Injuries to high school football athletes in California

Adiposity as a Risk Factor for Sport Injury in Youth: A Systematic Review

OBJECTIVE

To determine whether high or low adiposity is associated with youth sport-related injury.

DATA SOURCES

Ten electronic databases were searched to identify prospective studies examining the association between adiposity [body mass index (BMI) or body fat] and a future time-loss or medical attention sport-related musculoskeletal injury or concussion in youth aged 20 years and younger. Two independent raters assessed the quality (Downs and Black criteria) and risk of bias (Joanna Briggs Institute Critical Appraisal Tool). Random-effects meta-analyses were used to calculate pooled odds ratio [95% confidence interval (CI)] of injury.

MAIN RESULTS

Of 11 424 potentially relevant records, 38 articles were included with 17 eligible for meta-analyses. In qualitative synthesis, no clear association was identified between adiposity and any sport injury; however, 16/22 studies identified high adiposity as a significant risk factor for lower-extremity injury. Meta-analyses revealed higher BMI in youth with any sport-related injury and lower BMI in youth who developed a bone stress injury (BSI) compared with noninjured controls. The pooled OR (95% CI) examining the association of BMI and injury risk (excluding bone injury) was 1.18 (95% CI: 1.03-1.34). A major source of bias in included articles was inconsistent adjustment for age, sex, and physical activity participation.

CONCLUSIONS

Level 2b evidence suggests that high BMI is associated with greater risk of youth sport injury, particularly lower-extremity injury and excluding BSI or fracture. Although pooled mean differences were low, anthropometric risk of injury seems to be dependent on type and site of injury in youth sport.

A Review on Ergonomics in Agriculture. Part I: Manual Operations

Background: Agriculture involves several harmful diseases. Among the non-fatal ones, musculoskeletal disorders (MSDs) are the most prevalent, as they have reached epidemic proportions. The main aim of this investigation is to systematically review the major risk factors regarding MSDs as well as evaluate the existing ergonomic interventions. Methods: The search engines of Google Scholar, PubMed, Scopus, and ScienceDirect were used to identify relevant articles during the last decade. The imposed exclusive criteria assured the accuracy and current progress in this field. Results: It was concluded that MSDs affect both developed and developing countries, thus justifying the existing global concern. Overall, the most commonly studied task was harvesting, followed by load carrying, pruning, planting, and other ordinary manual operations. Repetitive movements in awkward postures, such as stooping and kneeling; individual characteristics; as well as improper tool design were observed to contribute to the pathogenesis of MSDs. Furthermore, low back disorders were reported as the main disorder. Conclusions: The present ergonomic interventions seem to attenuate the MSDs to a great extent. However, international reprioritization of the safety and health measures is required in agriculture along with increase of the awareness of the risk factors related to MSDs.

Incidence of Knee Injuries on Artificial Turf Versus Natural Grass in National Collegiate Athletic Association American Football: 2004-2005 Through 2013-2014 Seasons

BACKGROUND

The use of artificial turf in American football continues to grow in popularity, and the effect of these playing surfaces on athletic injuries remains controversial. Knee injuries account for a significant portion of injuries in the National Collegiate Athletic Association (NCAA) football league; however, the effect of artificial surfaces on knee injuries remains ill-defined.

HYPOTHESIS

There is no difference in the rate or mechanism of knee ligament and meniscal injuries during NCAA football events on natural grass and artificial turf playing surfaces.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

The NCAA Injury Surveillance System Men's Football Injury and Exposure Data Sets for the 2004-2005 through 2013-2014 seasons were analyzed to determine the incidence of anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), medial meniscus, and lateral meniscal tear injuries. Injury rates were calculated per 10,000 athlete exposures, and rate ratios (RRs) were used to compare injury rates during practices and competitions on natural grass and artificial turf in NCAA football as a whole and by competition level (Divisions I, Divisions II and III). Mechanisms of injury were calculated for each injury on natural grass and artificial turf surfaces.

RESULTS

A total of 3,009,205 athlete exposures and 2460 knee injuries were reported from 2004 to 2014: 1389 MCL, 522 ACL, 269 lateral meniscal, 164 medial meniscal, and 116 PCL. Athletes experienced all knee injuries at a significantly higher rate when participating in competitions as compared with practices. Athletes participating in competitions on artificial turf experienced PCL injuries at 2.94 times the rate as those playing on grass (RR = 2.94; 95% CI, 1.61-5.68). When stratified by competition level, Division I athletes participating in competitions on artificial turf experienced PCL injuries at 2.99 times the rate as those playing on grass (RR = 2.99; 95% CI, 1.39-6.99), and athletes in lower NCAA divisions (II and III) experienced ACL injuries at 1.63 times the rate (RR = 1.63; 95% CI, 1.10-2.45) and PCL injuries at 3.13 times the rate (RR = 3.13; 95% CI, 1.14-10.69) on artificial turf as compared with grass. There was no statistically significant difference in the rate of MCL, medial meniscal, or lateral meniscal injuries on artificial turf versus grass when stratified by event type or level of NCAA competition. No difference was found in the mechanisms of knee injuries on natural grass and artificial turf.

CONCLUSION

Artificial turf is an important risk factor for specific knee ligament injuries in NCAA football. Injury rates for PCL tears were significantly increased during competitions played on artificial turf as compared with natural grass. Lower NCAA divisions (II and III) also showed higher rates of ACL injuries during competitions on artificial turf versus natural grass.

The NBA and Youth Basketball: Recommendations for Promoting a Healthy and Positive Experience

Participation in sports offers both short-term and long-term physical and psychosocial benefits for children and adolescents. However, an overemphasis on competitive success in youth sports may limit the benefits of participation, and could increase the risk of injury, burnout, and disengagement from physical activity. The National Basketball Association and USA Basketball recently assembled a group of leading experts to share their applied research and practices to address these issues. This review includes the group's analysis of the existing body of research regarding youth sports participation and the related health, performance, and psychosocial outcomes. Based upon this, age-specific recommendations for basketball participation are provided that aim to promote a healthy and positive experience for youth basketball players.

The Epidemiology of Ankle Injuries Identified at the National Football League Combine, 2009-2015

Background:

American football is a leading cause of sports-related injuries, with the knee, ankle, and shoulder most commonly involved.

Purpose/Hypothesis:

The purpose of this study was to describe the epidemiology, characteristics, and imaging findings of ankle injuries in football players at the National Football League (NFL) Combine and determine the relationship to player position. We hypothesized that there would be a high relative incidence of ankle injuries in these players compared with other sports and that there would be a direct correlation between the incidence of ankle injuries and player position.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

A retrospective chart review of data collected from NFL Combine participants between 2009 and 2015 was performed. Patient demographics, history, physical examination results, and imaging findings were reviewed.

