Prevention of Lower Extremity Injuries in Basketball: A Systematic Review and Meta-Analysis

Is an Exercise-Based Injury-Prevention Program Effective in Team Handball Players? A Systematic Review and Meta-Analysis

OBJECTIVE

To assess the effectiveness of exercise-based injury-prevention programs in preventing sports injuries in team handball players.

DATA SOURCES

Scopus, PubMed, Web of Science, SPORTDiscus, and CINAHL from inception until April 2023.

STUDY SELECTION

Studies were included if they were randomized controlled trials or prospective cohort studies, contained a population of competitive team handball players, included an intervention designed specifically to prevent or reduce the risk of team handball injuries, and reported injury incidence rates specific to team handball players. Two researchers independently evaluated studies for inclusion and assessed their methodological quality.

DATA EXTRACTION

Study design, intervention details, participant characteristics, and the number of injuries in each group were extracted from each study by 2 independent researchers. The outcome of interest was the incidence rate of injury. Injury data were classified into 5 groups: shoulder injuries, lower extremity injuries, knee injuries, anterior cruciate ligament injuries, and ankle injuries. Extracted data were analyzed using a random-effects model to compute the overall effect estimates of injury-prevention programs in reducing the risk of injuries. Odds ratios (ORs) with 95% CIs were calculated based on the number of injuries in each group.

DATA SYNTHESIS

Meta-analyses were conducted independently for each injury classification. Results indicated that prevention programs reduced the risk of shoulder injuries (OR = 0.60; 95% CI = 0.42, 0.85; P = .004), lower extremity injuries (OR = 0.59; 95% CI = 0.37, 0.95; P = .03), knee injuries (OR = 0.53; 95% CI = 0.35, 0.78; P = .002), anterior cruciate ligament injuries (OR = 0.66; 95% CI = 0.45, 0.96; P = .03), and ankle injuries (OR = 0.57; 95% CI = 0.40, 0.81; P = .002) in team handball players.

CONCLUSIONS

In team handball players, injury-prevention programs appear to effectively reduce the risk of shoulder, lower extremity, knee, ankle, and anterior cruciate ligament injuries.

Sports Injuries in Basketball Players: A Systematic Review

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

The effects of functional training on physical fitness and skill-related performance among basketball players: a systematic review

Background: Evidence suggests that functional training (FT) positively impacts physical fitness and sports performance. However, a systematic review addressing the effects of FT on basketball players remains absent. This systematic review aims to explore the influence of FT on physical fitness and skill-related performance in basketball players. Methods: We searched six databases: Web of Science, Scopus, PubMed, China National Knowledge Infrastructure (CNKI), EBSCOhost, and Google Scholar. The search utilized a combination of keywords related to FT, physical fitness, and basketball. The Eligibility Criteria of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines were followed in this systematic review. Results: 11 studies were ultimately included in this review, collectively recruiting 333 basketball players. These studies demonstrated that FT significantly improved muscle strength, linear speed, cardiovascular endurance, flexibility, balance, and muscular endurance. However, the effects of FT on power, change-of-direction speed, and basketball-related performance were inconsistent. Most studies showed FT significantly improves these three variables, but a small number of studies did not find positive effects of FT using specific tests including standing long jump, Sargent jump, touch high, lane agility, lateral shuffle, dribbling line drill, and free-throw tests. Conclusion: FT is an effective training method for enhancing physical fitness including muscle strength, linear speed, cardiovascular endurance, flexibility, balance, and muscular endurance. However, the effects of FT on power, change-of-direction speed, and basketball-related performance were divergent. Some tests were not improved after FT potentially due to the short program lengths and training session durations, varied athletic levels of players examined, and different foci of the FT exercises administered. The collective evidence suggests FT programs, especially the specific exercises prescribed, should be tailored to the desired training objectives. More studies investigating the effects of FT on physical fitness and basketball-related performance with established tests are encouraged in the future to expand the current evidence base. Systematic Review Registration: https://inplasy.com/, Identifier INPLASY202360072.

Biomechanical Factors Predisposing to Knee Injuries in Junior Female Basketball Players

This cross-sectional observational study aims to determine isokinetic normality data at different speeds, and isometric data of ankle and knee joints, in healthy basketball players aged 15-16 years old. The participants were recruited through non-probabilistic convenience sampling. Sociodemographic, anthropometric, and biomechanical variables were collected. The study involved 42 participants. Right-leg dominance was higher in women (85.7%) than in men (78.6%). Men had a higher weight, height, and body mass index compared to women. Statistically significant differences were observed between sex and height (p < 0.001). Significant differences were found between sexes in knee flexor and extensor strength at different isokinetic speeds (30°, 120°, and 180°/s), except for the maximum peak strength knee flexion at 180°/s in the right leg. In the ankle, the variables inversion, eversion, and work strength values at different isokinetic speeds and full RoM, by sex, were not significantly different, except for the right (p = 0.004) and the left (p = 0.035) ankle full RoM. The study found lower knee extensor strength in women, indicating the need to improve knee flexor/extensor strength in women to match that of men, as seen in other joints. The results can guide the development of preventive and therapeutic interventions for lower limb injuries in basketball players.

Multivariate Analysis of Risk Factors for Injury and Surgical Interventions in Ankle and Knee Injuries in NBA Athletes

Objective

Lower extremity ankle and knee injuries occur at a high rate in the National Basketball Association (NBA) often requiring surgical intervention. This study aimed to identify surgical rates and risk factors for surgical intervention using multivariate analysis in ankle and knee injuries in NBA player.

Methods

Player demographics, performance metrics, advanced statistics, and injury characteristics were recorded using publicly available data. To standardize injury events over multiple years, injury events per 1000 athlete exposure events (AE, one player participating in one game) were calculated. Descriptive analysis and multivariate logistic regression were completed to find associations with surgical intervention in ankle and knee injuries.

Results

A total of 1153 ankle and knee injuries were included in the analysis with 73 (6.33%) lower extremity injuries treated with surgery. Knee injuries had a higher incidence of surgical intervention (0.23 AE) than ankle injuries (0.04 AE). The most frequent surgical knee injury was meniscus tear treated with meniscus repair (0.05 AE) and the most frequent ankle surgery was surgical debridement (0.01 AE) Multivariate logistic regression indicated lower extremity injuries that required surgery were associated with more minutes per game played (odds ratio [OR] 1.13; p = 0.02), a greater usage rate (OR 1.02 p < 0.001), the center position (OR 1.64; 95% [CI] 1.2-2.24; p = 0.002) and lower player efficiency rating (OR 0.96; 95% p < 0.001).

Conclusion

Knee surgery was significantly more frequent than ankle surgery despite similar injury rates per 1000 exposures. The center position had the greatest risk for lower extremity injury followed by minutes played while a higher player efficiency rating was protective against surgical intervention. Developing strategies to address these factors will help in the management and prevention of lower extremity injuries requiring surgical intervention.

Epidemiology and Sex-Specific Analysis of Basketball-Related Lower Extremity Fractures: A 10-Year Analysis of National Injury Data

BACKGROUND

Basketball-related fractures involving the lower extremities frequently present to emergency departments (ED) in the United States (US). This study aimed to identify the primary mechanisms, distribution, and trends of these injuries.

HYPOTHESIS

We hypothesize that (1) lower extremity fracture frequency will decrease from 2013 to 2022, (2) the ankle will be the most common fracture site, and (3) noncontact twisting will be the most common injury mechanism.

STUDY DESIGN

Descriptive epidemiological.

LEVEL OF EVIDENCE

Level 3.

METHODS

The National Electronic Injury Surveillance System (NEISS) was queried for lower extremity fractures from basketball presenting to US EDs from January 1, 2013 to December 31, 2022. Patient demographics, injury location, and disposition were recorded. The injury mechanism was characterized using the provided narrative. National estimates (NEs) were calculated using the NEISS statistical sample weight. Injury trends were evaluated by linear regression.

RESULTS

There were 6259 cases (NE: 185,836) of basketball-related lower extremity fractures. Linear regression analysis of annual trends demonstrated a significant decrease in lower extremity fractures over the study period (2013-2022: P = 0.01; R2 = 0.64). The most common injury mechanism was a noncontact twisting motion (NE: 49,897, 26.9%) followed by jumping (NE: 39,613, 21.3%). The ankle was the most common fracture site (NE: 69,936, 37.6%) followed by the foot (NE: 49,229, 26.49%). While ankle and foot fractures decreased significantly (P < 0.05), fractures of the lower leg, knee, toe, and upper leg showed no significant trends (P = 0.09, 0.75, 0.07, and 0.85, respectively).

