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Gavanda S, von Andrian-Werburg C, Wiewelhove T. Assessment of fatigue and recovery in elite cheerleaders prior to and during the ICU World Championships. Front Sports Act Living 2023; 5:1105510. [PMID: 36949892 PMCID: PMC10025303 DOI: 10.3389/fspor.2023.1105510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/24/2023] [Indexed: 03/08/2023] Open
Abstract
Introduction Little is known about the demands of competitive cheerleading. Therefore, the objective of this study was to assess fatigue and recovery during preparation for world championships. Methods Fifteen participants from the German senior "All-Girl" and "Coed" national teams (nine males and six women) were recruited. Data were collected during the final preparation (T1 -T7) and competition days (C1 -C2). Heart rate variability (HRV) and resting heart rate (HR) were measured every morning. Data on training load, recovery, and stress (Short Scale for Recovery and Stress) were surveyed after training. Countermovement jump height (CMJ), sit-and-reach, and exercise-induced muscle damage (EMID) scores were taken in the afternoon. Results There was a practically relevant decrease in CMJ (T2, T6). A trend for HR to increase (T5-C2) and HRV to decrease (T4, T6-C2) was evident. Through training, recovery decreased and recovered as C1 approached (mental performance: T2-T4 p = 0.004; T2-C1 p = 0.029; T3-T4 p = 0.029; emotional balance: T3-T4 p = 0.023; T3-C1 p = 0.014; general recovery status T1-T3 p = 0.008; T3-T4 p = 0.024; T3-C1 p = 0.041), whereas stress increased during the first days and returned to normal before C1 (emotional dysbalance: T2-T4 p = 0.014; T2-C1 p = 0.009; T3-T4 p = 0.023; T3-C1 p = 0.014). EMID scores increased for the upper and lower body between T3, T5-T7 (p ≤ 0.036) and T3, T6-T7 (p ≤ 0.047), respectively. Discussion Pre-competition training led to substantial fatigue, and most markers indicate that athletes do not compete fully recovered. This could possibly be avoided by optimizing the training load or implementing recovery strategies.
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Affiliation(s)
- Simon Gavanda
- Department of Fitness & Health, IST University of Applied Sciences, Düsseldorf, Germany
- Correspondence: Simon Gavanda
| | | | - Thimo Wiewelhove
- Department of Fitness & Health, IST University of Applied Sciences, Düsseldorf, Germany
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Xu AL, Beck JJ, Sweeney EA, Severson MN, Page AS, Lee RJ. Understanding the Cheerleader as an Orthopaedic Patient: An Evidence-Based Review of the Literature. Orthop J Sports Med 2022; 10:23259671211067222. [PMID: 35083360 PMCID: PMC8785319 DOI: 10.1177/23259671211067222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/27/2021] [Indexed: 11/24/2022] Open
Abstract
Cheerleading is a highly popular youth sport in the United States and has been increasingly recognized in recent years for its athleticism and competitive nature. The sport has changed dramatically since its inception. When the sport of cheerleading was first developed, its primary purpose was to entertain crowds and support other athletes. Today, cheerleaders are competitive athletes themselves. Cheerleaders, most of whom are in the pediatric age group, and their parents commonly approach orthopaedic surgeons and sports medicine physicians with questions regarding the risks associated with participation in the sport. Appropriate clinical guidance is especially important for athletes returning to the sport after an injury. However, unlike other popular sports (eg, football, basketball, and volleyball), the intricacies of cheerleading are not well-known to those outside the sport, including many health care providers. Previous studies have reported on the epidemiological patterns of injuries associated with cheerleading and how such aesthetic sports affect the body, finding that fractures and concussions are prevalent and that catastrophic injuries are more common than in most other sports. Here, we provide an evidence-based discussion of 10 pertinent topics regarding cheerleading and its risks to the musculoskeletal system. The purpose of this review is to provide a comprehensive resource for orthopaedic surgeons and sports medicine physicians who care for these athletes.