Results:

Of 2285 players, 1216 (53.2%) had a history of ankle injuries; of these, 987 (81.2%) had unilateral injuries, while 229 (18.8%) had bilateral injuries (total of 1445 ankles injured). This included 1242 ankle sprains (86.0% of ankle injuries): 417 (33.6% of sprains) high and 930 (74.9%) low. The most common soft tissue injuries were to the anterior talofibular ligament (n = 158, 12.7% of sprains) and syndesmosis (n = 137, 11.0%). Of all players at the NFL Combine with radiographs, 131 (10.9%) had evidence of an ankle fracture, all of which had healed. Magnetic resonance imaging (MRI) identified 66 players (28.9% of players at the combine who underwent MRI) with articular cartilage injuries: 62 involving the talus and 16 involving the tibia. Furthermore, 85 players (37.3% of players with MRI) with tendon injuries were identified: 26 Achilles, 55 peroneal, 3 flexor hallucis longus, and 19 posterior tibial. A total of 611 players (50.6% of players with radiographs) had signs of arthrosis on radiography. Running backs (61.9%), offensive linemen (60.3%), and tight ends (59.4%) had the highest rates of ankle injuries by position, while kickers/punters (23.3%) and long snappers (37.5%) had the lowest.

Conclusion:

Prior ankle injuries were present in more than 50% of elite college football players attending the NFL Combine. The rate of these ankle injuries varied by player position: offensive linemen, running backs, and tight ends had the highest overall rates, while special teams players had the lowest. Additional prospective work is needed to determine the impact of prior injuries on future playing career.

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.

Does variability within natural turfgrass sports fields influence ground-derived injuries?

Natural turfgrass sports fields exhibit within-field variations due to climatic conditions, field construction, field management, and foot traffic patterns from field usage. Variations within a field could influence the playing surface predictability and require athletes to make abrupt or frequent adjustments that lead to increased ground-derived injury occurrence. This study introduces a new methodology aimed at evaluating the potential relationship between within-field variations of turfgrass sports field properties and ground-derived athlete injuries. Collegiate Club Sport athletes self-reported ground-derived injuries over two years. Soil moisture, turfgrass quality, surface hardness, and turfgrass shear strength were quantified from their two home fields. Hot spot analysis identified significantly high (hot spots) and low (cold spots) values within the fields. Injury locations were compared to hot spot maps each month. Binomial proportion tests determined if there were differences between observed injury proportions and expected proportions. Twenty-three ground-derived injuries were reported overall. The observed injury proportions occurring in turfgrass quality cold spots [0.52 (95% CI 0.29-0.76)] and soil moisture hot spots [0.43 (95% CI 0.22-0.66)] was significantly higher than expected [0.20 (p < .001) and 0.21 (p < .05), respectively]. Most injuries in significant areas of turfgrass quality, soil moisture, and surface hardness were along edges of hot and cold spots. These results suggest a potential relationship between within-field variations and ground-derived injuries, particularly in transition areas between non-significant and significant high and low values. Future larger-scale studies can incorporate the reported methodology to validate this relationship and implement strategies that reduce ground-derived injuries.

The influence of playing surface on injury risk in italian elite rugby players

BACKGROUND

There is a growing interest in the use of artificial turf surfaces in rugby. In particular, artificial surfaces may be an useful means of increasing participation in the sport by allowing greater usage of a given pitch, especially in regions where natural turf pitches are difficult to maintain.

METHODS

The incidence of site, nature, cause, and severity of training and match injuries was prospectively recorded in two professional teams (one equipped with World Rugby certified third generation artificial turf and the other with natural grass over the 2014-2015 season).

RESULTS

A total of 23,840 minutes of exposure was displayed for the whole sample, 1,440 minutes during matches and 22,400 during training sessions. We recorded 37 (48%) traumatic injuries and 39 (52%) overuse injuries. For traumatic injuries, we did not find significant differences in the overall risk injury between grass and artificial turf considering match exposure and training sessions. For overuse injuries, there were significant differences in the overall risk injury between grass and artificial turf considering match exposure (p=0.03) and training sessions (p=0.02).

CONCLUSION

In elite Italian rugby players, artificial turf seems to be safe in regards to traumatic injury while it seems to be a risk factor for overuse injuries.

LEVEL OF EVIDENCE

II.

Full-Contact Practice and Injuries in College Football

Background:

Despite recent restrictions being placed on practice in college football, there are little data to correlate such changes with injuries.

Hypothesis:

Football injuries will correlate with a team’s exposure to full-contact practice, total practice, and total games.

Study Design:

Descriptive epidemiological study.

Methods:

All injuries and athlete injury exposures (AE × Min = athletes exposed × activity duration in minutes) were recorded for an intercollegiate football team over 4 consecutive fall seasons. Weekly injuries and injury rates (injuries per athletic injury exposure) were correlated with the weekly exposures to full-contact practices, total practices, formal scrimmages, and games.

Results:

The preseason practice injury rate was over twice the in-season practice injury rate (P < 0.001). For preseason, injury exposures were higher for full-contact practice (P = 0.0166), total practices (P = 0.015), and scrimmages/games (P = 0.034) compared with in-season. Preseason and in-season practice injuries correlated with exposure to full-contact practice combined with scrimmages for preseason (P < 0.008) and full-contact practice combined with games for in-season (P = 0.0325). The game injury rate was over 6 times greater than the practice injury rate (P < 0.0001). Concussions constituted 14.5% of all injuries, and the incidence of concussions correlated with the incidence of all injuries (P = 0.0001). Strength training did not correlate with injuries.

Conclusion:

Decreased exposure to full-contact practice may decrease the incidence of practice injuries and practice concussions. However, the game injury rate was over 6 times greater than the practice injury rate and had an inverse correlation with full-contact practice.

A 20-Year Comparison of Football-Related Injuries in American and Canadian Youth Aged 6 to 17 Years: A Replication Study

Introduction Little is known about Canadian youth football injuries. The objectives of this study were (a) to contrast the injuries in Canadian and American football players aged 6 to 17 years and (b) compare the injuries sustained during organized football with those in nonorganized football. Methods Using a retrospective cohort design based on data from the Canadian Hospitals Injury Reporting and Prevention Program and the National Electronic Injury Surveillance System a comparison of injuries was made. Results Trends in injuries were comparable. Proportions and odds of injuries were similar, except for a few exceptions. In Canada, more girls were injured and fractures were more prevalent. Compared with nonorganized football, organized football players were older, involved more males, and suffered more traumatic brain injuries and injuries to their lower extremities. Conclusion Canadian and American youth football injuries were similar. The type of football, be it organized or nonorganized, has an impact on injuries.

Incidence and Severity of Foot and Ankle Injuries in Men's Collegiate American Football

Background:

American football is an extremely physical game with a much higher risk of injury than other sports. While many studies have reported the rate of injury for particular body regions or for individual injuries, very little information exists that compares the incidence or severity of particular injuries within a body region. Such information is critical for prioritizing preventative interventions.

Purpose:

To retrospectively analyze epidemiological data to identify the most common and most severe foot and ankle injuries in collegiate men’s football.

Study Design:

Descriptive epidemiology study.

Methods:

Injury data were obtained from the National Collegiate Athletic Association (NCAA) Injury Surveillance System (ISS) for all foot and ankle injuries during the 2004-2005 to 2008-2009 seasons. Injuries were analyzed in terms of incidence and using multiple measures of severity (time loss, surgeries, medical disqualifications). This frequency and severity information is summarized in tabular form as well as in a 4 × 4 quantitative injury risk assessment matrix (QIRAM).

