Ankle Injury Prevention Programs for Soccer Athletes Are Protective: A Level-I Meta-Analysis

Ankle Injury Prevention Programs for Youth Sports: A Systematic Review and Meta-analysis

CONTEXT

Previous research has demonstrated that using a multicomponent approach to ankle injury preventions can significantly reduce ankle injuries; however, these studies lack specific intervention recommendations.

OBJECTIVE

To evaluate the exercise components of prevention programs on ankle injuries specifically in high school athletes. Secondary objectives were to assess the overall effectiveness of prevention programs on ankle injuries in this population and how compliance and education may impact success.

DATA SOURCES

A total of 5 databases were searched through September 26, 2022.

STUDY SELECTION

Study inclusion criteria included randomized control trials (RCTs) investigating exercise interventions in high school athletes aged 13 to 19 years, participation in sports competition, reporting of injury incidence, and specific exercise interventions used.

STUDY DESIGN

Systematic review and meta-analysis.

LEVEL OF EVIDENCE

Level 1.

DATA EXTRACTION

Pooled overall ankle injury incidence rate ratio and 95% CIs were calculated using random-effects meta-analysis.

RESULTS

A total of 10 studies were included, of which 9 used multicomponent exercise interventions and 1 used only balance training. Of the 10 studies, 3 demonstrated statistically significant reduction in ankle injuries. When data from all 10 studies were pooled and analyzed, there was a statistically significant overall reduction (incidence rate ratio, 0.74; 95% CI 0.60-0.91) in ankle injuries when comparing intervention groups with controls.

CONCLUSION

The most effective injury prevention programs included multiple components, emphasized strengthening and agility exercises, and promoted high adherence to the intervention. The importance of coach and player education on how and why to perform an injury prevention program as well as the frequency and duration of programs was also important. Exercise-based injury prevention programs may reduce ankle injury incidence in youth athletes by 26% when pooling data from a multitude of sport types/settings.

Lower Limb Anthropometric Profiling in Professional Female Soccer Players: A Proof of Concept for Asymmetry Assessment Using Video Analysis

The objective was to evaluate the clinical joint and limb measures in professional female soccer players. The study was a cross-sectional observational design. It was a preseason clinical setting. The inclusion criteria were outfield professional female soccer players, based in the UK, competing in the highest English league. The exclusion criteria included players who had had surgery in the last six months or had missed a single training session or match due to injury in the previous three months. In terms of the outcome measures, the dependent variables were the true limb length, ankle dorsiflexion, knee flexion and extension, hip flexion, extension, internal rotation and external rotation, and straight leg raise measured using video analysis software. Additionally, passive clinical knee and ankle stability tests were conducted. The independent variables were leg dominance and playing position (defender, midfielder, and attacker). For the results, all the ROM measurements demonstrated limb symmetry (p = 0.621). However, there were significant main effects of the playing position on the ankle dorsiflexion and hip internal rotation, with defenders demonstrating a significantly reduced range of motion in comparison to midfielders and attackers. A notable finding from the bilateral passive stability measures was that 38.3% of players exhibited ankle talar inversion instability when using a talar tilt. In conclusion, bilateral differences do not appear to be apparent in this population; however, positional differences may occur in the ankle and hip range of motion measures. A high proportion of this population may present with passive ankle inversion instability. Future research should consider whether this leads to a higher risk of injury in this population.

Risk factors of lower extremity injuries in youth athletes

Objective

Lower extremity sports injuries frequently occur during an individual's growth period. The object of the current study was to analyse the risk factors for lower extremity sports injuries for youth athletes. The secondary objective was to clarify the factors related to new injuries after a lower extremity injury.

Methods

We extracted information on youth athletes (aged 10-15 years) with sports-related disorders. Background data and injury situations were collected via a specific application. During the follow-up period, new injuries were also recorded. The athletes were divided into two groups according to injury location (lower extremity or other). We performed a multiple logistic regression analysis to clarify the association between injury location and background data.

Results

1575 complaints of lower extremity disorders and 328 complaints in other body parts were registered. According to the multiple regression analysis, practice time per week was significantly shorter for the lower extremity group than the other locations group (OR 0.98; 95% CI 0.963 to 0.999). Athletes whose future goal was at the recreational level had a significantly low incidence of new injuries after experiencing lower extremity disorders.