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Affiliation(s)
- Amy L. Xu
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer J. Beck
- Orthopaedic Institute for Children/UCLA, Santa Monica, California, USA
| | - Emily A. Sweeney
- Sports Medicine Center, Children’s Hospital Colorado, Aurora, Colorado, USA
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Megan N. Severson
- Carilion Clinic Orthopaedic Surgery, Roanoke, Virginia, USA
- Department of Orthopaedic Surgery, Virginia Tech-Carilion School of Medicine, Roanoke, Virginia, USA
| | - A. Stacie Page
- Department of Physical Medicine and Rehabilitation, The Johns Hopkins Hospital, White Marsh, Maryland, USA
| | - R. Jay Lee
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA
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Xu AL, Suresh KV, Lee RJ. Progress in Cheerleading Safety: Update on the Epidemiology of Cheerleading Injuries Presenting to US Emergency Departments, 2010-2019. Orthop J Sports Med 2021; 9:23259671211038895. [PMID: 34676270 PMCID: PMC8524718 DOI: 10.1177/23259671211038895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/25/2021] [Indexed: 10/29/2022] Open
Abstract
Background Although the athleticism required of cheerleaders has increased, the risks of cheerleading have been less studied as compared with other sports. Purpose To update our understanding of the epidemiology of cheerleading-related injuries. Study Design Descriptive epidemiology study. Methods We analyzed the National Electronic Injury Surveillance System (NEISS) for cheerleading-related injuries presenting to nationally representative emergency departments (EDs) in the United States from January 2010 through December 2019. Extracted data included patient age and sex, injury characteristics (diagnosis, body region injured, time of year, and location where injury occurred), and hospital disposition. Using patient narratives, we recorded the cheerleading skills, settings, and mechanisms that led to injury. NEISS sample weights were used to derive national estimates (NEs) from actual case numbers. Results From 2010 to 2019, a total of 9868 athletes (NE = 350,000; 95% CI, 250,000-450,000) aged 5-25 years presented to US EDs for cheerleading injuries. The annual number of injuries decreased by 15%, from 982 (NE = 35,000; 95% CI, 27,000-44,000) to 897 (NE = 30,000; 95% CI, 18,000-42,000) (P = .048), corresponding to a 27% decline in the injury rate per 100,000 cheerleaders (P < .01). The annual number of injuries caused by performing stunts decreased by 24%, from 240 (NE = 8700; 95% CI, 6700-11,000) to 216 (NE = 6600; 95% CI, 4000-9200) (P = .01), with a 36% decline in the corresponding injury rate per 100,000 cheerleaders (P < .01). Despite these decreases, annual incidence of concussions/closed head injuries increased by 44%, from 128 (NE = 3800; 95% CI, 2900-4700) to 171 (NE = 5500; 95% CI, 3400-7700) (P = .02), and patients requiring hospital admission increased by 118%, from 18 (NE = 330; 95% CI, 250-410) to 24 (NE = 720; 95% CI, 440-1000) (P < .01). The hospital admission rate increased by 9.0% (P = .02). Conclusion The number of cheerleading-related injuries presenting to US EDs decreased from 2010 to 2019. However, the incidence of concussions/closed head injuries and hospital admissions increased, suggesting that further measures are needed to improve safety for cheerleaders.
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Affiliation(s)
- Amy L Xu
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Krishna V Suresh
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - R Jay Lee
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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4
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Injury in yoga asana practice: Assessment of the risks. J Bodyw Mov Ther 2019; 23:479-488. [DOI: 10.1016/j.jbmt.2018.09.151] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 05/05/2018] [Accepted: 09/02/2018] [Indexed: 01/28/2023]
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Yau RK, Dennis SG, Boden BP, Cantu RC, Lord JA, Kucera KL. Catastrophic High School and Collegiate Cheerleading Injuries in the United States: An Examination of the 2006-2007 Basket Toss Rule Change. Sports Health 2018; 11:32-39. [PMID: 30354940 PMCID: PMC6299346 DOI: 10.1177/1941738118807122] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Cheerleading is a specialized athletic activity that can lead to catastrophic injuries. Cheerleading rules are in place to maximize safety of participants. The purpose of this study was to describe catastrophic cheerleading injuries among high school and collegiate-level participants in the United States and to explore whether the 2006-2007 basket toss rule change was effective at reducing the number of catastrophic injuries. Hypothesis: The 2006-2007 basket toss rule change contributed to a reduction in the number of catastrophic injuries among high school and collegiate cheerleaders. Study Design: Case series. Level of Evidence: Level 4. Methods: Data on catastrophic cheerleading injuries were collected by the National Center for Catastrophic Sport Injury Research from July 2002 to June 2017. Information collected included cheerleader, event, and injury characteristics. The impact of the 2006-2007 rule change banning the basket toss on any hard surfaces was assessed by comparing injury rates and 95% CIs before and after the rule change. Results: There were 54 catastrophic cheerleading injuries, or 3.6 injuries per year. From July 2002 through June 2017, the injury rate was 2.12 per 1,000,000 cheerleaders (95% CI, 1.56-2.69). Most cheerleaders sustained serious injuries (n = 27; 50%) during practice (n = 37; 69%) to the head (n = 28; 52%) and cervical spine (n = 17; 32%). From July 2002 through June 2017, basket tosses were the stunt that accounted for the highest proportion of injuries (n = 19; 35%). The basket toss injury rate decreased from 1.55 to 0.40 per 1,000,000 cheerleaders among both high school and collegiate cheerleaders after the rule change. Conclusion: Catastrophic injury rates in cheerleading decreased dramatically after the 2006-2007 rule change banning basket tosses from being performed on any hard surfaces. In particular, there was a nearly 4-fold reduction in the rate of catastrophic basket toss injuries.