CONCLUSION

Basketball-related lower extremity fractures decreased from 2013 to 2022, with the ankle being the most common fracture site and most fractures arising from a noncontact twist. Increasing utilization of outpatient clinics may have contributed to the decline, particularly for ankle and foot fractures. The prevalence of ankle fractures and twisting-related injuries reinforces the importance of protective footwear and targeted strengthening protocols.

How robust are clinical trials in primary and secondary ankle sprain prevention?

OBJECTIVES

Determine the statistical stability of RCTs examining primary and secondary prevention of ankle sprains.

METHODS

Databases were searched to August 2023. We included parallel design RCTs, using conservative interventions for preventing ankle sprain, reporting dichotomous injury event outcomes. Statistical stability was quantified using Fragility Index (FI) and Fragility Quotient (FQ). Subgroup analyses were undertaken to test if FI varied based on by study objective, original approach to analysis (frequency vs time to event), follow-up duration, and pre-registration.

RESULTS

3559 studies were screened with 45 RCTs included. The median number of events required to change the statistical significance (FI) was 4 (IQR 1-6). FI was similar regardless of study objective, original analysis, follow-up duration, and pre-registration status. Median (IQR) FQ was 0.015 (0.005-0.046), therefore reversing events <2 patients/100 would alter significance. In 80% of studies the number of patients lost to follow-up was greater than the FI.

CONCLUSION

RCTs informing primary and secondary prevention of ankle sprain are fragile. Only a small percentage of outcome event reversals would reverse study significance, and this is often exceeded by the number of drop outs. Robust reporting of dichotomous outcomes requires the use P values and key metrics such as FI or FQ.

A multicomponent neuromuscular warm-up program reduces lower-extremity injuries in trained basketball players: a cluster randomized controlled trial

OBJECTIVE

To assess the effects of a novel multicomponent neuromuscular warm-up program on lower-extremity injury incidence in basketball players competing at the regional level.

METHODS

A cluster randomized controlled experimental design was adopted to compare injury incidence between players exposed to the injury prevention warm-up program and those exposed to a typical warm-up program across an entire basketball season. Four teams consisting of 57 players (male: n = 42; female: n = 15) were allocated to the intervention group (age: 21.6 ± 2.5 years; height: 186.2 ± 8.8 cm; body mass: 80.0 ± 10.4 kg) and four teams consisting of 55 players (male: n = 43; female: n = 12) were allocated to the control group (age: 21.6 ± 2.6 years; height: 186.9 ± 9.1 cm; body mass: 81.5 ± 10.9 kg). The novel warm-up combined running exercises with active stretching, plyometrics, balance, strength, and agility drills. Coaching and medical staff provided details on injury incidence each week. Data analyses included the use of poisson regression analyses and the incidence rate ratio (IRR) with 95% confidence intervals (CI).

RESULTS

The intervention group experienced a significantly lower ankle sprain incidence rate (IRR = 0.26, 95% CI = 0.05, 0.98, p = 0.02) and a tendency toward a lower knee injury incidence rate (IRR = 0.32, 95% CI = 0.03, 1.78, p = 0.07) compared to the control group. Considering only non-contact lower-extremity injuries of any type, the intervention group experienced a significantly lower incidence rate compared to the control group (IRR = 0.26, 95% CI = 0.05, 0.98, p < 0.001).

CONCLUSION

This multi-team study demonstrated a novel multicomponent warm-up program resulted in less lower-extremity injuries, particularly ankle sprains and knee injuries, compared to a typical warm-up program in regional-level male and female basketball players.

Training and competition injury epidemiology in professional basketball players: a prospective observational study

BACKGROUND

There is a lack of epidemiological data comparing the characteristics of injuries sustained during basketball matches vs. training taking into account incidence, type of injury, body location and risk factors associated with the development of the injury.

PURPOSE

The main aim of the present study was to analyze the incidence and characteristics of training vs. competition injuries sustained by professional basketball players.

METHODS

The injuries incurred by 61 professional basketball players (mean ± SD, age: 25.7 ± 5.1 years; height: 200.2 ± 9.2 cm; body mass: 98.2 ± 13.8 kg) from the same team were prospectively recorded by the team's medical staff for 6 consecutive seasons (2014/15 to 2019/20). The team competed in a top national basketball division and in the EuroLeague among other national-level competitions. The injuries were recorded using a validated medical questionnaire that included information according to type, severity, location, and injury mechanism. Training and match times were also recorded for each player in order to calculate injury incidence.

RESULTS

A total of 306 injuries were reported, representing 12.59 injuries per 1000 h of basketball play. Most injuries occurred without direct contact with another player/object (70.9%) and were located in the lower limbs (74.8%), particularly in the knee (22.9%). The incidence of injuries was higher during competition than during training: 77.83 vs. 8.29 injuries per 1000 h of basketball play. However, there were no differences in the mechanism and mode of onset between training and competition injuries while the proportion of time-loss injuries was also similar in training and competition.

CONCLUSIONS

In summary, injury incidence in professional basketball was ~10-times higher during competition than during training. Beyond differences in incidence, injury characteristics were similar for basketball training and competition.

Prevention of Lower Extremity Musculoskeletal Injuries in Tactical and First Responder Populations: A Systematic Review and Meta-Analysis of Randomized Trials From 1955 to 2020

ABSTRACT

Sinnott, AM, Krajewski, KT, LaGoy, AD, Beckner, ME, Proessl, F, Canino, MC, Nindl, BC, Turner, RL, Lovalekar, MT, Connaboy, C, and Flanagan, SD. Prevention of lower extremity musculoskeletal injuries in tactical and first responder populations: A systematic review and meta-analysis of randomized trials from 1955 to 2020. J Strength Cond Res 37(1): 239-252, 2023-Lower extremity musculoskeletal injuries (LEMSIs) impose a significant burden on tactical and first responder populations. To determine the effectiveness of LEMSI prevention strategies, we performed a systematic review and meta-analysis of randomized controlled trials published in English from 1955 to 2020 (PROSPERO: CRD42018081799). MEDLINE, EMBASE, Cochrane, CINAHL, ProQuest, and DTIC databases were searched for trials that assigned military service members, police, firefighters, or paramedics to LEMSI prevention interventions with a minimum surveillance period of 12 weeks. Evidence was synthesized as odds ratios (OR) for LEMSI occurrence between individuals assigned to interventions and those assigned to standard activities. Risk of bias was assessed with the Cochrane Risk of Bias tool 2.0. Random-effects meta-analyses were conducted for (a) physical training and (b) footwear modifications to reduce LEMSI and (c) footwear modifications to reduce stress fractures specifically. Certainty in the body of evidence was determined with the GRADE approach. Of 28,499 records, 18 trials comprised of more than 11,000 subjects were synthesized. Interventions included physical training (8, N = 6,838), footwear modifications (8, N = 3,792), nutritional supplementation (1, N = 324), and training modifications (1, N = 350). Overall risk of bias was generally moderate ( N = 7 of 18) or high ( N = 9 of 18). Physical training (OR = 0.87, 95% CI [0.71, 1.08], p = 0.22, I 2 = 58.4%) and footwear modification (OR = 1.13, 95% CI [0.85, 1.49], p = 0.42, I 2 = 0.0%) did not reduce LEMSI or stress fractures (OR = 0.76, 95% CI [0.45, 1.28], p = 0.30, I 2 = 70.7%). Our results indicate that there is weak evidence to support current LEMSI prevention strategies. Future efforts will benefit from longer surveillance periods, assessment of women and nonmilitary populations, improved methodological rigor, and a greater breadth of approaches.

Context of injury prevention strategies in Swiss basketball: survey of athletes, medical staff and coaches

Objectives

This project aims to assess opinions, attitudes, knowledge, beliefs, practices and perceived barriers and facilitators of injury prevention (IP) strategies in Swiss basketball teams.

Methods

An online survey was sent to athletes, coaches and medical staff of the three best basketball leagues in Switzerland. The survey was subdivided in four sections: (1) characteristic of participants, (2) knowledge, opinions, attitudes and beliefs, (3) practices and (4) barriers and facilitators.

Results

Among 105 persons (n=45 female, n=60 male) who answered the survey, more than 60% (n=68) considered the risk of injury for basketball athletes as being high to very high. The ankle, knee and the hand were considered as being the most at risk. More than 80% of participants considered that recovery, training load and the warm-up quality were very important factors for IP. More than 90% of participants considered IP as either important or very important with 53 (50.5%) of the participants indicating using exercise-based IP in their clubs. Athletes and coaches' motivation and compliance were judged as either important or very important for successful IP implementation by more than 80% of participants, with the coach being reported as the most influential person. Environmental barriers towards human or infrastructural resources were also reported as factors influencing IP strategies, namely by female participants.

Conclusion

Good knowledge and positive attitude towards IP were reported by participants, but exercise-based IP strategies lack implementation. The coach was considered as the most influential person and was reported with the athletes as playing an important role towards successful implementation.