Results:

The rate of foot and ankle injuries was 15 per 10,000 athletic exposures (AEs). Five injuries were found to be responsible for more than 80% of all foot and ankle injuries: lateral ankle ligament sprains, syndesmotic (high ankle) sprains, medial ankle ligament sprains, midfoot injuries, and first metatarsophalangeal joint injuries. Ankle dislocations were found to be the most severe in terms of median time loss (100 days), percentage of surgeries (83%), and percentage of medical disqualifications (94%), followed by metatarsal fractures (38 days, 36%, and 49%, respectively) and malleolus fractures (33 days, 41%, and 59%, respectively). Statistical analysis suggests that the 3 measures of severity are highly correlated (r > 0.94), thereby justifying the use of time loss as a suitable proxy for injury severity in the construction of the QIRAM.

Conclusion:

Based on the QIRAM analysis, the 5 highest risk injuries were identified based on both incidence and severity (ankle dislocations, syndesmotic sprains, lateral ankle ligament sprains, metatarsal fractures, and malleolus fractures). A better understanding of the relative incidence and severity of these injuries will allow coaches, trainers, and researchers to more effectively focus their preventative interventions.

Ground condition as a risk factor in sports injury aetiology studies: the level of concordance between objective and subjective measures

Background

It is well known that the condition and type of sporting ground influences the risk of sports injury. However, the lack of evidence on the relationship between subjective and objective sporting ground condition assessments in sports injury aetiology studies has implications for the development of effective injury prevention strategies. This paper aims to examine concordance between subjectively rated and objective ground hardness and moisture measurements to inform data collection methods for future sports injury aetiology studies.

Methods

Subjective, observational assessments of ground hardness and soil moisture were recorded on 36 occasions during an Australian football season using two four-point scales of ‘very soft’ to ‘very hard’ and ‘very wet’ to ‘very dry’, respectively. Independent, objectively measured hardness and soil moisture were also undertaken at nine locations on the same grounds. The maximum and minimum ground values and the computed average of ground hardness and soil moisture were analysed. Somer’s d statistic was calculated to measure the level of concordance between the subjective and objective measures.

Results

A significant, moderate to substantial level of agreement was found between the subjective ratings and the average objective hardness values (d = 0.467, p <0.001), but there was perfect agreement on just less than half of the occasions. The level of concordance between the subjective and objective moisture ratings was low to moderate or trivial for all moisture measures (0.002 < d <0.264, p >0.05).

Conclusions

Compared to objective measures, the subjective assessments were more accurate for ground hardness than for soil moisture levels and raters were just as likely to underestimate or overestimate the condition under review. This has implications for future sports injury aetiology studies that include ground condition assessments and particularly the use of subjective measures to underpin the development of future injury prevention strategies.

Electronic supplementary material

The online version of this article (doi:10.1186/s40621-014-0027-y) contains supplementary material, which is available to authorized users.

Definition and usage of the term "overuse injury" in the US high school and collegiate sport epidemiology literature: a systematic review

BACKGROUND

A number of epidemiologic and surveillance-based studies of sports injury provide statistics on, and sometimes discussion of, overuse injuries. However, there is no consensus on the definition of "overuse." Some studies consider "overuse" as a mechanism of injury while others use a diagnosis-based definition.

OBJECTIVE

The objective of this study was to describe variation between studies in the definition and use of the term "overuse."

METHODS

PubMed and SPORTDiscus databases were searched between May and November 2012 to find articles published or online ahead of printing pertaining to US high school or collegiate athletics, which were epidemiologic in nature. Inclusion criteria required that the article present data collected on athlete exposure and provided statistics pertaining to overuse injuries. PRISMA guidelines were adhered to, to the best ability of the authors.

RESULTS

The initial search resulted in 5,182 articles with potential for inclusion. After review of titles or abstracts where appropriate, 232 studies were read in entirety to determine if they were appropriate for inclusion. Of the 35 articles included, 13 used data from the National Collegiate Athletics Association's Injury Surveillance System, 12 used data from the High School Reporting Information Online (RIO) injury surveillance system, and one used data from both of these systems. The remaining nine articles used data from distinct surveillance systems or prospectively collected data. All of these articles included data on overuse injuries, although not all provided definitions for overuse. A major finding from the literature is that the term "overuse" has been used both as a mechanism of injury and as an injury diagnosis (or a category of diagnoses). Specifically, of 35 articles, 14 used "overuse" as a mechanism of injury, seven used it as a category of injury diagnoses, eight used it as both a category of injury diagnoses and a mechanism of injury, and it was unclear in one how the term is used. Only one of the 35 articles provided a biomechanical definition for overuse injuries. Twelve of 35 articles combined "overuse" with other terms such as "chronic," "gradual onset," and "repetitive stress." Use of the term "no contact" was investigated in relation to "overuse." Four of 35 articles define overuse in the context of no contact injuries. Only one of 35 articles define "no contact" as a specific acute mechanism of injury, while all other mentions of "no contact" do not specifically distinguish whether "no contact" was limited to acute injuries only, or has potential to include "overuse" injuries.

CONCLUSION

There is a great deal of inconsistency in the use of the term "overuse" both within and between data sources. This is further complicated by the multiple uses of the term "no contact." We recommend that the term "overuse" only be used in regard to the mechanism of injury in order to enhance interpretation and understanding of the literature regarding overuse injuries and enhance the ability to compare results between studies. We also recommend the adoption of a common working definition of overuse injuries within injury surveillance. This definition should emphasize that overuse injuries are characterized by (1) a mechanism of gradual onset, and (2) an underlying pathogenesis of repetitive microtrauma.

Effects of two football stud configurations on biomechanical characteristics of single-leg landing and cutting movements on infilled synthetic turf

Multiple playing surfaces and footwear used in American football warrant a better understanding of relationship between different combinations of turf and footwear. The purpose of this study was to examine effects of shoe and stud types on ground reaction force (GRF) and ankle and knee kinematics of a 180° cut and a single-leg 90° land-cut on synthetic turf. Fourteen recreational football players performed five trials of the 180° cut and 90° land-cut in three shoe conditions: non-studded running shoe, and football shoe with natural and synthetic turf studs. Variables were analyzed with a 3 × 2 (shoe × movement) repeated measures analysis of variance (p < 0.05). Peak vertical GRF (p < 0.001) and loading rate (p < 0.001) were greater during 90° land-cut than 180° cut. For 180° cut, natural turf studs produced smaller peak medial GRFs compared to synthetic turf studs and non-studded shoe (p = 0.012). For land-cut, peak eversion velocity was reduced in running shoes compared to natural (p = 0.016) and synthetic (p = 0.002) turf studs. The 90° land-cut movement resulted in greater peak vertical GRF and loading rate compared to the 180° cut. Overall, increased GRFs in the 90° land-cut movement may increase the chance of injury.

Protective equipment and player characteristics associated with the incidence of sport-related concussion in high school football players: a multifactorial prospective study

BACKGROUND

The incidence of sport-related concussion (SRC) in high school football is well documented. However, limited prospective data are available regarding how player characteristics and protective equipment affect the incidence of SRC.

PURPOSE

To determine whether the type of protective equipment (helmet and mouth guard) and player characteristics affect the incidence of SRC in high school football players.

DESIGN

Cohort study; Level of evidence, 2.