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Affiliation(s)
- Rebecca K Yau
- Prevention Research Center, Berkeley, California.,School of Public Health, University of California, Berkeley, Berkeley, California
| | - Savannah G Dennis
- UNC Chapel Hill, National Center for Catastrophic Sport Injury Research, Chapel Hill, North Carolina
| | - Barry P Boden
- The Orthopaedic Center, a Division of Centers for Advanced Orthopaedics, Rockville, Maryland
| | - Robert C Cantu
- Emerson Hospital, Concord, Massachusetts.,Boston University, Boston, Massachusetts
| | | | - Kristen L Kucera
- UNC Chapel Hill, National Center for Catastrophic Sport Injury Research, Chapel Hill, North Carolina.,Department of Exercise and Sports Science, UNC Chapel Hill, Chapel Hill, North Carolina
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Kerr ZY, Zuckerman SL, Register-Mihalik JK, Wasserman EB, Valovich McLeod TC, Dompier TP, Comstock RD, Marshall SW. Estimating Concussion Incidence Using Sports Injury Surveillance Systems: Complexities and Potential Pitfalls. Neurol Clin 2018; 35:409-434. [PMID: 28673407 DOI: 10.1016/j.ncl.2017.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Numerous sports injury surveillance systems exist with the capability of tracking concussion incidence data. It is important for the consumers of sport-related concussion data, be they researchers or the public, to have a comprehensive understanding of the strengths and limitations of sports injury surveillance systems. This article discusses issues of system design and analysis that affect the interpretation and understanding of sport-related concussion incidence data from sports injury surveillance systems. Such understanding will help inform the design of sports injury surveillance systems and research studies that aim to identify risk factors, develop prevention strategies, and evaluate prevention mechanisms.
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Affiliation(s)
- Zachary Y Kerr
- Department of Exercise and Sport Science, Injury Prevention Research Center, University of North Carolina, Woollen 313, CB#8700, Chapel Hill, NC 27599-8700, USA.
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Medical Center North T-4224, Nashville, TN 37212, USA
| | - Johna K Register-Mihalik
- Department of Exercise and Sport Science, Injury Prevention Research Center, University of North Carolina, Fetzer 125, CB#8700, Chapel Hill, NC 27599-8700, USA
| | - Erin B Wasserman
- Datalys Center for Sports Injury Research and Prevention, 401 West Michigan Street, Suite 500, Indianapolis, IN 46202, USA
| | - Tamara C Valovich McLeod
- Athletic Training Programs, School of Osteopathic Medicine, A.T. Still University, 5850 East Still Circle, Mesa, AZ 85206, USA
| | - Thomas P Dompier
- Datalys Center for Sports Injury Research and Prevention, 401 West Michigan Street, Suite 500, Indianapolis, IN 46202, USA
| | - R Dawn Comstock
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Anschutz, Mail Stop B119, 13001 East 17th Place, Aurora, CO 80045, USA
| | - Stephen W Marshall
- Department of Epidemiology, Injury Prevention Research Center, University of North Carolina, Suite 500, Bank of America Building, CB#7505, Chapel Hill, NC 27599-7505, USA
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Naiyer N, Chounthirath T, Smith GA. Pediatric Cheerleading Injuries Treated in Emergency Departments in the United States. Clin Pediatr (Phila) 2017; 56:985-992. [PMID: 28403661 DOI: 10.1177/0009922817702938] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study investigates the epidemiology of cheerleading injuries to children in the United States. Data were analyzed from the National Electronic Injury Surveillance System for children 5 through 18 years of age treated in US emergency departments for cheerleading injuries from 1990 through 2012. An estimated 497 095 children ages 5 to 18 years were treated in US emergency departments for a cheerleading injury during the 23-year study period, averaging 21 613 injured children per year. From 1990 to 2012, the annual cheerleading injury rate increased significantly by 189.1%; and from 2001 to 2012, the annual rate of cheerleading-related concussion/closed head injury increased significantly by 290.9%. Falls were the most common mechanism of injury (29.4%) and were more likely to lead to hospitalization (relative risk = 2.47; 95% confidence interval = 1.67-3.68) compared with other injury mechanisms. The rising number and rate of pediatric cheerleading injuries underscore the need for increased efforts to prevent these injuries.
