bluuebunny/crossref_metadata_2025 huggingface dataset:
PROXIMAL NEUROMUSCULAR CONTROL PROTECTS AGAINST HAMSTRING INJURY IN MALE FOOTBALL PLAYERS: A PROSPECTIVE STUDY WITH EMG TIME-SERIES ANALYSIS DURING MAXIMAL SPRINTING
Authors: Schuermans Joke , Danneels Lieven , Tiggelen Damien Van , Palmans Tanneke , Witvrouw Erik
Published: August 2017

Background

Hamstring injuries remain a substantial problem in male football. Proximal neuromuscular control (‘core stability’) is considered to be of key importance in hamstring injury prevention, although scientific evidence regarding the exact nature of the core-hamstring association is non-existing at present.

Objective

To investigate whether core muscle activation patterns during sprinting are associated with hamstring injury risk.

Design

Cohort study.

Setting

Amateur football division.

Participants

60 male football players with no recent history of hamstring injury were recruited for the multi-muscle EMG time series analysis during sprint.

Assessment

Hamstring-, gluteal and trunk muscle activity time-series during the airborne- and stance phases of over-ground sprint acceleration were collected prior to follow up (1.5 seasons).

Main Outcome Measurements

EMG signals of the above-mentioned muscles were processed and explored in function of (1) the time within the running cycle and (2) injury occurrence during follow up.

Results

Players that remained injury free, presented significantly higher amounts of gluteal muscle activity during the front swing phase (p=0.018), and higher amounts of trunk muscle activity during the backswing phase of sprinting (p=0.0011). In particular, the risk of sustaining a hamstring injury during follow up lowered 87% and 46%, with each increment in normalized muscle activity of the Gluteus Maximus during front swing and the trunk muscles during backswing, respectively (p<0.02).

Conclusions

Muscle activity of the proximal core unit during explosive running presented to be associated with hamstring injury occurrence. Higher amounts of gluteal – and trunk muscle activity during the airborne phases of sprinting were able to protect participants against injury during follow up. Hence, the present results provide a basis for improved, evidence based, rehabilitation and prevention, particularly focusing on increasing neuromuscular control of the gluts and trunk muscle during sport specific activities (eg. sprint drills, agility drills).
THE INCIDENCE OF ILLNESS DECREASES OVER A 6-YEAR PERIOD DURING THE SUPER RUGBY TOURNAMENTS: A PROSPECTIVE COHORT STUDY INVOLVING 96 959 PLAYER DAYS
Authors: Schwellnus Martin , van Rensburg Audrey Jansen , van Rensburg Dina Christina Janse , van Rensburg Charl Janse , Jordaan Esme , Derman Wayne , Readhead Clint
Published: August 2017

Background

Illness accounts for a significant proportion of consultations with team physicians. Furthermore, intercontinental travel is a risk factor for illness in teams participating in the annual 16-week Super Rugby Tournament.

Objective

To determine if the incidence of illness in players participating in the Super Rugby Tournaments changed after illness prevention strategies were recommended before the 2013 tournament.

Design

Prospective cohort study.

Setting

Super Rugby Tournaments from 2010 to 2015 (6-year period).

Participants

Elite rugby players from five South African Super Rugby teams (average squad size=30 players).

Assessment

Participating teams and players were followed daily during the ≈16 week competition period for 6 years (96 959 player days). Team physicians recorded daily squad size and completed a daily illness log using an online injury and illness registration system (100% compliance). Following data analysis of the 2010 tournament resulting in two publications in 2012, recommendations to prevent illness were introduced before the 2013 tournament. Furthermore, in 2014, detailed written illness prevention guidelines were distributed to all team physicians.

Main Outcome Measurements

Incidence of illness (illness per 1000 player days).

Results

The incidence of illness (per 1000 player days; 95% CI) for each year was as follows: 2010 (14.3; 12.2–16.8), 2011 (12.2; 10.3–14.3), 2012 (12.4; 10.6–14.3), 2013 (4.8; 3.8–5.9), 2014 (6.5; 5.3–7.9) and 2015 (6.1; 5.1–7.2). The incidence of all illness in the period 2013 to 2015 was significantly lower in each year compared to the incidence of illness in each year during the period 2010 to 2012.

Conclusions

In this 6-year prospective cohort study, there was a significant reduction in the incidence of illness in the years following the publication of illness data in 2012. We suggest that the illness prevention recommendations, introduced from 2013, could account for this reduction in illness incidence.
A DOWNWARD HEAD POSTURE LEADS TO HIGHER CERVICAL SPINE LOADING DURING HEAD-FIRST IMPACTS IN SIMULATED RUGBY TACKLES
Authors: Seminati Elena , Preatoni Ezio , Trewartha Grant , Stokes Keith , Williams Sean , Cazzola Dario
Published: August 2017

Background

A rugby tackle is an open and unpredictable event, which can lead to intentional or unintentional head-first impacts rather than the preferred ‘shoulder first’ technique.

Objective

To identify the effect of head-neck orientation as well as collision speed on the loads experienced at the upper cervical spine and the relevance in terms of injury risk from head-first impacts.

Design

Repeated ‘tackles’ were simulated using a 40 kg punch bag (simulated ball carrier) making contact against a fixed instrumented head and neck anthropometric test device (ATD).

Setting

Biomechanics laboratory.

