A one-season prospective study of injuries and illness in elite junior tennis

Health problems among elite Dutch youth long track speed skaters: a one-season prospective study

OBJECTIVES

To describe the frequency, type, and severity of health problems in long-track speed skating to inform injury prevention strategies.

METHODS

We prospectively collected weekly health and sport exposure data on 84 highly trained Dutch athletes aged 15-21 years during the 2019/2020 season using the Oslo Sports Trauma Research Centre questionnaire on Health Problems and the trainers' documentation. We categorised health problems into acute or repetitive mechanisms of injury or illness and calculated incidences (per 1000 sports exposure hours), weekly prevalence and burden (days of time loss per 1000 sports exposure hours) related to the affected body region.

RESULTS

We registered 283 health problems (187 injuries, 96 illnesses), yielding an average weekly prevalence of health problems of 30.5% (95% CI 28.7% to 32.2%). Incidence rates were 2.0/1000 hours for acute mechanism injuries (95% CI 1.5 to 2.5) and 3.2/1000 hours for illnesses (95% CI 2.6 to 3.9). For acute mechanism injuries the head, shoulder and lumbosacral region had the highest injury burden of 5.6 (95% CI 4.8 to 6.5), 2.9 (95% CI 2.3 to 3.5) and 2.2 (95% CI 1.7 to 2.8) days of time loss/1000 hours, respectively. For repetitive mechanism injuries, the knee, thoracic spine, lower leg and lumbosacral region had the highest injury burden, with 11.0 (95% CI 9.8 to 12.2), 6.8 (95% CI 5.9 to 7.7), 3.9 (95% CI 3.2 to 4.6) and 2.5 (95% CI 1.9 to 3.1) days of time loss/1000 hours, respectively.

CONCLUSION

Our study demonstrated a high prevalence of acute and repetitive mechanism injuries in speed skating. These results can guide future research and priorities for injury prevention.

Injury Profile in Youth Female Athletes: A Systematic Review and Meta-Analysis

BACKGROUND

An increasing number of epidemiological studies assessing the incidence, prevalence and severity of injury in youth female sport are available. However, no study has sought to synthesise the current evidence base across all youth female sport. As such, a systematic review and meta-analysis of injury in this cohort is necessary to understand the diversity of injury and its associated burden between sports in addition to identifying the density of research available.

OBJECTIVE

To conduct a systematic review and meta-analysis of epidemiological data of injuries in youth female athletes with particular attention to injury incidence, mean days lost and injury burden.

METHODS

Searches were performed in PubMed, EBSCO (SPORTDiscus with Full Text MEDLINE, APA PsycINFO, CINAHL, Academic Search Complete) and Cochrane databases. Studies were considered if they reported time-loss injury incidence or prevalence in youth female (≤ 19 years old) athletes. Study quality and risk of bias were assessed using STROBE-SIIS extension, Newcastle-Ottawa Scale, and funnel plots, respectively. Injury incidence and burden rate data were modelled using a mixed-effect Poisson regression model. Days lost data were modelled using a generalised linear mixed model.

RESULTS

Thirty-two studies were included. The overall incidence rate, mean days lost per injury, and burden rate were 4.4 injuries per 1000 h (95% CI 3.3-5.9), 10 days (95% CI 6-15), and 46 days per 1000 h (95% CI 23-92), respectively. Forty percent of athletes sustained at least one time-loss injury. Competitive level was a significant moderator of match and training injury incidence, with elite youth athletes presenting greater pooled injury incidence estimates than non-elite athletes (p = 0.0315 and p = 0.0047, respectively). The influence of moderators on days lost and injury burden could not be determined due to an insufficient number of studies for analysis.

CONCLUSION

Despite a broad inclusion criterion, there is limited injury surveillance research available across youth female sport. Outside of soccer, little research density is evidenced with single studies available in popular team sports such as Australian football and rugby union. Insufficient study numbers reporting mean days lost and injury burden data were available for analysis, and pooled days lost data could only be estimated for soccer. This highlights a need for future research to report days lost data alongside injury number and exposure so burden can be calculated and the full risk of injury to youth female athletes can be identified.

Lower HAGOS subscale scores associated with a longer duration of groin problems in football players in the subsequent season

Introduction

Groin injuries represent a considerable problem in football. Although the Adductor Strengthening Programme reduced groin injury risk, players can still experience groin symptoms throughout the season. This study aimed to determine whether preseason Copenhagen Hip and Groin Outcome Score (HAGOS) and a history of previous injury can identify individuals at risk of having a longer duration of groin problems the subsequent season, using an 'any physical complaint' definition of injury.

Methods

Preseason HAGOS score and weekly groin problems were registered with the Oslo Sports Trauma Research Center Overuse questionnaire during one full season in 632 male semiprofessional adult players.

Results

The prognostic model showed a decreased number of weeks with groin problems for each increase in HAGOS score for 'groin-related quality of life' (QOL) (IRR=0.99, p=0.003). A 10-point higher 'QOL' score predicted 10% fewer weeks of groin problems. Additionally, previous hip/groin injury was associated with a 74% increase in the number of weeks with symptoms (p<0.001).

Conclusion

The HAGOS questionnaire applied preseason can detect players at risk of getting more weeks with groin problems the following season. The 'QOL' subscale seems to be the superior subscale for estimating subsequent groin problem duration. While HAGOS appears promising in identifying players at risk, previous groin injury is the most robust indicator, showing a substantial 74% increase in weeks with symptoms.

Introducing a new method to record injuries during military training: a prospective study among 296 young Norwegian conscripts

INTRODUCTION

Most epidemiological studies in the field of military medicine have been based on data from medical records and registries. The aims of this study were to test a self-reporting injury surveillance system commonly used in sports medicine in a military setting, and to describe the injury pattern among Norwegian army conscripts during a period of military training.

METHOD

A total of 296 conscripts in His Majesty the King's Guard were asked to report all injuries each week for 12 weeks, using a modification of the Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H2). We recorded all injuries irrespective of their need for medical attention or consequences for military participation. In addition, we retrieved data on injuries recorded by military physicians in the medical record from the Norwegian Armed Forces Health Register.

RESULTS

The mean weekly response rate was 74%. A total of 357 injuries were recorded, of which 82% were only captured through the OSTRC-H2 and 3% only in the medical records. The average weekly prevalence of injury was 28% (95% CI: 25% to 31%), and 10% (95% CI: 8% to 12%) experienced injuries with a substantial negative impact on training and performance. The greatest injury burden was caused by lower limb injuries, with knee and foot injuries as the predominant injury locations.

CONCLUSION

The OSTRC-H2 is suitable for use in a military setting and records substantially more injuries than the standard medical record. The prevalence of injuries among conscripts is high and comparable with many elite sports.

Occurrence of injuries and illnesses in athletes with a physical impairment; a forty-week prospective cohort study

OBJECTIVES

Currently, the knowledge about the epidemiology of sport-related health problems of athletes with a physical impairment is limited. Therefore, this study aims to describe the prevalence, incidence and severity of sport-related health problems of athletes with a physical impairment in the Netherlands over a one sport season.

DESIGN

Prospective cohort study.

METHODS

Athletes (n = 99) with a physical impairment participated in this study. After completing a baseline questionnaire, athletes started a 40-week health monitoring period, during which they completed the Dutch translation of the OSTRC Questionnaire on Health Problems every week. Based on the reported information, injury and illness prevalence, incidence, weekly cumulative severity score, weekly time loss from sport and the total burden were calculated.

RESULTS

A total of 368 health problems were reported by 95 athletes. These health problems consisted of 258 injuries and 110 illnesses. The average weekly prevalence of health problems was 48.0 %; for injuries 34.6 %, and illnesses 13.4 %. Differences were found when considering injury severity, with the highest severity scores for athletes with a limb deficiency. Furthermore, recreational athletes reported the highest injury severity scores, followed by athletes who competed nationally and athletes who competed internationally.

CONCLUSIONS

Data from this study show a high average weekly prevalence of health problems, and differences amongst various impairment categories and sport levels when considering the severity of injuries. These results add to the knowledge regarding sport-related health problem epidemiology in this population, indicating that impairment category and sport level should be taken into account when developing injury prevention strategies.

Does injury risk increase when youth athletes start to study at a sports high school?

Background/aim

The injury risk is high in adolescent elite athletes. However, little is known about how the injury risk changes when young talented athletes start studying at a sports high school. The primary aim was therefore to explore the risk of injury when the athlete starts to study at a sports high school. A secondary aim was to identify risk factors for injury.

Methods

A total of 489 athletes (age 15-16 years) were followed for 20 weeks, including 10 weeks before and 10 weeks after the athlete had started to study at a sports high school. Substantial injury was monitored in adolescent elite athletes using the Oslo Sports Trauma Research Centre Questionnaire.

Results

The results showed that the mean difference (md) in injury prevalence was significantly (p=0.001) higher across the 10 weeks after school had started (md 3.6; 95% CI 1.5 to 5.8), compared with the 10 weeks before. Female athletes had significantly (p<0.001) higher injury prevalence (md 6.4%; 95% CI 3.0 to 9.8) across the 10 weeks after school had started, whereas male athletes (md 0.9%; 95% CI -1.8 to 3.6) had not (p=0.530). Three significant (p<0.05) risk factors were identified; previous injury within the past 12 months (OR 3.23), higher training volume (OR 0.97) and lower well-being (OR 0.71).

Conclusions

Our results provide supporting evidence for increased injury risk in female adolescent elite athletes after the athletes had started to study at a sports high school.