Users' Perceptions About Lower Extremity Orthotic Devices: A Systematic Review

OBJECTIVE

To systematically review perceptions from adults, children, and caregivers in scientific and open sources to determine how well lower extremity orthotic devices (LEODs) meet users' functional, expressive, aesthetic, and accessibility (FEA2) needs.

DATA SOURCES

Scientific source searches were conducted in the National Library of Medicine (PubMed/MEDLINE) and Web of Science; open source searches were conducted in Google Search Engine in April 2020.

STUDY SELECTION

Inclusion criteria were reporting of users' perceptions about a LEOD, experimental or observational study design, including qualitative studies, and full text in English. Studies were excluded if the device only provided compression or perception data could not be extracted. One hundred seventy three scientific sources of 3440 screened were included (total of 1108 perceptions); 36 open sources of 150 screened were included (total of 508 perceptions).

DATA EXTRACTION

Users' perceptions were independently coded by 2 trained, reliable coders.

DATA SYNTHESIS

Across both source types, there were more perceptions about functional needs, and perceptions were more likely to be positive related to functional than expressive, aesthetic, or accessibility needs. Perceptions about expression, aesthetics, and accessibility were more frequently reported and more negative in open vs scientific sources. Users' perceptions varied depending on users' diagnosis and device type.

CONCLUSIONS

There is significant room for improvement in how LEODs meet users' FEA2 needs, even in the area of function, which is often the primary focus when designing rehabilitation devices. Satisfaction with LEODs may be improved by addressing users' unmet needs. Individuals often choose not to use prescribed LEODs even when LEODs improve their function. This systematic review identifies needs for LEODs that are most important to users and highlights how well existing LEODs address those needs. Attention to these needs in the design, prescription, and implementation of LEODs may increase device utilization.

Reduction of risk factors for ACL Re-injuries using an innovative biofeedback approach: A phase I randomized clinical trial

OBJECTIVES

Determine the safety and initial efficacy of a novel biofeedback intervention to improve landing mechanics in patients following anterior cruciate ligament reconstruction (ACLR).

METHODS

Forty patients post-ACLR (age: 16.9 ± 2.0 years) were randomly allocated to a biofeedback intervention or an attention control group. Patients in the biofeedback group completed 12 sessions over six-weeks that included bilateral unweighted squats with visual and tactile biofeedback. Patients in the control group completed a six-week educational program. Lower extremity mechanics were collected during a bilateral stop jump at baseline, six-weeks, and 12-weeks post-intervention. Linear mixed-effects models adjusted for sex and graft type determined the main effects of and interactions between group and time.

RESULTS

No group by time interaction existed for peak knee extension moment symmetry. A group by time interaction existed for peak vertical ground reaction force symmetry (p = 0.012), where patients in the biofeedback group had greater improvements in symmetry between baseline and post-intervention that were not maintained through the retention assessments.

CONCLUSION

This novel biofeedback program did not reduce risk factors for second ACL injuries. Future work could develop and test multidisciplinary interventions for reducing second ACL injury risk factors.

CLINICALTRIALS

GOV IDENTIFIER: (NCT03273673).

Prospective epidemiological study of basketball injuries during one competitive season in professional and amateur Spanish basketball

INTRODUCTION

There are few Spanish epidemiological studies of basketball injuries, even though it is the second most played sport and the leading sport played by females in Spain.

POPULATION

We studied 117 male and female basketball players from ten amateur or professional teams from four leagues in the 2014-2015 season.

RESULTS

There were 11.6 injuries per 1,000 hours of sporting activity, 9.6 injuries per 1,000 hours of training and 47.3 injuries per 1,000 hours of competition. The rate of injuries requiring downtime was 2.99 per 1,000 hours of training, 41.7 per 1,000 hours of competition and 4.1 per 1,000 hours of sporting activity overall. No significant differences were found in the incidence of injuries between leagues, but a higher incidence by season was found in teams participating in international competitions, due to the increased competition time. The ankle was the main site of injuries causing ≥ 8 days of downtime and knee injuries the site of those causing ≥ 29 days of downtime. The most frequent injuries were sprains, bruises, and muscle overloads and 63.8% of players had ≥ 1 potentially-recurring injury. The most prevalent injuries were ankle sprains (50%), thigh muscle injuries (12.2%) and knee tendinitis (7.4%). The only significant predisposing factor for injury was recurrent injury (adjusted OR 1.93, 95% CI 1.029-3.62). Age, sex, height, weight, position, body mass index, and professional/amateur competition were not significantly associated with the number of injuries or ≥ 7 days downtime in the multivariate analysis.

CONCLUSION

Preventive measures should be applied to the team as a whole at an early age, since recurrent injuries only explained a small percentage of the total injuries.

Correlation between preseason body composition and sports injury in an English Premier League professional football team

Objectives

To identify the correlation between preseason body composition and incidence coupled with injury burden throughout the season in adult male professional football players.

Methods

A retrospective case series was performed for linear regression analysis of preseason body composition variables and injury data. R² >0.10 was deemed of adequate correlation.

Results

All 36 professional football players in the male first team of an English Premier League professional football team were recruited, with none lost to follow-up. The total and mean incidence of injuries was 83.00 and 2.31 (95% CI 1.72 to 2.89), respectively. The mean injury burden was 58.32 (95% CI 37.67 to 78.98) days missed. Simple linear regression analysis indicated no significant or adequate correlations between incidence and preseason body composition variables. Injury burden revealed non-significant adequate negative correlations to body mass (R²=0.17), body mass index (BMI) (R²=0.15), waist circumference (R²=0.17), total bone mineral density (BMD) (R²=0.11) and mean embedded structures (R²=0.10).

Conclusions

Players with decreased body mass, BMI, waist circumference, total BMD and mean embedded structures may be prone to greater injury burden. Further studies with a larger sample size that incorporates multiple football teams are warranted to investigate this.

Knee Extensor Mechanism Tendinopathy: Evaluation, Treatment, and Prevention

ABSTRACT

Knee extensor mechanism tendinopathy, including patellar and quadriceps tendinopathy, is common among athletes and those involved in jumping sports. It is largely a clinical diagnosis that presents as anterior knee pain and stiffness with associated tenderness over the affected tendon. Imaging modalities, including ultrasound and/or magnetic resonance imaging, may be helpful with the diagnosis of difficult cases or in the planning of interventional procedures. Focused and structured rehabilitation using eccentric or heavy slow resistance exercise in conjunction with load management is important for recovery. Adjuvant therapies (e.g., injections or surgery) may be necessary in recalcitrant cases or those with insufficient response to rehabilitation efforts. Prevention strategies focus on improving biomechanics, landing mechanism and lower-extremity balance, flexibility, and strength.

Patellofemoral Pain Syndrome in Young Female Athletes: A Case-Control Study

Background

Patellofemoral pain syndrome (PFPS) is the most common cause of anterior knee pain in children and adolescents, and it is characterized by highly limiting, recurrent, frontal pain.

Objectives

The purpose of the study is to assess the incidence and onset of PFPS in the young female athletes and to compare it to healthy individuals.

Methods

Between 2017 and 2019, 51 subjects were reviewed and divided in three groups: rhythmic gymnastics athletes (RG; 21 individuals, mean age: 13.8 ± 3.6 years), basketball athletes (BG; 17 individuals, mean age: 14.2 ± 3.1 years), and control group (CG; 13 individuals, mean age: 14.5 ± 4.3 years). All patients underwent physical examination including patellar glide, tilt, grind and apprehension tests, tiptoe and jack tests, Coleman block, and navicular drop tests. The clinical and functional outcomes of the subjects were assessed using the Kujala patellofemoral score (KPS).

Results

In RG patients were recorded 66.7% of normal footprint (NF), 9.5% of cavus feet (FCF), and 23.8% of flatfeet (FFF); 14.8% patellar positive tests, KS = 98.6 ± 13.7. BG patients had 70.6% of NF, 11.8% FCF, and 17.6% of FFF; 23.5% patellar positive tests, KS = 98.3 ± 12.4. CG patients had 61.5% of NF, 7.7% of FCF and 30.8% of FFF; 15.4% patellar positive tests, KPS = 98,9 ± 15.3. No statistically significance was found between the three cohorts of patients.

Conclusions

PFPS is a common pathology; muscular imbalance and overuse could exacerbate pain and discomfort in young female athletes. Our findings show high type and level of sport activity are not related to increase frequency of clinical symptoms related to PFPS.

