Prevalence of adolescent injury from recreational exercise: an Australian perspective. Sport participation, sport injury, risk factors and sport safety practices in Calgary and area junior high schools. The longitudinal course, risk factors, and impact of sleep disturbances in children with traumatic brain injury. Perceived risk, risk taking, estimation of ability and injury among adolescent sport participants. Permanent sequelae in sports injuries: a population based study The effects of sleep extension and sleep hygiene advice on sleep and depressive symptoms in adolescents: a randomized controlled trial. Duration of Sleep and ADHD Tendency Among Adolescents in China Risk factors of acute and overuse musculoskeletal injuries among young conscripts: a population-based cohort study Treatment of hamstring strain in a collegiate pole-vaulter integrating dry needling with an eccentric training program: a resident's case report. Effect of a moderate fish intake on blood pressure, bleeding time, hematology, and clinical chemistry in healthy males. It will take more than an existing exercise programme to prevent injury Quantity and quality of sleep in the surgical intensive care unit: are our patients sleeping? Descriptive epidemiology of collegiate men's basketball injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004. Sleep patterns and injury occurrence in elite Australian footballers. The ACL injury enigma: we can't prevent what we don't understand. Foot morphology and foot/ankle injury in indoor football. Lifestyle correlates of self-reported sleep duration among Saudi adolescents: a multicentre school-based cross-sectional study. Does Cryotherapy Hasten Return to Participation? A Systematic Review. Risk Factors Associated With Grade 3 Pivot Shift After Acute Anterior Cruciate Ligament Injuries Cross-sectional and prospective associations between sleep, screen time, active school travel, sports/exercise participation and physical activity in children and adolescents Sleep in the Neurological Intensive Care Unit: Feasibility of Quantifying Sleep After Melatonin Supplementation With Environmental Light and Noise Reduction Sleep in critically ill patients requiring mechanical ventilation. Insomnia in a post-acute brain injury sample
PURPOSE To report the prevalence of recent  adolescent recreational and sporting  activities and associated injury . METHODS Data were collected during three school terms in 1997 using a vali date d question naire administered once only to 3538 girls and boys aged 11 - 12 years and 15 - 16 years . These students comprised 97.5 % of the students in these age ranges in r and omly selected state and private schools in the Adelaide metropolitan area ( South Australia ) . Participants identified up to three recreational and /or sporting activities in which they had participated in the previous week . Data were collected on the nature and extent of participation , and on associated injuries . Participation and injury reports were summarized descriptively in gender strata in the two adolescent age groups and stratum specific odds ratios were used to explore injury risk . RESULTS Subjects reported participating in 8997 sporting and /or recreational activities in the preceding week ( an average of 2.5 participations per student ) . Over 140 sports and recreational pursuits were represented , incorporating organized and nonorganized activities undertaken in teams , social groups , or alone . Approximately 25 % of adolescents reported at least one recreational injury . Injuries were mostly minor , reflecting soft tissue trauma and skin abrasions . Organized group sport incurred the highest risk of injury . There were marked gender and year level differences in injury risk in a number of common activities . CONCLUSIONS These findings support the need for ongoing education regarding injury prevention and management OBJECTIVES To examine rates of  sport participation , sport injury , risk factors and  sport safety practice s in young adolescents . DESIGN Cross-sectional . SETTING Calgary and area junior high schools . PARTICIPANTS A r and om sample of 1466 students ( aged 12 to 15 years ) . OUTCOME MEASURES Sport injury within one year prior to completing the survey . RESULTS Ninety-three per cent of students participated in sports in the previous year . The injury rate was 60.85 injuries/100 students/year ( 95 % CI 58.29 to 63.35 ) for students reporting at least one sport injury , 29.4 injuries/100 students/year ( 95 % CI 27.08 to 31.81 ) for medically treated injuries , and 12.28 injuries/100 students/year ( 95 % CI 10.64 to 14.07 ) for injuries presenting to a hospital emergency department . The greatest proportion of injuries occurred in basketball ( 14 % ) , soccer ( 12 % ) , hockey ( 8.6 % ) and snowboarding/skiing ( 7.1 % ) . CONCLUSIONS The rates of participation and injury in sports are high in junior high school students . Future research should focus on prevention strategies in sports with high participation and injury rates to have the greatest population health impact This study aim ed to examine the prevalence and trajectory of sleep disturbances and their associated risk factors in children up to 24 months following a traumatic brain injury ( TBI ) . In addition , the longitudinal association between sleep disturbances and children 's functional outcomes was assessed . This was a prospect i ve study of a cohort of children with TBI and a comparison cohort of children with orthopedic injury ( OI ) . Parental reports of pre-injury sleep disturbances were compared to reports of post-injury changes at 3 , 12 , and 24 months . Risk factors for sleep disturbances were examined , including severity of TBI , presence of psychosocial problems , and pain . Sleep disturbances were also examined as a predictor of children 's functional outcomes in the areas of adaptive behavior skills and activity participation . Both cohorts ( children with TBI and OI ) displayed increased sleep disturbances after injury . However , children with TBI experienced higher severity and more prolonged duration of sleep disturbances compared to children with OI . Risk factors for disturbed sleep included mild TBI , psychosocial problems , and frequent pain . Sleep disturbances emerged as significant predictors of poorer functional outcomes in children with moderate or severe TBI . Children with TBI experienced persistent sleep disturbances over 24 months . Findings suggest a potential negative impact of disturbed sleep on children 's functional outcomes , highlighting the need for further research on sleep in children with TBI OBJECTIVE To determine the predictive validity of perceived risk , risk taking , estimation of ability , overefficacy , and previous injuries on actual injury among adolescents in sport ; and to examine sex differences on these factors . METHODS A cohort of 260 ( 148 male , 112 female ) soccer players aged 11 to 14 years participated in a 3-month prospect i ve injury study . Preseason written measures included self-reported perceived risk , previous injuries , risk taking and estimation of ability . RESULTS Low levels of perceived risk and estimation of ability were associated with a significant increase in risk of injury , with odds ratios ( ORs ) ranging from 3.77 - 7.92 . Positive relationships between injury and both estimation of ability and overestimation of ability were supported . Estimation of ability was also positively related to risk taking . In this study , however , risk taking was not directly related to injury , nor were previous injuries . Girls reported higher levels of perceived risk and lower levels of risk taking than boys . However , boys and girls reported similar estimation of ability and overestimation of ability and subsequently incurred similar numbers of injuries . CONCLUSIONS Perceived risk and estimation of ability represent significant psychological risk factors for injury in adolescent sports . Sex differences in perceived risk , risk taking , and previous injuries should be considered when developing environmental and behavioral injury-prevention programs AIM To identify permanent sequelae after sports injuries in children and adolescents . METHODS In 1985 , a prospect i ve register was drawn up of all sports related injuries reported that year by the residents of Trieste , Italy aged 6–15 years . Moderate to severe injuries ( scoring ⩾ 2 on the abbreviated injury scale ( AIS ) ) were the object of a longitudinal clinical study . In 1988 , 30.9 % of the 220 subjects enrolled had sequelae . A further follow up was undertaken in 1997 . RESULTS The follow up in 1997 involved 54 subjects ( 26 girls ; average age 24.5 years ) . Subjective and objective sequelae , by now considered to be permanent , were found in 61.1 % , corresponding to 15 % of the AIS ⩾ 2 injuries recorded in 1985 . The prevalence of sequelae was similar in the two sexes , in relation to the child ’s age at time of injury , and in the different sports practised . It was higher in relation to the severity of the lesion ( 89 % of AIS 3 injuries examined , 56 % of AIS 2 injuries ) and to the type of lesion and its location . With regard to AIS ⩾ 2 injuries , permanent sequelae were found in 50 % of ankle fractures , 43 % of elbow fractures , 33 % of leg/foot fractures , 25 % of knee sprains , and 23 % of ankle sprains . CONCLUSIONS The frequency of sequelae in sports injuries in children and adolescents is high . The risk appears to be connected to certain anatomical and functional age characteristics . Prevention strategies should include specific assessment of physical fitness and adequate follow up after the accident , particularly rehabilitation OBJECTIVE Sleep problems are common and persistent during adolescence and can have negative effects on adolescents ' mood . To date , studies that investigate the effects of sleep extension on adolescents ' sleep and depressive symptoms are still lacking . This study aims to investigate the effects of gradual sleep extension combined with sleep hygiene advice in adolescents with chronic sleep reduction on objective ly measured sleep , self-reported sleep problems and depressive symptoms . METHODS Fifty-five adolescents with chronic sleep reduction ( mean age : 15.44 years ; 85.5 % females ) were included in the study . Participants were r and omly assigned to either a sleep extension group ( gradual sleep extension by advancing bedtimes in the evening and receiving sleep hygiene advice ) or to a control group ( no instruction ) .  Sleep was measured with actigraphy during three weeks , the first week was the baseline week , and the last two weeks were the experimental weeks during which sleep was extended . Other outcome variables were self-reported sleep problems ( daytime sleepiness , symptoms of insomnia and circadian rhythm sleep disorder ) and depressive symptoms , which were assessed before and after the experimental manipulation . RESULTS During the third week of the experiment , adolescents in the sleep extension group had earlier bedtimes , earlier sleep onsets , spent more time in bed and slept longer than adolescents in the control group . Their chronic sleep reduction , insomnia symptoms and depressive symptoms diminished significantly . In addition , there was a trend of improved circadian rhythm sleep disorder symptoms and sleep quality . CONCLUSION Gradual sleep extension combined with sleep hygiene advice seems to have beneficial effects on sleep , self-reported sleep problems and depressive symptoms of adolescents with chronic sleep reduction . Although we can not distinguish between the effects of sleep extension and sleep hygiene advice , the results suggest that advancing bedtimes can extend sleep and improve depressive symptoms Objective : This study investigates the association between duration of sleep and ADHD tendency among adolescents . Method : This population -based health survey uses a two-stage r and om cluster sampling design . Participants ages 13 to 17 are recruited from the total population of adolescents attending high school in one city of China .  