Patients (or Participants)

A single head-neck ATD was used to complete all the trials.

Interventions (or Assessment of Risk Factors)

10 repetitions were recorded in each of two speed ranges (low and high) and 3 ATD sagittal plane orientations (head-up [+20°], neutral [0°], and head-down [-20°]), 60 trials in total.

Main Outcome Measurements

Forces experienced at the equivalent of the C1 vertebra were measured by a load cell at the head joint of the ATD. ANCOVA (covariate=punch bag speed) and effect sizes were used to assess differences between tackle conditions.

Results

Low speed (2.34±0.18 m/s) tackles resulted in 37% lower peak impact forces compared with high speed (3.43±0.17 m/s) tackles. Total force on neck acted in multiple directions (75% in compression; magnitude of total force was 2.37±0.18 kN in neutral high speed condition) and it was substantially higher in the head-down orientation compared with the neutral (13%) and head-up orientation (17%).

Conclusions

Our findings support the idea that: 1) collision speed during a tackle affects the load experienced by the head-neck structures; 2) a neutral or head-up orientation of the head is preferred to a head-down orientation in the event of head-first impacts during simulated rugby tackle, which aligns with current Rugby Union coaching recommendations.
RISK FACTORS FOR NON-CONTACT ANTERIOR CRUCIATE LIGAMENT INJURY IN JAPANESE FEMALE HIGH SCHOOL BASKETBALL AND HANDBALL PLAYERS. A PROSPECTIVE THREE-YEAR COHORT STUDY
Authors: Shima Yosuke , Nakase Junsuke , Kitaoka Katsuhiko , Numata Hitoaki , Oshima Takeshi , Takata Yasushi , Kobayashi Takashi , Tsuchiya Hiroyuki
Published: August 2017

Background

Many studies have explored the risk factors for noncontact anterior cruciate ligament (ACL) injuries.

Objective

To prospectively evaluate risk factors for noncontact ACL injury in Japanese female high school basketball and handball players. We hypothesized those female high-school athletes suffering non-contact ACL injuries would demonstrate weaker hip abductor and knee flexor muscle strength, when compared to those without injury.

Design

Prospective cohort study.

Setting & Participants

A 3-year prospective cohort study was conducted using 317, 15-year-old high school female athletes between 2009 and 2014. At baseline, they underwent detailed examinations for various parameters that were documented at their first-year of high school.

Assessment of Risk Factors

The parameters assessed were height, weight, body mass index, general joint laxity, navicular drop measurement, anterior laxity of the knee, and angle of femoral anteversion, and strength assessment included knee extensor/flexor muscle strength and hip abductor strength. All ACL injuries that occurred during these 3 years were recorded. The parameters were compared using the Studentt-test. Parameters with P values<0.2 were considered independent variables by logistic regression analysis (simultaneous). The level of significance for all statistical analyses was set at α=0.05.

Results

Of the 317 players, 27 were excluded because they either had a history of ACL injury or could not complete the study. A total of 30 ACL tears occurred. Three of the ACL injuries were contact injuries, whereas the remaining 27 were noncontact ACL injuries. Muscle strength of hip abduction (P=0.001, 95% CI, 1.793–67.534) and femoral anteversion (P=0.037, 95% CI, 0.759–0.991) were found to be independent risk factors in logistic regression analysis.

Conclusions

We found that increased hip abductor muscle strength and decreased femoral anteversion were risk factors for noncontact ACL injury. However, there was only a little difference.
WHAT DOES RETURN TO PRE-INJURY RISK MEAN?
Authors: Shrier Ian , Zhao Meng , Piché Alexandre , Slavchev Pavel , Steele Russell J.
Published: August 2017

Background

Previous injury is the strongest predictor of subsequent injury. Some authors suggest injury always causes permanent structural damage, or that rehabilitation programs are grossly inadequate.

Objective

To describe the limitations of commonly used analyses assessing subsequent injury risk, and to explicitly define what “100% effective rehabilitation” means.

Design

Simulated studies based on observed data professional sport and performing arts.

Setting

Simulations were conducted with 100% rehabilitation post first injury (return to pre-injury state), in contexts where injury risk was stable over the season, and increased over the season.

Patients (or Participants)

Simulated data.

Interventions (or Assessment of Risk Factors)

The main independent variables are previous injury, time of first injury, and position. We included “participant” as a random effect.

Main Outcome Measurements

Injury risk expressed as injuries per games played.

Results

When our simulated data with 100% effective rehabilitation was based on constant injury risk during the season, traditional analyses found that previous injury was still strongly associated with subsequent injury. A causal analysis that included the participant as a random effect correctly showed that the injury risk for participants remained constant. When injury risk increased over the season, the traditional analysis found that previous injury was even more strongly associated with subsequent injury. A causal analysis that only included the participant as a random effect also suggested a higher injury risk. However, when the appropriate control group was chosen for comparison, the causal analysis correctly illustrated that pre-injury risk did not increase following an initial injury.