Prevention of Non-Contact Anterior Cruciate Ligament Injuries among Youth Female Athletes: An Umbrella Review

Anterior cruciate ligament (ACL) injuries account for a large percentage of knee injuries, disproportionately affecting female athletes. To help health professionals stay current, we performed an umbrella review to evaluate the effectiveness of ACL injury prevention programs in reducing non-contact ACL injury rates, determine the effective components within interventions, and provide clinical recommendations. Twelve databases (Medline, Embase, Cochrane Database of Systematic Reviews, SPORTDiscus, Cumulative Index to Nursing and Allied Health Literature, PEDro, Web of Science Core Collection, Epistemonikos, TRIP, BC Guidelines and Protocols, CPG Infobase, ProQuest Dissertations and Theses Global) were searched in May 2021 to identify relevant systematic reviews and meta-analyses. Four databases were searched again in September 2021 to identify recent primary literature. Non-contact ACL injury data were extracted to calculate incidence rate ratios (IRRs) and these were combined using an inverse variance random-effects model. A qualitative assessment of included reviews was performed. The methodological quality of the studies was assessed using a Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) or Cochrane Risk-of-Bias Tool for Randomized Trials (RoB 2). Sixteen reviews and two primary studies met the inclusion criteria. Across 11 primary studies, prevention programs were effective in reducing non-contact ACL injuries by 64% (IRR = 0.36 (95% CI: 0.18–0.70)). A multi-faceted exercise program, beginning in the pre-season and containing at least three exercise types, may be beneficial in reducing ACL injury risk.

Positional Differences in Physique, Physical Strength, and Lower Extremity Stability in Korean Male Elite High School Basketball Athletes

No studies have measured the physical strength and lower extremity stability of elite male high school basketball players. This study aimed to measure the physique, physical strength, and lower extremity stability of such athletes in Korea and analyze the differences according to their play positions. Overall, 204 male elite basketball players participated and were classified as guard (n = 97), forward (n = 69), and center (n = 38) according to their main playing position. All sub-variables of physique were significantly higher in the forward and center groups than in the guard group, and were significantly higher in the center group than in the forward group. Strength was significantly higher in the forward and center groups than in the guard group. Agility and speed were significantly faster in the guard group than in the forward and center groups. Y-balance analysis showed that the composite score of both feet tended to be higher in the order of center, forward, and guard, and it was significantly higher in the guard group than in the center group. These results could be used as basic data for selecting players, determining positions, and setting specific training goals for players of each position to improve physical strength and prevent injuries.

Epidemiology of injuries in elite male and female futsal: a systematic review and meta-analysis

The main purpose of this study was to conduct a systematic review and meta-analysis quantifying the incidence of injuries in futsal players. A systematic search was conducted using MEDLINE, PubMed, Web of Science and Scopus databases and subsequently, six studies (14 cohorts) were selected. Separate meta-analyses for male and female players were conducted using a Poisson random-effect regression model approach. The overall and match incidence rates in elite male futsal players were 6.8 (95% CI = 0.0-15.2) and 44.9 (95% CI = 17.2-72.6) injuries/1000 hours of exposure. Pooled training injury rate in male players was not calculated due to the lack of studies reporting training injuries in this cohort. For females, an overall, training and match incidence rates of 5.3 (95% CI = 3.5-7), 5.1 (95% CI = 2.7-7.6) and 10.3 (95% CI = 0.6-20.1) injuries/1000 hours of exposure were reported. In males, match incidence rate in International tournaments was 8.5 times higher than in national leagues (77.2 [95% CI = 60.0-94.5] vs 9.1 [95% CI = 0.0-19.3] for international tournaments and national leagues, respectively). Elite male and female futsal players are exposed to a substantial risk of sustaining injuries, especially during matches.

Descriptive epidemiology of injuries in Japanese collegiate men's basketball: 2013/2014 to 2019/2020

Background

Basketball is one of the most played sports in the world. However, only a few studies have examined the epidemiology of Japanese collegiate men’s basketball injuries. This study investigated the incidence of injury among Japanese collegiate men’s basketball from the 2013/2014 to the 2019/2020 seasons and identified unique patterns by comparing our data with the National Collegiate Athletic Association (NCAA) men’s basketball data.

Methods

Data from Japanese collegiate basketball teams of the Kanto Collegiate Basketball Federation Division I League during the 2013/2014 to 2019/2020 academic years (23 team-seasons) were used in this study. Injury rates per 1000 athlete exposures (AEs), injury proportions, and the injury rate ratio (IRR) were calculated according to the events, injury types, body parts, and common injury mechanisms. Injury rates were then compared with that from the time-loss injury data of the NCAA’s previous reports.

Results

In total, 480 injuries during 97,515 AEs were reported, leading to an injury rate of 4.92 per 1000 AEs (95% CI = 4.48–5.36). The overall injury rate was higher in Japan than in the NCAA ([2009/2010–2014/2015] IRR = 1.55, 95% CI = 1.39–1.73; [2014/2015–2018/2019] IRR = 1.64, 95% CI = 1.48–1.82). Lower extremity injuries occurred most frequently (73.5%). Ankle sprain was the most common injury in Japan, with higher injury rates than in the NCAA (IRR = 2.10; 95% CI = 1.72–2.57). The injury rate of concussion was lower in Japan than in the NCAA (IRR = 0.28; 95% CI = 0.14–0.55).

Conclusions

The rates of overall injury and ankle sprain were higher and that of concussion was lower in Japan than in the NCAA. These results suggested the existence of international differences in the pattern or features of injuries in basketball players.

Characterization and Sex-Related Differences in the Multi-Location External Workload Profile of Semiprofessional Basketball Players. A Cross-Sectional Study

AbstractCommonly, the monitoring of external workload has been performed using a single device on player's scapulae. The human body is a complex multi-articular system and quantification in a single location is insufficient, being necessary the assessment in multiple body locations simultaneously. Therefore, this study aimed to characterize the multi-location external workload in men's and women's players and to analyze the sex-related differences during the most common movements in basketball. Twenty-six semi-professional basketball players (n=13 men, n=13 women) were evaluated in five tests: linear and curvilinear movements, changing of speed, jumping and in-game movements. PlayerLoad_RT was evaluated at six anatomical locations simultaneously (scapulae, lumbar region, knees, and ankles) with WIMU PRO^TM inertial devices attached to the athlete using a full-body skinsuit. Statistical analysis was composed of a t-test of independent measures and Coheńs d effect size. The main results indicated: (1) the type of movement modified the external workload supported by the musculoskeletal structures; (2) sex-related differences were found in the vertical absorption of external workload (p<0.05); (3) no sex-related differences were shown in the horizontal profile (p>0.16). The multi-location monitoring will allow the identification of musculoskeletal structures with high vertical absorption of external load depending on sex (men > women: scapulae-lumbar and knee-ankle; women > men: lumbar-knee) and type of movement (scapulae-lumbar: decelerations; lumbar-knee: jumping; knee-ankle: in-game), just like horizontal differences in lower limb (outer > inner leg: curvilinear). Equally movements distribution throughout training sessions, strengthening and recovery programs of high-workload muscle groups according to player's characteristics could contributed to performance enhancement and reduce injury risk.

A Comprehensive Summary of Systematic Reviews on Sports Injury Prevention Strategies

Background

A large volume of systematic reviews and meta-analyses has been published on the effectiveness of sports injury prevention programs.

Purpose

To provide a qualitative summary of published systematic reviews and meta-analyses that have examined the effectiveness of sports injury prevention programs on reducing musculoskeletal injuries.

Study Design

Systematic review; Level of evidence, 4.

Methods

We searched the PubMed, CINAHL, EMBASE, and the Cochrane databases for systematic reviews and meta-analyses that evaluated the effectiveness of sports injury prevention programs. We excluded published abstracts, narrative reviews, articles not published in English, commentaries, studies that described sports injury prevention strategies but did not assess their effectiveness, studies that did not assess musculoskeletal injuries, and studies that did not assess sports-related injuries. The most relevant results were extracted and summarized. Levels of evidence were determined per the Oxford Centre for Evidence-Based Medicine, and methodological quality was assessed using the AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews, revised version).

Results

A total of 507 articles were retrieved, and 129 were included. Articles pertaining to all injuries were divided into 9 topics: sports and exercise in general (n = 20), soccer (n = 13), ice hockey (n = 1), dance (n = 1), volleyball (n = 1), basketball (n = 1), tackle collision sports (n = 1), climbing (n = 1), and youth athletes (n = 4). Articles on injuries by anatomic site were divided into 11 topics: general knee (n = 8), anterior cruciate ligament (n = 34), ankle (n = 14), hamstring (n = 11), lower extremity (n = 10), foot (n = 6), groin (n = 2), shoulder (n = 1), wrist (n = 2), and elbow (n = 1). Of the 129 studies, 45.7% were ranked as evidence level 1, and 55.0% were evidence level 2. Based on the AMSTAR-2, 58.9% of the reviews reported a priori review methods, 96.1% performed a comprehensive literature search, 47.3% thoroughly described excluded articles, 79.1% assessed risk of bias for individual studies, 48.8% reported a valid method for statistical combination of data (ie, meta-analysis), 45.0% examined the effect of risk of bias on pooled study results, and 19.4% examined the risk for publication bias.