Duration of sleep is measured by self-reported time to bed and rise . ADHD tendency is assessed via a structured personal interview . Data are analyzed using linear regression modeling with adjustment for the effects of cluster sampling . Results : There is a highly significant and negative association between duration of sleep and ADHD tendency ( t = —4.99 , p < .001 ) with a regression coefficient of —0.73 after adjusting for the potential confounding factors . Conclusion : Duration of sleep is associated with ADHD tendency among adolescents . It would be prudent for clinicians to include the assessment of sleep problems , including lack of sleep , in evaluating potential ADHD patients for treatment programs . ( J. of Att . Dis . 2008 ; 11(4 ) 437 - 444 Background Military service in Finl and is compulsory for all male citizens and annually about 80 % of 19-year-old men enter into the service . The elevated risk for many chronic diseases and loss of function among those who are inactive and unfit can be often detected already in youth . On the other h and , activity-induced injuries among young are true public health issue . The purpose of the present prospect i ve cohort follow-up study was to evaluate predictive associations between acute or overuse injuries and their various intrinsic risk factors . Methods Four successive cohorts of conscripts who formed a representative sample of Finnish young men were followed for 6 months . At the beginning of the service , the risk factors of injuries were measured and recorded and then the acute and overuse injuries treated at the garrison clinic were identified . Predictive associations between injuries and their risk factors were examined by multivariate Cox ’s proportional hazard models . Results Of the 1411 participants , 27 % sustained an acute injury and 51 % suffered from overuse injury . Concerning acute injuries , highest risk for severe injuries were detected among conscripts with low fitness level in both the st and ing long-jump and push-up tests ( hazard rate , HR=5.9 ; 95 % CI : 1.6‒21.3 ) . A history of good degree in school sports was not a protective factor against acute injuries . High waist circumference and , on the other h and , being underweight according to BMI increased the HR for overuse injuries . Brisk leisure time physical activity before military entry was a protective factor against overuse injuries . Poor result in Cooper ’s test was a warning signal of elevated risk of overuse injuries . Conclusion We confirmed previous findings that low level of physical fitness is predictor for musculoskeletal injuries during intensive physical training . The U-shaped relationship between body composition and overuse injuries was noticed indicating that both obesity and underweight are risk factors for overuse injuries . Persons with excellent sports skills according to their earlier degrees in school sports had similar HR for acute injuries than those with poorer degrees . This indicates that school-age sports skills and fitness do not carry far and therefore preventive programmes are needed to prevent activity-induced injuries BACKGROUND Hamstring strain injuries are among the most common injuries seen in sports . Management is made difficult by the high recurrence rates . Typical time to return to sport varies but can be prolonged with recurrence . Eccentric strength deficits remain post-injury , contributing to reinjury . Eccentric training has shown to be an effective method at prevention of hamstring injury in multiple systematic review s and prospect i ve RCTs but limited prospect i ve rehabilitation literature . Functional dry needling is a technique that has been reported to be beneficial in the management of pain and dysfunction after muscle strains , but there is limited published literature on its effects on rehabilitation or recurrence of injury . PURPOSE The purpose of this case report is to present the management and outcomes of a patient with hamstring strain , treated with functional dry needling and eccentric exercise . CASE DESCRIPTION The subject was an 18-year-old collegiate pole-vaulter who presented to physical therapy with an acute hamstring strain and history of multiple strains on uninvolved extremity . He was treated in Physical Therapy three times per week for 3 weeks with progressive eccentric training and 3 sessions of functional dry needling . OUTCOMES By day 12 , his eccentric strength on the involved extremity was greater than the uninvolved extremity and he reported clinical ly meaningful improvement in outcome scores . By Day 20 , he was able to return to full sports participation without pain or lingering strength deficits . DISCUSSION The patient in this case report was able to return to sport within 20 days and without recurrence . He demonstrated significant decreases in pain and dysfunction with dry needling . He had greater strength on the injured extremity compared to contra-lateral previously injured extremity . CONCLUSIONS This case illustrates the use of functional dry needling and eccentric exercise leading to a favorable outcome in a patient with hamstring strain . LEVEL OF EVIDENCE Level 4 This paper describes the outline and first results of an international study to investigate the effect of a reasonable amount of dietary fish on some aspects of cardiovascular risk . In Maastricht and Zeist , The Netherl and s , and Tromsø , Norway , healthy male volunteers were given a dietary supplement consisting of 100 g/d of mackerel or meat for a 6-wk period . Compliance was monitored on the basis of the urinary excretion of lithium , which was added to the supplements . Average compliance