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Affiliation(s)
- Nada Naiyer
- 1 Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Thiphalak Chounthirath
- 1 Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Gary A Smith
- 1 Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,2 The Ohio State University College of Medicine, Columbus, OH, USA.,3 Child Injury Prevention Alliance, Columbus, OH, USA
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Currie DW, Fields SK, Patterson MJ, Comstock RD. Cheerleading Injuries in United States High Schools. Pediatrics 2016; 137:peds.2015-2447. [PMID: 26729538 DOI: 10.1542/peds.2015-2447] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Approximately 400 000 students participate in US high school cheerleading annually, including 123,386 involved in competitive spirit squads. The degree of athleticism and the difficulty of cheerleading skills have increased in recent decades, renewing safety concerns. This study describes the epidemiology of high school cheerleading injuries and compares cheerleading injury rates and patterns relative to other sports. METHODS Data collected by the longitudinal, National High School Sports-Related Injury Surveillance Study from 2009/2010 through 2013/2014 were analyzed. RESULTS Injury rates in cheerleading ranked 18th of 22 sports, with an overall injury rate of 0.71 per 1000 athlete-exposures (AEs). Competition (0.85) and practice (0.76) injury rates were similar, whereas performance rates were lower (0.49). Although 96.8% of injured cheerleaders were girls, the overall injury rate was higher in boys (1.33 vs 0.69, rate ratio [RR]: 1.93, 95% confidence interval [CI]: 1.30-2.88). Although concussions were the most common cheerleading injury (31.1% of injuries), concussion rates were significantly lower in cheerleading (2.21 per 10,000 athlete-exposures) than all other sports combined (3.78; RR: 0.58, 95% CI: 0.51-0.66) and all other girls' sports (2.70; RR: 0.82, 95% CI: 0.72-0.93). Over half of all injuries occurred during stunts (53.2%). CONCLUSIONS Although safety remains a concern among cheerleaders, overall injury rates are lower than most other high school sports. Although overall injury rates are relatively low, cheerleading injuries may be more severe when they do occur. A detailed knowledge of cheerleading injury patterns relative to other sports is needed to drive targeted, evidence-based prevention efforts.
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Affiliation(s)
- Dustin W Currie
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado;
| | - Sarah K Fields
- Department of Communication, University of Colorado-Denver, Denver, Colorado; and
| | | | - R Dawn Comstock
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado
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9
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Neurocognitive test performance and symptom reporting in cheerleaders with concussions. J Pediatr 2013; 163:1192-5.e1. [PMID: 23941669 DOI: 10.1016/j.jpeds.2013.05.061] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 05/09/2013] [Accepted: 05/29/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate neurocognitive test results and symptom reporting after sports-related concussion in a group of female cheerleaders. STUDY DESIGN Junior and senior high school female cheerleaders (n = 138) underwent preparticipation baseline testing and repeated the ImPACT (Immediate Postconcussion Assessment and Cognitive Testing) evaluation within 7 days of concussive injury (range, 0-7 days; mean, 3.9 days). Postinjury neurocognitive and symptom scores were compared with preinjury (baseline) scores. "Abnormal" test performance was determined statistically using Reliable Change Index scores and self-reported symptoms. Main outcome variables included the composite scores indices from the ImPACT test, as well as symptoms reported by participants. Preinjury baseline and postinjury test results were compared using MANOVA. RESULTS As a group, cheerleaders with concussion evaluated within 7 days of injury performed poorly on the ImPACT test battery relative to their own baseline (F = 6.5; P = .00). In addition, 61% of the cheerleaders with concussions reported an increase in symptoms compared with baseline. The groups did not differ significantly by position on the squad (F = 0.37; P = .96). Of the group of cheerleaders who did not report increased symptoms at the time of postinjury evaluation, 37% had at least 1 abnormal ImPACT composite score result, suggesting some residual cognitive decline compared with baseline. CONCLUSION The diagnosis and management of concussion in cheerleaders should not consist solely of self-reported symptoms. Neurocognitive test results represent an important component of the evaluation process and may identify athletes with residual neurocognitive deficits who report being clinically asymptomatic.