METHODS

Certified athletic trainers (ATs) at each high school recorded the type of helmet worn (brand, model, purchase year, and recondition status) by each player as well as information regarding players' demographics, type of mouth guard used, and history of SRC. The ATs also recorded the incidence and days lost from participation for each SRC. Incidence of SRC was compared for various helmets, type of mouth guard, history of SRC, and player demographics.

RESULTS

A total of 2081 players (grades 9-12) enrolled during the 2012 and/or 2013 football seasons (2287 player-seasons) and participated in 134,437 football (practice or competition) exposures. Of these players, 206 (9%) sustained a total of 211 SRCs (1.56/1000 exposures). There was no difference in the incidence of SRC (number of helmets, % SRC [95% CI]) for players wearing Riddell (1171, 9.1% [7.6%-11.0%]), Schutt (680, 8.7% [6.7%-11.1%]), or Xenith (436, 9.2% [6.7%-12.4%]) helmets. Helmet age and recondition status did not affect the incidence of SRC. The rate of SRC (hazard ratio [HR]) was higher in players who wore a custom mouth guard (HR = 1.69 [95% CI, 1.20-2.37], P < .001) than in players who wore a generic mouth guard. The rate of SRC was also higher (HR = 1.96 [95% CI, 1.40-2.73], P < .001) in players who had sustained an SRC within the previous 12 months (15.1% of the 259 players [95% CI, 11.0%-20.1%]) than in players without a previous SRC (8.2% of the 2028 players [95% CI, 7.1%-9.5%]).

CONCLUSION

Incidence of SRC was similar regardless of the helmet brand (manufacturer) worn by high school football players. Players who had sustained an SRC within the previous 12 months were more likely to sustain an SRC than were players without a history of SRC. Sports medicine providers who work with high school football players need to realize that factors other than the type of protective equipment worn affect the risk of SRC in high school players.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Injuries in a Japanese Division I collegiate american football team: a 3-season prospective study

CONTEXT

Previous research on American football injuries in Japan has focused on incidence proportion in terms of the number of injuries divided by the number of players. This is the first study to examine injury rates over several seasons.

OBJECTIVE

To conduct a prospective study of injuries in a Japanese Division I collegiate American football team over the 2007 through 2009 seasons.

DESIGN

Cohort study.

SETTING

Collegiate football team at Doshisha University, Kyoto, Japan.

PATIENTS OR OTHER PARTICIPANTS

All 289 athletes who played on the collegiate Division I football team during the 2007 through 2009 seasons.

MAIN OUTCOME MEASURE(S)

A certified athletic trainer kept a daily record of all practice and game injuries. Injury rates were calculated according to season, injury type, body part, severity, and mechanism. Injuries were also analyzed according to position of player, school year, and playing experience.

RESULTS

The game injury rate (GIR; 32.7 injuries/1000 athlete-exposures) was higher than the practice injury rate (PIR; 10.9 injuries/1000 athlete-exposures) over the 3 seasons (P < .05). The PIR was higher among Japanese players than the comparable United States collegiate football injury rates (5.8-7.0 injuries/1000 athlete-exposures). Ankle and foot injuries occurred more frequently during games, whereas thigh and gluteal injuries occurred more frequently during practices.

CONCLUSIONS

Our data show differences between games and practices in terms of injury rates, body parts injured, and positions of players injured. The high PIR in Japan may be due to the increased contact during practices and length of practices compared with the United States. Further research involving multiple teams is recommended to validate the trends noted in this study. The expanded data set could assist in the development of safety regulations and preventive interventions for Japanese football.

The effect of playing surface on the incidence of ACL injuries in National Collegiate Athletic Association American Football

BACKGROUND

Artificial playing surfaces are widely used for American football practice and competition and anterior cruciate ligament (ACL) injuries are common. This study analyzed the National Collegiate Athletic Association (NCAA) Injury Surveillance System (ISS) men's football ACL injury database from 2004-2005 through 2008-2009 to determine the effect of playing surface on ACL injury in NCAA football athletes.

METHODS

This database was reviewed from the 2004-2005 through 2008-2009 seasons using the specific injury code, "Anterior cruciate ligament (ACL) complete tear." The injury rate was computed for competition and practice exposures. Ninety-five percent confidence intervals were calculated using assumptions of a Poisson distribution. Pair-wise, two-sample tests of equality of proportions with a continuity correction were used to estimate the associations of risk factors.

RESULTS

There was an incidence rate of 1.73 ACL injuries per 10,000 athlete-exposures (A-Es) (95% CI 1.47-2.0) on artificial playing surfaces compared with a rate of 1.24 per 10,000 A-Es (1.05-1.45, p<0.001) on natural grass. The rate of ACL injury on artificial surfaces is 1.39 times higher than the injury rate on grass surfaces. Non-contact injuries occurred more frequently on artificial turf surfaces (44.29%) than on natural grass (36.12%).

CONCLUSIONS

NCAA football players experience a greater number of ACL injuries when playing on artificial surfaces.

Incidence of injuries in high school softball and baseball players

CONTEXT

Participation in high school sports has grown 16.1% over the last decade, but few studies have compared the overall injury risks in girls' softball and boys' baseball.

OBJECTIVE

To examine the incidence of injury in high school softball and baseball players.

DESIGN

Cohort study.

SETTING

Greenville, South Carolina, high schools.

PATIENTS OR OTHER PARTICIPANTS

Softball and baseball players (n = 247) from 11 high schools.

MAIN OUTCOME MEASURE(S)

Injury rates, locations, types; initial or subsequent injury; practice or game setting; positions played; seasonal trends.

RESULTS

The overall incidence injury rate was 4.5/1000 athlete-exposures (AEs), with more injuries overall in softball players (5.6/1000 AEs) than in baseball players (4.0/1000 AEs). Baseball players had a higher initial injury rate (75.9/1000 AEs) than softball players (66.4/1000 AEs): rate ratio (RR) = 0.88, 95% confidence interval (CI) = 0.4, 1.7. The initial injury rate was higher than the subsequent injury rate for the overall sample (P < .0001) and for softball (P < .0001) and baseball (P < .001) players. For both sports, the injury rate during games (4.6/1000 AEs) was similar to that during practices (4.1/1000 AEs), RR = 1.22, 95% CI = 0.7, 2.2. Softball players were more likely to be injured in a game than were baseball players (RR = 1.92, 95% CI = 0.8, 4.3). Most injuries (77%) were mild (3.5/1000 AEs). The upper extremity accounted for the highest proportion of injuries (63.3%). The incidence of injury for pitchers was 37.3% and for position players was 15.3%. The rate of injury was highest during the first month of the season (7.96/1000 AEs).

CONCLUSIONS

The incidence of injury was low for both softball and baseball. Most injuries were minor and affected the upper extremity. The injury rates were highest in the first month of the season, so prevention strategies should be focused on minimizing injuries and monitoring players early in the season.

Practice-based research networks, part II: a descriptive analysis of the athletic training practice-based research network in the secondary school setting

CONTEXT

Analysis of health care service models requires the collection and evaluation of basic practice characterization data. Practice-based research networks (PBRNs) provide a framework for gathering data useful in characterizing clinical practice.

OBJECTIVE

To describe preliminary secondary school setting practice data from the Athletic Training Practice-Based Research Network (AT-PBRN).

DESIGN

Descriptive study.

SETTING

Secondary school athletic training facilities within the AT-PBRN.