Conclusions

Conclusions about the effectiveness of rehabilitation programs using traditional risk factor analysis will always show an increased risk of subsequent injury even if none exists. A causal analytical approach correctly identifies when the risk is present, but requires careful consideration about what is the appropriate control group for the given question.
THE INCIDENCE OF SWIMMING-INDUCED PULMONARY OEDEMA DURING MASS-PARTICIPATION TRIATHLON RACES: OPTIMISING ATHLETE SAFETY
Authors: Smith Ralph , Parkin James , Knight Nick , Kipps Courtney
Published: August 2017

Background

Swimming Induced Pulmonary Edema (SIPE) is life-threatening condition that can affect healthy triathletes. There have been several reported cases amongst triathletes, however the current estimation of incidence is derived from a survey of triathletes with self-reported symptoms suggestive of SIPE.

Objective

To investigate the incidence of SIPE and associated risk factors in mass participation Triathlon Competitions (TC).

Design

A retrospective analysis of Competitors' Medical Records (CMR).

Setting

11 consecutive UK-based TCs between 2011 and 2016. The competitions involved elite and non-elite competitors who raced Super Sprint, Sprint, Olympic and Olympic Plus distances.

Participants

CMR of patients presenting to Triathlon Medical Team (TMT) with medical complaints/injuries were analysed. Those diagnosed with SIPE were included. Diagnostic criteria included absence of water aspiration, acute onset of dyspnoea, cough and/or expectoration of frothy sputum, with evidence of pulmonary oedema on physical examination.

Assessment of Risk Factors

Patients' Age, gender, race distance, co-morbidities and medical management were recorded.

Main Outcome Measurements

The incidence of SIPE in TCs.

Results

68557 competitors started the TCs and 429 competitors presented to the TMT. Five case of SIPE were recorded, giving rise to an incidence of 0.73/10,000 competitors and 1.2% of all presentations to the TMT. Mean age was 42 (21–58) and a third were female. All were non-elite athletes competing in a variety of race distances; one patient had pre-existing cardiac comorbidities; and in 3 cases participants were competing in their first triathlon. All required supplementary oxygen and transfer to hospital for definitive management.

Conclusion

This report is the first to describe the incidence of SIPE in mass participation triathlon competitions. Event organisers and TMTs should be prepared for competitors developing SIPE which appears not to be bound by age, gender, race distance or co-morbidities. Further research is required to identity those who are at risk of SIPE.
NO ASSOCIATION BETWEEN STATIC AND DYNAMIC POSTURAL CONTROL AND ACL INJURY RISK AMONG FEMALE ELITE HANDBALL AND FOOTBALL PLAYERS
Authors: Steffen Kathrin , Nilstad Agnethe , Krosshaug Tron , Pasanen Kati , Bahr Roald
Published: August 2017

Background

Little research exists quantifying balance measures as potential risk factors for ACL injury.

Objective

To assess whether static and dynamic postural control were associated with an increased risk for ACL injury in female elite handball and football players.

Design

Prospective cohort study.

Participants

From 2007 through 2015, 838 female premier league players participated in pre-season testing and were prospectively followed for ACL injury risk.

Assessment of risk factors and main outcome measures

At baseline, we recorded player demographics, playing experience, ACL and ankle injury history. We measured the mean velocity of COP in medio-lateral (ML) and anterior-posterior (AP) directions (mm/s), as well as the area of the 95% confidence ellipse area (mm2). We used the Star Excursion Balance Test to measure anteromedial, medial and posteromedial reach directions (cm). To examine the stability of postural control measures over time, we examined long-term and short-term reproducibility. We followed a pre-defined statistical protocol with logistic regression models, one for each of the proposed risk factors.

Results

A total of 55 (6.6%) players (age: 20±4 yrs; height: 171±7 cm; body mass: 68±9 kg) sustained a non-contact ACL injury after baseline testing (1.8±1.8 yrs). When comparing height and leg-length normalized balance measures between injured and uninjured players in univariate analyses, none of the variables were statistically associated with an increased risk of ACL rupture. Short- and long-term reproducibility of the selected variables was poor. Players with a previous ACL injury had a 3-fold higher risk of sustaining a new ACL injury compared to previously uninjured players (OR 2.9, CI 1.4 to 5.7).

Conclusions

None of the static and dynamic postural control measures examined were associated with increased ACL injury risk among female elite handball and football players. Hence, the variables included in the current investigation cannot be used to predict injury risk.
INJURY PREVENTION IN YOUNG ATHLETES: INFLUENCE OF PREVENTION-SUPERVISION ON COMPLIANCE
Authors: Stoll Josefine , Mueller Juliane , Mueller Steffen , Cassel Michael , Mayer Frank
Published: August 2017

Background

Prevention programs are reducing the risk of injuries. The success of these programs is dependent on a high compliance. However, it is unclear which kind of supervision lead to a high compliance in young athletes.

Objective

To compare the influence of different kinds of prevention-supervision during prevention training on compliance in young athletes.

Design

Controlled trial.

Setting

University Potsdam, Medical Examination Center of the German Olympic Sports Federation.

Patients (or Participants)

173 young athletes (m/f: 108/68; 13.4±0.4 yrs, 164.±58.6 cm, 52.3±9.0 kg) from different sports were included.

Interventions (or Assessment of Risk Factors)

Athletes participated in a back pain prevention program (duration: 45 weeks; 4 exercises, 3 times/week, progression every 15 weeks). Following the initial introduction to the program, athletes were divided into 3 groups (G1: N=30; G2: N=54; G3: N=89). In G1 the coach, in G2 the coach and the athlete was responsible to execute the prevention program. In addition to G2, a therapist supervised the program once per week in G3. The number of prevention sessions was documented (paper & pencil) by coach (G1), athlete (G2) and athlete/therapist (G3).

