Risk factors and injury prevention in elite athletes: a descriptive study of the opinions of physical therapists, doctors and trainers

Illness is more prevalent than injury in trail runners participating in a mountainous ultra trail race

OBJECTIVES

Trail running is a popular off-road sport involving running in natural environments over various terrains, often in remote locations. This study aims to investigate the epidemiology and risk factors of injuries and illnesses, i.e. medical encounters, on race day among trail runners in a high-altitude ultra trail race.

METHODS

This descriptive cross-sectional study on an ultra trail race (38 km, 65 km and 100 km) in South Africa, included participants 18 years or older. Of the 331 race participants, 285(86.1%) consented to participate in the study. Data collection included demographic details, injuries (body region, specific body area, tissue type, pathology) and illnesses (organ system, symptom cluster, etiology). Risk factor analysis includes sex, age, weight, height, race distance, illness and injury history, training and running experience. Frequency (n, %), prevalence (%) and odds ratios (OR; 95%CI) are reported.

RESULTS

Eighty-nine (31.2%) individuals reported 131 medical encounters [49 injuries (37.4%); 82 illnesses (62.6%)]. Injuries were sustained by 14.7% of athletes, and 22.5% reported illnesses. For injuries, the lower limb was mainly involved (n = 41; 83.7%). Most injuries affected the foot (n = 18; 36.7%), ankle (n = 10; 20.4%) and knee (n = 7; 14.3%). Tissue types mainly involved skin (n = 21; 42.8%), ligament (n = 7; 14.3%) and muscle (n = 7; 14.3%). Multiple (n = 45; 54.9%) and gastrointestinal (n = 17; 20.7%) organ systems were mainly involved in illnesses. Only 100 km runners reported dehydration (n = 28; 31.5%), and one in every six of these runners (n = 5; 17.9%) did not finish. Runners reporting fatigue (n = 21; 23.6%) had a high (n = 8; 38.1%) did not finish rate. Two in every five participants (n = 36; 40.4%) with a medical encounter, did not finish. No medical encounter-associated risk factors were identified.

CONCLUSIONS

Illnesses were more common than injuries during the mountainous ultra trail race. Sustaining a medical encounter increased the chance of not completing the race. Further research on the epidemiology of race day medical encounters in trail running is required.

Personalizing Injury Management and Recovery: A Cross-Sectional Investigation of Musculoskeletal Injuries and Quality of Life in Athletes

Purpose

The study explores the impact of Musculoskeletal Injuries on the quality of life in youth athletes, aiming to understand the extent of these injuries' effects on their physical and mental wellbeing.

Patients and Methods

This cross-sectional study included 130 youth athletes, using questionnaires to collect data on demographics, training exposures (averaging 11±3.8 hours/week), overuse symptoms (using the Oslo Sports Trauma Research Center Overuse Injury Questionnaire), acute injury history, and overall wellbeing (assessed by the RAND 36-item Short Form Health Survey).

Results

Findings indicated that 55.4% of participants had suffered an acute injury in the past 6 months, leading to an average of 4 weeks of time loss. The mean score for OSTRC-O Scores was 16.8±6.4, with knee overuse averaging 21.3± 8.8. In terms of wellbeing, physical and mental health scores were 82.4±15.3 and 81.7±14.1 respectively. There were significant correlations between higher overuse scores and poorer physical functioning (r=-0.42), bodily pain (r=-0.38), vitality (r=-0.32), and mental health (r=-0.31). Acute injuries were linked with worse physical functioning and role limitations. Regression analysis showed that both overuse and acute injuries predicted poorer physical health.

Conclusion

The study underscores the significant prevalence of musculoskeletal injuries among youth athletes and delineates their profound impact on the quality of life, encompassing both the physical and mental health realms. These findings advocate for the critical integration of preventive measures and personalized training protocols, spotlighting the pivotal role of comprehensive biopsychosocial strategies in nurturing athletes' overall wellbeing. By prioritizing the quality of life as a key outcome, this research advocates for a more nuanced approach to injury management and recovery.

