (2) to determine if associations exist between sustaining a stinger and previous history of stingers, years played, equipment, age, body mass index (BMI), and conditioning; and (3) to provide descriptive statistics regarding stingers and position played, symptoms, activity during injury, mechanism of tackling, and reporting of stingers.

DESIGN

Retrospective.

SETTING

Canadian Atlantic University Sport football league.

PARTICIPANTS

Two hundred forty-four players.

ASSESSMENT OF RISK FACTORS

Two written questionnaires.

MAIN OUTCOME MEASURES

Number of players experiencing stingers that occurred during the 2010 season.

RESULTS

The incidence was 26% (64 of 244). A multivariate analysis revealed that previous history of a stinger (P < 0.0001) and years played (P = 0.0018) were associated with sustaining a stinger. There was no statistically significant effect related to additional equipment, a player's age, BMI, or participation in a strength training program. Linebackers, offensive linemen, and wide receivers had the highest incidence of stingers. The most frequent symptoms reported were tingling, numbness, burning, and weakness. Of all stingers sustained, only 59% (38 of 64) were reported to medical staff.

CONCLUSIONS

Stingers are a common injury in Canadian university football and are underreported to medical staff. Education of players at increased risk is needed.

Time-to-subsequent head injury from sports and recreation activities

OBJECTIVE

To provide population-based risk estimates for sustaining subsequent head injuries (HIs), which occur in sports and recreation (SR).

DESIGN

Population-based, retrospective, cross-sectional study.

SETTING

Retrospective review of data from 2 tertiary care and 3 community care emergency departments (EDs) in Edmonton, Alberta, Canada.

PATIENTS

Individuals younger than 36 years presenting to an ED with an SR-related injury between April 1, 1997, and March 31, 2008. There were 9246 subsequent ED records identified for 8958 patients in the main analysis.

MAIN OUTCOME MEASURES

Clinically diagnosed HI occurring in SR activities after an index presentation, and the number of days between ED presentations for diagnosed SR-HIs.

RESULTS

Individuals with 1 and 2 previous SR-related HIs were 2.62 [95% confidence interval (CI), 2.23-3.07] and 5.94 times, respectively, more likely (95% CI, 3.43-10.29) to sustain a subsequent HI than those without a previous HI. The median time-to first HI was 758 days from an initial injury and decreased to 613 days and 303 days for those at risk of second and third SR-related HIs (P < 0.0001). Individuals aged 7 to 13 years were 4.29 times more likely (95% CI, 2.65-6.92) to sustain an HI when presenting with a subsequent SR injury, compared with those aged 30 to 35 years.

CONCLUSIONS

The odds of sustaining a subsequent HI substantially increase with each successive HI. Time between SR-related HIs shortens as the number of HIs increases. Initial HI may be a key marker to institute high-risk injury prevention measures directed at young persons who present to EDs.

Surgical and therapeutic management of a complete proximal hamstring avulsion after failed conservative approach

STUDY DESIGN

Case report.

BACKGROUND

After 2 attempts at conservative care for a diagnosis of hamstring strain, the patient had a surgical hamstring allograft reconstruction. The purpose of this report is to describe the physical therapy approach to postoperative management of a hamstring reconstruction.

CASE DESCRIPTION

A 24-year-old female coach who sustained a complete avulsion of the proximal hamstring tendon while playing softball had a surgical hamstring reconstruction using an Achilles tendon allograft. Precautions concerning range of motion and stretching, weight-bearing status, and brace were followed to protect the surgical graft. Treatment incorporated cardiovascular, strength and proprioception exercises, and progressed with the focus on correct movement patterns and eccentric muscle control during functional movements.

OUTCOMES

The patient attended 25 physical therapy sessions over 7 months. Muscle strength improved from 4/5 to 5/5. Straight-leg raise range of motion decreased from 145 degrees to 90 degrees . Lower Extremity Functional Scale (LEFS) scores improved from 15/80 to 70/80.