Conclusion

The practice environments and psychological factors should receive more attention to prevent lower extremity injuries.

Effects of Different Hamstring Eccentric Exercise Programs on Preventing Lower Extremity Injuries: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis aims to investigate the effects and differences of various hamstring eccentric training protocols for the prevention of lower limb injuries, and we further propose a more refined hamstring eccentric training protocol for the prevention of lower limb injuries. A literature search for the effects of hamstring eccentric training on lower extremity sports injuries was conducted using the PubMed, Web of Science, and EMBASE databases, and the literature was searched covering the period from the date of the database's creation to 20 August 2022. A meta-analysis of the included literature was performed using R.4.21 for lower extremity injuries, injuries in various parts of the lower extremity, and subgroup analysis for exercise frequency, exercise cycle, and exercise population. A total of 23 randomized controlled trial (RCT) studies were found to be included in the meta-analysis, and 15 of these trials, totaling 14,721 patients, were determined to be included in the overall lower extremity injury prevention effect. The analysis showed that the implementation of a hamstring eccentric training program reduced lower extremity injuries by 28%, and it resulted in a 46% decrease in hamstring injury rate and a 34% decrease in knee injury rate. The subgroup analysis revealed that the frequency of exercise was most significant in the twice-a-week exercise group, that the exercise program was most effective in preventing injuries in the 21-30-week exercise period, and that the program was most effective in preventing injuries in elite athletes and amateur adult athletic populations, compared with adolescents.

Most amateur football teams do not implement essential components of neuromuscular training to prevent anterior cruciate ligament injuries and lateral ankle sprains

PURPOSE

Neuromuscular training (NMT) is effective at reducing football injuries. The purpose of this study was to document the use of NMT to prevent anterior cruciate ligament injuries and lateral ankle sprains in adult amateur football and to identify barriers for using NMT.

METHODS

A preseason and in-season online survey was completed by players and coaches of 164 football teams. The survey contained questions concerning injury history, type and frequency of NMT, and barriers when NMT was not used.

RESULTS

A total of 2013 players (40% female) and 180 coaches (10% female) completed the preseason survey, whereas 1253 players and 140 coaches completed the in-season survey. Thirty-four percent (preseason) to 21% (in-season) of players used NMT, but only 8% (preseason) to 5% (in-season) performed adequate NMT (i.e. both balance and plyometric exercises, at least twice per week). In the subpopulation of players with an injury history, 12% (preseason) and 7% (in-season) performed adequate NMT. With respect to the coaches, only 5% (preseason) and 2% (in-season) implemented adequate NMT. Most important barriers for using NMT for both players and coaches were a lack of belief in its effectiveness, a lack of knowledge, the belief that stretching is sufficient, and not feeling the need for it.

CONCLUSION

Most amateur football teams do not implement essential components of NMT. The results highlight the urgent need for developing strategies to enhance the adequate use of NMT in amateur football.

LEVEL OF EVIDENCE

II.

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.

Lateral Ankle Sprain and Subsequent Ankle Sprain Risk: A Systematic Review

OBJECTIVE

To evaluate the evidence regarding the association between lateral ankle sprain (LAS) history and the subsequent LAS risk, as well as sex differences in the observed associations.

DATA SOURCES

PubMed, CINAHL, and SPORTDiscus were searched through July 2020 for articles on LAS history and incidence during the study period.

STUDY SELECTION

Studies were included if they were prospective in nature and the authors reported the number of participants with and those without a history of LAS at study initiation as well as the number of participants in each group who sustained an LAS during the investigation.

DATA EXTRACTION

Data were study design parameters as well as the number of participants with and those without an LAS history and the number of subsequent LASs that occurred in both groups. Risk ratios (RRs) with 95% CIs compared the risk of LAS during the study period between those with and those without an LAS history for each investigation.