The Impact of Interaction between Body Posture and Movement Pattern Quality on Injuries in Amateur Athletes

Background: this study aimed to examine the impact of interaction between body posture and the quality of movement patterns on injury frequencies in amateur athletes. Methods: The study sample consisted of 89 young amateur athletes. Movement pattern quality was assessed by the Functional Movement Screen (FMS), test and body posture in the frontal plane was assessed by the moire method for the parameters Shoulder Slope Angle, Lower Scapula Protrusion Difference, and Pelvic Tilt Angle. Injury data were collected through completion of the Injury History Questionnaire for the past 12 months. Results: Using cluster analysis, participants were allocated into a either category with good (BPg) body posture or poor (BPp), and using FMS cutoff points (14), either a category of good movement pattern quality (MPg) or poor (MPp). Two-way ANOVA was performed, and the Bonferroni post-hoc test revealed a reduction in injuries among participants from the MPg-BPg group compared to the other three groups (p < 0.05). However, no interaction between factors was revealed. No statistically significant differences were observed among the remaining three groups in the case of injury prevalence (p > 0.05). Conclusions: A combination of proper body posture and high-quality movement patterns is associated with a lower frequency of injuries, without direct interaction between chosen factors, which suggests that they impact injury risk independently. Practicing suitable BP and ensuring high-quality MPs should be regarded as a strategy in injury prevention.

Is There an Association Between Injury History and Lower Extremity Joint Injury During Canada Games Competition?

Background

Injuries during elite level competition like the Canada Games, occur frequently and injury history is one of the strongest predictors of future injury; however, this association is unknown in the Canada Games.

Purpose

To determine the association between injury history and incidence of lower extremity joint injury during Canada Games competition.

Methods

Data from the 2009 - 2019 Canada Games (8710 male and 8391 female athletes) competitions were de-identified by the Canada Games Council for analysis. Injury data were cleaned and categorized for previous injury and injury type and location. Injury history was self-reported and included concussion, major surgical procedure, neck and back, trauma to joint or bone, and trauma to ligament or tendon. Injury from the Canada Games competitions were categorized to include ankle, knee, hip, and patellofemoral joint injuries. Chi-Square (χ2 ) test of independence determined association between injury history and incidence of lower extremity joint injury during Canada Games competition. IBM SPSS (Version 26) was used for statistical analysis (p-value < 0.05).

Results

Four hundred and seventy-five ankle, 503 knee, 253 hip, and 106 patellofemoral joint injuries were reported during 10 years of Canada Games competitions. There were significant associations between history of neck and back injuries with ankle injuries and knee injuries, history of trauma and overuse of ligament or tendon with hip injuries and history of trauma or overuse of joint or bone with patellofemoral joint injuries.

Conclusion

These findings support previous literature suggesting that injury history is associated with future injury.

Level of Evidence

3.

Perceptions of Physical Therapy and The Role of Physical Therapists In Injury Prevention Among Professional Basketball Players: A Qualitative Study

Background

Injury prevention is critical in competitive professional sports, however, the role of physical therapists in this aspect of healthcare is not fully understood.

Purpose

The purpose of this study was to describe professional basketball players' perceptions of physical therapy (PT) and physical therapists' role in injury prevention.

Study Design

Qualitative, semi-structured interview.

Methods

Thirty-five professional basketball players (mean age 23.1 years ± 3.9; 42% female; 72% African American; 90% college graduates) from over 20 teams participated. Athletes participated in semi-structured interviews that focused on injury prevention and utilization of PT services. Two researchers coded the transcripts, organized the findings into general categories, and created major themes. Data saturation was reached when no new information emerged.

Results

Over half (62.9%) stated that PT mainly addressed post-injury and return-to-sport rehabilitation. An overwhelming majority of players highlighted the use of an athletic trainer (AT) over physical therapists in injury prevention due to perceived expertise and trust.

Conclusion

While PTs are educated in preventive care and acute injury management, professional basketball players viewed their role primarily for return-to-sport rehabilitation. The organizational structure of healthcare in professional basketball may promote closer professional relationships with ATs while limiting those with physical therapists. The result is that elite athletes may miss out on treatment specific to the PT profession.

Level of Evidence

Level 4.

An exploratory study into the relationship between playing at home or away and concussion

PRIMARY OBJECTIVE

To investigate the effect of home and away game travel on risk of concussion across different levels of rugby union.

RESEARCH DESIGN

Exploration study across school, university, and professional rugby teams.

METHODS AND PROCEDURES

Retrospective analysis of concussion incidence and symptomology of surveillance data and prospective data collection for potential concussions via surveys. Data was collected from school rugby teams (n = 344 matches, over 2 years), a university rugby (n = 6 matches), and a professional rugby team (n = 64 matches, over two seasons).

MAIN OUTCOMES AND RESULTS

School level rugby had an increased prevalence of concussions in away matches (p = 0.02). Likewise, there was a significant increase (p < 0.05) in concussions at away matches in university rugby. In addition, the professional rug by team had significant differences in recovery times and symptoms with away fixtures, including longer recovery times (p < 0.01), more initial symptoms (p < 0.01), as well as greater and more severe symptoms at 48 hours (p < 0.05).