Well-being as a performance pillar: a holistic approach for monitoring tennis players

This perspective article aims to discuss the usefulness of tools that can assist tennis professionals effectively manage the well-being of their players. This includes identifying and monitoring meaningful metrics (i.e., training load, training intensity, heart rate variability), as well as careful planning of training and competition schedules with appropriate recovery periods. The use of innovative training methods (i.e., repeated-sprint training in hypoxia and heat training), and proper dietary practices, along with biometric assessment for young players, represents should be considered. Adopting a holistic approach to decision-making about training and competition, balancing both health and performance considerations, is crucial for tennis players and their support teams. More research is needed to refine best practices for enhancing tennis performance while prioritizing the well-being of players.

Can running-related injuries be prevented through an online behavioural intervention in adult novice runners? Results of a randomised controlled trial

Objective

To evaluate the effectiveness of the Runfitcheck on time until the onset of a new running-related injury (RRI) among adult novice runners.

Methods

A three-arm randomised controlled trial was conducted over 7 months. Adult novice runners completed a baseline online questionnaire on their characteristics, running activity, RRIs and injury preventive behaviour. Runners were randomly allocated to one of two intervention groups or the control group (n=238). One intervention group obtained access to the Runfitcheck (n=252), an online intervention to encourage injury preventive behaviour, and was fortnightly promoted to use Runfitcheck; the other intervention group (n=251) was directed towards the Runfitcheck once. Runners were followed for 4 months, not all starting at the same time over 7 months. The main outcome measure was time to a new RRI using the Oslo Sports Trauma Research Centre Overuse Injury Questionnaire, and was analysed with survival analysis Cox regression. Generalised estimating equations (GEE) were used to gain insight into the effectiveness of the Runfitcheck.

Results

The time to the occurrence of the first RRI did not differ between the study groups (Wald χ²=0.893). GEE analysis showed no difference in the risk of a new RRI in the group that was referred to the Runfitcheck once (OR 1.22, 95% CI 0.86 to 1.74) nor in the active approach group (OR 1.01, 95% CI 0.71 to 1.45) compared with the control group. Furthermore, the onset of the new RRIs did not change over time (OR 0.96, 95% CI 0.91 to 1.01).

Conclusions

The online intervention Runfitcheck was ineffective in reducing the instantaneous risk of new RRIs in adult novice runners. More research is needed to determine how injuries in novice runners can be prevented.

Trial registration number

Dutch Trial Registry (ID: NL7823).

Medical withdrawals in elite tennis in reference to playing standards, court surfaces and genders

OBJECTIVES

To examine the relationships between medical withdrawals, playing standards, court surfaces and genders in tennis players participating in all elite tours.

DESIGN

Descriptive epidemiology study.

METHODS

Medical withdrawals of men and women tennis players from Association of Tennis Professionals, Women Tennis Association, Challengers and International Tennis Federation Futures tours' matches have been identified considering the court surfaces (fast vs. slow). Proportion comparison and the binomial regression model were used to determine the influence of playing standards, court surfaces and genders on tennis players' likelihoods to withdraw.

RESULTS

A higher proportion of withdrawals was found for men in Challengers and Futures vs. Association of Tennis Professionals (4.8 %, 5.9 % vs 3.4 %; p < 0.001), but without difference between court surfaces (0.1 %, p > 0.05) whatever the playing standards. Women reported higher proportion of medical withdrawals sustained on slow surfaces (0.4 %, p < 0.001), but without different withdrawal rates between playing standards (3.9 %, p > 0.05). After adjustment, the odds of medical withdrawals were higher for Challengers (1.18, p < 0.001) and Futures (1.34, p < 0.001), with a higher likelihood to withdraw (1.04, p < 0.001) when playing on slow surfaces and with a gender-dependent effect indicating higher odds (1.29, p < 0.001) to withdraw for medical reasons in men in reference to women.

CONCLUSIONS

These findings demonstrated a gender-dependent effect on medical withdrawals from an elite tennis tournament with higher likelihood for men participating in Challengers/Futures tours and for women playing on slow surfaces.

Injury Occurrence in Amateur Rugby: Prospective Analysis of Specific Predictors over One Half-Season

Background and objectives: The incidence of injuries in rugby is extremely high, but studies have rarely examined the predictors of injury in amateur players. This study aimed to systematically analyse sports and injury factors as potential predictors of musculoskeletal injuries in senior-level amateur rugby players. Methods: The participants in this study were 101 senior-level rugby players from Croatia (average of 24.64 years old). At baseline, all participants were tested on sociodemographic and anthropometric parameters (age, body height and mass), consumption of dietary supplements, preseason injury status and training volume, and sport factors (position in game). Data on injury occurrence (dependent variable), prevalence of pain, training status, and characteristics of the played match were surveyed prospectively once a week during the three-month period (one half-season). Results: The logistic regression revealed a higher injury occurrence in forward players of the 1st row, 2nd row (OR = 5.07; 95% CI: 1.64–15.69), and center (OR = 4.72; 95% CI: 1.28–14.31), with reference to outside back players. When observed univariately, higher body mass, higher level of competition, more weekly training sessions, self-perceived pain, and playing with pain were significant injury risk factors. The multivariate logistic regression identified pre-season injury (OR = 1.30, 95% CI: 1.09–1.52), higher level of the game/match (OR = 1.44, 95% CI: 1.13–1.76), higher body mass (OR = 1.03, 95% CI: 1.01–1.05), and pain prevalence (OR = 5.71, 95% CI: 3.22-7.70) as multivariate predictors of injury occurrence over the season. Conclusion: The results of this study showed that among sport factors, the playing position, level of competition, and training exposure represent major injury risk factors. Therefore, in order to reduce the number of injuries, special emphasis should be placed on the specific tackling technique of forward players, which could both increase their situational efficiency and protect them from injuries. Additionally, perceived pain, injury history, and playing with injury were noted among injury factors as the ones that can be predictors of future injuries. In that manner, it is important that coaching and medical staff monitor players with previous injuries and with pain symptoms in order to act preventively against injury occurrence.

Injury Surveillance and Training Load Methods Used by Health Professionals in Tennis: An Online Multinational Survey

CONTEXT

Injury surveillance and training load monitoring are both essential for the development of preventative strategies for gradual-onset musculoskeletal injuries in elite sport. Our aim was to survey health professionals working with elite tennis players on whether and how they monitor injuries and training load.

DESIGN

A cross-sectional multinational online open-survey.

METHODS

The survey was developed and advertised in English, Spanish, and Portuguese languages on social media channels, a tennis academic journal, professional tennis associations, and clinical networks of the research team, from December 2020 to April 2021.

RESULTS

72 health professionals from 27 different countries working with elite tennis players responded to the survey. Injury surveillance is performed by 94% (68/72) of the survey respondents, with only 10% (7/68) using the consensus-recommended Oslo Sports Trauma Research Center questionnaire. Most common barriers identified by health professionals to injury surveillance are time constraints (66%), lack of knowledge (43%), and technology (31%). Training load monitoring is performed by 50% (36/72) of the health professionals working with elite tennis players. Main metrics monitored are weekly differences in training load (72%) and acute:chronic workload ratio (58%). Most common reasons for training load monitoring are injury prevention (94%), training planning (81%), and player feedback (53%).

CONCLUSIONS

Despite a high percentage of health professionals implementing injury surveillance metrics, most of them do not use any validated method. Only half of health professionals working with elite tennis players monitor training load. Lack of knowledge and technology were the main barriers reported for adequately monitoring injuries.

Effectiveness of a judo-specific injury prevention programme: a randomised controlled trial in recreational judo athletes

OBJECTIVES

To evaluate the effectiveness of a trainer-supervised judo-specific injury prevention warm-up programme on overall injury prevalence.

METHODS

We conducted a two-arm, cluster randomised controlled trial; the Injury Prevention and Performance Optimization Netherlands (IPPON) study. Judo athletes aged≥12 years were randomised by judo school to IPPON intervention or control group who performed their usual warm-up. Primary outcome was overall injury prevalence (%) over the follow-up period (16-26 weeks) measured fortnightly with the Oslo Sports and Trauma Research Centre Questionnaire. A modified intention-to-treat analysis was performed due to COVID-19, with estimates for the primary outcome obtained using generalised linear mixed models. Secondary outcomes included: prevalence of severe injuries, overall incidence, time-loss injuries, exposure, adherence and experiences of trainers and athletes.

RESULTS

269 judo athletes (IPPON: 117, Control: 152) were included. Mean injury prevalence over 16-26 weeks was 23% (95% CI 20% to 26%) in the IPPON and 28% (95% CI 25% to 30%) in the control group. We observed no significant difference of all reported injuries (OR 0.72 in favour of the IPPON group; 95% CI 0.37 to 1.39). Secondary outcomes also demonstrated no significant differences between groups. Specifically, no significant difference of severe injuries was reported (OR 0.80 in favour of the IPPON group; 95% CI 0.36 to 1.78). All trainers and 70% of athletes perceived the IPPON intervention as successful.

CONCLUSION

The IPPON intervention did not significantly reduce the overall and severe injury prevalence. Despite this, we suggest the IPPON intervention be considered as an useful alternative to regular judo warm-up, given the high adherence and the positive clinical experiences of trainers and athletes.

TRIAL REGISTRATION NUMBER

NTR7698.

