bluuebunny/crossref_metadata_2025 huggingface dataset:
MEASURING ECCENTRIC STRENGTH OF THE SHOULDER EXTERNAL ROTATORS USING A HAND-HELD DYNAMOMETER: RELIABILITY AND VALIDITY
Authors: Johansson F , Cools A , Skillgate E
Published: March 2014

Background

Shoulder strength assessment plays an important role in the clinical examination of the shoulder region. Eccentric strength measurements are of special importance guiding the clinician in the injury prevention or return to play decisions after injury.

Objective

The primary aim of this study was to examine the absolute and relative reliability and validity of a standardized eccentric strength measurement protocol for the glenohumeral external rotators.

Design

Reliability and Validity study.

Setting

Testing environment at the department of Rehabilitation Sciences and Physiotherapy of the Ghent University, Belgium.

Participants

25 healthy subjects (9 male and 16 female) without any history of shoulder pain were tested.

Risk factor assessment

The subjects were tested by two independent assessors using a hand-held dynamometer (HHD), and underwent an isokinetic testing procedure. A clinical protocol, using a HHD, a Dynaport accelerometer to measure acceleration and angular velocity and a Biodex to measure isokinetic testing was used.

Main outcome measurements

Three (3) eccentric strength measurements: (1) tester one with the HHD, (2) tester two with the HHD, and (3) Biodex isokinetic strength measurement.

Results

The intratester reliability was found to be excellent (0,879 and 0,858), whereas the intertester reliability was good with an ICC between testers of 0,714. Pearson correlation coefficients of 0,78 and 0,70 were found between the HHD and the isokinetic data, showing good validity of this new procedure.

Conclusions

This study shows that standardized eccentric rotator cuff strength can be measured and performed in the clinical setting with good to excellent reliability and validity using a HHD.
NEUROMUSCULAR KNEE JOINT CONTROL IN ADOLESCENTS WITH AND WITHOUT GENERALISED JOINT HYPERMOBILITY DURING LANDING IN THE SINGLE LEG HOP FOR DISTANCE TEST
Authors: Junge T , Juul-Kristensen B , Bloch Thorlund J , Søgaard J , Wedderkopp N
Published: March 2014

Background

Knee injuries often occur due to biomechanical factors such as knee joint laxity. Individuals with Generalised Joint Hypermobility (GJH) frequently have knee joint hypermobility. Thus, GJH has been proposed as an intrinsic risk factor for knee injuries in adults and adolescents. To potentially compensate for reduced passive joint stability, adequate neuromuscular knee joint control is required before and during loading of the lower extremities.

Objective

To determine whether there is a difference in the neuromuscular pre and post activation landing patterns of the knee in adolescents with GJH and without GJH (NGJH) in the Single leg Hop for Distance test.

Design

Case-control study with groups matched on age and sex.

Participants

54 adolescents (10–15 years), 25 with GJH and 29 with NGJH. GJH inclusion criteria were Beighton score ≥5/9 and hypermobility of at least one knee, and no current pain in the lower extremities.

Main outcome measurements

EMG of Vastus Medialis (VM), Vastus Lateralis (VL), Biceps Femoris (BF), Semitendinosus (ST), Gastrocnemius Medialis (GM) and Lateralis (GL) of the most hypermobile knee for the GJH group was used to determine pre- and post impact activation levels in % MVE before and during landing of the Single leg Hop for Distance test.

Results

Age and sex-adjusted analysis showed that GJH pre-activated ST 30% less compared with NGJH (22.1 (±12.6) vs 31.4 (±16.6.), P=.02). Conversely, GJH had a 28% higher GM pre-activity level than NGJH (32.5 (±14.8) vs 23.2 (±15.6), P=.02). There was no difference in performance (P=.67).

Conclusions

Lower ST but higher GM pre-activation levels were found in adolescents with GJH and knee joint hypermobility compared with NGJH. This latter is likely a compensatory strategy to enhance joint stability. For adolescents with GJH and knee joint hypermobility, intensive knee injury preventive training could be important, focusing among others on the ST.
RETURN TO SPORT FOLLOWING TOTAL HIP ARTHROPLASTY(THA): DO WE ALL AGREE?
Authors: Kaplan Y
Published: March 2014

Background

As younger,healthier patients are having THA, a greater emphasis is being placed on postoperative function, activity, and exercise. With recent advances in implant technology and surgical technique, the survival rates for modern prosthetic designs and patients with these high demands are promising. There is no current consensus on the safety of resuming to sport. The main concerns nevertheless are remaining instability, wear, loosening, and fracture.

Objective

To provide a narrative literature review relating to returning to sporting activity following a THA.

Design

An electronic search was conducted up to October 2013, using medical subject headings and free-text words. Subject-specific search was based on the terms “total hip arthroplasty”, “return to sport” and “exercise”.

Results

10 articles were found to be suitable. Only one was a prospective randomized study, comparing the type, intensity and frequency of sports activities performed after resurfacing hip arthroplasty vs. THA using a metal-on-metal bearing. All the rest were narrative reviews and expert opinion. One guideline consensus paper was published. Substantial limitations were observed in most of the publications, including small sample size, patient selection, trial quality, heterogeneity of outcome assessments, and potential sources of confounding variables not investigated.