Main Outcome Measurements

The number of response per athlete (documented sessions) and the training-sessions per week was analysed. Data are presented descriptively followed by analysis of group differences (ANOVA; post-hoc Tukey, α =0.05).

Results

All athletes in G1 responded and documented the training-session/week with a frequency of 2.0±0.4 sessions/week. In G2 53 athletes (2.5±0.7 sessions/week) and in G3 75 athletes (2.7±0.8 sessions/week) responded. Statistically significant differences could be shown between G1 and G2 (p=0.0005) and between G1 and G3 (p=0.058). There were no group differences between G2 and G3 (p=0.15).

Conclusions

For a targeted high compliance in prevention training, a supervised implementation seems necessary. Good teamwork between coach, athlete and therapist seems to be mandatory. A personal responsibility of the athlete is relevant.
IN-SEASON ARCHITECTURAL ADAPTATIONS OF THE BICEPS FEMORIS LONG HEAD IN ELITE AUSTRALIAN FOOTBALLERS
Authors: Timmins Ryan , Bourne Matthew , Williams Morgan , Opar David
Published: August 2017

Background

Hamstring strain injuries (HSI) are the predominant injury in the elite Australian Football League (AFL). Athletes who possess short biceps femoris long head (BFlh) fascicle lengths have an increased risk of future HSI than those who have longer fascicles. Fascicle length can be altered following interventions, however it is unknown what alterations occur in-season. It is also unknown if this may differ between those with and without a history of HSI.

Objective

Determine what architectural changes occur during an AFL season. Identify if these changes are different between those with and without a history of HSI.

Design

Cross-sectional retrospective injury study.

Setting

Elite Australian Football.

Participants

Thirty elite AFL players with (n=12) and without (n=18) a unilateral history of HSI.

Assessment of Risk Factors

BFlh architecture was assessed once a month on six separate occasions during the 2016 AFL season using two-dimensional ultrasound.

Main Outcome Measurements

BFlh fascicle length.

Results

Limbs with a history of HSI possess shorter fascicles than previously uninjured limbs at the start and throughout the season. From time point 1 to time point 2, previously injured BFlh fascicle lengths did not significantly change (p=0.247,d=0.23), whilst the contralateral uninjured BFlh(p=0.009,d=0.56) and athletes with no history of injury (p=0.002,d=0.75), significantly increased BFlh fascicle length. All athletes, independent of injury history, had a significant reduction in fascicle length at time point 6 compared to time point 2.

Conclusions

Fascicle lengths of BFlh vary across the in-season period in elite AFL players and the extent of these alterations appears to be influenced somewhat by HSI history. However, independent of injury history, there was a gradual decay in fascicle length as the season progresses.
A COMPARISON OF CALCANEAL BONE DENSITY IN COLLEGIATE ATHLETES AND NON-ATHLETES
Authors: Bennett Jason
Published: August 2017

Background

Limited evidence exists regarding calcaneal bone mineral density (cBMD) and lower extremity overuse bone injury (LEOBI).

Objective

Determine if there is an association between LEOBI (stress fractures and MTSS) and cBMD.

Design

Prospective cohort design.

Setting

NCAA Division I University.

Patients (or Participants)

84 (64 females, 20 males) intercollegiate athletes and 103 (82 females, 21 males) non-athlete college students. Inclusion criteria: ≥18 years of age and no current lower extremity injury.

Interventions (or Assessment of Risk Factors)

In Phase I, athlete surveys regarding injury history and for females, menstrual history, and height and weight were measured. Athletes were followed for 9–10 months to identify the occurrence of LEOBI. In Phase II, non-athlete college students completed injury history, physical activity, and, for females, menstrual history surveys, and height and weight were measured.

Main Outcome Measurements

cBMD was assessed using ultrasound densitometry. At the end of the study, athletes received a second cBMD measurement.

Results

In Phase I, there was no difference in initial cBMD (p>0.05) between athletes with and without LEOBI, but there was a trend towards decreased cBMD in athletes with LEOBI. At the end of the study, right cBMD (p=0.05) and left cBMD (p=0.07) were lower in athletes with LEOBI. In Phase II, non-athletes had significantly lower bilateral cBMD (p=.000) and speed of sound (SOS) (p=0.000) than athletes. Sub-analysis revealed highly significant differences in SOS (p=0.000) and cBMD (p=0.000) for females (non-athletes vs. athletes). Being a female non-athlete was a significant risk factor for a negative cBMD T-score for both the right (RR=2.2, 95% CI=1.4–3.3) and left (RR=1.7, 95% CI=1.1–2.6).

Conclusions

Athletes who did not experience LEOBI had significantly higher cBMD than non-athletes and athletes experiencing LEOBI. Future research should include larger sample sizes and adolescent subjects to identify influences on bone response to loading over time.
SHOULDER INJURIES IN TALENTED, COMPETITIVE SWIMMERS
Authors: van Dorssen Elsbeth , Stubbe Janine
Published: August 2017

Background

Shoulder injuries are common in swimmers. However, prevalence and risk factors for shoulder injuries in talented, competitive swimmers are unknown.

Objective

To gain insight in the prevalence and risk factors for shoulder injuries in talented swimmers.

Design

A prospective cohort study was conducted.