A longitudinal analysis of injury characteristics among elite and amateur tennis players at different tournaments from electronic newspaper reports

The non-complexity of tennis, coupled with its health benefits, renders it appealing and encourages varying competitions at different levels of age, gender, and expertise. However, the rapid increase in the participation rates witnesses a surge in injury occurrences, prompting the need for in-depth analysis to facilitate immediate intervention. We employed a media content analysis technique in which tennis-associated articles published in the last 5 years were examined. A total of 207 news reports were gathered and screened for analysis. Subsequently, 71 articles were excluded from the study due to content duplications or summary updates of existing news articles, while 23 news articles were also excluded from the study due to inappropriateness. Finally, 113 news reports directly related to injury in tennis were coded and analyzed. We examined various types of injuries reported from the screened articles with respect to their status (fresh, recurrent, and recovery) across expertise levels i.e., elite, or amateur. Similarly, the incidence of injury occurrences based on the types of tournaments the players engage in was also investigated. A chi-square analysis was employed to achieve the objectives of the study. Occurrences of tennis-associated injuries are disseminated across expertise levels [χ ( 18 ) 2 = 16.542; p = 0.555], with knee, hip, elbow, and shoulder injuries being highly prevalent in both elite and amateur players. Nevertheless, it was noted that elite players suffered a staggering 72.60% of injury-related problems, while amateur players sustained 27.40% of injuries. Moreover, the status of injury spreads based on types of tournaments [χ ( 4 ) 2 = 3.374; p = 0.497], with higher occurrences of fresh and recurrent injuries, while low recovery rates were observed. The findings further demonstrated that injuries are sustained regardless of tournament types [χ ( 36 ) 2 = 39.393; p = 0.321]. However, most of the injuries occurred at international tournaments (85%). Whereas, only 5.30% of the injuries occurred at national/regional tournaments while 9.70% were unidentified. It could be deduced from the findings of this investigation that elite players are more prone to injuries compared with amateur players. Furthermore, the most common tennis-related injuries affect the lower, trunk, and upper regions of the body, respectively. A large number of the reported tennis injuries are fresh and recurrent, with a few recoveries. The international tennis tournaments are highly attributed to injury occurrences as opposed to the national/regional tournaments. The application of the media-based data mining technique is non-trivial in projecting injury-related problems that could be used to facilitate the development of an injury index peculiar to the tennis sport for prompt intervention.

Athletic Identity and Shoulder Overuse Injury in Competitive Adolescent Tennis Players: The Smash Cohort Study

Objectives

Our primary aim was to determine if athletic identity is prospectively associated with shoulder overuse injuries. Secondly, we aimed to determine if athletic identity is prospectively associated with playing through pain and to describe how athletic identity relates to sex, age, playing level, weekly training load, and match volume.

Methods

A cohort of 269 adolescent tennis players were followed over a period of 52 weeks. Cox regression was used to estimate the hazard rate ratio (HRR) of first-time shoulder overuse injury associated with every 10-unit increase on the Athletic Identity Measurement Scale (AIMS).

Results

The adjusted HRR of shoulder overuse injury was 0.89 (95% CI: 0.36–2.20) and the odds ratio of playing through pain was 2.41 (95% CI: 0.74–8.96) for every 10 unit increase on AIMS. The level of athletic identity was higher among players at the national level than among players at the regional level and was weakly correlated to weekly hours of tennis matches, tennis training, and fitness training.

Conclusions

Our results indicate that higher levels of athletic identity may be associated with a lower incidence of shoulder overuse injuries, and potentially with playing through pain, although these results are inconclusive due to wide confidence intervals.

The Impact of Statewide Limitations of Practice on High School Injury Incidence During the COVID-19 Season: An Ecological Study

BACKGROUND

Abrupt training stoppage can increase injury incidence and risk following return to sport. The rate of coronavirus disease 2019 (COVID-19) infections in the general population has resulted in the abrupt stoppage of high school education and sport. The objective of this study was to (1) compare injury incidence proportion (IP) and excess injury in high school athletes before and during the COVID-19 pandemic; and (2) stratify by identified gender.

HYPOTHESIS

The COVID-19 academic year will demonstrate increased injury incidence, and injury incidence will be similar between genders.

STUDY DESIGN

Ecological.

LEVEL OF EVIDENCE

Level 2.

METHODS

High schools (6 states; 176 high schools) were matched between prepandemic and pandemic years. Injury IP with 95% confidence interval (CI) was calculated. Interrupted time series models with robust errors were performed to assess the IP ratio and excess injury incidence between prepandemic and pandemic academic calendar years.

RESULTS

A total of 98,487 athletes participated in high school sport in the prepandemic year and 72,521 athletes in the pandemic year; 15,477 injuries were reported in the prepandemic year compared with 14,057 injuries during the pandemic year. Injury IP (CI) was 15.7 (15.5-15.9) and 19.4 (19.1-19.7) for the prepandemic and pandemic years, respectively. Injury incidence ratio increased by 1.3 (1.2-1.5) between the prepandemic and pandemic years. Excess injuries were 1812 greater in the pandemic year compared with the prepandemic year. Female and male athlete incidence ratios were similar.

CONCLUSION

Prolonged sport stoppage due to the COVID-19 pandemic resulted in increased injury incidence compared with the previous high school academic year.

CLINICAL RELEVANCE

High school sports stakeholders should consider longer periods of ramp up for training in lieu of future sport stoppages compared with usual preseason training. These data may also have more generalizable implications to other abrupt sport and physical activity stoppage scenarios such as earthquakes and hurricanes.

Epidemiology of racket and paddle sports-related injuries treated in the United States emergency departments, 2007-2016

OBJECTIVE

Racket and paddle sports are popular worldwide. Although there are several epidemiologic studies on tennis, there are limited epidemiologic studies on injuries in badminton, squash, racquetball, table tennis, pickleball and other racket and paddle sports. We aimed to analyze acute racket and paddle sports injuries that presented to emergency departments.

DESIGN

Descriptive epidemiologic study; level of evidence 3.

SETTING

United States emergency departments (USEDs).

METHODS

Data from National Electronic Injury Surveillance System (NEISS) were queried to characterize racket and paddle sports-related (RPSR) injuries that presented to USEDs over a 10-year period.

RESULTS

From 2007 to 2016, there were 7,723 cases of racket and paddle sports-related (RPSR) injuries that presented to USEDs. This data provides a weighted estimate of 301,038 RPSR injuries in USEDs over the 10-year study period. The majority (60.3) of these injuries were in men. Men had a higher percentage of injuries of most body parts except the lower arm, wrist, and ankle. The mean age at the time of injury was 37 years. The highest percentage of sprains, strains, and lower extremity injuries occurred in athletes between ages 18-40 years. Between sports, table tennis had highest percentage of skin and internal organ injuries while badminton had the highest percentage of sprains, strains, fractures, and dislocations.

CONCLUSION

This study is the largest nationally representative study of RPSR injuries to date. RPSR injuries are varied in their presentation based on age, sex, body location, and type of injury.

CLINICAL RELEVANCE

This study determined common RPSR injuries presenting to USEDs, their patterns, and severity over a 10-year period. Researchers and clinicians can begin to use this data for future research studies and may consider this early data in management decisions.

Ankle Sprain in Young Athletes: A 2-Year Retrospective Study at a Multisport Club

Objective  The present study aimed to analyze ankle sprains in young athletes of basketball, futsal, artistic gymnastics, trampoline, tennis, judo, and volleyball over 2 seasons. Methods  Data of 529 athletes in the 1 ^st year and of 495 athletes in the 2 ^nd year of analysis were investigated from the injury record database of a sports club. The following data were considered: the demographic characteristics (age, body mass, height, and sex), the mechanism (contact or noncontact), the severity, the moment at which the injury occurred, and the recurrence. Also, the incidence rate, the injury risk of the first ankle sprain, and the incidence rate ratio between sports were calculated. Results  The athletes sustained 124 ankle sprains in the 2 years of analysis. The majority occurred during training (76.6%) and lead to absence from sports practice (75.8%). The injury recurrence was low: 2 athletes (1.6%) had a recurrence in the same year and 5 (4.0%) in the following year. The incidence rate (0.79 to 12.81 per 1,000 hours) and the injury risk (1.14 to 19.44%) varied among sports. Volleyball, basketball, and futsal presented the highest injury rate incidence. Tennis, gymnastics, and trampoline showed the lowest injury rate incidence. Judo showed an incidence rate different from those of basketball and volleyball in the 1 ^st year and similar to those of other sports in the 2 ^nd year. Conclusion  Ankle sprain greatly impacted sports practice and presented characteristics that differ among the investigated sports. These findings may contribute to developing preventive injury programs.

Eccentric and Isometric Shoulder Rotation Strength and Range of Motion: Normative Values for Adolescent Competitive Tennis Players

The aim of this cross-sectional study was to investigate isometric internal rotation (IR), external rotation (ER), abduction (ABD), and eccentric external rotation (eccER) shoulder strength and rotational range of motion (ROM) in adolescent male and female competitive tennis players. Additional aims of the study were to provide a tennis-specific normative database based on a large sample of players to deepen the knowledge regarding shoulder strength and ROM for adolescent competitive tennis players, and to discuss differences based on sex, age, and level of play. Shoulder strength and ROM was assessed in 301 adolescent competitive tennis players, 176 boys and 125 girls with a mean age of 14.6 and 14.4 years, respectively. Outcome variables of interest were isometric IR and ER strength, ABD strength, eccER shoulder strength, intermuscular strength ratios ER/IR and eccER/IR, IR ROM, ER ROM, and total range of motion (TROM). A General Linear Model two-way ANOVA was used to analyze differences in sex, age, and level of play. The findings of this study demonstrated age, side, and sex differences in the shoulder isometric strength, the eccER strength and ROM in adolescent competitive tennis players. Furthermore, when strength was expressed as ratios ER/IR and eccER/IR both sexes showed a lower ratio for eccER/IR in national players (0.95 ± 0.22 and 0.95 ± 0.23) compared to regional players (1.01 ± 0.32 and 1.07 ± 0.29) for male and female players, respectively. In conclusion, this paper presents a tennis-specific normative database for shoulder rotation strength and ROM in adolescent male and female competitive players. The key points in this evaluation are strength values normalized to body mass, intermuscular ratios, and TROM.