Conclusion

This comprehensive review provides sports medicine providers with a single source of the most up-to-date publications in the literature on sports injury prevention.

Parkour-Based Activities in the Athletic Development of Youth Basketball Players

While ideas from long-term athlete development (LTAD) models have been adopted and integrated across different sports, issues related to early specialization, such as increased risk of injury and burnout, are still common. Although some benefits may be associated with early sport specialization, sports sampling is purported to be a more effective approach to the long-term health and wellbeing of children. Furthermore, the concept of developing what are commonly referred to as "fundamental movement skills" (FMS) is central to the rationale for delaying single sports specialization. However, in place of sports sampling, it appears that the practice of strength and conditioning (S&C) has become a driving force behind developmental models for youth athletes, highlighted by the growing body of literature regarding youth athletic development training. In this perspective piece, we explore how conventional S&C practice may insufficiently develop FMS because typically, it only emphasizes a narrow range of foundational exercises that serve a limited role toward the development of action capabilities in youth athletic populations. We further discuss how this approach may limit the transferability of physical qualities, such as muscular strength, to sports-specific tasks. Through an ecological dynamics lens, and using basketball as an example, we explore the potential for parkour-based activity within the LTAD of youth basketball players. We propose parkour as a training modality to not only encourage movement diversity and adaptability, but also as part of an advanced strength training strategy for the transfer of conventional S&C training.

Acute effects of a neuromuscular warm-up on potential re-injury risk factors associated with unanticipated jump landings after anterior cruciate ligament reconstruction: A crossover trial

OBJECTIVE

To investigate acute effects of a single bout of football specific neuromuscular injury preventive warm-up on potential anterior cruciate ligament (ACL) re-injury risk factors during anticipated and unanticipated jump-landings.

DESIGN

Crossover.

METHODS

Fourteen participants (mean ± SD age, 23.4 ± 4.1 years) 6-24 months after ACL reconstruction performed the Prevent Injury and Enhance Performance (PEP) and bicycle ergometer warm-up in a randomised sequence. Washout phase was one week. Countermovement jumps with anticipated and unanticipated single-leg-landings were assessed. Decision-making quality was measured using landing error count.

RESULTS

No carry-over effects occurred (p > 0.05). The unanticipated task produced significantly higher peak ground reaction forces (Δ+4%, F₍₁₁₎ = 3.46, p < 0.001, eta² = 0.21) after PEP warm-up compared to ergometer warm-up. A lower number of decision (Δ+12%, F ₍₅₎ = 17.1, p < 0.001, eta² = 0.57) and cumulated (Δ+15%, F ₍₃₎ = 17.2, p < 0.001, eta² = 0.57) errors were recorded during the unanticipated condition following PEP compared to ergometer warm-up.

CONCLUSIONS

Evaluating unanticipated jump-landing ability prior to return to sports clearance may provide information on potential re-injury risk factors. PEP warm-up may be superior to bicycle ergometer warm-up at improving unanticipated decision-making quality among athletes cleared to return to sports.

Effectiveness of shoulder injury prevention programs in an overhead athletic population: A systematic review

OBJECTIVE

To analyze the effectiveness of shoulder injury prevention programs in overhead athletes.

DESIGN

Systematic Review.

METHODS

CINAHL, Embase, PubMed, and SPORTDiscus electronic databases were searched from database inception through December 2020 for randomized controlled or prospective cohort studies that implemented shoulder injury prevention programs in overhead athletes and reported shoulder injury incidence rates.

RESULTS

Seven studies fulfilled the inclusion criteria. Two studies reported on odds ratios (OR) that resulted in a reduction of shoulder injuries in overhead athletes following shoulder strengthening and flexibility exercises (OR, 0.72; 95% CI; 0.52, 0.98; OR, 0.22; 95% CI; 0.06, 0.75). One study reported on hazard ratio (HR) that resulted in a reduction of shoulder injuries following stretching of the posterior capsule (HR, 0.36; 95% CI; 0.13, 0.95).

CONCLUSION

There is limited research surrounding the effectiveness of shoulder injury prevention programs in overhead athletes specific to injury reduction. Only three studies reported a favorable effect in terms of injury prevention, with only one study at low risk of bias. At present, no conclusions can be made regarding the effectiveness of shoulder injury prevention programs in the overhead athlete.

The Effectiveness of Neuromuscular Warmups for Lower Extremity Injury Prevention in Basketball: A Systematic Review

BACKGROUND

Neuromuscular warmups have gained increasing attention as a means of preventing sports-related injuries, but data on effectiveness in basketball are sparse. The objective of this systematic review was to evaluate evidence of the effectiveness of neuromuscular warmup-based strategies for preventing lower extremity injuries among basketball athletes.

METHODS

PubMed and Cochrane Library databases were searched in February 2019. Studies were included if they were English-language randomized controlled, non-randomized comparative, or prospective cohort trials, tested neuromuscular and/or balance-focused warmup interventions among basketball players, and assessed at least one type of lower extremity injury as a primary outcome. Criteria developed by the USPSTF were used to appraise study quality, and GRADE was used to appraise the body of evidence for each outcome. Due to heterogeneity in the included studies, meta-analyses could not be performed.

RESULTS

In total, 825 titles and abstracts were identified. Of the 13 studies which met inclusion criteria for this review, five were balance interventions (3 randomized controlled trials) and eight were multicomponent interventions involving multiple categories of dynamic neuromuscular warmup (5 randomized controlled trials). Authors of four of the studies were contacted to obtain outcome data specific to basketball athletes. Basketball specific results from the studies suggest significant protective effects for the following lower extremity injuries: ankle injuries (significant in 4 out of the 9 studies that assessed this outcome); ACL injuries (2 of 4 studies); knee injuries generally (1 of 5 studies); and overall lower extremity injuries (5 of 7 studies). All but one of the non-significant results were directionally favorable. Evidence was moderate for the effect of multicomponent interventions on lower extremity injuries generally. For all other outcomes, and for balance-based interventions, the quality of evidence was rated as low.

CONCLUSION

Overall, the evidence is supportive of neuromuscular warmups for lower extremity injury prevention among basketball players. However, most studies are underpowered, some used lower-quality research study designs, and outcome and exposure definitions varied. Due to the nature of the study designs, effects could not be attributed to specific intervention components. More research is needed to identify the most effective bundle of warmup activities.

How injury prevention programs are being structured and implemented worldwide: An international survey of sports physical therapists

OBJECTIVE

To identify the role of sports physical therapists (PT) in the injury prevention process and to compare the structure of preventive programs and associated (organization) policies applied in athletic organizations and sports teams of varying gender and level world-wide.

DESIGN

cross-sectional study.

SETTING

LimeSurvey platform.

PARTICIPANTS

Sports PT working with athletes invited through the International Federation of Sports Physical Therapy.

MAIN OUTCOME MEASURES

Sports injury prevention program (IPP) structure and implementation.

RESULTS

414 participants fully participate in this survey study. Athlete's injury history (68.84%), the most common injuries within the sport modality (67.87%) and athlete's preseason screening results (64.01%) were most frequently used to customize IPPs. Warm-up (70.04%) and individually PT-guided exercise-therapy (70.04%) were the preferred methods to organize the prevention routine. The main barrier for IPP implementation was lack of time within the athlete's weekly training schedule (66.66%). The majority of the participants (72.84%) reported to evaluate the perception of IPP's effect by comparing current and preceding seasons' injury occurrences.

CONCLUSION

These survey results are the first identifying contemporary sports injury prevention organization and implementation policies on an international level. This information might support the sports PT community in improving and standardizing IPP (implementation) strategies worldwide.

High School Basketball Coach and Player Perspectives on Warm-Up Routines and Lower Extremity Injuries

BACKGROUND

While participation in sports-related activities results in improved health outcomes, high school athletes are at risk for lower extremity injuries, especially ankle, knee, and thigh injuries. Efforts to promote the adoption and implementation of evidence-driven approaches to reduce injury risk among school-aged athletes are needed. However, there is limited research regarding the perceived barriers, facilitators, and adherence factors that may influence the successful implementation of effective warm-up routines among this population.

METHODS

We conducted a qualitative study using semi-structured interviews and focus groups to assess high school basketball coach and player current practices, knowledge, and perspectives about warm-ups and lower-extremity injuries (LEIs). We interviewed coaches (n = 12) and players (n = 30) from May to October 2019. Participants were recruited from public high schools in a joint school district in Southern California. Multiple coders employed thematic analysis of the data using validated methods.