CONCLUSIONS

This research highlights an increased prevalence of concussion in school and university-aged rugby players away from home, as well as increased symptoms, symptom severity, and recovery times in professional rugby players.

Force, Power, and Morphology Asymmetries as Injury Risk Factors in Physically Active Men and Women

This study aimed to investigate whether asymmetry of force, power, and tissue morphology are lower limbs (LL) injury risk factors in physically active adults. Fifty-eight men aged 23.8 ± 1.2 years and forty-seven women aged 23.3 ± 1.0 years were examined. Physical activity level was measured by the International Physical Activity Questionnaire, and injury data were collected with the Injury History Questionnaire. The countermovement jump was performed to evaluate force and power. LL tissue composition was evaluated by a bioimpedance analyzer. The symmetry indices were calculated. A comparison between injured and non-injured subjects in both sexes was conducted to determine indices associated with injuries. The symmetry indices cut-off points were calculated to establish values indicating a significant injury risk increase, and logistic regression was performed. The relative peak force asymmetry above 4.049% was associated with increased injury risk in men. The LL skeletal muscle mass asymmetry above 3.584% was associated with a higher injury risk in women. Increased asymmetry in indicated indices by 1% was associated with 19.8% higher injury risk in men and 82.6% in women. Asymmetry proved to be an injury risk factor. However, a more suitable index for men is relative peak force asymmetry, whereas LL skeletal muscle mass asymmetry is more suitable for women.

Lower extremity injuries in the baseball athlete

Baseball is unique in its multiple facets: pitching, hitting, base rounding, and fielding are distinct activities that require different athletic skills to perform at a high level. Likewise, these different aspects of the game can contribute to a multitude of varying injuries. While high-velocity overhead throwing, along with batting, can produce a plethora of upper extremity injuries that often garner attention, injuries to the lower extremity can severely impact a player’s performance and ability to compete. The rigors of the short, explosive sprinting required for base running, as well as the dynamic movement required for fielding, create ample opportunity for lower limb injury, and even subtle pathology can affect a pitcher’s ability to perform or increase their long-term risk of injury. Chronic injury from conditions such as femoroacetabular impingement and hip labral tears can also occur. The purpose of the present review is to summarize the relevant epidemiology, pathophysiology, and treatment of lower extremity injuries in baseball athletes, with reference to current research into the prevention and management of such injuries.

A framework exploring the therapeutic alliance between elite athletes and physiotherapists: a qualitative study

Background

The therapeutic alliance (TA) is the bond between a patient and a physiotherapist during collaboration on recovery or training. Previous studies focused on the TA between physiotherapists and patients of the general population. Little information exists on whether this is similar in the demanding environment of elite athletes. The aim of this study was to investigate the components of TA between elite athletes and physiotherapists.

Methods

Ten elite athletes and ten physiotherapists were interviewed using one-on-one semi-structured interviews between June 2020 and October 2020. Athletes were included if they competed at national or international championships. Physiotherapists had to treat elite athletes on a regular basis. Interview questions were based on TA components of the general physiotherapy population. The interviews were transcribed and coded using inductive thematic analysis.

Results

The analysis resulted in an elite athlete TA framework which consists of nine themes and ten subthemes that could influence the TA. The nine themes are trust, communication, professional bond, social bond, elite athlete, physiotherapist, time, pressure and adversity, and external factors. This showed that the TA consists of bonds on different social levels, depends on the traits of both elite athletes and physiotherapists, and can be positively and negatively influenced by the external environment. The influences from the external environment seem to be more present in the elite athlete TA compared to the TA in the general physiotherapy setting. Multiple relations between themes were discovered. Trust is regarded as the main connecting theme.

Conclusion

This study provides a framework to better understand the complex reality of the TA between elite athletes and physiotherapists. Compared to the general physiotherapy setting, new themes emerged. The created framework can help elite athletes and physiotherapists to reflect and improve their TA and subsequently improve treatment outcomes.

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.

Body Composition, Training Volume/Pattern and Injury Status of Slovenian Adolescent Female High-Performance Gymnasts