was approximately 80 % and this decreased slightly in time . Systolic blood pressure decreased in both groups to a comparable degree ; consequently no specific effect of the fish supplement was observed . The fish supplement significantly prolonged bleeding times . Hematology was hardly affected but platelet counts decreased significantly . No indications were obtained for adverse effects of the fish supplement In 1983 , Ekstr and et al 1 published the first r and omised controlled trial ( RCT ) of an injury prevention programme for team ball sport . Three decades on from this l and mark study , it is worth reflecting on the progress made and the current ‘ state-of-play ’ in the field of team ball sport injury prevention research . The volume of published research has grown considerably with a recent systematic review of team ball sport injury prevention exercise programmes ( IPEPs ) identifying over 50 published trials.2 The scale , quality and outcomes of recent RCTs are also encouraging with a Swedish trial including over 4500 female soccer players and demonstrating a 64 % reduction  in the rate of anterior cruciate ligament ( ACL ) injuries.3  In 2013 , a subsequent sub analysis of the original Swedish RCT , published in this journal , highlighted the importance of adequate IPEP compliance in preventing injuries . The ACL injury rate was 88 % lower in highly compliant players , compared to those with low compliance.4 A 3-year follow-up,5 also published in this journal , investigated if coaches from the original trial and others in the same target BACKGROUND The lack of adequate sleep during intensive care unit ( ICU ) admission is a frequently overlooked complication . Disrupted sleep is associated with immune system dysfunction , impaired resistance to infection , as well as alterations in nitrogen balance and wound healing . The effects of surgical ICU admission on patients ' sleep quality and architecture remain poorly defined . The purpose of this study was to describe the quantity and quality of sleep as well as sleep architecture , as defined by polysomnography ( PSG ) , in patients cared for in the surgical ICU . METHODS A prospect i ve observational cohort study was performed at our urban Level I trauma center . A convenience sample of surgical or trauma ICU patients underwent continuous PSG for up to 24 hours to evaluate sleep patterns . A certified sleep technician performed , monitored , and scored all PSG recordings . A single neurologist trained in PSG interpretation review ed all PSG recordings . chi goodness-of-fit analysis was performed to detect differences in the proportion of time spent in stages 1 and 2 ( superficial stages ) , stages 3 and 4 ( deep stages ) , or rapid eye movement ( REM ) sleep between study patients and healthy historical controls . All PSG recordings were performed greater than 24 hours after the administration of a general anesthetic . Patients with traumatic brain injury were excluded . RESULTS Sixteen patients were selected to undergo PSG recordings . Median age was 37.5 years ( range , 20 - 83 ) , 81.3 % were male patients , 62.5 % were injured , and 31.3 % were mechanically ventilated . Total  PSG recording time was 315 hours ( mean , 19.7 hours per patient ) , total sleep time captured by PSG was 132 hours ( mean , 8.28 hours per patient ) , and there were 6.2 awakenings per hour of sleep measured . ICU patients had an increase in the proportion of time spent in the superficial stages of sleep , and a decrease in the proportion of time spent in the deeper stages of sleep as well as a decrease in REM sleep compared with healthy controls ( p < 0.001 ) . CONCLUSIONS Patients do achieve measurable sleep while cared for in a surgical ICU setting . However , sleep is fragmented and the quality of sleep is markedly abnormal with significant reductions in stages 3 and 4 and REM , the deeper restorative stages of sleep . Further studies on the effects of a strategy to promote sleep during ICU care are warranted OBJECTIVE To review 16 years of National Collegiate Athletic Association ( NCAA ) injury surveillance data for men 's basketball and identify potential areas for injury prevention initiatives . BACKGROUND Collegiate men 's basketball is a contact sport in which numerous anatomical structures are susceptible to both acute and overuse injuries . To date , no comprehensive reporting of injury patterns in NCAA men 's basketball has been published . MAIN RESULTS The overall rate of injury was 9.9 per 1000 athlete-exposures for games and 4.3 per 1000 athlete-exposures for practice s. Approximately 60 % of all injuries were to the lower extremity , with ankle ligament sprains being the most common injury overall and knee internal derangements being the most common injury causing athletes to miss more than 10 days of participation . A trend of increasing incidence of injuries to the head and face was noted over the 16-year span of the study , which may be related to an observed increase in physical contact in men 's basketball over the past 2 decades . RECOMMENDATIONS These results provide the most comprehensive description of injury patterns in NCAA men 's basketball to date . Many of the most common injuries seen in men 's basketball , such as ankle ligament sprains and knee internal derangements , may be at least partially preventable with interventions such as taping and bracing and neuromuscular training . However , r and omized controlled trials assessing the efficacy of such preventive measures among collegiate men 's basketball players are clearly lacking . The increase in head and facial injuries may indicate that officials need to assess the increased tolerance for physical contact in men 's basketball seen over the past 2 decades OBJECTIVES To examine the potential relationship between sleep duration and efficiency and injury incidence in elite Australian footballers . DESIGN Prospect i ve cohort