RESULTS

Coaches and players reported regular engagement (e.g., daily) in warm-up routines, but the time dedicated (range 5-45 min), types of exercises, and order varied substantially. Players often co-lead the warm-up practice with the coach or assistant coach. Despite regular engagement in warm-up, players and coaches report multiple challenges, including (1) limited time and space to warm-up effectively at games, (2) a perception that young players are not prone to injury, (3) competing demands for coaches' time during practice, and (4) coaches' lack of knowledge. Coaches and players perceive that warming up before practice will result in fewer injuries, and many players are motivated to warm up as a result of their personal injury experience; however, they desire guidance on the ideal exercises for preventing injury and training on the proper form for each exercise.

CONCLUSIONS

Regular involvement in basketball warm-up routines is common among high school teams, but the methods and time dedicated to these practices varied. Players and coaches are eager for more information on warm-up programs shown to reduce LEIs.

Epidemiology of Acute Extensor Mechanism Injuries in Collegiate-Level Athletes in the United States

BACKGROUND

Extensor mechanism injuries involving the quadriceps tendon, patella, or patellar tendon can be a devastating setback for athletes. Despite the potential severity and relative frequency with which these injuries occur, large-scale epidemiological data on collegiate-level athletes are lacking.

STUDY DESIGN

Descriptive epidemiology study.

LEVEL OF EVIDENCE

Level 4.

METHODS

Knee extensor mechanism injuries across 16 sports among National Collegiate Athletic Association (NCAA) men and women during the 2004-2005 to 2013-2014 academic years were analyzed using the NCAA Injury Surveillance Program (NCAA-ISP). Extensor mechanism injuries per 100,000 athlete-exposures (AEs), operative rate, annual injury and reinjury rates, in-season status (pre-/regular/postseason), and time lost were compiled and calculated.

RESULTS

A total of 11,778,265 AEs were identified and included in the study. Overall, 1,748 extensor mechanism injuries were identified, with an injury rate (IR) of 14.84 (per 100,000 AEs). N = 114 (6.5%) injuries were classified as severe injuries with a relatively higher median time loss (44 days) and operative risk (18.42%). Male athletes had higher risk of season-ending injuries in both all (3.20% vs 0.89%, P < 0.01) and severe (41.54% vs 16.33%, P < 0.01) extensor mechanism injuries. Similarly, contact injuries were more frequently season-ending injuries (4.44% vs 1.69%, P = 0.01). Women's soccer (IR = 2.59), women's field hockey (IR = 2.15), and women's cross country (IR = 2.14) were the sports with the highest rate of severe extensor mechanism injuries.

CONCLUSION

Extensor mechanism injuries in collegiate athletes represent a significant set of injuries both in terms of volume and potentially to their athletic careers. Male athletes and contact injuries appear to have a greater risk of severe injuries. Injuries defined as severe had a higher risk of operative intervention and greater amount of missed playing time.

CLINICAL RELEVANCE

Knowledge of the epidemiology of extensor mechanism injuries may help clinicians guide their athlete patients in sports-related injury prevention and management.

A Machine-Learning Approach to Measure the Anterior Cruciate Ligament Injury Risk in Female Basketball Players

Anterior cruciate ligament (ACL) injury represents one of the main disorders affecting players, especially in contact sports. Even though several approaches based on artificial intelligence have been developed to allow the quantification of ACL injury risk, their applicability in training sessions compared with the clinical scale is still an open question. We proposed a machine-learning approach to accomplish this purpose. Thirty-nine female basketball players were enrolled in the study. Leg stability, leg mobility and capability to absorb the load after jump were evaluated through inertial sensors and optoelectronic bars. The risk level of athletes was computed by the Landing Error Score System (LESS). A comparative analysis among nine classifiers was performed by assessing the accuracy, F1-score and goodness. Five out nine examined classifiers reached optimum performance, with the linear support vector machine achieving an accuracy and F1-score of 96 and 95%, respectively. The feature importance was computed, allowing us to promote the ellipse area, parameters related to the load absorption and the leg mobility as the most useful features for the prediction of anterior cruciate ligament injury risk. In addition, the ellipse area showed a strong correlation with the LESS score. The results open the possibility to use such a methodology for predicting ACL injury.

Preseason functional testing in young basketball players: asymmetries and intercorrelations

[Purpose] The present study aimed to examine the existence and degree of possible asymmetries of functional test performance and their intercorrelations in the lower extremities of young basketball players. [Participants and Methods] Twenty-seven healthy male basketball players (age: 15.52 ± 1.37 years) were examined for the symmetric function of their lower extremities using triple hop for distance tests in the sagittal and frontal plane (medial-lateral), the Y-balance test and a vertical jump test. [Results] Participants exhibited statistically significant side-to-side differences in only the medial triple hop test, as they jumped further on their non-dominant for stability lower limb. No other asymmetries were observed in the rest of the functional tests. Significant correlations were also indicated between the vertical jumptest and the three directions of the triple hop test for both lower limbs. [Conclusion] Our findings proved that young basketball players present a symmetrical picture of functional performance, as revealed by the evaluation of various functional tests. The only significant asymmetric adaptation observed in the medial triple hop test will have to be strengthened by future studies to be implemented in injury prevention programs.

Epidemiology of Sports-Specific Foot and Ankle Injuries

The epidemiology of any given topic sometimes is overlooked. This is true particularly with sports physicians and sports injuries. The identification of sports-specific injury patterns by collection and examination of data can help prevent injuries. Thus, as a physician involved in any sport, it is essential to have this knowledge because understanding it and imparting it may allow a valuable contribution to the health and safety of the athletes and success of the teams.

Plantar Pressure Profiles and Possible Foot Syndromes of Taiwanese College Elite Basketball Players

BACKGROUND

Plantar pressure assessments are useful for understanding the functions of the foot and lower limb and for predicting injury incidence rates. Musculoskeletal fatigue is likely to affect plantar pressure profiles. This study aimed to characterize college elite basketball players' plantar pressure profiles and pain profiles during static standing and walking.

METHODS

Fifty-one male elite basketball players and 85 male recreational basketball players participated in this study. An optical plantar pressure measurement system was used to collect the arch index (AI), regional plantar pressure distributions (PPDs), and footprint characteristics during static and dynamic activities. Elite basketball players' pain profiles were examined for evaluating their common musculoskeletal pain areas.

RESULTS

The AI values were in the reference range in recreational basketball players and considerably lower in elite basketball players. Elite basketball players' static PPDs of both feet were mainly exerted on the lateral longitudinal arch and the lateral heel and were relatively lower on the medial longitudinal arch and medial and lateral metatarsal bones. The PPDs mainly transferred to the lateral metatarsal bone and lateral longitudinal arch and decreased at the medial heel during the midstance phase of walking. The footprint characteristics of elite basketball players illustrated the features of calcaneal varus (supinated foot) of high arches and dropped cuboid foot. The lateral ankle joints and anterior cruciate ligaments were the common musculoskeletal pain areas.

CONCLUSIONS

Elite basketball players' AI values indicated high arches, and their PPDs tended to parallel the features of the high-arched supinated and dropped cuboid foot. Their pain profiles resonated with the common basketball injuries and reflected the features of Jones fracture and cuboid syndrome. The potential links among high-arched supinated foot, Jones fracture, and cuboid syndrome are worth further study.

Employing Standardised Methods to Compare Injury Risk Across Seven Youth Team Sports

Injury surveillance systems seek to describe injury risk for a given sport, in order to inform preventative strategies. This often leads to comparisons between studies, although these inferences may be inappropriate, considering the range of methods adopted. This study aimed to describe the injury epidemiology of seven youth sports, enabling valid comparisons of injury risk. Consistent methods were employed across seven sports [male American football, basketball, soccer, rugby league, rugby union; female soccer and rugby union] at a high school in England. A 24-hour time-loss injury definition was adopted. Descriptive statistics and injury incidence (/1000 match-hours) are reported. In total, 322 injuries were sustained by 240 athletes (mean age=17.7±1.0) in 10 273 player-match hours. American football had a significantly greater injury incidence (86/1000 h; 95% CI 61-120) than all sports except female rugby union (54/1000 h; 95% CI 37-76). Concussion was the most common injury (incidence range 0.0-26.7/1000 h), while 59% of injuries occurred via player contact. This study employed standardized data collection methods, allowing valid and reliable comparisons of injury risk between youth sports. This is the first known study to provide epidemiological data for female rugby union, male basketball and American football in an English youth population, enabling the development of preventative strategies.

Can we improve coaches' injury prevention views and implementation practices in the community female Gaelic sport of camogie?

Objectives

To evaluate the effect of a nationwide coach education workshop on the attitudes towards, willingness and perceived ability of camogie coaches to implement a Camogie Injury Prevention Programme (CIPP) and their implementation of this programme 4 weeks after the workshop.