Age and Gender Differences in Injuries and Risk Factors in Elite Junior and Professional Tennis Players

BACKGROUND

Elite tennis athletes experience injuries throughout the entire body. Impairments in trunk stability, lower limb flexibility, and hip range of motion (ROM) are modifiable risk factors that can impact injuries and performance. Information on nonmodifiable risk factors such as age and gender is limited. The purpose of this investigation was to provide information on risk factors to direct clinical decision-making and injury prevention and rehab programming in this population.

HYPOTHESIS

Prevalence and location of injuries will differ by age group and gender. Trunk stability, lower limb flexibility, and hip ROM will differ by age group and gender.

STUDY DESIGN

Cross-sectional study.

LEVEL OF EVIDENCE

Level 3.

METHODS

A de-identified database (n = 237; females = 126) from the United States Tennis Association High Performance Profile (HPP) 2014-2015 was used for the analysis. Subjects were elite junior and professional tennis players (mean age 14.6 [range, 9-27] years). The HPP is a tennis-specific assessment and questionnaire that includes retrospective information on injury history. Subjects were categorized by injury, gender, and age. Injury locations were classified by region. Trunk stability measures included drop vertical jump (DVJ), single-leg squat, and prone and side planks. Lower limb measures included hamstring, quadriceps and hip flexor flexibility, and hip rotation ROM.

RESULTS

A total of 46% of athletes reported an injury. Significant differences were found for injury prevalence and location by age group. Adolescent athletes (age 13-17 years) had more trunk injuries, while adult athletes (age ≥18 years) had more lower limb injuries. Adolescent athletes performed worse on DVJ, dominant side plank, and hamstring flexibility compared with young (age ≤12 years) and adult athletes. Significant gender differences in hip ROM included internal rotation on both the dominant and nondominant sides.

CONCLUSION

Impairments in trunk stability, lower limb flexibility, and hip rotation ROM may affect both health and performance outcomes in this population. Elite tennis athletes may benefit from additional off court programming to address trunk and lower limb impairments.

CLINICAL RELEVANCE

Adolescent elite tennis athletes may be at higher risk of trunk injuries. Age, gender, injury history, and impairments should be considered with all assessments and programming.

Illness prevalence and symptoms in youth floorball players: a one-season prospective cohort study involving 471 players

OBJECTIVE

To describe weekly illness prevalence and illness symptoms by sex in youth floorball players during one season.

DESIGN

Prospective cohort study.

SETTING

Players who were registered to play community level floorball during the 2017-2018 season (26 weeks) in two provinces in southern Sweden.

PARTICIPANTS

471 youth players aged 12-17 years. Mean (SD) age for 329 male players 13.3 (1.0) years and 142 female players 13.7 (1.5) years.

PRIMARY AND SECONDARY OUTCOME MEASURES

Weekly self-reported illness prevalence and illness symptoms according to the 2020 International Olympic Committee's consensus recommendations.

RESULTS

61% of youth floorball players reported at least one illness week during the season, with an average weekly illness prevalence of 12% (95% CI 10.8% to 12.3%). The prevalence was slightly higher among females (13%, 95% CI 11.6% to 14.3%) than males (11%, 95% CI 9.9% to 11.7%), prevalence rate ratio 1.20 (95% CI 1.05 to 1.37, p=0.009). In total, 49% (53% male, 43% female) of illness reports indicated that the player could not participate in floorball (time loss), with a mean (SD) absence of 2.0 (1.7) days per illness week. Fever (30%), sore throat (16%) and cough (14%) were the most common symptoms. Female players more often reported difficulty in breathing/tight airways and fainting, and male players more often reported coughing, feeling tired/feverish and headache. Illness prevalence was highest in the peak winter months (late January/February) reaching 15%-18% during this period.

CONCLUSIONS

Our novel findings of the illness prevalence and symptoms in youth floorball may help direct prevention strategies. Athletes, coaches, parents and support personnel need to be educated about risk mitigation strategies.

TRIAL REGISTRATION NUMBER

NCT03309904.

Psychosocial Risk Factors for Overuse Injuries in Competitive Athletes: A Mixed-Studies Systematic Review

Background

While the psychosocial risk factors for traumatic injuries have been comprehensively investigated, less is known about psychosocial factors predisposing athletes to overuse injuries.

Objective

The aim of this review was to systematically identify studies and synthesise data that examined psychosocial risk factors for overuse injuries in athletes.

Design

Systematic review.

Data Sources

MEDLINE, Web of Science and PsycINFO databases, supplemented by hand searching of journals and reference lists.

Eligibility Criteria for Selecting Studies

Quantitative and qualitative studies involving competitive athletes, published prior to July 2021, and reporting the relationship between psychosocial variables and overuse injury as an outcome were reviewed. This was limited to academic peer-reviewed journals in Swedish, English, German, Spanish and French. An assessment of the risk of bias was performed using modified versions of the RoBANS and SBU Quality Assessment Scale for Qualitative Studies.

Results

Nine quantitative and five qualitative studies evaluating 1061 athletes and 27 psychosocial factors were included for review. Intra-personal factors, inter-personal factors and sociocultural factors were found to be related to the risk of overuse injury when synthesised and reported according to a narrative synthesis approach. Importantly, these psychosocial factors, and the potential mechanisms describing how they might contribute to overuse injury development, appeared to be different compared with those already known for traumatic injuries.

Conclusions

There is preliminary evidence that overuse injuries are likely to partially result from complex interactions between psychosocial factors. Coaches and supporting staff are encouraged to acknowledge the similarities and differences between traumatic and overuse injury aetiology.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40279-021-01597-5.

Surveillance of Injury Types, Locations, and Intensities in Male and Female Tennis Players: A Content Analysis of Online Newspaper Reports

The popularity of modern tennis has contributed to the increasing number of participants at both recreational and competitive levels. The influx of numerous tennis participants has resulted in a wave of injury occurrences of different types and magnitudes across both male and female players. Since tennis injury harms both players' economic and career development, a better understanding of its epidemiology could potentially curtail its prevalence and occurrences. We used online-based tennis-related injury reports to study the prevalence, location types, and injury intensities in both male and female tennis players for the past five years. It is demonstrated from the chi-square analysis that injury occurrences are significantly associated with a specific gender (χ2(18) = 50.773; p = 0.001), with male players having a higher risk of injury manifestation (68.10%) as compared with female players (31.90%). Nonetheless, knee, hip, ankle, and shoulder injuries are highly prevalent in both male and female players. Moreover, the injury intensities are distributed across gender (χ2(2) = 0.398; p = 0.820), with major injuries being dominant, followed by minor injuries, whilst a few cases of career-threatening injuries were also reported. It was similarly observed that male players recorded a higher degree of both major, minor, and career-threatening injuries than female players. In addition, male players sustained more elbow, hip, knee, shoulder, and thigh injuries than female players. Whereas, female players mostly suffered from Achilles and back injuries, ankle and hamstring injuries affected both genders. The usage of online newspaper reports is pivotal in characterizing the epidemiology of tennis-related injuries based on locations and gender to better understand the pattern and localization of injuries, which could be used to address the problem of modern tennis-related injuries.

Methodological implications of adapting and applying a web-based questionnaire on health problems to adolescent football players

BACKGROUND

The Oslo Sport Trauma Research Centre Questionnaire on Health Problems (OSTRC-H) has become a popular tool to monitor health status in athletes. Originally developed for adult athletes, the tool is today also being used in adolescent athletes. However, little is known on the suitability of the questionnaire for the adolescent age group and the methodological implications of applying the tool to prospectively monitor illness and injury. To address this gap in methodological knowledge, the aim of this study is to outline and discuss the adaption and application process of the OSTRC-H to adolescent football players.

METHOD

The adaption process included a slightly modified back-translation method to translate the questionnaire. The application process included a web-based version of the Swedish OSTRC-H sent out once a week over 23 weeks to 115 adolescent football players aged 10-19 attending two football schools in Sweden. The response rate and prevalence of health problems over 23 weeks were calculated as feasibility indicators. Additionally, comprehensibility questions were added to the questionnaire in the end of the study.

RESULT

No major disagreement was found between the original and translated versions of the questionnaire. However, significant changes to the wording of the questions and answer categories were necessary to adapt it to adolescents. A visual body figure was also added. The average weekly response rate was 38% (SD 13.5). To increase this rate, questionnaire data was gathered retrospectively through telephone and email contact with the participants and their parents, elevating the response rate to 53% (SD 15.5). The adolescents experienced the questionnaire as easy to understand and to cover all relevant health problems.

CONCLUSION

Our study demonstrates the importance of adapting the questionnaire to the adolescent target group through translation, pre-tests, adjustments of wording and the facilitation of answering the questionnaire using a visual body figure. The study further shows the importance of keeping close and personal contact with the participants, their parents, teachers, and coaches throughout data collection. Future studies should take into account the age group and study context when adapting and applying the OSTRC-H to adolescents.