PATIENTS OR OTHER PARTICIPANTS

Clinicians (n = 22) and their patients (n = 2523) from the AT-PBRN.

MAIN OUTCOME MEASURE(S)

A Web-based survey was used to obtain data on clinical practice site and clinician characteristics. Patient and practice characteristics were obtained via deidentified electronic medical record data collected between September 1, 2009, and April 1, 2011. Descriptive data regarding the clinician and CPS practice characteristics are reported as percentages and frequencies. Descriptive analysis of patient encounters and practice characteristic data was performed, with the percentages and frequencies of the type of injuries recorded at initial evaluation, type of treatment received at initial evaluation, daily treatment, and daily sign-in procedures.

RESULTS

The AT-PBRN had secondary school sites in 7 states, and most athletic trainers at those sites (78.2%) had less than 5 years of experience. The secondary school sites within the AT-PBRN documented 2523 patients treated across 3140 encounters. Patients most frequently sought care for a current injury (61.3%), followed by preventive services (24.0%), and new injuries (14.7%). The most common diagnoses were ankle sprain/strain (17.9%), hip sprain/strain (12.5%), concussion (12.0%), and knee pain (2.5%). The most frequent procedures were athletic trainer evaluation (53.9%), hot- or cold-pack application (26.0%), strapping (10.3%), and therapeutic exercise (5.7%). The median number of treatments per injury was 3 (interquartile range = 2, 4; range = 2-19).

CONCLUSIONS

These preliminary data describe services provided by clinicians within the AT-PBRN and demonstrate the usefulness of the PBRN model for obtaining such data.

Acromioclavicular joint injuries in National Collegiate Athletic Association football: data from the 2004-2005 through 2008-2009 National Collegiate Athletic Association Injury Surveillance System

BACKGROUND

Injuries to the shoulder are common in collegiate football, and injuries to the acromioclavicular (AC) joint have previously accounted for up to 41% of all shoulder injuries.

PURPOSE

To determine the incidence and epidemiology of injury to the AC joint in National Collegiate Athletic Association (NCAA) football athletes.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

The NCAA Injury Surveillance System (ISS) men's football database was reviewed from the 2004-2009 playing seasons. The exposure data set from the same years was reviewed for the purposes of computing rates of injury per athlete exposure (AE). The injury rate (number of injuries divided by number of AEs) was computed per 10,000 AEs for competition and practice exposures. Ninety-five percent confidence intervals (95% CIs) for the incidence rates were calculated using assumptions of a Poisson distribution.

RESULTS

According to the estimates made by the NCAA ISS, a total of 748 injuries to the AC joint occurred in NCAA football players during 2,222,155 AEs, accounting for 4.49% of all injuries sustained during this 5-year surveillance period. The overall rate of injury was 3.34 per 10,000 AEs (95% CI, 3.10-3.59). Players were 11.68 (95% CI, 10.11-13.49) times more likely to sustain an injury in games than practices. Partial sprains (types I or II) accounted for 96.4% of injuries, while complete sprains (≥type III) accounted for the remaining 3.6%. The average amount of time lost per injury was 11.61 days. Complete sprains resulted in a mean time loss of 31.9 days (95% CI, 24.4-39.6) while partial injuries resulted in 11.0 days lost (95% CI, 9.6-12.3). Overall, 2.41% of injuries underwent surgical intervention, with 22.2% of complete sprains and 1.7% of partial injuries resulting in surgery. Complete sprains of the AC joint were 13.5 (95% CI, 4.63-35.26) times more likely to result in surgical intervention than partial sprains. The majority of injuries (71.93%) resulted from contact with another player and 47.09% occurred while tackling or being tackled. Of all injuries, 47.63% occurred during offensive plays, while defense accounted for 20.77%.

CONCLUSION

AC joint injuries in NCAA football players are predominantly low-grade sprains, leading to approximately 12 days of lost competition. The few severe sprains that occurred often resulted in surgery or required approximately 5 weeks of rehabilitation.

The relationship between ground conditions and injury: what level of evidence do we have?

OBJECTIVES

To identify studies which address the relationship between ground conditions and injury, in a sporting context and to evaluate current practice and provide recommendations for future studies that measure ground conditions and injury risk.

DESIGN

Systematic review.

METHODS

A comprehensive search of electronic databases from the earliest records available until the end of 2011, and supplemental hand searching was conducted to identify relevant studies. A classification scale was used to rate the methodological quality of studies.

RESULTS

79 potentially relevant articles were identified, and 27 met all inclusion criteria. They varied in methodological quality, with analytical observational studies the most common design, although four descriptive observational studies, considered to be of lower quality were also identified. Only five studies objectively measured ground conditions, and of studies that used subjective assessment, only one provided descriptors to explain their classifications. It appears that harder/drier grounds are associated with an increased injury risk but the presence of major limitations necessitates cautious interpretation of many key findings.

CONCLUSIONS

There is limited high quality evidence of the relationship between injury risk and ground conditions. Further research with high quality designs, and measurement of ground conditions are required to draw more definitive conclusions regarding this relationship.

Incidence and risk factors for injuries to the anterior cruciate ligament in National Collegiate Athletic Association football: data from the 2004-2005 through 2008-2009 National Collegiate Athletic Association Injury Surveillance System

BACKGROUND

Injuries to the anterior cruciate ligament (ACL) are common in athletic populations, particularly in athletes participating in football, soccer, and skiing.

PURPOSE

The purpose of this study was to analyze the National Collegiate Athletic Association (NCAA) Injury Surveillance System (ISS) men's football ACL injury database from the playing seasons of 2004-2005 through 2008-2009 to determine the incidence and epidemiology of complete injury to the ACL in NCAA football athletes.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

The NCAA ISS men's football database was reviewed from the 2004-2005 through 2008-2009 seasons using the specific injury code, "Anterior cruciate ligament (ACL) complete tear." The injury rate was computed for competition and practice exposures. Ninety-five percent confidence intervals (CIs) for the incident rates were calculated using assumptions of a Poisson distribution. Pairwise, 2-sample tests of equality of proportions with a continuity correction were used to estimate the associations of risk factors such as event type, playing surface, season segment, and football subdivision. Descriptive data were also described.

RESULTS

The ACL injury rate during games (8.06 per 10,000 athlete-exposures [AEs] 95% CI, 6.80-9.42) was significantly greater than the rate during practice (0.8 per 10,000 AEs 95% CI, 0.68-0.93). Players were 10.09 (95% CI, 8.08-12.59) times more likely to sustain an ACL injury in competition when compared with practices. When practice exposures were analyzed separately, the injury rate was significantly greater during scrimmages (3.99 per 10,000 AEs 95% CI, 2.29-5.94) compared with regular practices (0.83 per 10,000 AEs 95% CI, 0.69-0.97) and walk-throughs (0 per 10,000 AEs 95% CI, 0-0.14). There was an incidence rate of 1.73 ACL injuries per 10,000 AEs (95% CI, 1.47-2.0) on artificial playing surfaces compared with a rate of 1.24 per 10,000 AEs (95% CI, 1.05-1.45) on natural grass. The rate of ACL injury on artificial surfaces is 1.39 (95% CI, 1.11-1.73) times higher than the injury rate on grass surfaces.