Setting

Talented, Dutch swimmers, competing at National or International level, swimming at talent or training Centres of the Royal Dutch Swimming Federation.

Patients (or Participants)

128 swimmers were included at the start of the study. Five swimmers were excluded due to missing technique data, five swimmers quit their swimming career during the follow-up for different reasons than shoulder injuries. Data of the remaining 118 swimmers were included into the analyses.

Interventions (or Assessment of Risk Factors)

At baseline the following swimming technique was recorded during a 200 m race: 1. Maximal forward flexion in the shoulder joint during glide phase; 2. Crossing the vertical midline axis of the swimmers body with the hand during thrust-phase; 3. Dropped elbow (elbow at a lower level than line shoulder-wrist), at hand entry or early pull-through. Furthermore, online questionnaires were send to the participants on a two-weekly basis to record the time-loss shoulder injuries.

Main Outcome Measurements

A time-loss shoulder injury was defined as: ‘a shoulder complaint occurred as a result of participation in swimming practice or competition, resulted in the restriction of swimmers participation of at least 1 day’. Prevalence and incidence rates were calculated.

Results

In total, 28,8% of the swimmers sustained a shoulder injury during 1 year. Chi-squared tests showed an association between crossing the midline during thrust-phase and shoulder injuries (p-value=0.03). No significant association was found between the two other swimming techniques and shoulder injuries.

Conclusions

The prevalence of shoulder injuries is high in talented, competitive swimmers. Crossing the midline during thrust-phase may be a risk factor in developing shoulder pain.
RISK FACTORS FOR INJURIES IN ELITE YOUTH TENNIS PLAYERS
Authors: van Mechelen Joost , Nauta Joske , Pluim Babette , Verhagen Evert
Published: August 2017

Background

The number of elite junior tennis players is growing. However, very little is known about the risk factors for injuries in this specific population.

Objective

To identify risk factors for musculoskeletal injuries in elite youth tennis players.

Design

A prospective cohort study during the 2012–2013 Dutch tennis season.

Setting

Elite youth players.

Participants

Players were recruited from the Dutch national high-performance program during the pre-season intake. Seventy-three players agreed to participate (age range 11–14 years, 29 girls and 44 boys). All 73 players completed the entire follow-up period.

Assessment of Risk Factors

At baseline all players underwent a basic screening. Potential risk factors recorded included: (1) anthropometric data, (2) joint range of motion(ankle, hip, and shoulder), (3) pubertal stage, (4) current physical complaints.

Main Outcome Measurements

During the season, players reported physical complains on a weekly basis through the OSTRC injury questionnaire. The outcome of interest were the musculoskeletal injuries, subdivided into acute and overuse injuries.

Results

During the season, 113 musculoskeletal injuries were reported (78% overuse injuries). For acute injuries, no significant risk factors could be identified. Only pre-season complaints showed a borderline association with all acute injuries (HR 0.36 [95% CI 0.12–1.06], yes=1). When only considering lower extremities, a significant association between preseason complaints and injury at the lower extremity could be reported (HR 0.29 [95% CI 0.10–0.88], yes=1). Overuse injuries were significantly associated with total hours of sports participation (OR 7.15 [95% CI 1.32–38.98]) and wearing supportive insoles (OR 0.13 [95% CI 0.02–0.79], yes=1).

Conclusions

Preseason complaints, total hours of sports participation and the use of supportive soles were the factors associated of injuries in elite youth tennis players. Gender, pubertal stage and range of motion were not found to be risk factors for tennis injuries.
REPRODUCIBILITY OF THE DRGONIOMETER APP IN NORDIC HAMSTRING TEST ASSESSMENT
Authors: Vercelli Stefano , Baldaccini Alex , Sartorio Francesco , Bravini Elisabetta , Ferriero Giorgio
Published: August 2017

Background

The break-point angle (BPA) obtained during the Nordic Hamstring Test (NHT) can be used for preventive purposes to identify individuals with low eccentric hamstring strength. Video analysis is the preferred standard method, but there lacks an easily accessible and highly reproducible method for field use.

Objective

To establish the reproducibility (reliability and agreement) of the smartphone application ‘DrGoniometer’ (DrG) for measuring BPA in healthy adults.

Design

Diagnostic study.

Setting

Clinical setting.

Patients (or Participants)

Five volunteers and four raters (two physiotherapists and two physiotherapy students).

Interventions (or Assessment of Risk Factors)

Ten NHT videos per subject were obtained by smartphone camera (total=50 videos). Raters independently measured the BPA, first using DrG app set in blind modality on two separate occasions (one week apart), then by standardized video analysis software on a PC.

Main Outcome Measurements

Intra- and inter-rater reliability of DrG was calculated with ICC(2,1)(95% IC). Longitudinal standard error of measurement (SEM) and inter-rater agreement within 5° and 10° were also calculated. The agreement of DrG with video analysis was expressed as 95% limits of agreement (LoA) with the Bland-Altman method.

Results

Intra- and inter-rater reliability of the DrG were excellent, with ICC=0.885 (95% IC=0.836–0.918) and .821 (95%IC=0.738–0.885), respectively. The SEM was 2°. All four raters had substantial inter-rater agreement within the limits of 5° (68% and 78%) and 10° (94% and 100%) for the DrG and video analysis methods, respectively. The agreement between the two methods was good, with 95% LoA equal to 13.4° (mean difference=1.0±6.7°).