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Waters N. What goes up must come down! A primary care approach to preventing injuries amongst highflying cheerleaders. J Am Assoc Nurse Pract 2013; 25:55-64. [PMID: 23347241 DOI: 10.1111/1745-7599.12000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE This article provides information regarding the most common nonlife-threatening and catastrophic injuries that occur during cheerleading, and describes the role of the nurse practitioner (NP) in managing patients who participate in cheerleading. DATA SOURCES Literature review of evidence-based research articles, epidemiological reports, and current guidelines. CONCLUSIONS Cheerleading is one of the most popular sports among adolescent females, and participation has increased rapidly in recent years. Rates of injury have also increased as the difficulty of this activity reaches new heights. Several factors such as body changes during puberty, societal pressures affecting nutrition, and lack of safety regulations place cheerleaders at risk for injury. Sprains/strains are the most common injury, and concussions are the most common traumatic injury. Injuries occur as a result of tumbling, stunting, falling, spotting, and unsafe practice surfaces. IMPLICATIONS FOR PRACTICE The role of the NP in injury prevention is to identify risk factors during preparticipation physicals, initiate conditioning and strength training routines, and implement safety measures during practices and competitions. The NP should also provide education and guidance to cheerleaders, parents, and coaches.
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Affiliation(s)
- Nicole Waters
- School of Nursing, Columbia University, New York, NY 10032, USA.
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Sports Neuropsychology With Diverse Athlete Populations: Contemporary Findings and Special Considerations. JOURNAL OF CLINICAL SPORT PSYCHOLOGY 2012. [DOI: 10.1123/jcsp.6.4.363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This paper aims to familiarize readers with the contemporary scientific literature available on sports concussion as it relates to populations divergent from adult males who play football and hockey. Herein, we focus on important issues such as age, gender, culture, language, sport type, and premorbid conditions (such as learning disabilities [LD] and attention deficit/hyperactive disorder [ADHD]) that can influence concussion incidence, severity, and recovery.
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Abstract
Over the last 30 years, cheerleading has increased dramatically in popularity and has evolved from leading the crowd in cheers at sporting events into a competitive, year-round sport involving complex acrobatic stunts and tumbling. Consequently, cheerleading injuries have steadily increased over the years in both number and severity. Sprains and strains to the lower extremities are the most common injuries. Although the overall injury rate remains relatively low, cheerleading has accounted for approximately 66% of all catastrophic injuries in high school girl athletes over the past 25 years. Risk factors for injuries in cheerleading include higher BMI, previous injury, cheering on harder surfaces, performing stunts, and supervision by a coach with low level of training and experience. This policy statement describes the epidemiology of cheerleading injuries and provides recommendations for injury prevention.
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Miller JM, Svoboda SJ, Gerber JP. Diagnosis of an isolated posterior malleolar fracture in a young female military cadet: a resident case report. Int J Sports Phys Ther 2012; 7:167-72. [PMID: 22530191 PMCID: PMC3325632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND AND PURPOSE The ankle is the most commonly injured joint during athletic activity. While ankle sprains are certainly the most common injury, ankle fractures can occur frequently. One type of ankle fracture with a reportedly low incidence is the isolated posterior malleolar fracture. Because of the low incidence, isolated posterior malleolar fractures can present a diagnostic challenge. The purpose of this case report is to describe the diagnostic process used for this rare injury that occurred in a physically active college-aged female who injured her ankle when landing from a fall during performance on a military obstacle course. CASE DESCRIPTION A 19 year old female United States Military Academy cadet presented to a direct access physical therapy clinic. She was limping, not using any assistive device, and was wearing an ace bandage around her right ankle/foot. Two days earlier she fell from a "10 foot high" structure while performing the military obstacle course. She did not recall details of impact, but she was told by several bystanders that it appeared that she landed on her right foot followed immediately by a transition to her buttocks and then to her back. OUTCOMES Ottawa Ankle Rules and ligamentous testing were negative; however, she was tender to palpation just anterior to the achilles tendon and lateral to the posterior edge of the medial malleolus. Based on mechanism of injury and tenderness of the posterior ankle, a potential posterior ankle fracture was suspected and subsequently confirmed by radiographic studies of the ankle including standard radiographs and computerized tomography. DISCUSSION While the Ottawa Ankle Rules are generally effective in detecting many types of ankle fractures, clinicians should not rely solely on such prediction rules. This case highlights the importance of completing a thorough history and performing a thorough physical examination. This case report focuses on differential diagnosis. It is important to consider all aspects of the patient evaluation process collectively instead of examination pieces individually.