Body composition (BC), training volume/pattern, and injury status are a few important factors affecting training quality and sport performance in female artistic gymnastics. We aimed to examine BC status, training volume/pattern, and injury status during the first competition period. Our cross-sectional study included 17 female gymnasts (age: 17.4 ± 4.1 years, body height: 159.8 ± 6.2 cm, and body weight: 54.8 ± 5.3 kg) who were high performance at the international and national level. The BC (measured by dual-energy X-ray absorptiometry) parameters included body height and mass, body fat percentage (BF %), lean body mass (LBM), body mass index (BMI), total bone mineral density (BMD total), and total bone mineral content (BMC total). Training volume and pattern were assessed via an author-developed questionnaire, while injury status (i.e., anatomical location, symmetry and rate of injuries) was assessed via a modified questionnaire on overuse injuries used in sports injury epidemiology studies with elite-level athletes. Body composition parameters were as follows: the BMI was 21.5 ± 1.4 kg/m², BF % was 21.9 ± 4.7%, LBM was 41.2 ± 3.4 kg, BMD total was 1.22 ± 0.08 g/cm², and BMC total was 2486 ± 344 g. Furthermore, the average weekly volume of training was 23.5 ± 1.4 h, with the highest training volume occurring on Monday and Tuesday and high variability within gymnasts. Our study also revealed that the most frequently injured joints that had the most negative impact on training volume, sport performance and pain status were the ankles and low back, followed by the knees and shoulders. This kind of yearly screening method is warranted to allow more definitive conclusions to be made on adjusted training and preventive strategies.

Pain, Culture and Pedagogy: A Preliminary Investigation of Attitudes Towards "Reasonable" Pain Tolerance in the Grassroots Reproduction of a Culture of Risk

In recent years a considerable body of psychological research has explored the relationship between membership of socio-cultural groups and personal pain perception. Rather less systematic attention has, however, been accorded to how such group membership(s) might influence individual attitudes towards the pain of others. In this paper, immersion in the culture of competitive sport, widely regarded as being exaggeratedly tolerant of risky behaviours around pain, is taken as a case-in-point with students of Physical Education (PE) in tertiary education as the key focus. PE students are highly-immersed in competitive sporting culture both academically and (typically) practically, and also represent a key nexus of cross-generational transmission regarding the norms of sport itself. Their attitudes towards the pain that others should reasonably tolerate during a range of activities, sporting and otherwise, were evaluated through a direct comparison with those of peers much less immersed in competitive sporting culture. In total, N=301 (144 PE, 157 non-PE) undergraduate students in the UK responded to a vignette-based survey. Therein, all participants were required to rate the pain (on a standard 0-10 scale) at which a standardised "other" should desist engagement with a set of five defined sporting and non-sporting tasks, each with weak and strong task severities. Results indicated that PE students were significantly more likely to expect others to persevere through higher levels of pain than their non-PE peers, but only during the sport-related tasks - an effect further magnified when task severity was high. In other tasks, there was no significant difference between groups, or valence of the effect was actually reversed. It is argued that the findings underscore some extant knowledge about the relationship between acculturated attitudes to pain, while also having practical implications for understanding sport-based pedagogy, and its potentially problematic role in the ongoing reproduction of a "culture of risk."

The correlation between stroke characteristics and stroke effect of young table tennis players

BACKGROUND

An optimal stroke is essential for winning table tennis competition. The main purpose of this study was to examine the correlations between the stroke characteristics and the stroke effect.

METHODS

Forty-two young table tennis players were randomly selected from China Table Tennis College (M<inf>age=</inf>14.21; M<inf>height=</inf>1.57m; M<inf>weight=</inf>46.05 kg, right-hand racket, shake-hands grip, no injuries in each joint of the body). The high-speed infrared motion capture system was used to collect the data of stroke characteristics, and the high-speed camera was used to measure the spin speed of the stroke. The influence of stroke characteristics on stroke effect was analyzed.

RESULTS

The time duration of backswing and forward motion were significantly correlated with ball speed (r=-0.403, P<0.01; r=-0.390, P<0.01, respectively) and spin speed (r=-0.244, P=0.027; r=-0.369, P<0.01, respectively). The ball speed was positively correlated with the linear velocity of right wrist joint (r=0.298, P<0.01), and the angular velocity of right elbow joint (r=0.219, P=0.013), right hip joint (r=0.427, P<0.01) and right ankle joint (r=0.443, P<0.01). The spin speed was positively correlated with the linear velocity of right wrist joint (r=0.238, P=0.031), and the angular velocity of right elbow joint (r=0.172, P=0.048) and right hip joint (r=0.277, P=0.012). The placement had a negative correlation with the angular velocity of right knee joint (r=-0.246, P=0.026).

CONCLUSIONS

The time allocation of the three phases of backspin forehand stroke had an important correlation with stroke effect, especially the ball speed and spin speed. The movement of the right wrist joint and right ankle joint were mainly correlated with the ball speed of the stroke. The spin speed of the stroke was mainly correlated with the movement of the right wrist joint. The placement of the stroke was mainly correlated with the rotation of the right knee joint.