Conclusions

DrG proved to be a highly reproducible method for measuring the BPA in the NHT in healthy subjects. Given its wide availability, low cost, and ease of use, the DrG app can be considered a good resource for field-based BPA measurement.
EFFECTIVELY TRAINING PHYSICAL EDUCATION TEACHERS TO IMPLEMENT INJURY PREVENTIVE STRATEGIES INTO THEIR PE LESSONS
Authors: Vercruysse Sien
Published: August 2017

Background

Physical education teachers (PETs) can be effectively trained to implement injury preventive strategies into their own lives.1 However, to decrease negative effects of sports injuries in adolescents, injury prevention within this population is needed as well. Therefore, the current study trains PETs to implement injury preventive strategies both in their own lives and in their PE lessons.

Objective

Aim 1 was investigating whether an intervention can effectively improve PETs' injury preventive knowledge. Aim 2 was investigating whether the intervention led to more injury preventive implementation in PETs own extracurricular sporting activities. Aim 3 was investigating whether the intervention enhanced PET injury preventive implementation in their PE lessons.

Design

An RCT was conducted.

Setting

Secondary school PETs, active in second grade (14–16 years), were recruited.

Participants

Fourteen PETs were randomly assigned to either intervention (Mage 41.43±10.21) or control group (Mage 38.86±8.32). Per PET one of their classes of pupils from second grade was questioned (n=271).

Interventions

An effective injury prevention intervention1 was provided with adaptations for a more easily implementation in PE lessons.

Main Outcome Measurements

PET injury preventive knowledge, preventive behaviour in extracurricular sporting activities and during PE lessons were assessed at three different time points; before the intervention (pre), 4 (post) and 7 weeks (follow-up) after receiving the intervention. Pupils filled out a questionnaire on their PET injury preventive teaching behaviour (pre-post-follow-up).

Results

The injury prevention intervention resulted in an improvement of PET injury preventive knowledge (F(10,2)=7.718, p=0.005), PET preventive behaviour in own extracurricular sporting activities (F(14,2)=4.105; p=0.047) and in their teaching behaviour towards the pupils in PE lessons (F(14,2)=3.147; p=0.061). Reports of pupils pointed in the same direction as the reports of PETs.

Conclusions

The intervention improved PET injury preventive knowledge and behaviour, both in their own lives as in their PE lessons.
THE FEASIBILITY OF A SPORTS PHYSICAL THERAPIST LED IMPLEMENTATION OF A PREVENTIVE TRAINING PROGRAM IN A DUTCH AMATEUR FOOTBALL CLUB
Authors: Verheul Maartje , Barendrecht Maarten
Published: August 2017

Background

Preventive training programs are effective in reducing injury risk but the implementation of these programs on club level remains a challenge. The sports physical therapist (SPT) could play an important role in this process. The feasibility of a SPT led implementation process has not yet been investigated.

Objective

To investigate the feasibility of a SPT led implementation of a preventive warm-up program in a Dutch amateur football club.

Design

Implementation study.

Setting

A Dutch amateur football club.

Patients (or Participants)

Club officials, trainers, coaches and athletes.

Interventions (or Assessment of Risk Factors)

SPT led implementation of the FIFA11+ warm-up program on all club levels in a Dutch amateur football club.

Main Outcome Measurements

Tasks and time-management of the SPT. Effectiveness of different aspects of the implementation process using the RE-AIM framework.

Results

Important tasks on sports medical subjects were the development of a training program adjusted to the context and the adopters, and yearly coach education (workshops and manuals). Management tasks consisted of the composition of an implementation team and plan, and the support of this team during the implementation process. Overall during the first season it took the SPT 50 hours to complete these tasks. After one season adoption (88.4%) and implementation (88.9%) on trainer level as well as maintenance on club level (>92%) were high.

Conclusions

A SPT led implementation process of an injury prevention program in an amateur football club seems a feasible option to change club level policy and behaviour on injury prevention, in addition to implementation strategies on national level and in coach education. Prospective randomized trials are needed to investigate the additional effectiveness of such club level implementation.
KINETIC CHAIN RELATED RISK FACTORS FOR THE DEVELOPMENT OF LOWER EXTREMITY INJURIES IN WOMEN: A PROSPECTIVE STUDY
Authors: Verrelst Ruth , Tiggelen Damien Van , Ridder Roel De , Witvrouw Erik
Published: August 2017

Background

Attention has turned to the role of the overall kinetic chain function within the development of lower extremity (LE) injury, however few longitudinal studies have been conducted so far.

Objective

To prospectively determine kinetic chain related risk factors for the development of lower extremity (LE) injury in women.

Design

Prospective cohort design.

Setting

Department of Physical Education at the University of Ghent, Belgium.

Participants

Ninety healthy, female physical education students aged 19.33±0.87 years were tested.

Assessment of Risk Factors

Kinematic and VGRF parameters were measured during a triple hop jump (THJ). Cox regression analysis was used to identify the kinetic chain related risk factors for the development of LE injury.

Main Outcome Measurements

The LE injury follow-up was assessed using a weekly online questionnaire and a three-monthly retrospective control questionnaire. LE injury was diagnosed by an experienced medical doctor.