DATA SYNTHESIS

A total of 19 studies involving 6567 patients were included. The follow-up periods ranged from 14 weeks to 2 years. Assessment scores indicated the studies were of moderate to high quality. A significantly higher risk of LAS during the study period was observed among those with a history of LAS in 10 of 15 studies (RR range = 1.29-6.06). Similar associations were seen in 4 of 6 studies of all-male samples (RR range = 1.38-8.65) and 1 of 4 studies with an all-female sample (RR = 4.28).

CONCLUSIONS

Strong evidence indicates that a previous LAS increased the risk of a subsequent LAS injury. Men with a history of LAS appeared to be at a higher risk of sustaining a subsequent LAS, but women were not. However, further data are needed to draw definitive conclusions from the limited number of sex-specific studies.

Musculoskeletal practices for the preparticipation physical examination

Background

Little is known about the musculoskeletal (MSK) exam providers use during the Preparticipation Physical Examination (PPE). The primary aims of this study were to determine current practice with regards to the MSK screening exam, if goals are being met, and if there may be opportunities for improvement.

Methods

This cross-sectional survey-based study utilized a REDCap instrument that was distributed to members of the American Academy of Family Physicians (AAFP) and the American Medical Society for Sports Medicine (AMSSM). Questions focused on participant demographics and MSK exam practices for the PPE. Descriptive statistics were used.

Results

The study had a total of 616 participants with a response rate of 9 %. The majority of respondents (82 %) were familiar with the 4th Edition PPE Monograph and 80 % either moderately or strongly agreed that they use this as a guideline for their MSK screening exam. The 90 s MSK screening test was implemented by 52 % of the participants. The majority of participants use an orthopedic exam as part of their PPE (82 %). Ninety-two percent of participants felt satisfied that their MSK exam would screen for current injury, while only 42 % were satisfied that it effectively screened for future injury. 86 % of participants agree that the MSK exam should be performed, while 26 % said that they don’t perform a physical exam at all.

Discussion

There is a lack of understanding of the PPE Monograph as there is wide variability in MSK screening techniques providers use despite the majority of participants being familiar with the guidelines described in the monograph. Additionally, providers don’t believe that the MSK exam screens for future injury.

Conclusions

The goals of the MSK portion of the 4th Edition PPE monograph are not adequately being met and there is a need for further research to validate screening exams for the prevention of MSK injury.

Relationship between Posture and Non-Contact Lower Limb Injury in Young Male Amateur Football Players: A Prospective Cohort Study

Posture, a potentially modifiable injury risk factor, is considered important in injury screening/prevention in athletes, yet few studies investigate relationships between posture and injury. This prospective cohort study investigated whether static posture is associated with lower limb injury risk in male football players (n = 263). Nine aspects of static standing posture (left and right rearfoot, knee interspace, lateral knee, lumbar lordosis, thoracic kyphosis, scoliosis S and C, forward head) were assessed from photographs during the pre-season using the modified Watson and Mac Donncha scale, which was dichotomised for analysis (deviated or normal). Player characteristics (age, height, mass, body mass index, competition level), match/training exposure, and previous and in-season non-contact lower limb injuries were recorded. Binary logistic regression investigated relationships between posture and injury (previous and in-season). Eighty previous and 24 in-season lower limb injuries were recorded. Previous injury was not associated with any postural variable. In-season injury was associated with previous injury (OR = 3.04, 95% CI 1.20-7.68, p = 0.02) and having a normal thoracic curve compared to kyphosis (OR = 0.38, 95% CI 0.15-1.00, p = 0.05) but no other postural variables. Static postural deviations observed in male football players in the pre-season are not typically associated with non-contact lower limb injury risk; thus, they are unlikely to add value to pre-season screening programs.

Reducing Injuries in Soccer (Football): an Umbrella Review of Best Evidence Across the Epidemiological Framework for Prevention

Soccer is the most popular sport in the world. Expectedly, the incidence of soccer-related injuries is high and these injuries exert a significant burden on individuals and families, including health and financial burdens, and on the socioeconomic and healthcare systems. Using established injury prevention frameworks, we present a concise synthesis of the most recent scientific evidence regarding injury rates, characteristics, mechanisms, risk and protective factors, interventions for prevention, and implementation of interventions in soccer. In this umbrella review, we elucidate the most recent available evidence gleaned primarily from systematic reviews and meta-analyses. Further, we express the exigent need to move current soccer injury prevention research evidence into action for improved player outcomes and widespread impact through increased attention to dissemination and implementation research. Additionally, we highlight the importance of an enabling context and effective implementation strategies for the successful integration of evidence-based injury prevention programs into real-world soccer settings. This narrative umbrella review provides guidance to inform future research, practice, and policy towards reducing injuries among soccer players.