Back injuries in Major League Baseball

BACKGROUND

There is a scarcity of epidemiological studies on back injuries in Major League Baseball (MLB). In our study, we explore all back related injuries in the MLB from 2010 to 2016 (inclusive) in an aim to help better understand these injuries, assess their risks, and improve their prevention policies.

METHODS

The transaction lists from the MLB website were screened for back injuries from 2010 THROUGH 2016. Only players who were placed on the disabled list (DL) for one or more days due to back-related injury were included in our study. Our database included the player's position, team, injury location, injury type, days spent on the DL and month of injury occurrence.

RESULTS

254 back injuries, an equivalent of 7% of all injuries, were recorded between 2010 and 2016 (inclusive). These injuries increased from 2010 to 2016. Back related injuries were found to place players on the disabled list for around 54 days. Injuries were recorded mostly during April, and strain was significantly greater than any other type of injury (P value <0.001).

CONCLUSIONS

Back injuries are prevalent in the MLB. Better understanding of the trends and patterns of these injuries will help in establishing better prevention policies.

Machine Learning to Predict Lower Extremity Musculoskeletal Injury Risk in Student Athletes

Injury rates in student athletes are high and often unpredictable. Injury risk factors are not agreed upon and often not validated. Here, we present a random-forest machine learning methodology for identifying the most significant injury risk factors and develop a model of lower extremity musculoskeletal injury risk in student athletes with physical performance metrics spanning joint strength measured with force transducers, postural stability measured using a force plate, and flexibility, measured with a goniometer, combined with previous injury metrics and athlete demographics. We tested our model in a population of 122 student athletes with performance metrics for the lower extremity musculoskeletal system and achieved an injury risk accuracy of 79% and identified significant injury risk factors, that could be used to increase accuracy of injury risk assessments, implement timely interventions, and decrease the number of career-ending or chronic injuries among student athletes.

Wearable Sensors Detect Differences between the Sexes in Lower Limb Electromyographic Activity and Pelvis 3D Kinematics during Running

Each year, 50% of runners suffer from injuries. Consequently, more studies are being published about running biomechanics; these studies identify factors that can help prevent injuries. Scientific evidence suggests that recreational runners should use personalized biomechanical training plans, not only to improve their performance, but also to prevent injuries caused by the inability of amateur athletes to tolerate increased loads, and/or because of poor form. This study provides an overview of the different normative patterns of lower limb muscle activation and articular ranges of the pelvis during running, at self-selected speeds, in men and women.

METHODS

38 healthy runners aged 18 to 49 years were included in this work. We examined eight muscles by applying two wearable superficial electromyography sensors and an inertial sensor for three-dimensional (3D) pelvis kinematics.

RESULTS

the largest differences were obtained for gluteus maximus activation in the first double float phase (p = 0.013) and second stance phase (p = 0.003), as well as in the gluteus medius in the second stance phase (p = 0.028). In both cases, the activation distribution was more homogeneous in men and presented significantly lower values than those obtained for women. In addition, there was a significantly higher percentage of total vastus medialis activation in women throughout the running cycle with the median (25th-75th percentile) for women being 12.50% (9.25-14) and 10% (9-12) for men. Women also had a greater range of pelvis rotation during running at self-selected speeds (p = 0.011).

CONCLUSIONS

understanding the differences between men and women, in terms of muscle activation and pelvic kinematic values, could be especially useful to allow health professionals detect athletes who may be at risk of injury.

Habitual and ready positions in female table tennis players and their relation to the prevalence of back pain

Background

The current body of knowledge shows that there is very little research into the occurrence and scale of asymmetry or postural defects in table tennis. It is interesting which regions of the spine are exposed to the greatest changes in the shape of its curvatures and whether the asymmetrical position of the shoulder and pelvic girdles in table tennis players changes when adopting the ready position. Consequently, can overload occur in certain parts of the spine and can the asymmetry deepen as a response of adopting this position? The reply to these questions may be an indication of the need for appropriate compensatory or corrective measures. Therefore, the aim of the study was to evaluate the effect of body position during play on the change in the shape of anterior–posterior spinal curvatures and trunk asymmetry in table tennis players.

Methods

To evaluate body posture the photogrammetric method based on the Moiré phenomenon with equipment by CQ electronic was applied. The study involved 22 female players practicing competitive table tennis (the age of 17 ± 4.5, with the average training experience of 7 ± 4.3 years, body mass of 47.8 ± 15.8, and body height of 161.2 ± 10.4). Each participant completed an author’s own questionnaire on spinal pain. The shape of curvatures in the sagittal and frontal plane was evaluated in the participant in the habitual standing position and in the table tennis ready position. Descriptive statistical analysis was performed and the significance of differences was tested using the Mann–Whitney U test.