Conclusion

Each sport should be evaluated on its potential risk to a joint replacement, whether from the force of repetitive injury or the possibility of catastrophic failure. Likewise, a surgeon can use techniques, biomaterials, and implants that will maximize an athlete's chance of success over time. There is a need for a long-term, high-quality, prospective randomized control trial that will compare low vs. high impact sports and their effect on the prostheses. Until then, definitive recommendations should be made based on each patient's expectations, goals and the surgeon's past experience.
ECCENTRIC TRAINING FOR ELBOW HYPERMOBILITY
Authors: Kaux JF , Delvaux F , Forthomme B , Marguerite FD , François D , Crielaard JM , Croisier JL
Published: March 2014

Background

Patients with hypermobility suffer from joints problems and chronic pain is the most frequently reported symptom.

Objective

Eccentric muscle strengthening could be very important to protect hypermobile joints.

Design

Case report.

Setting

Amateur tennis player.

Patient

A girl (16 y.o.) affected by an Ehler-Danlos syndrome presented pain in the right elbow and the right wrist after a season of tennis.

Interventions

Her training consisted of wrist prono-supination and flexion-extension muscle group reinforcement and proprioceptive training. To protect the wrist against excessive load, the eccentric strengthening exercises of prono-supinator and flexor-extensor muscles of elbow and wrist were undertaken gradually, at increasing speeds within a limited range of motion in flexion and extension, on an isokinetic device after an evaluation. She was also given an orthesis restricting the joint range of motion of the wrist.

Main outcome measurements

The evaluation was made by isokinetic evaluation, visual analog scale and MOS-SF36 questionnaire before and after training.

Results

The patient rapidly noted a decrease in pain and an increase in the stability of her right arm even when playing tennis. Isokinetic evaluation objectified a significant improvement in maximal torque in flexion-extension muscles of the right elbow. She was also given individualized home exercises.

Conclusions

The goal of this eccentric training is to avoid hypermobility by using the muscles as a protective brake in the control of joint positioning. Muscles can be reinforced in eccentric mode with starting position at the maximum length of these muscles when unstreched. The exercises can be carried out safely on an isokinetic device, at slow speed and limited range of joint motion to avoid risk of luxation. Thus, in this case report, the eccentric exercises using an isokinetic device were effective to safely reinforce the muscles as a protective brake for joint hypermobility and prevent pain during practicing tennis.
THE FINDINGS OF THE AUSTRALIAN FITNESS INDUSTRY RISK MANAGEMENT (AFIRM) PROJECT
Authors: Keyzer P , Finch C , Norton K , Dietrich J , Sekendiz B
Published: March 2014

Background

The AFIRM Project is designed to consider, firstly, how does Australian regulation currently control risk management in the fitness industry and thereby prevent adverse health outcomes and injury, and the legal liability associated with those risks? Secondly, what sustainable changes could be made to Australian regulation for more effective risk management in the health and fitness industry in order to prevent the risk of adverse health outcomes and injury, and the legal liability associated with those risks?.

Objective

Our objective is to develop new best practice benchmarks to improve safety in the fitness industry and reduce the risk of adverse health and injury outcomes.

Design

After conducting focus groups in four States of Australia using nominal group technique, we developed a survey that was administered to 1178 people. We also conducted observational audits of fitness facilities.

Settings

See “Design”.

Participants

Of the 1 178 survey respondents, 62% were female, the mean age was 40, 46% were self-employed or sole traders and 32% were part-time employees of a fitness facility.

Results

Focus group respondents reported (lack of) education, (lack of) supervision, (poor) technique, (defective) equipment, (unsuitable) environment and overcrowding as principal issues in the focus group sessions, while also raising the issues of scope of practice, defective pre-exercise screening, medical risks associated with de-conditioned clients, poor or inappropriate nutritional advice, inadequacy of qualifications and unrealistic expectations of clients as key risks, from their perspective. The survey was designed around these themes and was conducted online in May and June 2013 and promoted through a communications strategy of social media, direct e-marketing and (minor) traditional media. It used 45×6-point Likert scale items (e.g. “How frequently do you observe customers using weights that are too heavy?”) that were then factor analysed. The results will be provided.
TRUNK MOTION AND MUSCULAR STRENGTH AFFECT KNEE VALGUS MOMENT DURING SINGLE-LEG LANDING AFTER OVERHEAD STROKE IN BADMINTON
Authors: Kimura Y , Tsuda E , Hiraga Y , Maeda S , Sasaki S , Sasaki E , Fujita Y , Ishibashi Y , Makino M
Published: March 2014

Background

Anterior cruciate ligament (ACL) injury in knees opposite to the racket-hand side frequent occurs during single-leg landing after overhead stroke in badminton. Although large lateral inclination of trunk during single-leg landing seems to generate knee valgus moment which causes ACL injury, it has not been examined.

Objective

To evaluate if there was a correlation between trunk kinematics and knee valgus moment during single-leg landing after overhead stroke, in addition, to evaluate an association with muscular strength of trunk.

Design

Controlled laboratory study.

Setting

Female college badminton players with no history of knee injury.

Participants

8 right-handed players.

Risk factor assessment

Subjects performed single-left-legged landing after an overhead stroke following back-stepping. The kinematic and kinetic data of the trunk and left lower extremity during landing were measured using 3-dimensional motion analysis system. Isometric trunk flexion and extension strength was measured using a dynamometer.

Main outcome measurement

Change in lateral trunk bending angle and maximum knee valgus moment during landing were measured. The correlation between these and trunk strength were analyzed.