Ankle Sprain Versus Muscle Strain Injury in Professional Men's Basketball: A 9-Year Prospective Follow-up Study

Background:

Ankle sprain is the most common injury in basketball players. However, in our routine clinical evaluation, we observe a high frequency of muscle injury. Currently, no reliable information is available regarding the magnitude of these types of injury.

Purpose:

To describe the type and rate of muscle injuries in male basketball players and discuss clinical management and prevention strategies.

Study Design:

Descriptive epidemiology study.

Methods:

A total of 59 professional male basketball players were evaluated over 9 seasons (2007-2015). All injuries during the study period were registered through use of a validated electronic medical record system.

Results:

We analyzed 463 injuries, of which 207 resulted in time loss and 256 required medical attention, for a total exposure time of 42,678 hours for the 59 players involved in the study. Muscle strains and ankle sprains accounted for 21.2% (n = 98) and 11.9% (n = 55) of all injuries, respectively. The global incidence rate was 10.8 injuries per 1000 player-hours (95% CI, 9.9-11.9). The global injury burden was 53.9 days lost due to injuries per 1000 hours for a total exposure time. The incidence rate of muscle strains (2.3; 95% CI, 1.9-2.8) was higher than that of ankle sprains (1.3; 95% CI, 1-1.7). The incidence rate for muscle injuries for the entire study period was 1.8 times higher (95% CI, 1.28-2.49) than that for ankle sprains.

Conclusion:

In this study, muscle injuries were more commonly observed compared with ankle sprains. Prevention strategies for muscle injuries may be worth discussing.

Effectiveness of multicomponent lower extremity injury prevention programmes in team-sport athletes: an umbrella review

OBJECTIVE

To identify which exercise combinations are most effective as part of a lower extremity injury prevention programme for team-sport athletes.

DESIGN

Umbrella review.

DATA SOURCES

A comprehensive literature search was performed in PubMed, Scopus, Cochrane Library and PEDro databases. Studies published between January 2000 and March 2017 were included in this umbrella review.

STUDY ELIGIBILITY CRITERIA

Moderate to high-quality systematic reviews that investigated the effectiveness of a combination of two or more exercise components, that is, strength, agility, plyometrics, balance, stretching, technique, warm-up and functional activity, regarding injury incidence/rate of lower extremity injuries in team-sport athletes. The methodological quality of the included systematic reviews was independently assessed by two reviewers using the Assessing the Methodological Quality of Systematic Reviews measurement tool and the Grading of Recommendations Assessment, Development and Evaluation guidelines were used to assess the overall quality of evidence for particular outcomes.

RESULTS

Twenty-four systematic reviews met the inclusion criteria. Multicomponent exercise interventions were effective in reducing the injury incidence/rate of lower extremity, knee, ACL and ankle injuries, but not groin injuries. Strength and balance exercise components were included in 10 of 11 effective injury prevention programmes for the lower extremity, knee, ACL and ankle injuries.

SUMMARY/CONCLUSION

Lower extremity injury prevention programmes in team sports are effective in preventing lower extremity, knee, ACL and ankle injuries. Lower extremity muscle strength and balance exercises should be prioritised in lower extremity injury prevention programmes for team-sport athletes.

[Recent progress in foot and ankle surgery]

The article focuses on the recent progress in foot and ankle surgery, including the diagnosis of disease, treatment protocols, outcomes, and evaluation tools as well as other innovations. New and accurate diagnostic modalities and measurements have undergone a breakthrough. Diagnostic modalities tend to be simpler and less expensive. Measurement tools also change to simpler and more accurate. The accuracy and efficacy of surgery and the minimally invasive method have become more popular and important. New treatments and basic research have also made breakthroughs.