Results and Conclusions

This study demonstrated the dominance of kyphotic body posture in table tennis players, which can be caused by many hours of using the ready position during playing. After adopting this position, there are significant differences in the angles of anterior and posterior spinal curvatures compared to the habitual posture. This may be the cause of overloads and pain complaints reported by the study participants. Adopting the ready position is also associated with an increase in asymmetry in the position (rotation) of the pelvis and spinous processes (frontal plane). Therefore, training programs should be extended with exercises that relieve the spine in the vertical line and exercises that improve symmetry of the work of the upper limbs, body trunk muscles and the pelvis.

The effect of match fatigue in elite badminton players using plantar pressure measurements and the implications to injury mechanisms

The purpose of this study was to investigate the differences in plantar pressure under the lead and trail foot between two lunge tasks to the net in the dominant (LD) and non-dominant (LND) directions, and to explore how fatigue affects the plantar pressure patterns whilst performing movements before and after a competitive match. Peak and mean pressure were measured with the Biofoot-IBV in-shoe system from five repetitions of each task, with sensors positioned under the calcaneus, midfoot and phalanges on the lead and trail foot. Data were collected pre and immediately post-playing an official first national league competition match. The study was conducted with a sample of thirteen first league badminton players. A 2 × 2 repeated ANOVA found significant differences between the two tasks and between pre- and post-match (fatigued state). Players also had different foot pressure distributions for the LD and LND tasks, which indicated a difference in loading strategy. In a fatigued state, the plantar pressure shifted to the medial aspect of the midfoot in the trail limb, indicating a reduction in control and a higher injury risk during non-dominant lunge tasks.

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.

Prevalence of dentofacial injuries among combat sports practitioners: A systematic review and meta-analysis

BACKGROUND/AIM

Combat sports might result in injuries to the face and teeth. However, it is unclear how often they occur and which sports presents the highest rates. The aim of this study was to investigate the prevalence of dentofacial injuries in combat sports participants.

MATERIAL AND METHODS

A systematic review was performed. Six main electronic databases and three grey literature databases were searched. Studies were blindly selected by two reviewers based on pre-defined eligibility criteria. Studies that evaluated the prevalence of dentofacial injuries (teeth, alveolar bone, jaw, lips, and/or cheekbones) among combat sports participants were considered eligible. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. The software r statistics version was used to perform all meta-analyses. Cumulative evidence of the included articles was evaluated using GRADE criteria (Grading of Recommendations Assessment, Development and Evaluation).

RESULTS

From 1104 articles found on all databases, 27 were finally included. Eighteen studies were judged at low, seven at moderate, and two at high risk of bias. The following sports were investigated: boxing, capoeira, fencing, jiu-jitsu, judo, karate, kendo, kickboxing, kung fu, muay thai, sumo, taekwondo, wrestling, and wushu. Results from the meta-analysis suggested a dental pooled prevalence of 25.2% (12.3%-40.8%, i²  = 100%) and dentofacial pooled prevalence of 30.3 (18.1%-44.1%, i²  = 100%). Considering the sports' categories individually, jiu-jitsu had the highest pooled prevalence of dentofacial injuries (52.9% [37.9%-67.8%, i²  = 92%]), while judo was the sport with the lowest pooled prevalence (25.0% [7.6%-48.2%, i²  = 98%]). Among Panamerican sports, boxing had the highest prevalence of dental injuries (73.7% [58.7%-86.3%, i²  = 0%]). For dentofacial injuries, the GRADE criteria were considered low.

CONCLUSIONS

Overall pooled prevalence of dentofacial injuries in combat sports was approximately 30%. Raising awareness regarding the frequency of these injuries might encourage the use of protective devices and reduce complications related to these incidents.

Subject-specific and group-based running pattern classification using a single wearable sensor

The objective of this study was to determine whether subject-specific or group-based models provided better classification accuracy to identify changes in biomechanical running gait patterns across different inclination conditions. The classification process was based on measurements from a single wearable sensor using a total of 41,780 strides from eleven recreational runners while running in real-world and uncontrolled environment. Biomechanical variables included pelvic drop, ground contact time, braking, vertical oscillation of pelvis, pelvic rotation, and cadence were recorded during running on three inclination grades: downhill, -2° to -7°; level, -0.2° to +0.2°; and uphill, +2° to +7°. An ensemble and non-linear machine learning algorithm, random forest (RF), was used to classify inclination condition and determine the importance of each of the biomechanical variables. Classification accuracy was determined for subject-specific and group-based RF models. The mean classification accuracy of all subject-specific RF models was 86.29%, while group-based classification accuracy was 76.17%. Braking was identified as the most important variable for all the runners using the group-based model and for most of the runners based on a subject-specific models. In addition, individual runners used different strategies across different inclination conditions and the ranked order of variable importance was unique for each runner. These results demonstrate that subject-specific models can better characterize changes in gait biomechanical patterns compared to a more traditional group-based approach.