study . METHODS Australian footballers ( n=22 ) from one AFL club were studied across the 2013 competitive season . In each week sleep duration and efficiency were recorded via actigraphy for 5 nights ( the 3 nights preceding a game , the night of the game and the night after the game ) . Injury incidence was monitored and matched with sleep data : n=9 players suffered an injury that caused them to miss a game . Sleep in the week of the injury ( T2 ) was compared to the average of the previous 2 weeks ( T1 ) . A two-way repeated measures ANOVA was used to determine any effect of sleep duration and efficiency on injury . Significance was accepted at p<0.05 . RESULTS Injury incidence was not significantly affected by sleep duration , sleep efficiency or a combination of these factors . Analysis of individual nights for T2 versus T1 also showed no differences in sleep quality or efficiency . However , a main effect for time was found for sleep duration and efficiency , with these being slightly , but significantly greater ( p<0.05 ) at T2 ( 437±61min and 82±7 % ) than T1 ( 414±64min and 79±7 % ) . CONCLUSIONS No significant effect of sleep duration and efficiency on injury occurrence was found in elite Australian footballers M ultiple risk factors , both modifiable and nonmodifiable , are known to manifest within the noncontact anterior cruciate ligament ( ACL ) injury mechanism.1 I will primarily address neuromechanical contributions to injury risk , which are often a key focus at meetings of this nature ; such factors are amenable to training and , hence , largely modifiable . I hope , however , that as the reader progresses through the document , the critical importance of underlying nonmodifiable factors within the result ant neuromechanical strategy will not be lost . Sexual dimorphism in modifiable neuromuscular factors linked to ACL injury is well documented , with the ‘ ‘ female ’ ’ movement pattern interpreted as riskier . Females , for example , l and in a more extended posture,2 are more quadriceps dominant,1–3 and demonstrate altered muscle activation and coactivation4 and greater out-of-plane knee motions5 and loads6–9 than males . Neuromuscular training strategies continue to evolve in line with these findings and represent an ever-increasing and equally important research focus.10–12 Recent epidemiologic data , however , suggest that in spite of these ongoing initiatives and reported early successes,13,14  ACL injury rates and the associated sex disparity have not diminished.15 If current prevention methods delivered reasonable efficacy , one would assume that a noticeable reduction in these rates would already be evident . It appears , therefore , that current strategies fail to counter key factors implicated within the injury mechanism . In particular , underst and ing of the precise contributions of neuromuscular control and result ant biomechanics to the injury mechanism and their integration with nonmodifiable structural and hormonal factors remains limited . The current lack of insight into the neuromechanical contributions to noncontact ACL injury risk and , thus , how they can be effectively countered appears to arise through several key factors . The remainder of this paper will focus on some of these factors , in the hope that research ers of ACL injury mechanisms and prevention will begin to address them . Currently , potential neuromechanical predictors of injury risk are generated primarily from the laboratory-based assessment of ‘ ‘ safe ’ ’ movement tasks . Although much can be gained from evaluating high-risk sport postures within a controlled laboratory setting , inferring injury risk from such assessment s is question able . Hence , research that more effectively brings together the laboratory and field environments appears warranted . Sports in which ACL injuries are common are largely governed by a r and om and often complex series of dynamic events , requiring an equally complex , central ly coordinated response.16,17 Integrating more sport-relevant factors within the in vivo experimental testing environment may , therefore , provide further crucial insights into the causal factors of noncontact ACL injury , facilitating the development of more effective and adaptable prevention methods . Authors of recent studies have begun to acknowledge this fact by regularly incorporating into the experimental design fatiguing8,18,19 and decision-making20–22 tasks , factors inherent in realistic sport participation . Because each of these factors promotes substantial adaptation in the neuromechanical profile and , in particular , exaggerates variables considered high risk , including them when assessing injury predictors is critical . Further , recent data suggest that the combined effect of these tasks may represent a worst-case scenario in terms of injury risk , in which substantial compromise of spinal and , specifically , supraspinal control promotes ineffective decision , response , and result ant movement strategies.16 Along with increasing efforts to develop more realistic laboratory testing environments , a similar research groundswell is bringing the laboratory to the field . Such developments not only permit biomechanical assessment s during actual ACL injury scenarios but also contribute substantially to the screening and , ultimately , diminution or elimination of high-risk neuromechanical factors . Model-based image-matching techniques , for example , using commercially available software applications , can estimate joint kinematics with reasonable accuracy from videos of actual injury events.23 Combining these data with neuromuscular measures obtained for similar movements within the laboratory setting may provide helpful insights into the neuromechanical profile of the ACL injury . Other recent developments , such as markerless motion capture techniques24 and wearable motion sensors,25 may similarly allow the