CONCLUSION

Between 2004 and 2009, NCAA football players experienced a greater number of ACL injuries in games compared with practices, in scrimmages compared with regular practices, and when playing on artificial turf surfaces. This latter finding will need to be confirmed by additional studies.

Hamstring muscle strains in professional football players: a 10-year review

BACKGROUND

Investigations into hamstring strain injuries at the elite level exist in sports such as Australian Rules football, rugby, and soccer, but no large-scale study exists on the incidence and circumstances surrounding these injuries in the National Football League (NFL).

HYPOTHESIS

Injury rates will vary between different player positions, times in the season, and across different playing situations.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

Between 1989 and 1998, injury data were prospectively collected by athletic trainers for every NFL team and recorded in the NFL's Injury Surveillance System. Data collected included team, date of injury, activity the player was engaged in at the time of injury, injury severity, position played, mechanism of injury, and history of previous injury. Injury rates were reported in injuries per athlete-exposure (A-E). An athlete-exposure was defined as 1 athlete participating in either 1 practice or 1 game.

RESULTS

Over the 10-year study period 1716 hamstring strains were reported for an injury rate (IR) of 0.77 per 1000 A-E. More than half (51.3%) of hamstring strains occurred during the 7-week preseason. The preseason practice IR was significantly elevated compared with the regular-season practice IR (0.82/1000 A-E and 0.18/1000 A-E, respectively). The most commonly injured positions were the defensive secondary, accounting for 23.1% of the injuries; the wide receivers, accounting for 20.8%; and special teams, constituting 13.0% of the injuries in the study.

CONCLUSION

Hamstring strains are a considerable cause of disability in football, with the majority of injuries occurring during the short preseason. In particular, the speed position players, such as the wide receivers and defensive secondary, as well as players on the special teams units, are at elevated risk for injury. These positions and situations with a higher risk of injury provide foci for preventative interventions.

The effect of playing surface on injury rate: a review of the current literature

Synthetic playing surfaces are widely used for field and court sports. Artificial turf surfaces are commonly used as an alternative to natural grass, while outdoor surfaces like clay and acrylic are also prevalent. The effect of these synthetic surfaces on injury rates has not been clearly established. The available literature is largely limited to football and soccer data and the majority of studies are short-term. Confounding variables such as climate, player position and footwear, as well as varying definitions of injury, also make it difficult to draw firm conclusions about the general effect of artificial playing surfaces on injury rates. Many peer-reviewed studies cite a higher overall rate of injury on first- and second-generation artificial turf surfaces compared with natural grass. Despite differences in injury type, the rate of injury on third-generation and natural grass surfaces appears to be comparable. It also appears that clay is significantly safer than either grass or hard court tennis surfaces, but this is a conclusion drawn with limited data. Further research investigating overall injury trends as well as sport-specific data is needed to draw more definitive conclusions regarding the effect of artificial playing surfaces on injury rates.

An update on the epidemiology of pediatric fractures

Despite public health measures to prevent childhood injuries, the incidence of pediatric fractures is increasing. This fracture incidence is dependent on many demographic factors, the various contributors to bone health, and an individual's risk-taking behavior. Although traditional play activities continue to be the prevalent causes for fractures, there is an evolving array of new sport and recreation activities that carry significant fracture risk. The following review article outlines the developing epidemiology of pediatric fractures by analyzing some of the individual risk factors that influence fracture incidence as well as the variety of activities that are associated with these fractures.

The Effect of the Shoe-Surface Interface in the Development of Anterior Cruciate Ligament Strain

The shoe-surface interface has been implicated as a possible risk factor for anterior cruciate ligament (ACL) injuries. The purpose of this study is to develop a biomechanical, cadaveric model to evaluate the effect of various shoe-surface interfaces on ACL strain. There will be a significant difference in ACL strain between different shoe-surface combinations when a standardized rotational moment (a simulated cutting movement) is applied to an axially loaded lower extremity. The study design was a controlled laboratory study. Eight fresh-frozen cadaveric lower extremities were thawed and the femurs were potted with the knee in 30 deg of flexion. Each specimen was placed in a custom-made testing apparatus, which allowed axial loading and tibial rotation but prevented femoral rotation. For each specimen, a 500 N axial load and a 1.5 Nm internal rotation moment were placed for four different shoe-surface combinations: group I (AstroTurf-turf shoes), group II (modern playing turf-turf shoes), group III (modern playing turf-cleats), and group IV (natural grass-cleats). Maximum strain, initial axial force and moment, and maximum axial force and moment were calculated by a strain gauge and a six component force plate. The preliminary trials confirmed a linear relationship between strain and both the moment and the axial force for our testing configuration. In the experimental trials, the average maximum strain was 3.90, 3.19, 3.14, and 2.16 for groups I–IV, respectively. Group IV had significantly less maximum strain (p<0.05) than each of the other groups. This model can reproducibly create a detectable strain in the anteromedial bundle of the ACL in response to a given axial load and internal rotation moment. Within the elastic range of the stress-strain curve, the natural grass and cleat combination produced less strain in the ACL than the other combinations. The favorable biomechanical properties of the cleat-grass interface may result in fewer noncontact ACL injuries.

Risk factors for injury among high school football players

BACKGROUND

Football is the most popular interscholastic high school sport in the United States. Prior research has described a higher rate of injury among high school football players than in other sports, but few studies have examined potential predictors while controlling for other risk factors.

METHODS

Using a 2-stage cluster sampling technique, we conducted a prospective cohort study from 1996 to 1999 among varsity athletes from 12 sports in 100 North Carolina high schools. A total of 3323 football players participated. Injury exposure and risk factor data were collected by trained school personnel. Incidence rates, rate ratios, and odds ratios (ORs) were estimated using Poisson and logistic regression.

RESULTS

There were 1064 injured athletes and 1238 injuries; 106 injuries resulted in greater than 3 weeks lost from participation. The overall incidence rate was 3.54 per 1000 athlete-exposures (95% confidence interval [CI] = 3.31-3.78). The rate of game injury was 9 times that of practice injury (OR = 9.2; 95% CI = 6.6-11). Athletes with a prior injury had twice the injury rate of those without (1.9; 1.5-2.4). Among those injured, having a coach with more experience, qualifications, and training was associated with half the odds of severe injury (0.49; 0.27-0.92).

CONCLUSIONS

Prior injury, additional years of playing experience, and older age were predictors of injury incidence after controlling for multiple risk factors. A high level of coaching skills did not reduce the injury rate, but was protective against severe injury.

Effects of field location, time in competition, and phase of play on injury severity in high school football

This study evaluated the effects of competitive intensity, represented by the variables time in competition, phase of play, and field location, on injury severity in U.S. high school football. The injury rate was higher in competition than practice (RR = 4.75, 95% CI: 4.34-5.20). Mild and moderate injuries were frequently lower leg/foot/ankle sprains/strains and concussions. Severe injuries were frequently knee Sprains/strains and arm fractures. Severe injuries composed a greater proportion of injuries sustained during the beginning and middle of competition compared with injuries sustained during the end/overtime (IPR = 1.83, 95% CI: 1.25-2.69). Compared with injuries sustained during general play, a greater proportion of kickoff/punt injuries were severe (IPR = 1.69, 95% CI: 1.07-2.68) or were concussions (IPR = 1.86, 95% CI: 1.05-3.30). Identifying factors contributing to severe injury is a crucial first step toward developing targeted evidence-based interventions aimed at reducing the incidence of severe injuries among the millions of high school football players.