Results

The average of maximum knee valgus moment was 0.34±0.24 Nm/kg/m, and the change in lateral trunk bending angle was 22.9±13.3 degrees, respectively. The mean trunk flexion strength was 2.2±0.9 Nm/kg. The knee valgus moment was significantly correlated with the change in lateral trunk bending angle (r=0.87, P<.05) and the trunk flexion strength (r=−0.94, P<.01). The change in lateral trunk bending angle was also significantly correlated with the trunk flexion strength (r=−0.94, P<.01).

Conclusions

Larger lateral trunk bending associated with weak flexion strength increased knee valgus moment during single-leg landing. The core muscle training focused on trunk flexion strength may improve neuromuscular control of trunk and avoid excessive knee valgus moment in playing badminton, and this may play an important role of ACL injury prevention.
SPECIFIC EXERCISE TARGETING THE SEMITENDINOSUS IN FEMALE ACL-RECONSTRUCTED ATHLETES
Authors: Lauridsen HB , Bencke J , Thorborg K , Andersen LL , Sonne-Holm S , Aagaard P , Hölmich P , Zebis MK
Published: March 2014

Background

The most commonly used graft in ACL-reconstructions is harvested from the semitendinosus muscle (ST) which causes atrophy and reduced muscle strength in the hamstrings. As the ST serves as an important ACL agonist, exercises that causes high levels of ST muscle activity after ACL-reconstruction, is of great interest to prevent re-rupture of the ACL.

Objectives

The purpose of the present study was to examine the level of neuromuscular hamstring muscle activity during two commonly used strength exercises, the two hand Kettlebell Swing (KS) and the Nordic Hamstring (NH), in previously ACL-reconstructed female athletes.

Design

Cross-sectional study.

Settings

Biomechanical laboratory.

Participants

Recruitment ongoing – the study is planned to include 20 participants. Preliminary data from five female athletes (age 28±7 yrs) with a total of 6 ACL-reconstructed knees are presented. In all cases, ST tendon was used as graft. The time between surgery and testing was 52±47months.

Intervention

Ten consecutive KS's were performed corresponding to a maximal load (12–16 kg) where correct technique was maintained. Additional, five consecutive NH curls were executed. Muscle activity for the hamstring muscles was obtained during the exercise evaluation and during hamstring MVC.

Main outcome measurements

Peak EMG of the medial (ST) and lateral (BF) hamstring during KS and NH was normalized to peak EMG amplitude during MVC.

Results

The exercise evaluation showed a significantly higher peak ST EMG activity during KS than NH (91±23% vs. 63±23%, respectively), P=.011. No difference was observed in peak BF EMG activity between exercises (82±30% vs. 66±36%, respectively), P=.125.

Conclusion

The present finding suggests that the KB exercise could be introduced in rehabilitation when aiming at enhanced ability to recruit ST during forceful movements. However, to avoid adverse effects in the early phase of rehabilitation, caution must be taken when introducing high-intensity training among ACL reconstructed patients.
INJURY AND ILLNESS SURVEILLANCE DURING THE 43RD ISAF YOUTH SAILING WORLD CHAMPIONSHIP 2013 IN LIMASSOL, CYPRUS
Authors: Leong D , Vaz Pardal C , Tan B , Lin C
Published: March 2014

Background

Prior studies have indicated that the competitive youth sailor is at risk for sailing-related injuries. Data collected during a large-scale elite youth sailing event is the first step toward developing effective injury/illness prevention strategies in this population.

Objective

To describe the incidence, pattern, and severity of sailing-related injuries and illnesses among competitive youth sailors during the 43rdISAF Youth Sailing World Championship.

Design

Prospective descriptive study using the International Olympic Committee injury surveillance system reporting forms. Team officials and medical centre doctors submitted daily surveillance reports.

Setting

43rdISAF Youth Sailing World Championship, 13 to 20 July 2013, Limassol, Cyprus.

Participants

All participating sailors in the ISAF World Youth Sailing Championship.

Risk factor assessment

The following risk factors were studied: training load, participation in other sports, use of sunscreen/lifejacket, alcohol and drug consumption.

Main Outcome Measurements

The occurrence or non-occurrence of sailing-related injuries and illnesses; the number of injuries; the site, type, cause/mechanism of injury; and contributing factors to injuries.

Results

11 (3%) sailors out of 351 sailors reported 11 injuries. The rate of injury was 3.9 injuries per 1000 athlete-days. The most commonly injured site was the foot/toe (36%). The top three types were laceration/abrasion (27%), toe nail injury (27%), and contusion/haematoma/bruise (18%). Most injuries were the result of contact with a stagnant object or an acute event. Treatment was sought in 55%, and 1 sailor withdrew from the competition as a result. Of the 4 illnesses, vomiting/diarrhea was the most common symptom (40%) and the gastrointestional system was most commonly affected (75%).

Conclusions

During a high-level sailing competition, 3% of youth sailors reported injuries and 1% reported illness. The injuries were mainly acute events occurring during racing, while illness was mainly of the gastrointestinal system. This data provides us with the basis for future studies and analysis of injury mechanisms and risk factors in elite sailing.
SELF-REPORTED 12-MONTH OVERUSE INJURY HISTORY IN YOUTH BASKETBALL AND FLOORBALL
Authors: Leppänen M , Pasanen K , Kujala UM , Parkkari J
Published: March 2014

Background

The popularity of organized sports, especially team sports is growing among youth. High training volume and intensity at early age may predispose young athletes to overuse injuries.

Objective

To examine the occurrence, nature and severity of overuse injuries in youth basketball and floorball.