Proposing a Patellar Tendinopathy Screening tool following a systematic review

BACKGROUND

Patellar tendinopathy (PT) is an overuse injury of the knee. The mechanism of injury is associated with repetitive stress on the patellar tendon of the knee as a result of explosive movement. Patellar tendinopathy is prevalent in all populations and is associated with intrinsic and extrinsic risk factors.

OBJECTIVES

Primarily, the objective was to report on the intrinsic and extrinsic risk factors for PT, entailing a systematic review of the literature; the secondary objective was to use these risk factors to compile a proposed PT screening tool from the review and standard outcome measures.

METHOD

A systematic review was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Elimination criteria of the articles included duplicates, titles, abstracts and methodological quality. The evidence was collected, characterised with regard to the intrinsic and extrinsic risk factors and summarised descriptively.

RESULTS

The search yielded 157 feasible articles prior to commencement of article elimination. Six articles were included with a mean methodological quality score of 69%. Eight intrinsic and five extrinsic risk factors were identified. These identified risk factors are all relevant to the pathology and formed the basis for a proposed PT screening tool. The Victorian Institute of Sports Assessment for Patellar Tendinopathy Questionnaire, Visual Analog Scale and the Pain Provocation Test are also included in the proposed test.

CONCLUSION

Intrinsic and extrinsic risk factors for PT were identified, and consequently, the proposed PT screening tool was formulated for possible future testing in appropriate studies.

CLINICAL IMPLICATIONS

Prevention of PT through intrinsic and extrinsic risk factor identification, and implementation in the clinical setup as a possible outcome measurement tool with which to verify functional improvement in PT rehabilitation.

Using wearable sensors to classify subject-specific running biomechanical gait patterns based on changes in environmental weather conditions

Running-related overuse injuries can result from a combination of various intrinsic (e.g., gait biomechanics) and extrinsic (e.g., running surface) risk factors. However, it is unknown how changes in environmental weather conditions affect running gait biomechanical patterns since these data cannot be collected in a laboratory setting. Therefore, the purpose of this study was to develop a classification model based on subject-specific changes in biomechanical running patterns across two different environmental weather conditions using data obtained from wearable sensors in real-world environments. Running gait data were recorded during winter and spring sessions, with recorded average air temperatures of -10° C and +6° C, respectively. Classification was performed based on measurements of pelvic drop, ground contact time, braking, vertical oscillation of pelvis, pelvic rotation, and cadence obtained from 66,370 strides (~11,000/runner) from a group of recreational runners. A non-linear and ensemble machine learning algorithm, random forest (RF), was used to classify and compute a heuristic for determining the importance of each variable in the prediction model. To validate the developed subject-specific model, two cross-validation methods (one-against-another and partitioning datasets) were used to obtain experimental mean classification accuracies of 87.18% and 95.42%, respectively, indicating an excellent discriminatory ability of the RF-based model. Additionally, the ranked order of variable importance differed across the individual runners. The results from the RF-based machine-learning algorithm demonstrates that processing gait biomechanical signals from a single wearable sensor can successfully detect changes to an individual's running patterns based on data obtained in real-world environments.

RUNNING INJURY DEVELOPMENT: THE ATTITUDES OF MIDDLE- AND LONG-DISTANCE RUNNERS AND THEIR COACHES

BACKGROUND

Behavioral science methods have rarely been used in running injury research. Therefore, the attitudes amongst runners and their coaches regarding factors leading to running injuries warrants formal investigation.

PURPOSE

To investigate the attitudes of middle- and long-distance runners able to compete in national championships and their coaches about factors associated with running injury development.

METHODS

A link to an online survey was distributed to middle- and long-distance runners and their coaches across 25 Danish Athletics Clubs. The main research question was: "Which factors do you believe influence the risk of running injuries?". In response to this question, the athletes and coaches had to click "Yes" or "No" to 19 predefined factors. In addition, they had the possibility to submit a free-text response.

RESULTS

A total of 68 athletes and 19 coaches were included in the study. A majority of the athletes (76% [95%CI: 66%; 86%]) and coaches (79% [95%CI: 61%; 97%]) reported "Ignoring pain" as a risk factor for running injury. A majority of the coaches reported "Reduced muscle strength" (79% [95%CI: 61%; 97%]) and "high running distance" (74% [95%CI: 54%; 94%]) to be associated with injury, while half of the runners found "insufficient recovery between running sessions" (53% [95%CI: 47%; 71%]) important.