Injuries in youth football: national emergency department visits during 2001-2005 for young and adolescent players

OBJECTIVES

Limited research exists describing youth football injuries, and many of these are confined to specific regions or communities. The authors describe U.S. pediatric football injury patterns receiving emergency department (ED) evaluation and compare injury patterns between the younger and older youth football participants.

METHODS

A retrospective analysis of ED data on football injuries was performed using the National Electronic Injury Surveillance System-All Injury Program. Injury risk estimates were calculated over a 5-year period (2001-2005) using participation data from the National Sporting Goods Association. Injury types are described for young (7-11 years) and adolescent (12-17 years) male football participants.

RESULTS

There were an estimated total of 1,060,823 visits to U.S. EDs for males with football-related injuries. The most common diagnoses in the younger group (7-11 years) were fracture/dislocation (29%), sprain/strain (27%), and contusion (27%). In the older group (ages 12-17 years), diagnoses included sprain/strain (31%), fracture/dislocation (29%), and contusion (23%). Older participants had a significantly higher injury risk of injury over the 5-year study period: 11.0 (95% confidence interval [CI] = 9.2 to 12.8) versus 6.1 (95% CI = 4.8 to 7.3) per 1,000 participants/year. Older participants had a higher injury risk across all categories, with the greatest disparity being with traumatic brain injury (TBI), 0.8 (95% CI = 0.6 to 1.0) versus 0.3 (95% CI = 0.2 to 0.4) per 1,000 participants/year.

CONCLUSIONS

National youth football injury patterns are similar to those previously reported in community and cohort studies. Older participants have a significantly higher injury risk, especially with TBI.

Sports injuries to high school athletes with disabilities

INTRODUCTION

Physical activity in sports comes with an inherent risk for injury. For children with disabilities, their injury risk may be complicated by preexisting disability. However, very little research exists on sports injuries to young athletes with disabilities. To best manage potential injuries to children with disabilities, data on sports injury patterns are needed. The purpose of this study was to measure the frequency of and risk factors for injury to high school athletes with disabilities.

METHODS

A total of 210 athletes from 8 special education high schools that are part of an interscholastic sports league participated in the study. Seven of the 8 schools were followed for 1 season each of basketball, softball, soccer, and field hockey, and 1 school enrolled only during field hockey. Data were collected from coaches on daily exposure sessions (game, practice, and conditioning, as well as length of session), athlete characteristics (disability, gender, age, seizure history, and behavioral problems), and nature of injuries resulting in any type of medical treatment.

RESULTS

Thirty-eight injuries were reported among 512 special athletes for a rate of 2.0 per 1000 athlete exposures. Soccer (3.7 per 1000) had the highest rate of injury. More than half of the injuries were abrasions and contusions. Those at highest risk for injury were athletes with autism, athletes with histories of seizures, and starters. Athletes with autism had approximately 5 times the injury rate of athletes with mental disabilities. Athletes with seizures had >2.5 times the rate of injury reported among those with no seizure history.

CONCLUSIONS

This adapted sports program is a reasonably safe activity for children with disabilities. Nonetheless, findings have important implications for prevention. The preparticipation medical examination may be an excellent opportunity to create special guidelines, particularly for athletes with autism and seizure history.

A prospective study of injury patterns in high school pole vaulters

BACKGROUND

The pole vault is a track and field event that has witnessed a large increase in participants during the past 5 years. Currently there are no prospective studies that have evaluated injury patterns in pole vaulters.

OBJECTIVES

To determine the injury rate and to describe injury patterns in high school pole vaulters.

STUDY DESIGN

Descriptive epidemiological study.

METHODS

This was a prospective cohort study of 140 Wisconsin high school athletes who participated in pole vaulting during the 2005 and 2006 track and field seasons. Baseline athlete information was obtained at the beginning of each season. When an injury occurred, an injury report form was completed to document diagnosis and circumstances of the incident. Injury rates were expressed as injuries per 100 athletes per season as well as injuries per 1000 athletic exposures. Risk factors were analyzed by calculating relative risks for baseline athlete variables.

RESULTS

The injury rates were 26.4 injuries per 100 athletes per season (95% confidence interval, 18.6-36.4) and 7.1 injuries per 1000 athletic exposures (95% confidence interval, 5.0-9.8). Trauma to the lower extremities accounted for 71.5% of injuries. The most common injury types were ligament sprains (31.6%). Landing incorrectly was the most frequent mechanism of injury (26.3%). A history of pole-vault injury was associated with increased risk of injury (relative risk, 2.4; 95% confidence interval, 1.4-4.1).

CONCLUSION

Injuries are common in young vaulters. Injury mechanisms indicate that many could be avoided by using proper technique, particularly during the landing phase. Coaches should focus on vaulters with prior injuries to identify risky behavior and to help correct poor technique.

An epidemiologic comparison of high school sports injuries sustained in practice and competition

CONTEXT

More than 7 million US high school students play sports.

OBJECTIVE

To compare practice and competition injury rates and patterns in 5 boys' sports (football, soccer, basketball, wrestling, and baseball) and 4 girls' sports (soccer, volleyball, basketball, and softball) during the 2005-2006 school year.

DESIGN

Prospective injury surveillance study.

SETTING

Injury data were collected from 100 nationally representative United States high schools via High School RIO (Reporting Information Online).

PATIENTS OR OTHER PARTICIPANTS

Athletes from participating high schools injured while participating in a school-sanctioned practice or competition in one of the above sports.

MAIN OUTCOME MEASURE(S)

Practice and competition injury rates, body site, diagnosis, and severity.

RESULTS

High school athletes participating in these 9 sports at participating schools sustained 4350 injuries during the 2005-2006 school year, which corresponds to an estimated 1 442 533 injuries nationally. The rate of injury per 1000 athlete-exposures was higher in competition (4.63) than in practice (1.69) (rate ratio [RR] = 2.73, 95% confidence interval [CI] = 2.58, 2.90). Of all sports, football had the highest competition (12.09) and practice (2.54) injury rates per 1000 athlete-exposures. Compared with injuries sustained during practice, higher proportions of competition injuries were head/face/neck injuries (proportion ratio [PR] = 1.61, 95% CI = 1.34, 1.94), particularly in boys' soccer (PR = 7.74, 95% CI = 2.53, 23.65) and girls' basketball (PR = 6.03, 95% CI = 2.39, 15.22). Competition injuries were more likely to be concussions (PR = 2.02, 95% CI = 1.56, 2.62), especially in boys' soccer (PR = 6.94, 95% CI = 2.01, 23.95) and girls' basketball (PR = 5.83, 95% CI = 2.06, 16.49). Higher proportions of competition injuries caused the athlete to miss more than 3 weeks of play (PR = 1.28, 95% CI = 1.08, 1.52), particularly in baseball (PR = 3.47, 95% CI = 1.48, 8.11) and volleyball (PR = 2.88, 95% CI = 1.01, 8.24).