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Affiliation(s)
- Joseph M. Miller
- Physical Therapy Services, Evans Army Community Hospital, Fort Carson, CO USA
| | - Steven J. Svoboda
- John A. Feagin Jr. Sports Medicine Fellowship US Military Academy, West Point, NY USA
| | - J. Parry Gerber
- US Army-Baylor Post-Professional Doctoral/Residency in Sports Medicine Physical Therapy US Military Academy, West Point, NY USA
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Epidemiology of cheerleading injuries presenting to NEISS hospitals from 2002 to 2007. J Trauma Acute Care Surg 2012; 72:521-6. [DOI: 10.1097/ta.0b013e31823f5fe3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Football helmet drop tests on different fields using an instrumented Hybrid III head. Ann Biomed Eng 2011; 40:97-105. [PMID: 21994055 DOI: 10.1007/s10439-011-0377-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Accepted: 07/29/2011] [Indexed: 10/16/2022]
Abstract
An instrumented Hybrid III head was placed in a Schutt ION 4D football helmet and dropped on different turfs to study field types and temperature on head responses. The head was dropped 0.91 and 1.83 m giving impacts of 4.2 and 6.0 m/s on nine different football fields (natural, Astroplay, Fieldturf, or Gameday turfs) at turf temperatures of -2.7 to 23.9 °C. Six repeat tests were conducted for each surface at 0.3 m (1') intervals. The Hybrid III was instrumented with triaxial accelerometers to determine head responses for the different playing surfaces. For the 0.91-m drops, peak head acceleration varied from 63.3 to 117.1 g and HIC(15) from 195 to 478 with the different playing surfaces. The lowest response was with Astroplay, followed by the engineered natural turf. Gameday and Fieldturf involved higher responses. The differences between surfaces decreased in the 1.83 m tests. The cold weather testing involved higher accelerations, HIC(15) and delta V for each surface. The helmet drop test used in this study provides a simple and convenient means of evaluating the compliance and energy absorption of football playing surfaces. The type and temperature of the playing surface influence head responses.
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16
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Shields BJ, Smith GA. The potential for brain injury on selected surfaces used by cheerleaders. J Athl Train 2009; 44:595-602. [PMID: 19911085 DOI: 10.4085/1062-6050-44.6.595] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Although playground surfaces have been investigated for fall impact attenuation, the surfaces that cheerleaders use have received little attention. OBJECTIVE To determine (1) the critical height for selected surfaces used by cheerleaders at or below which a serious head impact injury from a fall is unlikely to occur, (2) the critical heights for non-impact-absorbing surfaces for comparison purposes, and (3) the effect of soil moisture and grass height on g(max) (which is defined as the multiple of g [acceleration due to gravity at the earth's surface at sea level: ie, 32.2 feet x s(-1) x s(-1)] that represents the maximum deceleration experienced during an impact) and the Head Injury Criterion (HIC) at the critical height for a dry grass surface. DESIGN Observational study. SETTINGS A local cheerleading gym, indoor locations within the authors' institution, and various outdoor locations. MAIN OUTCOME MEASURE(S) g(max), HIC, and critical height. RESULTS Critical heights for the surfaces tested ranged from 0.5 ft (0.15 m) for concrete and vinyl tile installed over concrete to more than 11 ft (3.35 m) for a spring floor. Increases in grass height and soil moisture resulted in an increase in the critical height for grass surfaces. Only spring floors and 4-in (0.10-m)-thick landing mats placed on traditional foam floors had critical heights greater than 10.5 ft (3.20 m), thus providing enough impact-absorbing capacity for performance of 2-level stunts. CONCLUSIONS The potential for serious head impact injuries can be minimized by increasing the shock-absorbing capacity of the surface, decreasing the height from which the person falls, or both. Cheerleaders and cheerleading coaches should use the critical heights reported in this study to compare the relative impact-absorbing capacities of the various surfaces tested, with critical height as an indicator of the impact-absorption capacity of the surface. The findings of this study can be used to select the most appropriate surface for the type of maneuver to be performed, based on the maximum height expected to be achieved by the cheerleader(s) during execution of the maneuver. Cheerleaders should not perform maneuvers at heights that exceed the critical height for the surface on which they are performing.
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Affiliation(s)
- Brenda J Shields
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
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