Design

A descriptive retrospective study.

Setting

Finnish youth basketball and floorball.

Participants:

406 athletes (mean age 15.9, SD 2.0) from six basketball and floorball clubs (210 basketball and 196 floorball players).

Main outcome measurements

Self-reported history of overuse injuries over the preceding 12-month period. Data was obtained from a questionnaire. The severity of injuries was defined according to time-loss from full-time game or training.

Results

172 overuse injuries (sustained by 139 players) were reported. Basketball players sustained 97 and floorball players 75 overuse injuries. Injury incidence in basketball was 1.1 and in floorball 0.8 injuries/1000h of exposure. Most of the overuse injuries involved the lower extremities (72% of all injuries). Most commonly injured site was the knee (45%). Another common site of the injury was the area of lower back/pelvis (26%), followed by the calf/shin (11%). No differences between the genders or the two sports were observed. Most of the injuries were slight (time-loss 1–3 days) injuries (33%). 23% of injuries were mild (time-loss 4–7 days), 20% were moderate (time-loss 8–28 days) and 25% of injuries were severe (time-loss ≥29 days) injuries. Overuse injuries caused an average time-loss of 24 days (SD 52).

Conclusions

Over a one third of the players participating in the study reported having sustained an overuse injury in the preceding 12 months. Remarkable proportion of overuse injuries were severe injuries. Overuse injuries often cause long absence from full-time game and training. Prospective studies to assess the risk factors and mechanisms of overuse injuries among youth team sports are needed.
FRONTAL KNEE ANGLE DURING SINGLE LEG SQUAT AND VERTICAL DROP JUMP; A COMPARISON OF YOUTH ATHLETES WITH OR WITHOUT A HISTORY OF KNEE INJURY
Authors: MacDonald K , Whittaker J , Baltich J , Emery CA
Published: March 2014

Background

Knee joint injury has been associated with changes in hip and knee joint function and is a known risk factor for the development of post-traumatic osteoarthritis (PTOA). The Vertical Drop Jump (VDJ) and Single Leg Squat Test (SLS) have been used to examine lower extremity neuromuscular control.

Objective

To determine if young adults with and without a 3–10 year history of knee joint injury differ in frontal knee angles or knee ankle ratio during VDJ and SLS.

Design

Historical Cohort.

Setting

Laboratory Setting.

Participants

25 individuals with history of intra-articular knee joint injury, sustained participating in sport 3–10 years previously, and 25 matched (age, sex, sport) uninjured controls (16 males;17–26 yrs: 34 females;14–26 yrs).

Risk factor assessment

History or no history of intra-articular knee injury (clinical diagnosis resulting in time loss from sport).

Main outcome measurements

Frontal knee angle (FKA) (degrees) and knee and ankle separation distances (KAR) were measured from an image representing the lowest moment of the SLS and VDJ extracted from video and measured using ImageJ (National Institute of Health, v.1.47) software. Test-retest reliability (sub-sample n=20) was examined (ICC) and descriptive statistics (means, 95%CI) used to compare study groups.

Results

No differences in right to left FKA differential was found for the injured participants compared to matched controls during the SLS (ICC 0.97) [injured 5.78°(3.01, 8.54); uninjured 4.75°(1.85, 7.66) or VDJ (ICC 0.98) [injured 7.69°(2.58, 12.80); uninjured 9.64°(5.57, 13.70)]. Similarly, no between groups differences for KAR (ICC 0.99) were demonstrated [injured 1.00 (0.90, 1.09); uninjured 1.04 (0.97, 1.12)].

Conclusions

Individuals with a 3–10 year history of knee injury demonstrate similar FKA and KAR during the VDJ and SLS compared to healthy controls. These finding are encouraging as the functional joint changes associated with knee joint injury do not appear to be present in this timeframe post-injury.
MUSCLE INJURY RATES IN PROFESSIONAL FOOTBALL INCREASE WITH FIXTURE CONGESTION: AN 11-YEAR FOLLOW-UP OF THE UEFA CHAMPIONS LEAGUE INJURY STUDY
Authors: Bengtsson H , Ekstrand J , Waldén M , Hägglund M
Published: March 2014

Background

The influence of fixture congestion on injury rates and team performance has only been scarcely investigated.

Objective

To study associations between match load, recovery days, injury rates and team match performances in professional football.

Design

Prospective cohort study.

Setting

European professional football.

Participants

27 teams, all selected by the UEFA and all competing at the highest level of European football, playing 8 150 competitive matches during the 11-year study period were included.

Assessment of risk factors

Injury rates and team match performances were compared depending on the number of recovery days between matches using two different cut offs (≤3 vs. >3 days and ≤4 vs. ≥6 days). Match load, injury rates and team match performances were also studied over extended match sequences during the season, each sequence containing five consecutive matches over a mean of 27 days (range 7–104 days).

Main outcome measurements

Number of time loss injuries/1000 h of exposure and amount of matches won, lost or drawn.

Results

Team performance showed no association with match load except for Europa League matches that indicated more matches lost with ≤3 days compared with >3 days recovery (P=.048). Total injury rates and muscle injury rates, specifically hamstring and quadriceps injuries, were increased in league matches with ≤4 days compared with ≥6 days recovery preceding the match (rate ratio [RR] 1.09, 95% CI 1.00–1.18, and RR 1.32, 95% CI 1.15–1.51, respectively) while no differences were found when using the other cut off (≤3 vs. >3 days). High match load during a match sequence was associated with an increase in muscle injury rates (P=.012).