assessment of lower limb joint mechanics during actual sport participation and , possibly , true injury scenarios . These devices may also provide an excellent method of screening for high-risk , sport-relevant neuromechanical profiles and , further , countering them through dynamic , real-time feedback techniques . These possibilities alone suggest that additional exploration of such methods is warranted . Current modeling methods , while obviously not representing an actual on-field assessment , also afford an important extension beyond in vivo , laboratory-based experimental methods . The recent development and Journal of Athletic Training 2008;43(5):538–540 g by the National Athletic Trainers ’ Association , Inc www.nata.org/jat While the pronated foot is implicated as a risk factor for sports injury in some studies , others suggest that a supinated foot posture increases the risk of overuse lower limb injuries . Athletes in a given sports discipline may tend to have a similar foot morphology , which varies from that observed elsewhere . Further , the foot morphology that is beneficial for performance in a sport may be detrimental with regard to injury . Intra- and inter-rater reliability of the Foot Posture Index ( FPI-6 )  as a measure of foot morphology was determined ( ICC ( 2,1 ) 0.88 and 0.69 respectively ) . Thereafter , in a prospect i ve cohort study using the FPI-6 , 76 adolescent male indoor football ( Futsal ) players were measured and followed monthly over one competition season . Coach-rated ability and reports of any overuse injuries at the ankle and /or foot over this period were obtained . A significant negative linear relationship was found between the mean FPI-6 scores and coach-rated ability ( p=0.008 ) , with supinated and under-pronated postures related to higher ability level . Overall , 33 % of injuries at the ankle and /or foot were classified as overuse . Foot Posture Index scores of less than 2 , indicating the supinated and under-pronated feet , were found to be associated with a significant increase in the risk of overuse injury ( p=0.008 ) . The greater rigidity of these foot types may assist adolescent , male , indoor football players to perform at a higher level in their sport . Unfortunately , these players are also more likely to sustain ankle and /or foot overuse injuries BACKGROUND Lifestyle factors are important determinants of adequate sleep among adolescents . However , findings on sleep duration relative to lifestyle factors are conflicting . Therefore , this study examined the association of self-reported sleep duration with physical activity , sedentary behaviours and dietary habits among Saudi adolescents . METHODS A multicentre school-based cross-sectional study was conducted in three major cities in Saudi Arabia . The sample included 2868 secondary -school students ( 51.9 % girls ) aged 15 - 19 years , r and omly selected using a multistage stratified cluster sampling technique . In addition to  anthropometric measurements , sleep duration , physical activity , sedentary behaviours and dietary habits were assessed using self-reported question naire . RESULTS Several lifestyle factors were associated with sleep duration in adolescents . While controlling for some potential confounders , the findings showed that high screen time [ > 5 h/day ; adjusted odds ratio ( aOR ) = 1.505 , 95 % confidence interval ( CI ) = 1.180 - 1.920 , P = 0.001 ] and low ( aOR = 1.290 , 95 % CI = 1.064 - 1.566 , P = 0.010 ) to medium ( aOR = 1.316 , 95 % CI = 1.075 - 1.611 , P = 0.008 ) physical activity levels were significantly related to daily sleep of 8 h or longer . Furthermore , having low intake of breakfast ( <3 day/week compared with 5 days or more per week ) decreased the odd of having adequate sleep duration by a factor of 0.795 ( 95 % CI = 0.667 - 0.947 , P < 0.010 ) . CONCLUSIONS Short sleep duration ( < 8 h/day ) among Saudi adolescents 15 - 19 year olds was significantly associated with several lifestyle factors . Intervention programs aim ing for improving sleeping habits among adolescents need to consider such potential association of lifestyle variables with sleep duration OBJECTIVE : To search the English- language literature for original research addressing the effect of  cryotherapy  on return to participation after injury . DATA SOURCES : We search ed MEDLINE , the Physiotherapy Evidence Data base , SPORT Discus , the Cochrane Review s data base , and CINAHL from 1976 to 2003 to identify r and omized clinical trials of  cryotherapy .  Key words used were cryotherapy , return to participation , cold treatment , ice , injury , sport , edema , and pain . DATA SYNTHESIS : Original research , including outcomes - assessment measures of return to participation of injured subjects , was review ed using the Physiotherapy Evidence Data base ( PEDro ) Scale . Four studies were identified and review ed by a panel of certified athletic trainers . The 4 articles ' scores ranged from 2 to 4 on the PEDro scale , which has a maximum of 10 points . Two of the articles suggested that cryotherapy speeds return to participation after ankle sprains . However , these authors failed to provide in-depth statistical analysis of their results . A confounding factor of compression as part of the treatment prevented interpretation of the effects of cryotherapy in 1 article . CONCLUSIONS : After critically review ing the literature for the effect of cryotherapy on return-to-participation measures , we conclude that cryotherapy may have a positive effect . Despite the extensive use of cryotherapy in the management of acute injury , few authors have actually examined the effect of cryotherapy alone on return-to-participation measures . The relatively poor quality of the studies review ed is of concern . R and omized , controlled clinical studies of the effect of cryotherapy on acute injury and return to participation are needed to better