Psychological Factors Change During the Rehabilitation of an Achilles Tendon Rupture: A Multicenter Prospective Cohort Study

OBJECTIVE

The authors sought to gain insight into the changes in psychological factors during rehabilitation after Achilles tendon rupture (ATR) and to explore the association between psychological factors during rehabilitation and functional outcome 12 months after ATR.

METHODS

Fifty patients clinically diagnosed with ATR were invited to visit the hospital 3, 6, and 12 months after injury for data collection. They completed questionnaires assessing psychological factors: psychological readiness to return to sport (Injury Psychological Readiness to Return to Sport Questionnaire); kinesiophobia (Tampa Scale for Kinesiophobia); expectations, motivation, and outcome measures related to symptoms and physical activity (Achilles Tendon Total Rupture Score); and sports participation and performance (Oslo Sports Trauma Research Centre Overuse Injury Questionnaire). To determine whether psychological factors changed over time, generalized estimating equation analyses were performed. Multivariate regression analyses were used to study the association between psychological factors at 3, 6, and 12 months and outcome measures at 12 months after ATR.

RESULTS

Psychological readiness to return to sport improved, and kinesiophobia decreased significantly during rehabilitation. Psychological readiness at 6 and 12 months showed significant associations with sports participation and performance. Kinesiophobia at 6 months was significantly associated with symptoms and physical activity. Motivation remained high during rehabilitation and was highly associated with symptoms and physical activity, sports participation, and performance.

CONCLUSION

Psychological factors change during rehabilitation after ATR. Patients with lower motivation levels during rehabilitation, low psychological readiness to return to sports, and/or high levels of kinesiophobia at 6 months after ATR need to be identified.

IMPACT

According to these results, psychological factors can affect the rehabilitation of patients with ATR. Physical therapists can play an important role in recognizing patients with low motivation levels and low psychological readiness for return to sport and patients with high levels of kinesiophobia at 6 months post-ATR. Physical therapist interventions to enhance motivation and psychological readiness to return to sport and to reduce kinesiophobia need to be developed and studied in the post-ATR population.

LAY SUMMARY

With Achilles tendon rupture, level of motivation, psychological readiness for return to sport, and fear of movement can affect rehabilitation outcome. A physical therapist can help recognize these factors.

Prevalence and Burden of Self-Reported Health Problems in Junior Male Elite Ice Hockey Players: A 44-Week Prospective Cohort Study

BACKGROUND

Little is known about the burden of overuse injuries and illnesses in junior elite ice hockey.

PURPOSE

To describe the prevalence and burden of all health problems in junior male elite ice hockey players in Norway during 1 school year.

STUDY DESIGN

Descriptive epidemiological study.

METHODS

A total of 206 junior male ice hockey players (mean age, 17 years; range, 15-20 years) attending specialized sports academy high schools in Norway reported all health problems, acute injuries, overuse injuries, and illnesses, weekly during the 2018-2019 school year (44 weeks). The players self-reported injuries and illnesses using the Oslo Sports Trauma Research Center Questionnaire on Health Problems.

RESULTS

Of the players included, 25% (95% CI, 23%-27%) reported at least 1 health problem at any given time, while 16% (95% CI, 14%-17%) experienced health problems with a substantial negative effect on training and performance. Of the total burden of health problems, acute injuries accounted for 44%, overuse injuries 31%, and illnesses 25%. For acute injuries, the greatest burden was caused by injuries to the ankle, knee, and hand, whereas for overuse injuries the most burdensome location was the hip/groin and knee.

CONCLUSION

This study documented that while acute injuries did represent the greatest problem among junior elite ice hockey players, overuse injuries, especially to the knee and hip/groin, also had a substantial effect.

Brazilian version of the OSTRC Questionnaire on health problems (OSTRC-BR): translation, cross-cultural adaptation and measurement properties

BACKGROUND

The Oslo Sports Trauma Research Center - Questionnaire on Health Problems (OSTRC-QHP) has been shown to be a valid and reliable questionnaire for monitoring athletes with acute, overuse, and illness problems.

OBJECTIVES

To translate and cross-culturally adapt the OSTRC-QHP into Brazilian-Portuguese (OSTRC-BR), and investigate the measurement properties of this version.

METHODS

The original (Norwegian) questionnaire was translated and culturally adapted following existing guidelines. Measurement properties of the OSTRC-BR were investigated in 134 athletes followed for 13 weeks. Reliability was analyzed via internal consistency and test-retest reliability. Responsiveness was assessed by effect size (ES) estimations, correlation of the OSTRC-BR severity score with the Global Perceived Effect scale (GPE) and the Numeric Pain Rating Scale (NPRS), and by the Receiver Operating Characteristic (ROC) Curve test based on the area under the curve (AUC).

RESULTS

The OSTRC-QHP has been translated and cross-culturally adapted successfully. The Cronbach's alpha was 0.93 (95% CI: 0.92, 0.94). Intrarater reliability (ICC_2,1) of 0.96 (95% CI: 0.94, 0.98) was classified as excellent. ES estimation showed large effects (1.14 to 1.39). OSTRC-BR correlation was moderate (0.58 to 0.72) with the GPE and substantial (0.84 to 0.89) with the NPRS. The AUC values were above 0.70 when analysing all types of health problems.

CONCLUSIONS

The OSTRC-BR presented adequate measurement properties. The OSTRC-BR is a valid, reliable, responsive, and, therefore, an adequate tool for monitoring Brazilian athletes from different sports during training and competitions.

The socio-economic impact of running-related injuries: A large prospective cohort study

Objectives

To evaluate the impact of running‐related injuries (RRIs) on activities of daily living (ADL), work, healthcare utilization, and estimated costs.

Design

Prospective cohort study with data from a randomized controlled trial.

Methods

Adult recreational runners who registered for a running event (distances 5 to 42 km) were included in this study. Minimum follow‐up duration was 3 months (preparation, event participation, and post‐race period). Injuries were registered using a standardized definition. Primary outcome measure was a standardized 5‐item survey on limitations in ADL. The survey data were categorized to the number of injured runners with complete/moderate/no limitations. This outcome was expressed as the percentage of injured runners with any limitation (complete or moderate limitations amalgamated). Secondary outcomes were work absenteeism, the number of healthcare visits per injured runner, and estimated direct medical and indirect costs per participant and per RRI.

Results

1929 runners (mean [SD] age 41 [12] years, 53% men) were included in this study and 883 runners (46%) sustained a RRI during the course of the study. Injured runners reported the highest limitations (% with any limitation) of RRIs during the first week of injury on sports and leisure activities (70%) and transportation activities (23%). 39% of the injured runners visited a healthcare professional. Work absenteeism due to the RRI was reported in 5% of the injured runners. The total mean estimated costs were €74 per RRI and €35 per participant.

Conclusions

Injured runners are mainly limited in their transportation activities and during sports and leisure. While the estimated costs of RRIs are not high when expressed per participant, the absolute costs may be substantial due to the popularity of running.

'The Little Engine That Could': A Qualitative Study of Medical Service Access and Effectiveness among Adolescent Athletics Athletes Competing at the Highest International Level

Little is known about provision of medical services to adolescents prior to participating in international top-level sports. This study aimed to investigate experiences of medical service provision among high-level adolescent athletics (track and field) athletes from three continents. A thematic narrative analysis was applied to data collected from 14 athletes by semi-structured interviews. Although competing at the highest international level, these adolescent athletes had difficulties making sense of symptoms of ill health, especially on their own. With increasing exercise loads, the athletes’ medical support needs had extended beyond the capacity of parents and local communities. As there was no organized transfer of the responsibility for medical support to sports organizations, the athletes often had to manage their health problems by themselves. There were major variations among the adolescent athletes with regards to medical service access and quality. The services used ranged from sophisticated computer-assisted biomechanical analyses to traditional healers. Decreased exercise load was the common sports injury treatment. The results of this study demonstrate how the ethical standards underpinning youth sports as well as the equal provision of medical services to adolescents are challenged across the world. Further research on health service provision to adolescent top-level athletes is warranted.

The Association Between the Acute:Chronic Workload Ratio and Running-Related Injuries in Dutch Runners: A Prospective Cohort Study

OBJECTIVE

To investigate the association between the acute:chronic workload ratio (ACWR) and running-related injuries (RRI).

METHODS

This is a secondary analysis using a database composed of data from three studies conducted with the same RRI surveillance system. Longitudinal data comprising running exposure (workload) and RRI were collected biweekly during the respective cohorts' follow-up (18-65 weeks). ACWR was calculated as the most recent (i.e., acute) external workload (last 2 weeks) divided by the average external (i.e., chronic) workload of the last 4, 6, 8, 10 and 12 weeks. Three methods were used to calculate the ACWR: uncoupled, coupled and exponentially weighted moving averages (EWMA). Bayesian logistic mixed models were used to analyse the data.

RESULTS

The sample was composed of 435 runners. Runners whose ACWR was under 0.70 had about 10% predicted probability of sustaining RRI (9.6%; 95% credible interval [CrI] 7.5-12.4), while those whose ACWR was higher than 1.38 had about 1% predicted probability of sustaining RRI (1.3%; 95% CrI 0.7-1.7). The association between the ACWR and RRI was significant, varying from a small to a moderate association (1-10%). The higher the ACWR, the lower the RRI risk.