Conclusions

Fixture congestion was associated with increased muscle injury rates but had no, or very limited, influence on team match performances.
FLUCTUATIONS IN STRIKE INDEX AND SPATIOTEMPORAL PARAMETERS IN PREVIOUSLY INJURED VS UNINJURED RUNNERS
Authors: Mann R , Meijer K , Malisoux L , Brunner R , Urhausen A , Nuehrenboerger C , Theisen D
Published: March 2014

Background

Long-range correlations in running stride interval have been proposed as an indicator of running-related injury (RRI) and found to change with running speed. They have not yet been used to distinguish running style between runners having previously sustained a RRI or not.

Objectives

To compare long-range correlations and stride-to-stride variability of strike index (SI) and spatiotemporal parameters in previously injured and uninjured runners over various running speeds. We hypothesized significant effects of groups and running speed for these parameters.

Design

Retrospective, case-control study.

Setting

Recreational runners.

Participants

69 regular male and female runners (currently asymptomatic) either having sustained a RRI during the previous year (n=26) or not (n=43).

Risk factor assessment

Five 2-minute incremental running intervals were performed at 80, 90, 100, 110 and 120% of the individual typical running speed on a treadmill. SI, contact time (CT), flight time (FT), stride time (ST), duty factor (CT/ST), stride length (SL) and frequency were measured using an insole-based system. Coefficient of variance (CV) and the scaling exponent α of the detrended fluctuation analysis were calculated, and effects were analysed using repeated measures analyses of variance.

Main outcome measurements

RRI, defined as a pain or complaint to the lower limbs, progressive in nature and influencing running activity for >1 week.

Results

The RRI group displayed lower CV than the controls for CT (P=.01) and FT (P=.027). Significant differences in α between normalised speeds were found for all variables (P<.048) except SL. CV differed significantly between normalised speeds for ST and SL. No significant interactions were found.

Conclusions

Previously uninjured runners display significantly greater CV in CT and FT. Long-range correlations of SI and spatiotemporal parameters change according to running speed, but are not significantly different between previously injured and uninjured runners. Further prospective study to confirm these findings is warranted.
DOES WHOLE-BODY CRYOTHERAPY AFFECT THE RECOVERY PROCESS AFTER HAMSTRING DAMAGING EXERCISE: A CROSSOVER STUDY
Authors: Markovic G , Fonda B , Nejc Š
Published: March 2014

Background

Delayed onset muscle soreness, induced by strenuous exercise, is one of the most common recurrent forms of sports injury and is associated with exercise-induced muscle damage (EIMD).

Objective

We examined the effects of whole-body cryotherapy (WBC) on biochemical markers, pain, and performance parameters during a 5-day recovery period after a damaging plyometric exercise. We hypothesized that WBC would have beneficial effects on muscle recovery after such an exercise bout.

Design

Randomized crossover study design.

Setting

Recreational athletes.

Participants

11 recreational male athletes volunteered in this study. Inclusion criteria were that the subjects were familiar with plyometric exercise, but they did not perform this type of exercise for at least 3 months prior to the study, were not injured or receiving any medications in the last 9 months, and were within normal baseline levels for biochemical markers.

Interventions

Participants completed a bout of damaging exercise for the hamstring muscles on two separate occasions separated by 10 weeks. During the control condition, subjects received no treatment after the damaging exercise. The experimental condition consisted of WBC everyday during the recovery period. WBC included single 3-min daily exposures to low temperatures (–140 to –195 °C) in the cryo-cabin.

Main outcome measurements

Biochemical markers, perceived pain sensation, squat- and counter movement-jump, maximal and explosive isometric torque production.

Results

Majority of the observed variables showed statistically significant time effects (P<.05) in control group, which indicates the presence of muscle damage. Significant interaction between the control and WBC condition was evident for the rate of torque development (P<.05). Pain measures substantially differed between the WBC and the control condition after the exercise.

Conclusions

The results of the present study do not provide conclusive support for the use of WBC as a technique to enhance functional recovery after EIMD.
DO TOURNAMENT SCHEDULE AND SQUAD COMPOSITION INFLUENCE INJURY TYPES AND RATES IN INTERNATIONAL RUGBY?
Authors: Mathema P , Moore I , Ranson C
Published: March 2014

Background

This report contrasts injury rates, types and potential risk factors between two equal length yet markedly different international rugby campaigns.

Objective

To compare tournament injury problems and potential risk factors for single nation versus combined nation international rugby teams.

Design

Details of all time-loss injuries, training and match exposure for the Wales Team during the 2013; 6 Nations, and British and Irish Lions (BIL) during the Australia tour. Analysis was based on consensus injury surveillance methods.

Setting

International Rugby Union.

Participants

All Wales (n=36) and 2013 BIL squad (n=45) players.

Risk factor assessment

Contrasting injury exposure, rates and severity.

MainoOutcome measurement

Training and match injury; exposure, incidence, (per 1000hours), prevalence (% of players unavailable) and days-lost per injury.

Results

Wales played 5 matches and BIL 10 in a similar time period. 81% of Wales' squad players played in at least one match as compared to 98% of BIL. Wales had 28% more training hours exposure. Wales had a higher injury incidence/1000 hrs than BIL (total 27 vs. 18, match 260 vs. 90, training 5 vs. 4) and prevalence (15 vs. 10%), but fewer days-lost per injury (11 vs. 17). For Wales, 67% of the squad sustained injuries, with an average of 1.6 injuries per injured player whilst 54% of BIL sustained injuries (1.1 per injured player). Forty-seven percent of Wales players started in a match and half were replaced in at least one game as compared to 62% of BIL players and 92% being replaced. Of the match injuries, 81% of Wales' players, versus 56% BIL, completed the match.