Results

Thirty-five participants were diagnosed with a LE injury. The results of this study identified that in the sagittal plane, decreased dynamic range of motion (ROM) of the pelvis segment (P=0.043) and increased dynamic ROM of the knee and ankle joint (P=0.041 andP=0.028 respectively) during landing phase are predictive parameters for the development of LE injury in females. No VGRF parameters were found to be of predictive value.

Conclusions

The pattern of decreased ROM of the pelvis segment in the sagittal plane combined with increased ROM of knee and ankle joint in the sagittal plane during landing phase, can be seen as decreased ability of equally absorbing forces throughout the kinetic chain during the landing phase of the THJ, which might lead to LE injury.
AN ASSESSMENT OF CLINICAL JOINT AND LIMB MEASURES IN PROFESSIONAL FEMALE SOCCER PLAYERS: SCREENING TOOLS FOR INJURY PREVENTION?
Authors: Weaver Kristian , Relph Nicola
Published: August 2017

Background

Female soccer has only recently become a professional sport within the UK. The need for accurate and reliable screening and profiling of professional female soccer players could assist in the design of injury prevention programmes.

Objective

To evaluate the clinical joint and limb measures during a preseason screening process in professional female soccer players.

Design

Cross-sectional, descriptive study.

Setting

Sports Therapy clinic.

Participants

32 professional UK-based female soccer players (aged 23±3.60, mass 62.41±6.37 kg, height 167±6.65 cm) participated in the study.

Assessment of Risk Factors

Risk factors were assessed during the English Women's Super League preseason, January 2016. The independent variable was leg dominance.

Main Outcome Measurements

The outcome measures were leg length, knee to wall distance, knee flexion and extension, hip flexion and extension, hip internal and external rotation ranges of motion (ROM), straight leg raise hip flexion angle from both dominant and non-dominant legs. A qualified and experienced Sports Therapist subjectively assessed and recorded joint ligament laxity at the knee and ankle.

Results

Paired T-Tests revealed significantly reduced ROM in the dominant side compared to the non-dominant side for both hip flexion (p=0.005) and hip internal rotation (p=0.021). However, all other ROM measurements demonstrated limb symmetry. The most notable findings from the subjective laxity measures was that 35.9% of players had ankle talar inversion laxity.

Conclusions

Reduced hip ROM in the dominant side of players may increase the risk of lower limb injury. It may be important to include hip flexibility training into pre-season injury prevention programmes for female soccer players to ensure lower limb symmetry. Furthermore, ankle strengthening, proprioception and single leg change of direction exercises may be included in training programmes due to the high prevalence of ankle laxity in this sample. Future studies should monitor these measurements across a season and correlate them with injury incidence.
UNDERSTANDING HOW CLINICIANS AND ATHLETES MAKE RETURN TO PLAY DECISIONS – TOWARDS PREVENTING RE INJURIES
Authors: Weir Adam , Wangensteen Arnlaug , Serner Andreas , Steele Russel J. , Shrier Ian
Published: August 2017

Background

Clinicians and athletes do not always agree when return to play (RTP) is advisable. A better understanding of how RTP decisions are made could help prevent re injury.

Objective

To describe and compare risk assessments from sport medicine physicians, physiotherapists and athletes during routine care of injured athletes, and to elicit if there were factors that influenced their risk tolerance.

Design

Feasibility study to establish this method of examining the way athletes and clinicians make RTP decisions.

Setting

Specialized orthopedic and sports medicine hospital in Doha, Qatar.

Patients

We recruited the physician, the physiotherapist, and the athlete they were caring for (“triplet”) to participate. Triplets were recruited from an acute groin injury study and an acute hamstring injury study. Of the 15 athletes approached, 5 were excluded because we obtained risk estimates from only 1 stakeholder. Of the remaining 10 cases, we obtained risk estimates from 7 triplets and 3 doublets.

Outcome measures

Participants provided their own estimated probability distribution for risk of re-injury within the subsequent 2 months after RTP, based on the available knowledge. In addition, we asked participants about factors that influenced their risk tolerance for the particular case.

Results

The figure shows the risk estimations in 2 of the 10 cases, illustrating that there were clear and considerable differences in risk estimates.

Figure 1

Factors that modified risk tolerance in at least three participants were “timing and season”, “pressure from athlete” and “external pressure”. Overall, risk modifiers influenced the decision in 13 of 27 possible cases.

Conclusion

Clinicians and athletes with access to the same information can have considerably different estimates for the risk of reinjury. Risk tolerance in the real world is sometimes modified by external factors.
WORKLOAD SPIKES COMBINED WITH HIGH CUMULATIVE LOAD IS ASSOCIATED WITH INCREASED INJURY RISK IN ELITE RUGBY SEVENS PLAYERS
Authors: West Stephen , Williams Sean , Cross Matthew , Howells Dan , Mobed Remi , Kemp Simon , Stokes Keith
Published: August 2017

Background

Match and training demands differ between seven and fifteen-a-side rugby. The association between training load and injury risk has not been examined in elite Rugby Sevens.

Objective

To explore the association between training load measures and injury risk in elite Rugby Sevens players.

Design

Two-season (2014/15 and 2015/16) prospective cohort study.

Setting

The England men's Rugby Sevens squad.

Participants

42 players (31 players followed over one-season, 11 players over two-seasons).