CONCLUSION

Runners and their coaches emphasize ignoring pain as a factor associated with injury development. The question remains how much running, if any at all, runners having slight symptoms or mild pain, are able to tolerate before these symptoms develop into a running-related injury.

LEVEL OF EVIDENCE

3b.

Understanding clusters of risk factors across different environmental and social contexts for the prediction of injuries among Canadian youth

BACKGROUND

Among Canadian youth, injury is the most common reason for presentation to the emergency department. Youth who commonly engage in multiple risk-taking behaviours are at greater risk for injury, but is it unknown if this phenomenon is more pronounced in different contexts. We aimed to study relationships between risk-taking behaviours and injury, and variations in such relationships between different environmental and social contexts, among youth in Canada.

METHODS

Risk-taking behaviour and injury outcome data were collected from grade 9 to 10 students using the 2009-2010 (Cycle 6) of the Health Behaviour in School-Aged Children Survey (n=10,429). Principal components analysis was used to identify clusters of risk-taking behaviours. Within each identified cluster, the degree of risk-taking was categorized into quartiles from lowest to highest engagement in the behaviours. Risk ratios with 95% confidence intervals were calculated to determine the association between the risk of any injury and the degree of risk-taking behaviour specific to the cluster. Clusters were then examined across home, school, neighbourhood and sport contexts.

RESULTS

Four clusters of risk-taking behaviour were identified which were labelled as "gateway substance use", "hard drugs and weapons", "overt risk-taking", and "physical activity". Each cluster was related to injury occurrence in a graded fashion. Clusters of risk behaviour were most strongly associated with injuries sustained in neighbourhood settings, and expectedly, increasing physical activity behaviours were associated with increased risk of sport injuries and injuries occurring at school.

CONCLUSIONS

This study furthers understanding of clustered risk-taking phenomena that put youth at increasing levels of injury risk. Higher risks for injury and associated gradients were observed in less structured contexts such as neighbourhoods. In contrast, clustered physical activity behaviours were most related to school injury or sport injury and were more likely to be sustained in a supervised context. Understanding the clustered and cumulative nature of risk-behaviours, and how these vary by environmental and social context, helps to explain potential mechanisms of injury as well as modifiable factors that may be important avenues for intervention.

PREVALENCE OF MUSCULOSKELETAL PAIN IN MARATHON RUNNERS WHO COMPETE AT THE ELITE LEVEL

BACKGROUND

Musculoskeletal pain can be an important sign of overuse injury in elite athletes. However, its prevalence and whether it is associated with aspects of training in marathon runners who compete at the elite level is still not clear.

PURPOSE

The purpose of this research was to assess the prevalence, location and intensity of running-related musculoskeletal pain over the previous 12 months in marathon runners who compete at the elite level and to verify whether certain training characteristics are associated with musculoskeletal pain.

DESIGN

Cross sectional study.

METHODS

One hundred and ninety-nine elite marathon runners were verbally interviewed regarding their personal demographics, training routines, and the presence, location and intensity of musculoskeletal pain.

RESULTS

The prevalence of any running-related musculoskeletal pain in elite distance runners was 75%, and the most frequently reported location was the lower leg (19.1%). The presence of pain was independent of age, experience, and volume of training.

CONCLUSIONS

Running-related musculoskeletal pain is highly prevalent in marathon runners who compete at the elite level.

CLINICAL RELEVANCE

Studies about prevalence and location of musculoskeletal pain and factors-related in this population are important to contribute to the development of educational and preventive strategies.

EVIDENCE LEVEL

2.

Analysis of combat sports players' injuries according to playing style for sports physiotherapy research

[Purpose] This study describes the characteristics of injuries in strike and non-strike combat sports, and the results are intended for use in the area of sports physiotherapy research. [Subjects and Methods] The study was conducted on 159 athletes involved in a variety of combat sports. The participants included elite college players of the following sports: judo (47), ssireum (19), wrestling (13), kendo (30), boxing (16), and taekwondo (34). Of the participants, 133 were male and 26 were female. In the case of ssireum and boxing, all of the athletes were male. [Results] In the case of the combat sports, the types of injury and injured regions differed according to playing style. Dislocation and injuries to the neck, shoulders, and elbows were more frequent in the non-strike sports, while injuries to the wrists and hands were more frequent in the strike sports. There was a high incidence of sprains, strains, bruises, and injuries to the lower limbs in both groups. [Conclusion] We suggest that the characteristics of injuries in combat sports differ according to playing style, and our study will therefore provide physical therapists and researchers with information that can be used to prevent injury.