Methods

Coaches (n=98) from all four provinces in Ireland were recruited and completed a questionnaire prior to and immediately following a developed workshop on the CIPP. Four weeks later 40 of the 98 coaches completed a follow-up questionnaire. Descriptive statistics were completed and a mixed between-within analysis of variance was conducted to examine the differences in willingness and perceived ability to conduct the CIPP over time and between genders. Non-parametric tests examined the differences in attitude scores. The implementation rate of the programme 4 weeks following the workshop was also assessed.

Results

Just 13.4% of coaches had previously heard of the CIPP. Significant improvements in attitudes towards, willingness and perceived ability to conduct the CIPP was noted (p<0.001) post-workshop. Ninety-one per cent of coaches reported that implementing the CIPP in a phased approach with their teams would be beneficial. The camogie coaches primarily viewed the CIPP content favourably, finding the exercises important, relevant and mostly enjoyable. However, some coaches reported that the Nordic hamstring curl is too challenging for players to complete (immediately following workshop: 28.7%; 4 weeks later: 53.3%). Four weeks after the workshop, 72.5% of coaches who responded were implementing the CIPP with their teams in the community.

Conclusions

Due to the success of the education workshop, the Camogie Association should incorporate this injury prevention workshop into all mandatory camogie coaching education courses.

Ankle and Lower Leg Injuries in Professional Baseball Players

BACKGROUND

Ankle and lower leg injuries are very common in sports, and numerous studies have discussed their diagnosis and management. Our study differs in that we report lower leg injuries in professional baseball players spanning the 2011-2016 seasons by utilizing a comprehensive injury surveillance system developed by Major League Baseball (MLB).

PURPOSE

To determine the injury characteristics of ankle and lower leg injuries in professional baseball players during the 2011-2016 seasons by utilizing the MLB injury surveillance system.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

Our study is a descriptive epidemiological evaluation through a retrospective review of injury data from the MLB Health and Injury Tracking System (HITS) since its implementation in 2010. We included any professional baseball player (MLB and Minor League Baseball [MiLB]) who was identified as having an ankle or lower leg injury between January 1, 2011, and February 28, 2017.

RESULTS

Over the study period, there were a total of 4756 injuries, of which 763 (16%) occurred in MLB players and 3993 (84%) occurred in MiLB players. The mean number of days missed for all players was 27.8 ± 141.4 days, with a median of 3 days. From 2011 through 2016, it was estimated that there were 414,912 athlete exposures (AEs) in MLB and 1,796,607 AEs in MiLB. Of the 4756 injuries recorded, 550 (12%) took place during the MLB regular season, and 3320 (70%) took place during the MiLB regular season. Injuries in MLB players, however, were 1.7 times more likely to require surgery (P < .001). Additionally, rates of injury to the lower leg were stratified by position, with infield players experiencing injuries at a 1.6 times greater rate than any other position (P < .001).

CONCLUSION

In conclusion, this is the only epidemiological study to focus primarily on ankle and lower leg injuries in professional baseball players, utilizing an injury surveillance system developed by MLB.

Forty-five per cent lower acute injury incidence but no effect on overuse injury prevalence in youth floorball players (aged 12-17 years) who used an injury prevention exercise programme: two-armed parallel-group cluster randomised controlled trial

Objective

To study whether an injury prevention exercise programme would reduce the number of injuries in youth floorball players.

Methods 

81 youth community level floorball teams (48 clusters=clubs) with female and male players (12–17 years) were cluster-randomised into an intervention or control group. Intervention group coaches were instructed to use the Swedish Knee Control programme and a standard running warm-up before every training session, and the running warm-up before every match, during the season. Control teams continued usual training. Teams were followed during the 2017/2018 competitive season (26 weeks). Player exposure to floorball and occurrence of acute and overuse injuries were reported weekly via a web-based player survey using the Oslo Sports Trauma Research Centre Questionnaire.

Results 

17 clusters (301 players) in the intervention group and 12 clusters (170 players) in the control group were included for analyses. There were 349 unique injuries in 222 players. The intervention group had a 35% lower incidence of injuries overall than the control group (adjusted incidence rate ratio (IRR) 0.65, 95% CI 0.52 to 0.81). The absolute risk reduction was 6.6% (95% CI 3.2 to 10.0), and the number needed to treat was 152 hours of floorball exposure (95% CI 100 to 316). Intervention group teams had a 45% lower incidence of acute injuries (adjusted IRR 0.55, 95% CI 0.37 to 0.83). There was no difference in the prevalence of overuse injuries (adjusted prevalence rate ratio 0.96, 95% CI 0.73 to 1.26).

Conclusion 

The Knee Control injury prevention programme reduced acute injuries in youth floorball players; there was no effect on overuse injuries.

Trial registration number

Clinical Trials NCT03309904.

Effects of basketball match-play on ankle dorsiflexion range of motion and vertical jump performance in semi-professional players

BACKGROUND

The aim of this study was to investigate the effects of basketball match-play on ankle dorsiflexion range of motion (ROM) and countermovement (CMJ) performance, and their association with internal match load.

METHODS

Thirty semi-professional basketball players participated in this study. Ankle dorsiflexion ROM and bilateral CMJ performance were evaluated before (pre-match) and immediately after match-play (post-match). In addition, ankle dorsiflexion ROM was measured 48 hours post-match. Furthermore, for each player, the ankle dorsiflexion ROM scores were categorized as normal or restricted according to previously reported reference values (>2 cm change from baseline pre-match to post-match and to 48 hours post-match).

RESULTS

Ankle dorsiflexion ROM was increased post-match from pre-match in dominant and non-dominant limbs (most likely small) and decreased 48 hours post-match (most likely moderate) compared with immediately post-match measures in both limbs. Approximately 20% of all players showed restricted ankle dorsiflexion ROM values 48 hours post-match. CMJ performance was higher post-match than pre-match.

CONCLUSIONS

Ankle dorsiflexion ROM is still reduced 48 h after a competitive basketball match in semi-professional basketball players. The implementation of specific recovery strategies aiming at minimizing a decrease in ankle dorsiflexion after a match might be considered to reduce the likelihood of ankle injury.

Epidemiology of Foot and Ankle Injuries in National Collegiate Athletic Association Men's and Women's Ice Hockey

Background:

Ice hockey is a high-speed contact sport in which athletes are prone to many different injuries. While past studies have examined overall injury rates in ice hockey, foot and ankle injuries among collegiate ice hockey players have yet to be analyzed.

Purpose/Hypothesis:

The purpose of this study was to elucidate the epidemiology of foot and ankle injuries among collegiate ice hockey players utilizing data from the National Collegiate Athletic Association (NCAA) Injury Surveillance Program. We hypothesized that male ice hockey players would sustain more injuries compared with female ice hockey players and that the injuries sustained would be more severe.

Study Design:

Descriptive epidemiology study.

Methods:

Data on all foot and ankle injuries sustained during the academic years 2004 through 2014 were obtained from the NCAA Injury Surveillance Program. Injury rates, rate ratios (RRs), and injury proportion ratios were reported with 95% CIs.

Results:

Over the study period, the overall rate of foot and ankle injuries for men was higher than that for women (413 vs 103 injuries, respectively; RR, 4.01 [95% CI, 3.23-4.97]). Injury rates were highest during the regular season for both men (358 injuries; RR, 64.78 [95% CI, 58.07-71.49]) and women (89 injuries; RR, 38.37 [95% CI, 30.40-46.35]) compared with the preseason or postseason. The most common injury in men was a foot and/or toe contusion (22.5%), while women most commonly sustained a low ankle sprain (31.1%). For men, foot and/or toe contusions accounted for the most non–time loss (≤24 hours ) and moderate time-loss (2-13 days) injuries, while high ankle sprains accounted for the most severe time-loss (≥14 days) injuries. For women, foot and/or toe contusions accounted for the most non–time loss injuries, low ankle sprains accounted for the most moderate time-loss injuries, and high ankle sprains accounted for the most severe time-loss injuries.

Conclusion:

Foot and ankle injuries were frequent among collegiate ice hockey players during the period studied. For men, contusions were the most commonly diagnosed injury, although high ankle sprains resulted in the most significant time lost. For women, low ankle sprains were the most common and resulted in the most moderate time lost. These findings may direct future injury prevention and guide improvements in ice skate design.