Assessment of Risk Factors

Training loads were recorded for all sessions using the session-Rating of Perceived Exertion method. A generalised linear mixed effects model examined the association between training load measures and injury risk in the subsequent week. The acute:chronic workload variable (one-week load divided by four-week average load) was parsed into tertiles: low=<1.15; medium=1.15–1.45; high=>1.45.

Main Outcome Measurements

Injury and the relative risk (RR) associated with increases in training load measures.

Results

152 training and 30 match injuries were recorded. The incidence rate was 91/1000 player-match-hours (90% CI: 68–123) and 14/1000 player-training-hours (90% CI: 12–16). Mean severity (day's absence) of injuries was 31 days during matches and 21 days during training. There was a substantial interaction between four-week cumulative load and acute:chronic workloads, such that typically high versus typically low four-week cumulative loads (i.e., a 7140 AU difference) coupled with high acute:chronic workloads were clearly associated with injury risk (RR: 2.08, 90% CI 1.17–3.68). This effect was unclear in the low (RR: 1.02, 90% CI: 0.62–1.68) and medium (RR: 1.44, 90% CI: 0.81–2.55) acute:chronic workload ranges.

Conclusions

The injury incidence rate in elite Rugby Sevens training is substantially higher than in the 15-a-side game. The coupling of high cumulative loads with high acute:chronic workloads was associated with an increased injury risk, therefore practitioners should avoid high acute:chronic workloads during periods of high cumulative load.
THE USE OF NON-STEROIDAL ANTI-INFLAMMATORIES (NSAIDS) AT THE 2016 LONDON MARATHON
Authors: Whatmough Steven , Mears Stephen , Kipps Courtney
Published: August 2017

Background

Non-steroidal Anti-Inflammatories (NSAID) used during exercise are associated with medical risks. Such risks include gastric side effects and renal side effects (Kusteret al, 2013). More specifically NSAIDs are implicated in the development of exercise-associated hyponatremia (Hew-Butleret al, 2015)).

Objective

To identify the incidence of NSAID use in runners at the 2016 London Marathon.

Design

This study will take the form of a prospective observational study.

Setting

The 2016 London Marathon.

Participants

Participants were recruited during the marathon registration. 109 runners completed the questionnaire. In addition, a subset of 41 runners completed an immediate pre-race questionnaire on the morning of the race, of which 28 were followed up after crossing the finish line.

Independent Variables

Online and printed medical advice was available to all race participants. This included advice to refrain from using NSAIDs before and during the race was provided.

Main Outcome Measures

Planned NSAID use, actual NSAID use and awareness of safe doses and NSAID risks.

Results

50 (45.9%) of the registration cohort planned to take an NSAID during the marathon. Of the athletes returning for data collection at the start line, 14 (34.1%) had already consumed an NSAID on the morning of the marathon. At the finish line, 16 of the 28 (57.1%) of athletes completing the study had consumed an NSAID. Seven runners had taken over the recommended dose of NSAID during the marathon. 13 (46%) correctly stated the risks of taking an NSAIDs, whilst only 10 (35%) were aware of the correct safe dose.

Conclusions

NSAID use by runners during the marathon remains high despite published medical guidance advising against its use. Overdose of NSAIDs is a concern as it carries increased risks. A lack of awareness of the risks of taking NSAIDs may contribute towards these findings.
PREDICTING LOWER EXTREMITY INJURY RISK IN SPORT THROUGH MOVEMENT QUALITY SCREENING: A SYSTEMATIC REVIEW
Authors: Whittaker Jackie , Motte Sarah de la , Dennett Liz , Booysen Nadine , Lewis Cara , Wilson David , McKay Carly , Warner Martin , Padua Darin , Emery Carolyn , Stokes Maria
Published: August 2017

Background

The identification of risk factors for lower extremity musculoskeletal (MSK) injury in sport is required to inform primary and secondary injury prevention strategies.

Objective

To determine whether measures of poor movement quality are associated with lower extremity MSK injury in sport.

Design

Systematic Review.

Methods

Five electronic databases (Medline, EMBASE, CINAHL, Sport Discus, SCOPUS) were systematically searched using keywords and Medical Sub-heading terms. Studies selected included: English language; original data; prospective analytic design; a rating of movement compensation, asymmetry, impairment or efficiency through composite batteries and/or individual tests; and participants with lower extremity MSK injury sustained with sport participation. PRISMA guidelines were followed and two independent raters assessed study quality [Downs and Black (DB) criteria] and level of evidence (Oxford Centre of Evidence-Based Medicine model).

Results

Of 4361 potential relevant studies, 13 were included. The majority (11/13) of the studies were low quality cohort studies (level 4 evidence). Median DB score was 11/33 (range 3–14). Heterogeneity in methodology and injury definition precluded meta-analyses. The Functional Movement Screen (FMS) was the most common movement quality outcome investigated (11/13 studies). Two studies considered interrelationships between risk factors, five reported diagnostic accuracy and none evaluated an intervention program targeting individuals identified as high-risk. There is inconsistent evidence that poor movement quality is associated with increased risk of lower extremity injury in sport.

Conclusions

There is insufficient evidence for widespread adoption of movement quality screening programs for predicting lower-extremity injury in sport. Future research should aim to identify the most relevant movement quality outcomes for predicting injury risk through high quality cohort studies. This should be followed by development and evaluation of pre-participation screening and lower extremity injury prevention programs through high quality randomized controlled trials targeting individuals at the greatest risk based on screening tests with validated test properties.