CONCLUSIONS

The ACWR showed an inversely proportional association with RRI risk that can be represented by a smooth L-shaped, second-order, polynomial decay curve. The ACWR using hours or kilometres yielded similar results. The coupled and uncoupled methods revealed similar associations with RRIs. The uncoupled method presented the best discrimination for ACWR strata. The EWMA method yielded sparse and non-significant results.

Psychological factors during rehabilitation of patients with Achilles or patellar tendinopathy: a cross-sectional study

OBJECTIVE

to examine psychological factors during rehabilitation of patients with Achilles or patellar tendinopathy as well as the association between psychological factors and tendinopathy severity, sport participation, and satisfaction with activity level and tendon function.

DESIGN

cross-sectional study.

SETTING

online survey platform.

PARTICIPANTS

119 patients (mean age: 44 years (SD 14)) diagnosed with Achilles or patellar tendinopathy.

MAIN OUTCOME MEASURES

A range of patient-reported psychological and outcome measures were recorded. Multivariate regression analyses were performed to establish the association between each psychological factor and outcome measures, adjusted for relevant confounders.

RESULTS

Psychological readiness and confidence to return to sports (I-PRRS) and pain catastrophizing (PCS) were significantly associated with tendinopathy severity (modified VISA), sport participation(OSTRC-O), and satisfaction. Kinesiophobia (TSK) and the importance to patients of returning to pre-injury activity level were significantly associated with sports participation and satisfaction.

CONCLUSION

The current study provides evidence of impairments in psychological factors during rehabilitation of patients with Achilles and patellar tendinopathy. Most investigated psychological factors were associated with tendinopathy severity, function, participation, and satisfaction. Physical therapists should recognize patients with lack of psychological readiness to return to sports and also patients with kinesiophobia or catastrophizing thoughts when experiencing pain.

Can we explain running-related injury preventive behavior? A path analysis

BACKGROUND

Behavioral and social science theories/models have been gaining attention in sports injury prevention.

OBJECTIVE

To investigate the potential of the Theory of Planned Behavior in explaining running-related injury preventive behavior.

METHODS

Six-month prospective cohort study based on data gathered from a randomized controlled trial. From a total of 1512 invited trail runners, 232 were included in this study. Preventive behaviors and their determinants were assessed at baseline and two and six months after baseline. Five-point Likert scales were used to assess the determinants of preventive behavior. A Bayesian path analysis was conducted applying mixed models and mediation analysis.

RESULTS

A 1-point increase in intention, attitude, subjective norm, and perceived behavioral control predicted an increase of 54% (95% Bayesian credible interval [BCI]: 38, 71) in the rate of performing running-related injury preventive behavior, explaining 49% (R² 0.49; 95% BCI: 0.41, 0.56) of the variance around preventive behavior. Intention and perceived behavioral control predicted running-related injury preventive behavior directly, while 40% (95% BCI: 21, 61) and 44% (95% BCI: 20, 69) of the total effect of attitude was mediated by intention and perceived behavioral control, respectively. Attitude, subjective norm, and perceived behavioral control predicted intention.

CONCLUSIONS

The Theory of Planned Behavior may have the potential to explain half of the variance around running-related injury preventive behavior and intention. Therefore, such theory may be considered a relevant and useful tool in developing, investigating, and/or implementing programs aimed at preventing running-related injuries.

COLLEGE STUDENTS’ PHYSICAL AND MENTAL HEALTH EXERCISE BASED ON TENNIS

ABSTRACT College students are often under great pressure, and their physical and mental health is the focus of attention in college education. In order to cultivate high-quality talents and relieve the pressure of college students, many colleges and universities have set up a variety of sports courses, including tennis courses. Analyzing the influence of tennis on the physical and mental health of college students, this study studies the situation of college students participating in tennis by consulting literature, designing questionnaires and using an experimental measurement method, while it constructs the physical health evaluation index and mental health evaluation index of college students. On this basis, this study evaluates the influence of tennis on students’ physical and mental health. The results show that tennis has a positive impact on the physical and mental health of college students. Tennis can not only enhance college students’ cardiopulmonary function and muscle strength, but also cultivate students’ independent personality, eliminate depression tendency, make students independent, flexible and active, which is conducive to the development of students’ mental health. It is hoped that this study can provide some reference for the research of college students’ physical and mental health exercise based on tennis.

Cross-Cultural Adaptation and Validation of the Oslo Sports Trauma Research Center Questionnaires on Overuse Injury and Health Problems (2nd Version) in Spanish Youth Sports

Background:

The Oslo Sports Trauma Research Center Questionnaires on Health Problems (OSTRC-H) and Overuse Injury (OSTRC-O) have shown a greater ability to identify athletes with health problems and to estimate the severity of those problems compared with traditional surveillance methods. Despite the numerous language adaptations of these questionnaires and their extended use, some of their measurement properties remain unknown. Moreover, these questionnaires are not available for Spanish-speaking athletes, and the validity and reliability of these questionnaires in youth athletes are unknown.

Purpose:

To cross-culturally adapt and investigate the measurement properties of the second version of the OSTRC-H (OSTRC-H2) and OSTRC-O (OSTRC-O2) questionnaires in Spanish youth athletes.

Study Design:

Cohort study (diagnosis); Level of evidence, 2.

Methods:

Following international guidelines, we developed Spanish cross-cultural adaptations of the questionnaires, including a comprehensibility analysis with 30 participants from the target population. In the second phase, 73 athletes (age range, 12-18 years) were invited to participate in an 11-week prospective study. The reliability (internal consistency and test-retest reliability) of both questionnaires was assessed through use of Consensus-Based Standards for the Selection of Health Measurement Instruments recommendations. The construct validity and responsiveness of the OSTRC-H2 were evaluated using the convergence of the OSTRC-H2 severity score and the number of days of time loss. The response rate after 11 weeks was calculated as a feasibility indicator.

Results:

Equivalent Spanish versions were developed. A total of 63 athletes (age range, 12-17 years) participated in the prospective study. The Cronbach alpha was 0.93 (95% CI, 0.92-0.94) for OSTRC-H2 and 0.88 (95% CI, 0.86-0.90) for OSTRC-O2. The intraclass correlation coefficient was 0.87 (95% CI, 0.79-0.92) and 0.85 (95% CI, 0.81-0.89), and the Cohen kappa was 0.80 (95% CI, 0.71-0.89) and 0.87 (95% CI, 0.78-0.96), respectively, for OSTRC-H2 and OSTRC-02. Correlations between the severity score and time loss (Spearman rho = 0.61) and between the changes in both scores over time (Spearman rho = 0.78) were within our expected range. The response rate was 95.5% for the OSTRC-O2 and 99.6% for the OSTRC-H2.

Conclusion:

These results present equivalent, reliable, and feasible Spanish versions of both questionnaires as well as evidence of the validity and responsiveness of the OSTRC-H2.

DESCRIPTIVE PROFILE OF SHOULDER RANGE OF MOTION AND STRENGTH IN YOUTH ATHLETES PARTICIPATING IN OVERHEAD SPORTS

Background

The unilateral and repetitive nature of overhead sports, often result in a biomechanical overload of the upper extremity. Understanding the musculoskeletal shoulder range of motion (ROM) and strength patterns in the youth sports of baseball, softball, and tennis could assist injury prevention screening and further the development of conditioning and rehabilitation programs.

Purpose

To generate a descriptive profile of shoulder musculoskeletal characteristics and determine whether bilateral differences in shoulder ROM exist in youth baseball, softball, and tennis athletes. A secondary aim was to determine whether shoulder rotational adaptations are correlated with playing position, sport, or years of experience.

Study Design

Descriptive Laboratory.

Methods

A total of 136 competitive youth overhead athletes (baseball: n = 51,12.8 ± 0.9yrs; softball: n = 63,12.3 ± 1.1yrs; and tennis: n = 22,12.5 ± 0.9yrs) participated. Bilateral shoulder internal (IR) and external (ER) passive ROM and external rotation strength were measured using an inclinometer and handheld dynamometer.

Results

Significant differences (p<.001) in bilateral shoulder ROM and ER strength were found between the athletes in the three sports. Post-hoc test revealed tennis athletes had greater bilateral shoulder ROM than both baseball and softball athletes, but baseball and softball athletes had greater bilateral ER strength than tennis athletes. There were no differences between baseball and softball athletes. Additionally, tennis athletes had greater bilateral internal rotation and total ROM but less ER strength than baseball pitchers, baseball positional athletes, softball pitchers, and softball positional athletes. There were no significant differences between positions and baseball and softball athletes. There were no significant correlations between playing position, sport, or years of experience.

Conclusion

The results of this study showed differences in shoulder passive ROM and strength adaptations between youth tennis, baseball, and softball athletes. The descriptive nature of this study is impactful as it presents specific ROM adaptions seen in this population. Future research is needed to further evaluate if the "at risk" ROM identified in older populations holds true in the youth population.

Level of Evidence

Diagnosis, Level 3b.

Tennis-specific extension of the International Olympic Committee consensus statement: methods for recording and reporting of epidemiological data on injury and illness in sport 2020

The IOC has proposed standard methods for recording and reporting of data for injury and illness in sport. The IOC consensus statement authors anticipated that sport-specific statements would provide further recommendations. This statement is the tennis-specific extension of the partner IOC statement. The International Tennis Federation Sport Science and Medicine Committee, in collaboration with selected external experts, met in June 2019 to consider athlete health monitoring issues specific to tennis. Once the IOC consensus statement was finalised, the tennis-specific consensus was drafted and agreed on by the members over three iterations. Compared with the IOC consensus statement, the tennis consensus contains tennis-specific information on injury mechanism, mode of onset, injury classification, injury duration, capturing and reporting exposure, reporting risk and study population. Our recommendations apply to able-bodied as well as wheelchair tennis players. Where applicable, specific recommendations are made for wheelchair tennis.