eluci date the treatment responses Background : Recent literature has demonstrated that involvement in pivoting sports at the time of injury , increased posterior-inferior tibial slope ( PITS ) , anterolateral capsular ligament ( ALCL ) disruptions , and combined lateral meniscal lesions all contribute to a higher grade of pivot shift after acute anterior cruciate ligament ( ACL ) injuries . Purpose : To identify risk factors associated with grade 3 pivot shift after acute ACL injuries . Study Design : Case-control study ; Level of evidence , 3 . Methods : A data base of patients undergoing primary ACL reconstruction from 2009 to 2015 after acute ACL injuries was retrospectively review ed . A total of 30 patients ( 30 knees ) with grade 3 pivot shift were identified as the study group . Moreover , 30 patients ( 30 knees ) with grade 1 and 30 patients ( 30 knees ) with grade 2 pivot shift were r and omly chosen as the 2 control groups . All pivot-shift tests were performed with the patients under anesthesia . Predictors of grade 3 pivot shift that were explored included patient age , sex , time from injury to surgery , pivoting sports involvement at the time of injury , lateral PITS , medial PITS , ALCL disruptions , preoperative KT-1000 arthrometer side-to-side difference , and combined lateral or medial meniscal lesions . Comparisons were performed between the study group and the 2 control groups . Univariable and multivariable logistic regressions were used to identify independent risk factors that were associated with grade 3 pivot shift . Results : Univariable and multivariable logistic regressions between the study group and the 2 control groups showed that  pivoting sports involvement  at the time of injury ( odds ratio1 [ OR1 ; grade 3 vs grade 1 pivot shift with grade 1 = reference ] , 11.88 ; 95 % CI , 1.94 - 149.91 ; OR2 [ grade 3 vs grade 2 pivot shift with grade 2 = reference ] , 3.41 ; 95 % CI , 1.92 - 22.60 ) , abnormal degree of lateral PITS ( OR1 , 14.41 ; 95 % CI , 1.69 - 174.78 ; OR2 , 6.41 ; 95 % CI , 1.48 - 47.70 ) , ALCL disruptions ( OR1 , 8.28 ; 95 % CI , 1.71 - 117.14 ; OR2 , 4.96 ; 95 % CI , 1.07 - 28.75 ) , and combined lateral meniscal lesions ( OR1 , 27.56 ; 95 % CI , 5.48 - 240.52 ; OR2 , 5.83 ; 95 % CI , 1.21 - 38.56 ) were independent risk factors of grade 3 pivot shift after acute ACL injuries . Conclusion : For acute ACL injuries , the best set of predictors of grade 3 pivot shift were pivoting sports involvement at the time of injury , abnormal lateral PITS , ALCL disruptions , and combined lateral meniscal lesions . These results may provide additional information for counseling patients on residual laxity and risks for graft rerupture after ACL reconstruction Background The aim of this study was to investigate how sleep , screen time , active school travel and sport and /or exercise participation associates with moderate-to-vigorous physical activity ( MVPA ) in nationally representative sample s of Norwegian 9- and 15-y-olds , and whether these four behaviors at age nine predict change in MVPA from age nine to 15 years . Method We pooled cross-sectional accelerometer and question naire data  from 9- ( n = 2366 ) and 15-y-olds ( n = 1554 ) that participated in the first ( 2005/06 ) and second ( 2011/12 ) wave of the Physical Activity among Norwegian Children Study to investigate cross-sectional associations . To investigate prospect i ve associations , we used data from a sub- sample that participated in both waves ( at age nine and 15 years , n = 517 ) . Results Cross-sectional analyses indicated a modest , inverse association between screen time and MVPA among 9- ( − 2.2 min/d ( 95 % CI : -3.1 , − 1.3 ) ) and 15-y-olds ( − 1.7 min/d ( 95 % CI : -2.7 , − 0.8 ) ) . Compared to their peers with 0–5 min/d of active travel to school , 9- and 15-y-olds with ≥16 min/d accumulated 7.2 ( 95 % CI : 4.0 , 10.4 ) and 9.0 ( 95 % CI : 3.8 , 14.1 ) more min/d of MVPA , respectively . Nine-y-old boys and 15-y-olds reporting ≥8 h/week of sports and /or exercise participation accumulated 14.7 ( 95 % CI : 8.2 , 21.3 ) and 17.9 ( 95 % CI : 14.0 , 21.8 ) more min/d of MVPA , respectively , than those reporting ≤2 h/week . We found no cross-sectional association between sleep duration and MVPA in either age group . None of the four behaviors predicted change in MVPA from age nine to 15 years ( p ≥ 0.102 ) . Conclusion Active travel to school and sport/exercise participation may be important targets for future interventions aim ed at increasing MVPA in children and adolescents . However , future studies are needed to determine causality Purpose : Sleep deprivation may be particularly detrimental to intensive care unit ( ICU ) patients . Polysomnography has demonstrated abnormal sleep in medical and surgical ICU population s. Both environmental factors and circadian disruption have been implicated . We hypothesized that patients in a neurologic ICU would demonstrate similar sleep disturbances and that a combination of sleep-promoting interventions would increase sleep time . Methods : Twelve patients were enrolled in this pilot-r and omized , controlled , study in a neurologic ICU . For adult patients undergoing continuous EEG for clinical purpose s ,  noise-cancelling headphones and eye masks were worn , and an oral dose of melatonin was administered for 3 days , or until EEG was stopped . Sleep was scored according to st and ard criteria ; EEG was characterized and analyzed quantitatively . Results : Sixty-five percent of the patients ' recordings were unscorable based on accepted st and ardized criteria ; therefore , sleep measures could not be compared . For those with sleep that could be scored , total sleep time was normal , although sleep was fragmented and time spent in slow-wave or rapid eye movement sleep was notably decreased . Patients with unscorable recordings had worse injury severity measures , absent or significantly