Eight Weeks of Plyometric Training Improves Ability to Change Direction and Dynamic Postural Control in Female Basketball Players

The aim of this study was to examine the effects of 8 weeks of plyometric training on the ability to change direction and postural control in female basketball players. 25 national level female basketball players aged 18–27 years participated in the study. Volunteers were randomly assigned to an experimental group (n = 13) who replaced a part of their standard regimen by plyometric training twice weekly for 8 weeks, and a control group (n = 12) who continued their usual in-season training program. Before and after the intervention, the ability to change direction and postural control were assessed by force platform under both static and dynamic conditions (with the eyes open and then closed). Isokinetic testing was also performed to calculate the Hamstring/Quadriceps (H/Q) strength ratio. The intervention improved ability to change direction (p ≤ 0.001, d = 1.51) and shortened path length (p = 0.038, d = 0.937) during static balance testing. However, it did not yield significant inter-group differences in postural control in the antero-posterior plane. The stance in the medio-lateral plane seemed the most responsive to the intervention, with reductions in surface area (p = 0.012, d = 0.285), velocity with the eyes closed (p = 0.031, d = 0.968), and path length with the eyes open (p = 0.029, d = 0.968). The intervention did not change the H/Q ratio at the two speeds tested (60° and 120°.s^–1). In summary, the addition of 8 weeks plyometric training to the usual in-season basketball regimen of top-level female basketball players enhanced their ability to change direction and reduced the risk of falls and injuries by improving postural control, but did not increase the H/Q measure of knee stability.

Association of pre-season musculoskeletal screening and functional testing with sports injuries in elite female basketball players

Basketball is one of the most popular sports in Lithuania, and participation in women’s basketball is on the rise. Pre-participation examinations, including musculoskeletal screening and functional performance testing, is an essential part of a multidisciplinary approach to prevent future injuries. Because the lower extremities are the most commonly-injured body area in basketball players. Assessing fundamental movement qualities is of utmost importance. The aim of our study was to determine if functional tests can predict sports injuries in elite female basketball players. A total of 351 records for professional female basketball players were screened during 2013–2016 season. We analysed functional characteristics before the season and used functional performance tests for injury risk assessment: the Functional Movement Screen (FMS), the lower quarter Y Balance test (YBT-LQ) and the Landing Error Scoring System (LESS). Data from 169 players’ records were analysed: 77 of them made it to the end of season without injury, making up the non-injured group, while 92 of them suffered lower limb sport injuries during the sport season (injury group). Student’s t-test and the Mann-Whitney U-test were used to determine differences between groups. The most commonly encountered sports injuries in our population were those of knee 40.2% and ankle 38%. The injury group had a lower total FMS score (p = 0.0001) and higher total LESS score (p = 0.028) than non-injury group. The dynamic balance of lower limbs was similar in both groups. Imperfect functional movement patterns and poor jump-landing biomechanics during pre-season screening were associated with lower extremity injuries in elite female basketball players. Impairments of dynamic stability in the lower extremities were not associated with injury rates in our population. A combination of functional tests can be used for injury risk evaluation in female basketball players.

Epidemiology of Ankle Sprains and Chronic Ankle Instability

OBJECTIVE

To provide a focused overview of the existing literature on the epidemiology of acute ankle sprains (lateral, medial, and high/syndesmotic) with an emphasis on incidence studies from the United States. In addition, we provide a brief overview of chronic ankle instability (CAI), posttraumatic osteoarthritis, and injury prevention to contribute to our understanding of the epidemiology of these injuries and the current state of the science on ankle sprains and ankle instability in sports medicine.

BACKGROUND

Acute ankle sprains are one of the most common musculoskeletal injuries, with a high incidence among physically active individuals. Additionally, acute ankle sprains have a high recurrence rate, which is associated with the development of CAI. Understanding the epidemiology of these injuries is important for improving patients' musculoskeletal health and reducing the burden of lower limb musculoskeletal conditions.

DESCRIPTION

Acute ankle-sprain incidence rates are summarized among the general population, as well as among physically active populations, including organized athletics and military personnel, with a focus on incidence in the United States. The link between a prior ankle sprain and a future acute ankle sprain is described. We also discuss the association between the incident ankle sprain and adverse, long-term outcomes such as CAI and posttraumatic osteoarthritis. Finally, we summarize injury-prevention successes and future directions for research and prevention.

CLINICAL APPLICATIONS

This information is useful for health care providers to understand the expected incidence rates of acute ankle sprains, be aware of the association between ankle sprains and negative short- and long-term outcomes, and be familiar with existing injury-prevention programs.

Epidemiology of Ankle Sprains and Chronic Ankle Instability

OBJECTIVE

To provide a focused overview of the existing literature on the epidemiology of acute ankle sprains (lateral, medial, and high/syndesmotic) with an emphasis on incidence studies from the United States. In addition, we provide a brief overview of chronic ankle instability (CAI), posttraumatic osteoarthritis, and injury prevention to contribute to our understanding of the epidemiology of these injuries and the current state of the science on ankle sprains and ankle instability in sports medicine.

BACKGROUND

Acute ankle sprains are one of the most common musculoskeletal injuries, with a high incidence among physically active individuals. Additionally, acute ankle sprains have a high recurrence rate, which is associated with the development of CAI. Understanding the epidemiology of these injuries is important for improving patients' musculoskeletal health and reducing the burden of lower limb musculoskeletal conditions.

DESCRIPTION

Acute ankle-sprain incidence rates are summarized among the general population, as well as among physically active populations, including organized athletics and military personnel, with a focus on incidence in the United States. The link between a prior ankle sprain and a future acute ankle sprain is described. We also discuss the association between the incident ankle sprain and adverse, long-term outcomes such as CAI and posttraumatic osteoarthritis. Finally, we summarize injury-prevention successes and future directions for research and prevention.

CLINICAL APPLICATIONS

This information is useful for health care providers to understand the expected incidence rates of acute ankle sprains, be aware of the association between ankle sprains and negative short- and long-term outcomes, and be familiar with existing injury-prevention programs.

On the Court: A Comprehensive Analysis of Basketball Facial Trauma

With basketball gradually becoming increasingly popular across the United States, it is necessary for health care providers to understand injuries associated with the sport. We aim to determine the incidence of basketball-related facial injuries and further describe their patterns with regard to age, mechanism of injury, and degree of injury. An analysis of emergency department visits under the National Electronic Injury Surveillance System was conducted from 2015 through 2017. Chi-squared testing (χ ² ) was performed to compare categorical variables. After a review of results, a total of 4,578 patients were included for analysis spanning a 3-year time period (2015-2017). Lacerations were the most common injury overall (57.9%). Nasal fractures were by far the most common fracture (76.1%), and elbows to the face and collisions with other players were the most common types of injury mechanisms (31 and 28.7%, respectively). Adolescents (aged 12-18 years) were the most frequently injured group (42.5%), although young adults (aged 19-34 years) were also frequently affected (30.1%). Basketball facial trauma remains a prominent issue. Our research, in correlation with previous research, shows that current precautions to injury are not widely observed or are ineffective to the extent of need for further reform. It thus becomes necessary to provide patient education and develop more practical methods for decreasing player injury.

COMPARISON OF NON-CONTACT AND CONTACT TIME-LOSS LOWER QUADRANT INJURY RATES IN MALE COLLEGIATE BASKETBALL PLAYERS: A PRELIMINARY REPORT

BACKGROUND

Male collegiate basketball (BB) players are at risk for musculoskeletal injury. The rate of time-loss injury in men's collegiate BB, for all levels of National Collegiate Athletic Association (NCAA) competition, ranges from 2.8 to 4.3 per 1000 athletic exposures (AE) during practices and 4.56 to 9.9 per 1000 AE during games. The aforementioned injury rates provide valuable information for sports medicine professionals and coaching staffs. However, many of the aforementioned studies do not provide injury rates based on injury mechanism, region of the body, or player demographics.

HYPOTHESIS/ PURPOSE

The purpose of this study is two-fold. The first purpose of this study was to report lower quadrant (LQ = lower extremities and low back region) injury rates, per contact and non-contact mechanism of injury, for a cohort of male collegiate basketball (BB) players. The second purpose was to report injury risk based on prior history of injury, player position, and starter status.

STUDY DESIGN

Prospective, descriptive, observational cohort.

METHODS

A total of 95 male collegiate BB players (mean age 20.02 ± 1.68 years) from 7 teams (NCAA Division II = 14, NCAA Division III = 43, NAIA = 21, community college = 17) from the Portland, Oregon region were recruited during the 2016-2017 season to participate in this study. Each athlete was asked to complete an injury history questionnaire. The primary investigator collected the following information each week from each team's athletic trainer: athletic exposures (AE; 1 AE = game or practice) and injury updates.

RESULTS

Thirty-three time-loss LQ injuries occurred during the study period. The overall time-loss injury rate was 3.4 per 1000 AE. Division III BB players had the highest rates of injury. There was no difference in injury rates between those with or without prior injury history. Guards had a significantly greater rate of non-contact time-loss injuries (p = 0.04).

CONCLUSIONS

Guards experienced a greater rate of LQ injury than their forward/center counterparts. Starters and athletes with a prior history of injury were no more likely to experience a non-contact time-loss injury than nonstarters or those without a prior history of injury. These preliminary results are a novel presentation of injury rates and risk for this population and warrant continued investigation.

LEVEL OF EVIDENCE

2.