Association of acute and chronic workloads with injury risk in high-performance junior tennis players

This study examined the association and predictive ability of several markers of internal workload on risk of injury in high-performance junior tennis players. Fifteen young, high-level tennis players (9 males, 6 females; age: 17.2 ± 1.1 years; height: 178.5 ± 8.7 cm; mass: 68.1 ± 4.8 kg) participated in this investigation. Data on injury epidemiology and internal workload during training were obtained for one competitive season. The session-rating of perceived exertion (s-RPE) was used to calculate internal workload markers in absolute (acute workload and chronic workload for 2-weeks, 3-weeks and 4-weeks) and relative terms (acute:chronic workload ratios [ACWR] for 2-weeks, 3-weeks and 4-weeks). Associations and diagnostic power for predicting tennis injuries were examined through generalised estimating equations and receiver operating characteristics analyses. During the season, a total of 40 injuries were recorded, corresponding to 3.5 injuries per 1000 h of tennis practice. The acute workload was highly associated with injury incidence (P=0.04), as injury risk increased by 1.62 times (95% CI: 1.01-2.62) for every increase of 1858.7 arbitrary units (AU) of the workload during the most recent training week. However, acute workload was a poor predictor of injury, and associations between injury and internal workload markers were weak (all P>0.05). These findings demonstrate an association between high values of acute workload and the risk of injury in high-level tennis players. However, a high acute workload is only one of the many factors associated with injury, and by itself, has low predictive ability for injury.

A 2-year prospective study of injuries and illness in an elite national junior tennis program

Objectives: Injury and illness in elite national tennis programs can limit players' current and future performance. This study aimed to prospectively examine injuries and illnesses in an Irish elite national junior tennis program over 2 years. Methods: All injuries and illnesses that led to missed tennis training and match play in the Irish national junior tennis program (n = 82) over 2 years were collected in a prospective cohort study. Injury and illness prevalence and rates were calculated and reported with respect to gender and age group. Descriptive statistics were calculated for the type of illness and the region, location, type, nature, mechanism, and severity of injury. Results: Over the course of the study, 54% of players became injured, with 9.0% receiving more than one injury. Injuries were most frequent in the under-16 age group (12.93 injuries per 1,000 athletic exposures), compared to younger age groups (4.13 [U10], 3.43 [U12], 4.63 [U14] injuries per 1,000 athletic exposures) and seniors (1.98 injuries per 1,000 athletic exposures). Lower (49.5%) and upper limb (35.9%) injuries were frequent and mostly occurred due to overextension (35.9%). No significant differences in males and females injury rates were noted. However, females received a greater proportion of shoulder injuries (23.5% vs 10.9%), with more knee injuries in males (29.1% vs 7.8%). 0.52 illnesses per 1,000 athletic exposures were reported, with respiratory/cardiorespiratory (43.5%) most frequent. Injuries lead to greater average sessions lost (6.77 ± 11.56) than illness (1.83 ± 1.11). Conclusion: These findings can inform injury and illness preventative strategies to minimize absence from tennis play and should be prioritized in the under-16 group. Due to the different injury profiles between males and females, tailored preventative programs should be developed for males and females individually.

Pattern of injuries amongst tennis players in Accra, Ghana

Background

Tennis is a popular global sport characterised by repeated, explosive motions and the involvement of several muscle groups during different strokes, which fluctuates randomly from brief periods of maximal or near maximal work to longer periods of moderate and low intensity activity.

Objectives

To determine the pattern of injuries amongst tennis players in Accra.

Method

A cross-sectional study was conducted, involving 142 male and female participants selected from tennis clubs in Accra and the Accra sports stadium. A standardised tennis injury report form was used to obtain data from participants. Data on the parts of the body mostly injured and the types of injury mostly sustained by the players were summarised and presented appropriately with the use of graphs and pie charts. Assessment of the causes underlying the prevailing injuries to tennis players was also tabulated and comparisons made.

Results

Out of a total of 170 injuries recorded, knee (39 [27.5%]) and shoulder (31 [21.1%]) injuries were the most commonly sustained. Most (80 [56.3%]) tennis injuries occurred during training. Other injuries (26 [18.3%]) occurred during competitions or tournaments whilst 26 (18.3%) occurred during social play. About 10 (7.0%) participants were not certain of the type of activity at the time of injury. The majority (35 [24.65%]) of the players received no treatment for their injuries. However, few of the injuries (20 [14.08%], 14 [9.86%], 6 [4.23%]) sustained were treated by medical personnel, physiotherapists or nurses respectively. There was no association between warm-up before play and cause of injury (p = 0.375). There was also no association between shoe type and cause of injury (p = 0.253).

Conclusion

The majority of the injuries occurred in the upper and lower limbs. Most of these injuries occurred during training with overuse and overexertion being the most common cause.

Clinical implications

It is important to educate tennis players and coaches on injury prevention measures and the use of protective gear during tennis.

A prospective study of sport injuries in youth females

OBJECTIVES

To examine sports and physical education (PE) injury rates in youth females during a school year and to investigate if an association exists between injury and phase of the menstrual cycle.

DESIGN

Prospective cohort.

SETTING

An online questionnaire was used to record training and competition exposure and self-reported injuries for 30-weeks.

PARTICIPANTS

103 PE students (12-15 years) from a girls' secondary school.

MAIN OUTCOME MEASURES

Injury rates and prevalence of acute, gradual onset/overuse and substantial injuries.

RESULTS

On average, girls trained 3.4 h/week and competed 1 h/week. During the study, 74 participants reported 595 injuries. The average weekly prevalence of all injuries was 20.7% (95% CI: 20.0-21.3), of which 8.6% (95% CI: 8.3-9.0) were acute injuries and 12.0% (95% CI: 11.4-12.6) were gradual onset/overuse injuries. The overall rate of sport and PE injuries was 10.4 injuries/1000 h of exposure. The most common acute injury involved the ankle (35%) while the most common gradual onset/overuse injury involved the knee (51%). There was no significant association between the stage of the menstrual cycle and the likelihood of injury (P = 0.18).

CONCLUSION

The high number of injuries in this population of girls suggests preventative measures, particularly targeting the lower extremity, are needed.

Prevalence and Burden of Health Problems in Male Elite Ice Hockey Players: A Prospective Study in the Norwegian Professional League

Background

As previous epidemiological studies in elite ice hockey have focused on acute time-loss injuries, little is known about the burden of overuse injuries and illnesses in ice hockey.

Purpose

To report the prevalence and burden of all health problems in male professional ice hockey players in Norway during a single competitive season.

Study Design

Descriptive epidemiological study.

Methods

A total of 225 male ice hockey players in the GET League (the premier professional league) in Norway reported all health problems (acute injuries, overuse injuries, and illnesses) during the 2017-2018 competitive season. Players reported all injuries and illnesses for 31 weeks using the Oslo Sports Trauma Research Center Questionnaire on Health Problems.

Results

At any given time, 40% (95% CI, 37%-43%) of players reported symptoms from an injury or illness, and 20% (95% CI, 19%-22%) experienced health problems with a substantial negative impact on training and performance. Acute injuries represented the greatest incidence, prevalence, and burden (defined as the cross-product of severity and incidence). The most burdensome acute injuries were to the head/face, shoulder/clavicle, knee, and ankle. The most burdensome overuse injuries were to the knee, lumbar spine, and hip/groin.

Conclusion

This registration captured a greater burden from overuse injuries than traditional injury registration, but acute injuries did represent a major problem. These data provide guidance in the development of prevention programs for both acute and overuse injuries, which should focus on the lumbar spine, hip/groin, and knee.

Effectiveness of an e-health tennis-specific injury prevention programme: randomised controlled trial in adult recreational tennis players

BACKGROUND

Despite reported injury rates of up to 3 per 1000 hours exposure, there are no evidence-based prevention programmes in tennis.

PURPOSE

To evaluate the effectiveness of an e-health prevention programme for reducing tennis injury prevalence.

STUDY DESIGN

Two-arm, researcher-blinded randomised controlled trial.

METHODS

Adult tennis players of all playing levels were randomised in an unsupervised programme lasting 12 weeks (TennisReady group or control group). The primary outcome was the overall injury prevalence over a 16-week period, measured at 2 weekly intervals with the Oslo Sports and Trauma Research Centre questionnaire. Estimates for the primary outcome and associated 95% CIs were obtained using generalised estimating equation models. Secondary outcome scores included prevalence of substantial injuries, overall incidence, adherence and time-loss injuries.

RESULTS

A total of 579 (83%) (TennisReady n=286, control n=293) participants were included in the primary analysis. The mean injury prevalence was 37% (95% CI 33% to 42%) in the TennisReady vs 38% (95% CI 34% to 42%) in the control group (adjusted p-value 0.93). The prevalence of substantial injuries was 11% (95% CI 9% to 14%) in the TennisReady vs 12% (95% CI 9% to 15%) in the control group (p value of 0.79). Analysis of the secondary outcome scores showed no difference between groups. The mean prevalence rates between high (8%) and low (92%) adherent groups were 32% (95% CI 23% to 44%) and 37% (95% CI 33% to 42%), respectively (p value 0.36).