slower posterior dominant rhythm , and less coherence of posterior faster frequencies . Clinical outcomes were similar between intervention and control groups . Conclusions : Although sleep-promoting interventions were feasible , sleep quantification based on currently accepted criteria limited the ability to score sleep . Similar to other ICUs , sleep in the neurologic ICU is abnormal ; patients with unscorable sleep-like states have greater injury severity . This study was limited by strict enrollment criteria . A reliable method to quantify sleep and sleep-like states in the ICU is needed STUDY OBJECTIVES To objective ly measure sleep in critically ill patients requiring mechanical ventilation and to define selection criteria for future studies of sleep continuity in this population . DESIGN Prospect i ve cohort analysis . SETTING University teaching hospital medical-surgical ICU . PATIENTS Twenty critically ill ( APACHE II [ acute physiology and chronic health evaluation II ] acute physiology score [ APS ] , 10 + /- 5 ) , mechanically ventilated adults ( male 12 , female 8 , age 62 + /- 15 years ) with mild to moderate acute lung injury ( lung injury score , 1.8 + /- 0.9 ) 10 + /- 7 days after admission to the ICU . MEASUREMENTS AND RESULTS Patients were divided into three groups based on 24-h polysomnography ( PSG ) findings . No patient demonstrated normal sleep . In the " disrupted sleep " group ( n = 8) , electrophysiologic sleep was identified and was distributed throughout the day ( 6:00 AM to 10:00 PM ; 4.0 + /- 2.9 h ) and night ( 10:00 PM to 6:00 AM ; 3.0 + /- 1.9 h ) with equivalent proportions of non-rapid eye movement ( NREM ) and rapid eye movement ( REM ) sleep . Nocturnal sleep efficiency was severely reduced ( 38 + /- 24 % ) with an increased proportion of stage 1 NREM sleep ( 40 + /- 28 % total sleep time [ TST ] ) and a reduced proportion of REM sleep ( 10 + /- 14 % TST ) . Severe sleep fragmentation was reflected by a high frequency of arousals ( 20 + /- 17/h ) and awakenings ( 22 + /- 25/h ) . Electrophysiologic sleep was not identifiable in the PSG recordings of the remaining patients . These were classified either as " atypical sleep " ( n = 5 ) , characterized by transitions from stage 1 NREM to slow wave sleep with a virtual absence of stage 2 NREM and reduced stage REM sleep , or " coma " ( n = 7 ) , characterized by > 50 % delta or theta EEG activity with ( n = 5 ) and without ( n = 2 ) evidence of EEG activation either spontaneously or in response to deep painful stimuli . The combined atypical sleep and coma groups had a higher APS ( 13 + /- 4 vs 6 + /- 4 ) and higher doses of sedative medications than the disrupted sleep group . CONCLUSION Sleep , as it is conventionally measured , was identified only in a subgroup of critically ill patients requiring mechanical ventilation and was severely disrupted . We have proposed specific criteria to select patients for future studies to evaluate potential causes of sleep disruption in this population Objective : The purpose was to establish the frequency of insomnia within the post-acute TBI population and compare it with insomnia rates among other rehabilitation out patients . Design : A prospect i ve study was undertaken of 50 consecutive post-acute TBI admissions and a comparison group of 50 rehabilitation out patients evenly divided between spinal cord injury ( SCI ) and musculoskeletal ( MSK ) cases . Setting : Subjects were recruited at various outpatient clinics of a major rehabilitation hospital . Patients : Among the TBI subjects , the predominant cause of injury was motor vehicle accident ; both mild and severe injuries were well represented in the sample ; and , on average , patients were almost 4 months post-injury . The comparison and TBI groups did not differ significantly with respect to education or marital status . However , the MSK group was older and a higher proportion of the SCI group was female . Measures : The Pittsburgh Sleep Quality Index ( PSQI ) , Beck Depression Inventory ( BDI ) , and sleep diaries  were administered to the TBI group . Only the PSQI and BDI were completed by the comparison group . Results : Thirty per cent of the patients were found to suffer from insomnia . Sleep initiation was a problem almost twice as often as sleep duration . An additional 12 % did not meet the DSM-IV criteria for insomnia but , nevertheless , experienced a degradation of sleep quality , as measured by the PSQI . Conversely , only slightly more than half ( 58 % ) of the TBI sample reported sleep to be relatively normal and satisfactory . Insomnia was also commonly reported by the patients in the rehabilitation comparison groups . They generated significantly higher mean PSQI Global Scores relative to the TBI group and the frequency of poor sleep quality was elevated significantly above the TBI rate . Relative to the TBI cases , twice as many comparison group patients were classified by the PSQI as insomniacs . Conclusion : Poor sleep quality and insomnia were definitely problems for the TBI group , although the magnitude of these problems was much greater for the rehabilitation comparison group . De grade d and disordered sleep may represent widespread challenges within the rehabilitation population in general
Conclusions : Chronic lack of sleep in adolescents is associated with greater risk of sports and musculoskeletal injuries .
Current evidence can not yet definitively determine the effect of acute lack of sleep on injury rates .
Background : Although sleep has been identified as an important modifiable risk factor for injury , the effect of decreased sleep on sports injuries in adolescents is poorly studied .
The objective of this study was to quantitatively and qualitatively review published literature to examine if a lack of sleep is associated with sports injuries in adolescents and to delineate the effects of chronic versus acute lack of sleep .