Conclusions

Higher injury rates for Wales may have been due to factors such as; lower substitution rates, greater starter match exposure and previously injured players returning to play in the same tournament.
NATIONAL TEAM RUGBY PLAYER INJURY TYPES, RATES AND RISK FACTORS OVER TWO-YEARS
Authors: Mathema P , Ranson C , Moore I
Published: March 2014

Background

Injury surveillance may provide valuable information regarding relationships between initial and subsequent injuries. Subsequent Injury Categorisation (SIC) may be useful in sports such as rugby that have high rates of re-injury amongst elite players.

Objective

To identify types, rates and potential risk factors for injury, and subsequent injury, in international rugby players.

Design

Prospective injury surveillance using consensus methods and SIC.

Setting

Tier 1 international and professional rugby.

Participants

Players from one national team squad over two years.

Risk factor assessment

Injury types, rates and severity, according to team (national or club), mechanism and activity (training or match) at time of injury, and SIC.

Main outcome measurement

Training and match injury incidence (per 100 days), prevalence (% of players unavailable) and average days-lost per injury were calculated for each variable along with the percentage of injuries within each SIC.

Results

Overall incidence was 44/100 days (match 30/100 days, training 9/100 days), prevalence was 21% and 16 days were lost per injury. International incidence was highest (25 vs. 19/100 days), but days-lost per injury was greater for club injuries (19 vs. 14 days). Incidence and prevalence was greatest for international impact injuries (11 vs. 6/100 days, 7 vs. 4%), but there were a similar number of days-lost per injury (21 days). During international campaigns the anterior thigh, knee and lower leg regions had the highest injury rates, whilst on Club duty the hip, knee and shoulder were highest. Twenty-nine percent of the 252 subsequent injuries were coded as being related to a previous injury. Fourteen percent of subsequent injuries were a direct recurrence.

Conclusions

High incidence of impact injuries in international rugby may be due to greater number of contact events. Injury prevention strategies may need to target different body areas for international vs. club rugby. SIC analysis may allow subsequent injury risk to be better managed.
EFFECT OF TRUNK MOTOR CONTROL TRAINING ON HIP MUSCLES IN ELITE FOOTBALL PLAYERS
Authors: Mendis D , Stanton W , Hides J
Published: March 2014

Background

Decreased size and altered function of lumbo-pelvic muscles has been found in elite athletes with low back pain (LBP). Previous research has shown that training trunk neuromotor control in elite football players with and without LBP improved the size and function of muscles important in stability of the lumbo-pelvic region. Hip muscles also contribute to lumbo-pelvic stability and imbalances in these muscles have been associated with LBP in collegiate athletes.

Objective

To investigate if a motor control intervention program targeting trunk muscles affects hip muscle size in elite football players with and without LBP.

Design

The trial was delivered as a stepped-wedge design with 3 treatment arms: 15 weeks intervention, 8 weeks intervention and a wait-list control who received 7 weeks intervention toward the end of the playing season.

Setting

Elite level football club in the National Australian Football League (AFL).

Participants

Complete training squad of 46 elite players from an AFL club.

Interventions

The motor control program, delivered over the playing season, involved performance of voluntary contractions of the trunk muscles with feedback from ultrasound imaging.

Main outcome measurements

Cross-sectional areas of the iliacus, psoas, iliopsoas, sartorius, gluteus minimus, gluteus medius and upper gluteus maximus muscles were measured from magnetic resonance images.

Results

The motor control training program was associated with an increase in hip muscle size especially for those with LBP (P<.01).

Conclusions

The motor control training program, which targeted proximal muscles of the lumbar spine, had an effect on both trunk and hip muscles. Neuromuscular control training programs may benefit more muscles in the kinetic chain than trunk muscles alone. This finding may be due to the functional components of the motor control program that encouraged optimal trunk and femoro-pelvic alignment when load was added in functional weight bearing positions.
SCREENING ATHLETES WITH PATELLAR TENDINOSIS: CLINICAL INFORMATION TO GUIDE PREVENTIVE ATTITUDES
Authors: Mendonça L , Bittencourt N , Zuin A , Barreto R , Ocarino J , Fonseca S
Published: March 2014

Background

Patellar tendinosis is a degenerative condition that could lead to tendon rupture. Conservative treatment is long-term and surgery may be required to enhance tissue regeneration. Therefore, the athlete could have his/her successful career jeopardized. Some clinical tests, usually used in patellar tendon assessment, could be associated to patellar tendon morphologic abnormalities (PTA). However, their relationship to PTA is not established and they could be used in sports practice as a strategy for preventive care.

Objective

To investigate the association of VISA-P questionnaire, single-leg decline squat test and patellar tendon pain history to tendon morphological abnormalities at ultrasound.

Design

Cross-sectional study.

Setting

Athletes filled in VISA-P questionnaire, performed the single-leg decline squat test (SLDS) and informed about patellar tendon pain history. Athletes with Osgood-Schlater and/or Siding-Larsen-Johansson disease were excluded. An experienced examiner performed the ultrasonographic exam in tendon sagittal and transverse planes. Tendons that presented hypoechoic areas and thickness were considered as positive for morphological abnormalities.