DISCUSSION

A complete avulsion of the proximal insertion is rare. Conservative management of hamstring tears has traditionally focused on end-range passive stretching, modalities, and direct hamstring strengthening. New evidence recommends a program that is more protective of the injured tissue and includes exercises such as core stabilization; indirect hamstring strengthening may be beneficial in the treatment of hamstring injuries. This concept was taken into account when considering the rehabilitation protocol and progression for this patient.

LEVEL OF EVIDENCE

Therapy, level 4.

Does the apolipoprotein epsilon 4 allele predispose varsity athletes to concussion? A prospective cohort study

OBJECTIVE

To determine the association between the apolipoprotein epsilon 4 allele and concussion. We hypothesized that apolipoprotein epsilon 4 carriers may be more likely to sustain a concussion.

DESIGN

Prospective cohort study.

SETTING

University of Toronto varsity athletics.

PARTICIPANTS

Included 318 of 822 collegiate student athletes who participated in University of Toronto varsity sports from September 2002 to April 2006.

ASSESSMENT OF RISK FACTORS

The presence of apolipoprotein epsilon 4 was described dichotomously after genotyping blood samples collected from participants.

MAIN OUTCOME MEASUREMENTS

Concussions were identified by sport-medicine professionals present on the sidelines using on-field assessment forms. All concussion diagnoses were verified by a sports medicine physician. Survival analysis was used to determine the association between apolipoprotein epsilon 4 and first concussion.

RESULTS

The unadjusted hazard ratio for concussion in the apolipoprotein epsilon 4 carriers was 1.18 (95% CI: 0.52, 2.69) compared to noncarriers. Adjustment for sex, weight, height, and team type resulted in a hazard ratio of 1.06 (95% CI: 0.41, 2.72), indicating little effect from confounding factors.

CONCLUSIONS

There is no important association between carrying the apolipoprotein epsilon 4 allele and sustaining a concussion. At this time, we do not recommend preseason genetic testing for varsity athletes as a mechanism for targeting prevention strategies.

The burden and determinants of neck pain in the general population: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders

STUDY DESIGN

Best evidence synthesis.

OBJECTIVE

To undertake a best evidence synthesis of the published evidence on the burden and determinants of neck pain and its associated disorders in the general population.

SUMMARY OF BACKGROUND DATA

The evidence on burden and determinants of neck has not previously been summarized.

METHODS

The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders performed a systematic search and critical review of literature published between 1980 and 2006 to assemble the best evidence on neck pain. Studies meeting criteria for scientific validity were included in a best evidence synthesis.

RESULTS

We identified 469 studies on burden and determinants of neck pain, and judged 249 to be scientifically admissible; 101 articles related to the burden and determinants of neck pain in the general population. Incidence ranged from 0.055 per 1000 person years (disc herniation with radiculopathy) to 213 per 1000 persons (self-reported neck pain). Incidence of neck injuries during competitive sports ranged from 0.02 to 21 per 1000 exposures. The 12-month prevalence of pain typically ranged between 30% and 50%; the 12-month prevalence of activity-limiting pain was 1.7% to 11.5%. Neck pain was more prevalent among women and prevalence peaked in middle age. Risk factors for neck pain included genetics, poor psychological health, and exposure to tobacco. Disc degeneration was not identified as a risk factor. The use of sporting gear (helmets, face shields) to prevent other types of injury was not associated with increased neck injuries in bicycling, hockey, or skiing.

CONCLUSION

Neck pain is common. Nonmodifiable risk factors for neck pain included age, gender, and genetics. Modifiable factors included smoking, exposure to tobacco, and psychological health. Disc degeneration was not identified as a risk factor. Future research should concentrate on longitudinal designs exploring preventive strategies and modifiable risk factors for neck pain.

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

BACKGROUND

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

PURPOSE

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

STUDY DESIGN

Descriptive epidemiology study.

METHODS

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

RESULTS

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

CONCLUSION

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

Injuries to high school football athletes in California

BACKGROUND

Among all high school sports, football has the highest rate of injury. Prior research has been limited primarily because of challenges in surveillance, defining injuries, and measuring exposures.