CONCLUSION

Providing an unsupervised e-health tennis-specific exercise programme did not reduce the injury rates and should not be implemented.

TRIAL REGISTRATION NUMBER

NTR6443.

Risk Factors for Lower-Extremity Injuries Among Contemporary Dance Students

OBJECTIVE

To determine whether student characteristics, lower-extremity kinematics, and strength are risk factors for sustaining lower-extremity injuries in preprofessional contemporary dancers.

DESIGN

Prospective cohort study.

SETTING

Codarts University of the Arts.

PATIENTS

Forty-five first-year students of Bachelor Dance and Bachelor Dance Teacher.

ASSESSMENT OF RISK FACTORS

At the beginning of the academic year, the injury history (only lower-extremity) and student characteristics (age, sex, educational program) were assessed using a questionnaire. Besides, lower-extremity kinematics [single-leg squat (SLS)], strength (countermovement jump) and height and weight (body mass index) were measured during a physical performance test.

MAIN OUTCOME MEASURES

Substantial lower-extremity injuries during the academic year were defined as any problems leading to moderate or severe reductions in training volume or in performance, or complete inability to participate in dance at least once during follow-up as measured with the Oslo Sports Trauma Research Center (OSTRC) Questionnaire on Health Problems. Injuries were recorded on a monthly basis using a questionnaire. Analyses on leg-level were performed using generalized estimating equations to test the associations between substantial lower-extremity injuries and potential risk factors.

RESULTS

The 1-year incidence of lower-extremity injuries was 82.2%. Of these, 51.4% was a substantial lower-extremity injury. Multivariate analyses identified that ankle dorsiflexion during the SLS (OR 1.25; 95% confidence interval, 1.03-1.52) was a risk factor for a substantial lower-extremity injury.

CONCLUSIONS

The findings indicate that contemporary dance students are at high risk for lower-extremity injuries. Therefore, the identified risk factor (ankle dorsiflexion) should be considered for prevention purposes.

How do the new Olympic sports compare with the traditional Olympic sports? Injury and illness at the 2018 Youth Olympic Summer Games in Buenos Aires, Argentina

OBJECTIVE

To describe injuries and illnesses across traditional and new sports among the participating athletes of the Buenos Aires 2018 Youth Olympic Summer Games (BA YOG) (6-18 October 2018).

METHODS

We recorded the daily number of athlete injuries and illnesses (1) through the reporting of all National Olympic Committee (NOC) medical teams and (2) in the polyclinic and medical venues manned by the BA YOG 2018 medical staff.

RESULTS

In total, 3.984 athletes from 206 NOCs were observed. NOCs and BA YOG 2018 medical staff reported 619 injuries and 334 illnesses, equalling 15.5 injuries and 8.4 illnesses per 100 athletes over the 13-day period. The eight new sports on the Youth Olympic programme (futsal, beach handball, karate, roller speed skating, kitesurfing, BMX freestyle, climbing and break dancing) fell in between the other sports with respect to injury and illness risk. Injury incidence was highest in rugby (43% of all rugby players), followed by boxing (33%) and badminton (24%), and lowest in swimming, archery, roller speed skating, equestrian, climbing and rowing (<5%). The highest incidences of illness were recorded in golf (20%), followed by triathlon (16%), beach volleyball and diving (both 14%). Of the illnesses, 50% affected the respiratory system and 15% the gastrointestinal system. Injury and illness incidences varied between continents with athletes representing Europe having significantly fewer injuries and illnesses compared with other continents, apart from a similar illness incidence to Asian athletes.

CONCLUSION

The overall injury incidence of 15.5 injuries per 100 athletes was higher, while the overall illness incidence of 8.4 illnesses per 100 athletes was similar to previous youth and Olympic Games. The new sports did not differ significantly compared with the other sports with respect to injury and illness risk.

The acute effect of match-play on hip range of motion and isometric strength in elite tennis players

Background

Groin injuries are some of the most common injuries tennis players suffer. Several factors (e.g., post-match decrease in hip adductor (ADD) strength) have been proposed as possible mechanisms for increasing the incidence of this type of injury. However, the risk factors of developing groin injuries after a tennis match have not yet been delineated.

Objective

The aim of this study was to determine the effect of tennis match-play on isometric ADD and abductor (ABD) strength and passive hip range of motion (ROM).

Methods

Twenty-six male tennis players (20.30 ± 4.98 years) took part in this study. Participants completed an evaluation of strength and flexibility hip measurements before and after a simulated tennis match. Dominant and non-dominant passive hip ROM, ADD and ABD isometric strength, and the ADD/ABD strength ratio were measured before and immediately post-match. A global positioning system (GPS) and a session rating of perceived exertion (RPE) were used to assess the locomotive demands and internal match load.

Results

Isometric dominant ADD strength (17.8%, p ≤ 0.01) and ADD/ABD strength ratio (11.6%, p = 0.04) were lower post-match compared to the pre-match values. No between-limbs differences were observed for isometric ADD strength, ABD strength, and passive hip ROM tests. RPE showed an expected increase between pre- vs. post-match (pre- vs. post-warming-up, 3.42 ± 2.08 vs. 5.62 ± 2.29, p < 0.01). In addition, a significant relationship between ADD strength and the volume of tennis practice per week was found, stablishing that tennis players with lower volume of training per week suffered a reduction in ADD strength in their dominant limb after match-play (r = 0.420, p = 0.04).

Conclusion

The assessment of ADD strength and the ADD/ABD strength ratio in the dominant limb may be considered a post-match tool that can be used to identify players who require rest and additional recovery strategies before competing again.

A One-Season Prospective Study of Illnesses, Acute, and Overuse Injuries in Elite Youth and Junior Track and Field Athletes

Background: In high-level adult athletes, injury incidences and characteristics have been reported during international championships and during one season. Youth track and field athletes are also exposed to injury risk, although less information is available on this specific population, as well as on illness risk.

Aim: To determine the prevalence of health problems (i.e., illnesses, acute, and overuse injuries) in high level Youth and Junior Track & Field athletes.

Method: During the 2015–16 athletics season (30 weeks from December 2015 to July 2016), we conducted a prospective cohort study on a population of Youth and Junior Irish national level athletes, during which athletes were asked to complete a weekly web-based questionnaire (Oslo Sports Trauma Research Center questionnaire on health problems) regarding their health problems.

Results: A total of 70 athletes participated (37 male and 33 female athletes), with an average weekly response rate of 71%. The average weekly prevalence for all athletes was 27% (95%CI 17 to 38%) for all health problems, and 11% (95%CI 3 to 18%) for substantial health problems. Average prevalence varied significantly between endurance and explosive disciplines: a higher prevalence of all and substantial health problems and all and substantial overuse injuries was found in endurance disciplines. A higher prevalence of acute injuries was found in explosive disciplines. Characteristics of acute and overuse injuries differed according to sex and discipline: hamstring strain/cramps/spasms was the main injuries in explosive disciplines, and knee tendinopathy and lower leg strain/cramp/spasms in endurance disciplines, trunk cramps/spasms being frequent in both disciplines. Upper respiratory tract problems were the most commonly reported illnesses regardless of sex and disciplines.

Conclusion: This study provides important information regarding the extent of health problem in Youth and Junior track and field athletes. This could help orient injury prevention measures. For injuries, it should be focused on muscle injuries, especially located on the hamstring, calf, and trunk. For illness, prevention measures could include: screening tests for airway problems, but also general illness prevention measures (e.g., drinking regularly, eating “safe” food, regular hand washing, decreasing contact with sick people, avoiding dehydration).

Investigating the Prevalence and Predictors of Injury Occurrence in Competitive Hip Hop Dancers: Prospective Analysis

Hip hop is a popular form of competitive and recreational sport worldwide, but studies rarely investigate injury prevalence and factors associated with injury occurrence in this sport. This study aimed to prospectively examine injury occurrence in hip hop dancers in a three-month period and to evaluate potential predictors of injury occurrence in hip hop dancers. The participants were 129 competitive hip hop dancers (114 females, 17.95 ± 4.15 years of age). Study predictors were obtained at study baseline and included sociodemographic factors, sport-related factors, previous injury status, anthropometric and body build indices (body height, mass, body mass index, and body composition variables), and dynamic balance performance (obtained by the Star Excursion Balance Test—SEBT). The outcome was injury occurrence, which was prospectively observed once a week by the Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC). During the course of the study, 101 injuries occurred, equating to an annual injury incidence of 312%. On average, each dancer suffered 0.78 injuries (95% Confidence Interval (95% CI): 0.61–0.97) across a study period of three months (0.76 (95% CI: 0.60–0.95) and 0.93 (95% CI: 0.75–1.13), in females and males, respectively; Mann Whitney Z-value: 0.68, p = 0.52). Seventeen percent of dancers suffered multiple injuries, and 49% of all injuries were time-loss injuries. The knee was the most frequently injured body location (42% of all reported injuries), followed by the back region (32%) and the ankle (15%). Previous injury was a strong predictor of injury occurrence (Odds Ratio: 3.76, 95% CI: 1.87–4.59). Lower injury risk was evidenced among those participants who achieved better scores on several SEBT variables, irrespective of gender and previous injury status; with no significant influence of anthropometric and body build variables on injury occurrence. This study highlighted a high injury rate in hip hop dancers. Dancers and coaches should be informed about the certain protective effects of dynamic balance on the prevention of musculoskeletal injury in hip hop in order to assure safe and effective practices. The usage of SEBT as a convenient and cheap testing procedure is encouraged in other dance disciplines.