Participants

43 athletes (26 volleyball, 14 basketball, 3 running) participated in this study, 38 males and 5 females, mean age of 24.8±6.7 years, weight of 87.6±13.7 kg and height of 1.93 ±0.1 m.

Risk factor assessment

VISA-P, single-leg decline squat test and patellar tendon pain history.

Main outcome measurements

Patellar tendon hypoechoic areas and thickness at ultrasound.

Results

Significant associations to PTA were found. VISA-P showed an OR of 5.4 (1.3–26), SLDS of 3.8 (1.4–11) and pain history of 7.5 (1.6–42). Therefore, an athlete who presents a score under 80 points at VISA-P, for example, have 5.4 more chance to present PTA compared to an athlete that does not have PTA.

Conclusions

VISA-P, SLDS and patellar tendon pain history can be easily applied in clinical practice and should be used as a screening tool in sports modalities that present a high PTA prevalence.
IMPACT OF AIR FLIGHT ON GAMES MISSED POST CONCUSSION IN NHL PLAYERS
Authors: Milzman D , Altman J , Hatoum Z , Berman D , Neustadtl A , Pasternac K , Campbell M
Published: March 2014

Background

Concussions(mTBI) occur at variable reported rates of 1–4 per 100 player games in the NHL. Hypoxia exacerbates neuronal death following mild TBI in animals and Oxygen deprivation leads to greater mitochondrial dysfunction in concussed brains. This study will evaluate the impact of mild hypoxia associated with airline travel on duration of concussion symptoms in NHL players.

Methods

All NHL players with publicly reported concussions in 2010–11 through the 2012–13 (3) seasons were evaluated to determine the impact of air flight with pressurized cabins in the immediate 4–6 hour period following games in which the concussion occurred. This retrospective cohort study used publicly available post-game reports of concussion, next game played, and air distance traveled. Players with any associated injury were excluded. All available NHL and team reports were used to confirm travel night-of following an away game to either next stop of road trip (NHL) or home location and diagnosis of concussion and games missed. Only flights within 6 hours of end of game were included.

Results

239 concussions occurred during the 3 study seasons of which 35 players were excluded for additional injuries or concussion lasted over the end of a season. 202/204 (99%) of NHL players with diagnosed concussions missed at least one game with a mean 9.2 games (SD +/- 9.6) missed. Those players that flew after suffering an mTBI missed 32.9% more games with: 10.5 (95% CI: 2.5–17.7) missed games and 26.5 days for those 99 NHL'ers (95% CI: 2.5–17.7) VS. 7.9 (95% CI: 0–16.5) games and 20.7 days for the 205 NHL'ers that did not fly; P<.01. Odds Ratio to miss games post concussion after air travel to no air travel: 3.8:1.

Discussion

This initial report of an increased rate of recovery in terms of nearly 1/3 more games missed, for professional athletes flying commercial airlines due to likely increased concussion penumbra and lack of brain rest following mTBI. Future studies should evaluate standard 48–72 hour post mTBI brain rest, without any air flight to abate the decreased oxygen tension suffered during pressurized cabin flight.
THE IMPACT OF INJURY IN WELSH PROFESSIONAL RUGBY
Authors: Moore I , Mathema P , Ranson C
Published: March 2014

Background

A detailed understanding of injury types and rates is needed to inform effective injury prevention and management. This is the first comprehensive injury surveillance report across the four Welsh Rugby Union (WRU) Region Professional Teams.

Objective

To identify priority injury problems and potential risk factors across the WRU Regions.

Design

A designated medical team member from each Region recorded; all time-loss injuries, training and match exposure during the 2012–2013 domestic season. Consensus injury surveillance (Fulleret al., 2007) methods were used for data analysis.

Setting

Top tier Welsh professional rugby.

Participants

All players (173) from the four WRU Region clubs during the 2012–2013 season.

Risk factor assessment

The relationships between; injury rates, types and severity, and mechanism of injury, player age and activity (training or match) at time of injury.

Main outcome measurement

Training and match Injury incidence (per 1000 hours), injury prevalence (% of players unavailable) and average days-lost per injury were calculated for each variable.

Results

Overall injury incidence was 10/1000 hrs (2/1000 training hrs, 98/1000 match hrs), prevalence was 18% and days-lost per injury was 26. Acute strain/sprain and impact injuries had the highest injury incidence and prevalence (3–4/1000 hrs and 6–8%). Older players (>24 years) had higher; injury incidence (6 vs. 4 for younger players), injury prevalence (11 vs. 8%) and more days lost per injury (27 vs. 24). The majority of match injuries occurred during tackles (63%). Strength training and running caused the greatest number of training injuries, with strength training injuries resulting in longer periods out (49 vs. 34 days lost per running injury).

Conclusions

Prevention strategies should target the high rate of match injuries.Older players may require bespoke injury risk management, and exposure to contact events (particularly tackles) needs to be recorded to ascertain the specific activity risk.
INJURY TYPES AND RATES IN AN INTERNATIONAL CRICKET TEAM: APPLICATION OF SUBSEQUENT INJURY CATEGORISATION
Authors: Mount S , Moore I , Ranson C
Published: March 2014

Background

Longitudinal injury surveillance may provide valuable information regarding relationships between initial and any subsequent injuries. The Subsequent Injury Categorisation (SIC) (Finch & Cook, 2013) has been proposed as a method for examining these relationships.