HYPOTHESIS

Football injury patterns differ across player and session characteristics.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

More than 5000 football players from 87 high schools in California were observed for 2 seasons (2001 and 2002). School representatives were trained to collect data on injuries, player characteristics, and daily exposures. Data were analyzed using descriptive statistics and clustered Poisson regression.

RESULTS

Players sustained 25.5 injuries per 100 players, 9.3 injuries per 10,000 player-hours, and 8.4 injuries per 100 session-hours. Session rates were highest during games, on artificial turf (13.8 of 100), during foggy weather (25.1 of 100), and on clear evenings (21 of 100). Offensive and defensive backfielders had about a 20% increased rate of injury compared with linemen. The adjusted injury rate for starters was 60% higher than the rate for nonstarters (relative rate, 1.6; 95% confidence interval, 1.4-1.9).

CONCLUSION

Risk profiles differed by experience, playing position, and surface types. We recommend future sports injury research that measures time-dependent exposures at the individual level and for various types of environmental playing conditions.

Central nervous system injuries in sport and recreation: a systematic review

Many sports have been associated with a variety of neurological injuries affecting the central nervous system (CNS), with some injuries specific to that sport. A systematic review of sport-specific CNS injuries has not been attempted previously, and could assist in the understanding of morbidity and mortality associated with particular sporting activities, either professional or amateur. A systematic review of the literature was performed using PubMed (1965-2003) examining all known sports and a range of possible CNS injuries attributable to that sport. Numerous sporting activities (45) have associated CNS injuries as reported within the literature. The sports most commonly associated with CNS injuries are: football, boxing, hockey, use of a trampoline, and various winter activities. A number of sporting activities are associated with unique CNS injuries or injury-related diseases such as heat stroke in auto racing, vertebral artery dissection in the martial arts, and dementia pugilistica in boxing. Neurological injuries of the CNS due to sport comprise a wide collection of maladies that are important for the neurologist, neurosurgeon, orthopaedic surgeon, physiatrist, sports medicine doctor, athletic trainer and general physician to recognise.

Preventing head and neck injury

A wide range of head and neck injury risks are present in sport, including catastrophic injury. The literature since 1980 on prevention of head and neck injury in sport was reviewed, focusing on catastrophic and brain injury and identifying the range of injury prevention methods in use. There have been few formal evaluations of injury prevention methods. Approaches that are considered, or have been proven, to be successful in preventing injury include: modification of the baseball; implementation of helmet standards in ice hockey and American football and increased wearing rates; use of full faceguards in ice hockey; changes in rules associated with body contact; implementation of rules to reduce the impact forces in rugby scrums. Helmets and other devices have been shown to reduce the risk of severe head and facial injury, but current designs appear to make little difference to rates of concussion. Research methods involving epidemiological, medical, and human factors are required in combination with biomechanical and technological approaches to reduce further injury risks in sport.

The effect of helmet use on injury severity and crash circumstances in skiers and snowboarders

The aim of this study was to examine the effect of helmet use on non-head-neck injury severity and crash circumstances in skiers and snowboarders. We used a matched case-control study over the November 2001 to April 2002 winter season. 3295 of 4667 injured skiers and snowboarders reporting to the ski patrol at 19 areas in Quebec with non-head, non-neck injuries agreed to participate. Cases included those evacuated by ambulance, admitted to hospital, with restriction of normal daily activities (NDAs) >6 days, with non-helmet equipment damage, fast self-reported speed, participating on a more difficult run than usual, and jumping-related injury. Controls were injured participants without severe injuries or high-energy crash circumstances and were matched to cases on ski area, activity, day, age, and sex. Conditional logistic regression was used to relate each outcome to helmet use. There was no evidence that helmet use increased the risk of severe injury or high-energy crash circumstances. The results suggest that helmet use in skiing and snowboarding is not associated with riskier activities that lead to non-head-neck injuries.