CONCLUSIONS

Rates and patterns of high school sport injuries differed between practice and competition. Providing athletic trainers with this information is a crucial step in developing the targeted, evidence-based interventions required to effectively reduce injury rates among the millions of high school student-athletes.

Injury patterns in professional arena football

BACKGROUND

No studies to date have evaluated the injury patterns in professional arena football. The purpose of this study is to describe the characteristics of general injury patterns in the Arena Football League.

HYPOTHESES

(1) Game injury rates are higher than are practice injury rates, (2) a small number of injuries are related to collision with the boards, and (3) athletes playing on both offense and defense have higher injury rates than do athletes playing either offense or defense alone.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

A retrospective review of injury data including 1199 injuries over a 4-year period from February 2002 to December 2005, inclusive of preseason and postseason practices and competition, was conducted. Data regarding the injured body part, position of the player, nature of injury, mechanism of injury, missed playing time, playing surface, and when the injury occurred were collected and analyzed.

RESULTS

Injury rates during practice were 14.6 injuries per 1000 exposures and game injury rates were 111.3 per 1000 exposures. Few recorded injuries (2.2%) involved a collision with the sideline boards.

CONCLUSION

Game injury rates are higher than are practice injury rates. Athletes playing on both offense and defense did not have higher injury rates in games than did athletes playing either offense or defense. The sideline boards used in the Arena Football League did not appear to contribute dramatically to the injury rates. Despite the differences between arena and stadium football, Arena Football League injury patterns are similar to published collegiate football injury patterns.

Epidemiology of basketball injuries among adults presenting to ambulatory care settings in the United States

OBJECTIVE

Little information exists that examines the epidemiology of injuries among adults who engage in sports and recreational activities. The purpose of this study is to examine basketball-related injuries among adults presenting to ambulatory settings in the United States.

DESIGN

Retrospective review of medical records.

SETTING

Emergency departments, outpatient departments, and physicians' offices in the United States.

PATIENTS

Nationally representative sample of adults presenting to ambulatory care settings in the United States for treatment of injuries incurred while playing basketball.

MAIN OUTCOME MEASURES

Body site injured, type of injury, ambulatory treatment site, and utilization of diagnostic testing.

RESULTS

An annual average of 507,000 adults were treated in an ambulatory care setting for injuries related to playing basketball. The majority of these patients sought treatment in physicians' offices. Females had a much lower rate of visits (0.8/1000) for basketball-related injuries than males (5.7/1000); African American males had a rate 2.7 times higher than white males. The most common injuries were sprains and strains to the lower leg and/or ankle region and fractures of the hand, wrist, or fingers. Specific analyses of patients presenting to the emergency department diagnosed with sprain/strain injuries to the lower leg/ankle region revealed that 93% of these patients received an x-ray procedure.

CONCLUSIONS

Basketball injuries constitute a significant portion of ambulatory medical care use in the United States each year, particularly among young adult males and African American males. Better surveillance of adult participation in sports and recreational activities is needed to better identify risk and protective factors for injuries.

Influence of environmental and ground conditions on injury risk in rugby league

While the theoretical basis for a relationship between ground and environmental conditions and injury in rugby league is compelling, corroborative research is far from substantive. This study investigated the relationship between environmental and ground conditions and injury risk in 156 semi-professional rugby league players. Injuries were prospectively recorded from 157 training sessions and 137 competitive matches played over two consecutive competitive seasons. Daily weather variables (maximum and minimum temperature, relative humidity, and rainfall) were recorded, while ground conditions were subjectively rated as heavy, slippery, firm, or hard. Regression analysis was conducted to examine the independent effects of the environmental variables, ground condition, session type (training, match), and the interaction between ground condition and session type on injury. Higher temperatures, greater humidity, and greater levels of rainfall were all associated (p<.05) with softer ground conditions. A higher 365-day rainfall was associated with fewer injuries. Both the number of injuries and injury rate were higher in matches than in training sessions and when ground conditions were harder. For both number of injuries and injury rate, there was a statistically significant interaction between ground condition and session type, with harder ground conditions resulting in a higher injury rate in matches, but not training sessions. In conclusion, in rugby league, ground conditions do not influence training injuries, however, both harder ground conditions and less rainfall are associated with a greater number of match injuries.

Epidemiology of high school and collegiate football injuries in the United States, 2005-2006

BACKGROUND

Football, one of the most popular sports among male high school students in the United States, is a leading cause of sports-related injuries, with an injury rate almost twice that of basketball, the second most popular sport.

HYPOTHESIS

Injury patterns will vary between competition and practice exposures and between levels of play (ie, high school vs. National Collegiate Athletic Association [NCAA]).

STUDY DESIGN

Descriptive epidemiology study.

METHODS

Football-related injury data were collected over the 2005-2006 school year from 100 nationally representative high schools via High School RIO (Reporting Information Online) and from 55 Division I, II, and III colleges via the NCAA Injury Surveillance System.

RESULTS

Nationally, an estimated 517,726 high school football-related injuries (1881 unweighted injuries) occurred during the 2005-2006 season. The rate of injury per 1000 athlete-exposures was greater during high school competitions (12.04) than during practices (2.56). The rate of injury per 1000 athlete-exposures was also greater during collegiate competitions (40.23) than during practices (5.77). While the overall rate of injury per 1000 athlete-exposures was greater in the NCAA (8.61) than in high school (4.36), high school football players sustained a greater proportion of fractures and concussions. Running plays were the leading cause of injury, with running backs and linebackers being the positions most commonly injured.

CONCLUSION

Patterns of football injuries vary, especially by type of exposure and level of play. Future studies should continue to compare differences in injury patterns in high school and collegiate football, with particular emphasis placed on high-risk plays (running plays) and positions (running backs and linebackers).

Incidence and distribution of pediatric sport-related injuries

OBJECTIVE

To provide a critical review of the available literature on the descriptive epidemiology of pediatric sport-related injuries.

DATA SOURCES

MEDLINE (1966 to 2006) and SPORTDiscus (1975 to 2006) were searched to identify potentially relevant articles. A combination of medical subject headings and text words was used (epidemiology, children, adolescents, athletic injuries, sports, injury, and injuries). Additional references from the bibliographies of retrieved articles were also reviewed.

STUDY SELECTION

Published research reports on the incidence and distribution of injury in children's and youth sports. Specific emphasis was placed on reviewing original studies, which report incidence rates (rate of injuries per unit athlete time). Forty-nine studies were selected for this review.

DATA EXTRACTION

Data summarized include incidence of injury relative to who is affected by injury (sport, participation level, gender, and player position), where injury occurs (anatomical and environmental location), when injury occurs (injury onset and chronometry), and injury outcome (injury type, time loss, clinical outcome, and economic cost).

DATA SYNTHESIS

There is little epidemiological data on injuries for some pediatric sports. Many of the studies retrieved were characterized by methodological short-comings and study differences that limit interpretation and comparison of findings across studies. Notwithstanding, the studies reviewed are encouraging and injury patterns that should be studied further with more rigorous study designs to confirm original findings and to probe causes of injury and the effectiveness of preventive measures.

CONCLUSIONS

Incidence and severity of injury are high in some child and youth sports. This review will assist in targeting the relevant groups and in designing future research on the epidemiology of pediatric sports injuries. Well-designed descriptive and analytical studies are needed to identify the public health impact of pediatric sport injury.