Objective

To identify priority injury problems and potential risk factors for injury and subsequent injury in international cricket.

Design

Prospective injury surveillance using consensus methods and SIC.

Setting

International cricket.

Participants

All players from one national team squad during over 2 years (2011–2013).

Risk factor assessment

The contrasting; injury types, rates and severity, according to body area, position and activity (training or match) at time of injury, and SIC.

Main outcome measurement

Training and match injury incidence (per 100 days), prevalence (% of players unavailable) and average days-lost per injury were calculated for each variable along with the percentage of injuries within each SIC. Further analysis of the SIC is in process.

Results

225 injuries were sustained (73 time-loss and 152 non time-loss), with an overall incidence of 10/100 days (7/100 days matches, 3/100 days training), prevalence of 13% and average of 32 days-lost per injury. Ankle, knee and hand regions had the highest incidence, but lumbar and abdomen regions had the greatest days-lost per injury. Fast bowlers had the highest incidence (6/100 days) and prevalence (8%). Wicket-keepers had the greatest days-lost per injury (68 days). Thirty-five percent of the 219 subsequent injuries sustained were coded as being related to a previous injury. Twelve percent of all subsequent injuries were a recurrence.

Conclusions

International cricketers have a high rate of non time-loss injury, particularly to the ankle, knee and shoulder whereas thigh strains and lower back injuries result in the greatest time-loss. Injury prevention strategies should target these problems, particularly in fast bowlers. Analysis of the SIC may provide further insight into injury risk predicators.
RISK FACTORS FOR LOWER EXTREMITY INJURIES IN ELITE FEMALE FOOTBALL PLAYERS
Authors: Nilstad A , Andersen TE , Bahr R , Holme IM , Steffen K
Published: March 2014

Background

The incidence of lower extremity injuries in female football players is high, but their risk factors are poorly understood.

Objective

To investigate risk factors for lower extremity injuries in elite female football players.

Design

Prospective cohort study.

Study setting

Elite football league.

Participants

Norwegian elite female football players.

Risk factor assessment

Baseline screening tests were conducted prior to the 2009 competitive football season and included tests assessing maximal lower extremity strength, balance, knee valgus angles in a drop jump landing, knee joint laxity, generalized joint laxity and foot pronation. We also included a questionnaire to collect information on demographic data, elite level experience and injury history. Time-loss injuries and exposure in training and match were recorded prospectively during the subsequent football season using weekly text messaging. Players reporting an injury were contacted to collect data regarding injury circumstances. Univariate and multivariate regression analyses were used to calculate odds ratios (OR) and 95% confidence intervals (CI) for one standard deviation change.

Main outcome measurements

New lower extremity injuries.

Results

In total, 173 players provided complete screening tests and registrations of injuries and exposure throughout the season. A total of 171 injuries in 107 players (62%) were recorded. Multivariate analyses showed that greater BMI (OR 1.51, CI 1.21–1.90, P=.001) was the only factor significantly associated with new lower extremity injuries. Greater BMI was associated with new thigh injuries (OR 1.51, CI 1.08–2.11, P=.01), lower knee valgus angles in a drop jump landing was associated with ankle injuries (OR 0.64, CI 0.41–1.00, P=.04) and a previous knee injury with lower leg and foot injuries (OR 3.57, CI 1.27–9.99, P=.02), whereas neither of the factors investigated influenced the risk of knee injuries.

Conclusion

Greater BMI was associated with lower extremity injuries in elite female football players.
GENERALIZED LIGAMENTOUS LAXITY MAY BE A PREDISPOSING FACTOR FOR MUSCULOSKELETAL INJURIES
Authors: Rahmatullah Bin Abd Razak H , Bin Ali N , Sen Howe T
Published: March 2014

Background

Generalized ligamentous laxity has been implicated with musculoskeletal injuries. Little evidence has emerged from the Asia-Pacific regarding the epidemiology of generalized ligamentous laxity.

Objective

The aim of this study is to determine if generalized ligamentous laxity may be a predisposing factor for musculoskeletal injuries in young males. We hypothesized that generalized ligamentous laxity would be more common in individuals with musculoskeletal injuries compared with controls.

Design

Prospective case-control study.

Setting

Military.

Participants

All participants were male Singaporeans who were serving their National Service in the same military institute. The cases comprised of 100 consecutive individuals who presented to the primary healthcare centre in the institute with musculoskeletal injuries involving the upper or lower extremities that occurred as a result of physical activity. Our control group comprised of 100 age- and gender-matched individuals but did not have any musculoskeletal symptoms or injury for a period of 3 months or more from the time of recruitment.

Assessment of risk factors

Demographic data were gathered using a questionnaire. The surveyed factors include personal history, smoking history and sporting activity as well as the baseline demographic and anthropometric data.

Main outcome measurements

The Beighton score was used to measure laxity, which was determined to be present by overall scores equal to or exceeding 4.

Results

Generalized ligamentous laxity was present in 12% of the cases compared with 4% of controls (P=.043). Individuals who presented with musculoskeletal injuries were 3.35 times more likely to have generalized ligamentous laxity as compared to controls. Lower limb injuries were more common than upper limb injuries amongst the cases.

Conclusions

Generalized ligamentous laxity was more common in individuals who presented with a musculoskeletal injury. It may be a predisposing factor for musculoskeletal injuries. Prehabilitation may be an important aspect of training that should be emphasized to individuals identified to have generalized ligamentous laxity.