Sport injuries: relations to sex, sport, injured body region

The present study evaluated the association among sex, sport, and injured body region of sport injuries. The subjects were 329 men and 127 women, ranging in age from 17 to 28 years, attending classes in the departments of Physical Training and Sport of Atatürk University (Erzurum, Erzincan, and Ağri in Turkey). There were no differences between men and women in percentages of injuries. The difference among various sports in the percentages of injured athletes was statistically significant. Running had the lowest percentage of injuries and basketball had the highest percentage. The most frequently injured body regions were the foot and the ankle in basketball, volleyball, soccer, and running, but in wrestling, the knee. These findings suggest that injury rates are associated with the sport rather than sex of player, and the most frequently injured body regions are the lower extremities. Therefore, the muscles of lower extremity should be strengthened to avoid injuries.

Development of a new activity score for the evaluation of ankle instability

BACKGROUND

Tegner and Lysholm described their generally acknowledged activity score in 1985. It was originally tested for knee ligament injuries, but for the past 17 years it has been used for other joint evaluations as well. The development of already existing and new kinds of sports, differences between knee and ankle loading, and different injury rates provided reasons for developing an ankle-specific activity score.

HYPOTHESIS

The new score should have a higher reliability, validity, and sensitivity than the Tegner score when evaluating ankle-related activity changes.

STUDY DESIGN

Methodological study.

METHODS

Fifty-three sports, 3 working activities, and 4 general activities were inserted into a 0-to-10 category system based on the rankings of a 7 x 2-point pre-evaluation system, followed by a direct comparison with the Tegner score and reliability, validity, and sensitivity testing on 2 different patient populations.

RESULTS

In direct comparison, there is a strong overall correlation of the 2 activity-scoring systems (r = 0.7565), but the ankle activity score proved to be different from the Tegner score in the higher categories, especially in the top 4 ankle score categories (r = 0.1450). Further tests demonstrated the high reliability (1.00) of the new score. Analysis of variance proved that activity changes measured by the ankle score correspond well to the difference between the patients' subjective results and their Karlsson functional scores (P =.0119). This is not the case when we measure ankle activity changes using the knee-specific Tegner score (P =.0987). Furthermore, ankle score differences spread over a wider range (-1.18 +/- 2.12) than did Tegner score differences (-0.68 +/- 1.29), which demonstrates the higher sensitivity of the new score.

CONCLUSIONS

Based on these results, the new ankle activity score could be a better complement in the complex evaluation of ankle instability.

A comparison of 2 rehabilitation programs in the treatment of acute hamstring strains

STUDY DESIGN

Prospective randomized comparison of 2 rehabilitation programs.

OBJECTIVES

The objectives of this study were to compare the effectiveness of 2 rehabilitation programs for acute hamstring strain by evaluating time needed to return to sports and reinjury rate during the first 2 weeks and the first year after return to sport. A third objective was to investigate the relationship between functional testing performance and time to return to sports and reinjury rates after return to sport.

BACKGROUND

Hamstring muscle strains are common in sports and often result in chronic pain, recurrent hamstring strains, and reduced sports performance. Current rehabilitation programs are primarily developed anecdotally and lack support from prospective, randomized research.

METHODS AND MEASURES

Twenty-four athletes with an acute hamstring strain were randomly assigned to 1 of 2 rehabilitation groups. Eleven athletes were assigned to a protocol consisting of static stretching, isolated progressive hamstring resistance exercise, and icing (STST group). Thirteen athletes were assigned to a program consisting of progressive agility and trunk stabilization exercises and icing (PATS group). The number of days for full return to sports, injury recurrence within the first 2 weeks, injury recurrence within the first year of returning to sports, and lower-extremity functional evaluations were collected for all subjects and compared between groups.

RESULTS

The average (+/- SD) time required to return to sports for athletes in the STST group was 37.4 +/- 27.6 days, while the average time for athletes in the PATS group was 22.2 +/- 8.3 days. This difference was not statistically significant (P = .2455). In the first 2 weeks after return to sports, reinjury rate was significantly greater (P = .00343, Fisher's exact test) in the STST group, where 6 of 11 athletes (54.5%) suffered a recurrent hamstring strain after completing the stretching and strengthening program, as compared to none of the 13 athletes (0%) in the PATS group. After 1 year of return to sports, reinjury rate was significantly greater (P = .0059, Fisher's exact test) in the STST group. Seven of 10 athletes (70%) who completed the hamstring stretching and strengthening program, as compared to only 1 of the 13 athletes (7.7%) who completed the progressive agility and trunk stabilization program, suffered a recurrent hamstring strain during that 1-year period.

CONCLUSIONS

A rehabilitation program consisting of progressive agility and trunk stabilization exercises is more effective than a program emphasizing isolated hamstring stretching and strengthening in promoting return to sports and preventing injury recurrence in athletes suffering an acute hamstring strain. Future randomized clinical trials should investigate the potential for progressive agility and trunk stabilization programs in the prevention of hamstring strain injury during sports.

Risk factors for sports injuries--a methodological approach

The methodology for studies designed to investigate potential risk factors for sports injury is reviewed, using the case of hamstring strains as an example. Injuries result from a complex interaction of multiple risk factors and events. Therefore, a multivariate statistical approach should be used. In addition, the sample size of the study needs to be considered carefully. Sample size mainly depends on the expected effect of the risk factor on injury risk, and to detect moderate to strong associations 20-50 injury cases are needed, whereas small to moderate associations would need about 200 injured subjects. Studies published to date on the risk factors for hamstring strains have methodological limitations, and are too small to detect small to moderate associations.

Patterns in childhood sports injury

OBJECTIVE

The purpose of this epidemiologic study is twofold: first, to determine the relative frequency of sports-related injuries compared with all musculoskeletal injuries in patients 5 to 21 years of age presenting to the emergency department (ED), and second, to evaluate the sports-specific and anatomic site-specific nature of these injuries.

METHODS

Patterns of injury in patients 5 to 21 years of age presenting to four pediatric EDs with musculoskeletal injuries in October 1999 and April 2000 were prospectively studied. Information collected included age, sex, injury type, anatomical injury site, and cause of injury (sports-related or otherwise). Information about patient outcome and disposition was also obtained.

RESULTS

There were a total of 1421 injuries in 1275 patients. Musculoskeletal injuries were more common in male patients (790/62%) than in female patients. The mean age of the patients was 12.2 years (95% CI, 12.0-12.4). Sprains, contusions, and fractures were the most common injury types (34, 30, and 25%, respectively). Female patients experienced a greater percentage of sprains (44% vs 36%) and contusions (37% vs 33%) and fewer fractures (22% vs 31%) than male patients. Sports injuries accounted for 41% (521) of all musculoskeletal injuries and were responsible for 8% (495/6173) of all ED visits. Head, forearm, and wrist injuries were most commonly seen in biking, hand injuries in football and basketball, knee injuries in soccer, and ankle and foot injuries in basketball.

CONCLUSIONS

Sports injuries in children and adolescents were by far the most common cause of musculoskeletal injuries treated in the ED, accounting for 41% of all musculoskeletal injuries. This represents the highest percentage of sports-related musculoskeletal injuries per ED visit reported in children to date. As children and adolescents participate in sports in record numbers nationwide, sports injury research and prevention will become increasingly more important.

Epidemiology of injuries in the Australian Football League, seasons 1997-2000

OBJECTIVE

To describe the epidemiology of injuries in the Australian Football League (AFL) over four seasons.

METHODS

An injury was defined as "any physical or medical condition that caused a player to miss a match in the regular season." The rationale for this definition was to eliminate a previously noted tendency of team recorders to interpret injury definitions subjectively. Administrative records of injury payments to players who did not play matches determined the occurrence of an injury.

RESULTS

The seasonal incidence of new injuries was 39 per club (of 40 players) per season (of 22 matches). The match injury incidence for AFL games was 25.7 injuries per 1000 player hours. The injury prevalence (percentage of players missing through injury in an average week) was 16%. The recurrence rate of injuries was 17%. The most common and prevalent injury was hamstring strain (six injuries per club per season, resulting in 21 missed matches per club per season), followed in prevalence by anterior cruciate ligament and groin injuries.

CONCLUSIONS

The injury definition of this study does not produce incidence rates that are complete for all minor injuries. However, the determination of an injury is made by a single entity in exactly the same manner for all teams, which overcomes a significant methodological flaw present in other multiteam injury surveillance systems.