Impact of school sports injury

Sports-Related Musculoskeletal Injuries in Medical Students

Background

Little attention is paid to the problem of sports-related injuries in amateur or nonathletes or recreational student athletes. We investigated the prevalence of sports-related musculoskeletal (MSK) injuries in medical students and attempted to identify the risk factors for these injuries.

Methods

We conducted a cross-sectional questionnaire-based observational study on medical students of a tertiary care teaching hospital in central India. A total of 500 medical students were approached; the questionnaire consisted of details, such as age, gender, height, weight, predominant sport played or the sport during which they sustained an injury, estimated time spent playing every week, if they had undergone any formal training for the sport, any preexisting MSK condition, details of the injury and the treatment taken, if any, after joining medical school, and duration from getting injured to return to studies and sports. The odds ratio (OR) and logistic regression were calculated for multiple parameters. Statistical significance was set at P ≤ 0.05.

Results

Seventy-four of the 402 students who responded reported sustaining a sports-related injury; 33 and 41 students reported injury while playing contact and noncontact sports, respectively. Of these, 58 students reported that they had received formal training in sports. Football, volleyball, cricket, and kabaddi were the sports during which most injuries occurred. The injury rate was 3.7 per 1000 playing or practice hours.

Conclusions

Almost one-fifth of the students reported sustaining a sports-related MSK injury after joining medical school. The risk factors identified for these injuries were male gender, participation in team sports, participation in noncontact sports, and lack of adequate preparation or practice.

Efficacy of a Neuromuscular Warm-up Program in Reducing the Risk of School Sports Injury among Chinese Children: A Cluster Randomized Controlled Trial

Background

Children who participate in sports have reduced cardiovascular risk, obesity, and type 2 diabetes. However, sports participation also comes with an inherent risk of sports-related injuries.

Purpose

To examine the efficacy of a school-based neuromuscular warm-up program (NWP) in reducing the risk of school sports injury (SSI) in children and the impact of different levels of compliance on the effectiveness of the program.

Study Design

Randomized controlled trial; Level of evidence, 1.

Methods

A total of 421 students from grades 4 to 6 at a single school (age range, 9-14 years) were randomized by grade to an intervention group and a control group. The intervention group participated in a 13-week simplified (8-minute) NWP designed to reduce SSI risk. The control group participated in a standard warm-up of the same length and duration. Exposure, compliance, and injury data were collected via a weekly form. The primary injury outcome was all SSIs. Secondary outcomes included injuries from physical education (PE) and non-PE class, upper and lower extremity injuries, other location injuries, and time-loss injuries. A Poisson regression model using an intent-to-treat analysis was performed to estimate the incidence rate ratio (IRR) for all injuries in the intervention group compared with the control group. To examine the influence of level of compliance, we divided the intervention group into low compliance (participation 1-2 times/wk) and high compliance (participation >2 times/wk) then compared the difference on injury rates (IRs) between these groups and the control group.

Results

There were significant differences between the intervention and control groups regarding all SSIs (IRR, 0.47; 95% CI, 0.23-0.96; P = .038), PE class injuries (IRR, 0.37; 95% CI, 0.14-0.99; P = .048), and other location injuries (IRR, 0.20; 95% CI, 0.05-0.82; P = .025). The compliance analysis revealed that although the low-compliance group was able to reduce the risk of SSIs (IR, 4.43; 95% CI, 2.49-6.37) compared with the control group (IR, 7.60; 95% CI, 5.61-9.59), the high-compliance group produced a better effect in reducing the SSI risk (IR, 1.80; 95% CI, 0.04-3.56).

Conclusion

The simplified NWP used in this study was efficacious in the reduction of SSIs in children.

Registration

ChiCTR2100043875 (Chinese Clinical Trial Registry; http://www.chictr.org.cn).

Injuries of Primary School Children during Sports Activities

Introduction

The purpose of the research was to analyse the injuries of primary school children in the framework of organised sports activities at school and in clubs or associations, and in leisure time without professional guidance.

Methods

We surveyed 631 participants, of which there were 282 boys and 349 girls from eight Slovenian primary schools. Frequencies were calculated and a Chi-square test was performed.

Results

In physical education (PE) at school, 32% of the participants were injured in one school year, and there were no statistically significant differences in the number of injuries according to sex (p=0.18) and age (p=0.12). Most injuries were recorded in the lower extremities (50%), in the form of wounds. The participants were injured less often in PE at school than in a club or association, and more often than in their leisure time. The participants were absent from PE classes for longer after an injury in a club or association than in PE, while no significant differences in absences after injury were found. At school, the participants were most often injured in ball games, boys in football (43%) and girls in volleyball (19%). In activities in a club or association, we recorded the most injuries in boys in martial arts (18%) and dance for girls (19%). In their leisure time, boys suffered the most injuries from football (26%) and cycling, while girls suffered the most from running and rollerblading.

Conclusion

In the last ten years, the number of injuries in PE has increased in Slovenia. Based on the obtained results, we propose measures to reduce injuries and thus encourage more sports activities among children and adolescents, while ensuring their safety.

Economic consequences of injury in female Australian footballers: A prospective observational study of emergency department presentations

OBJECTIVE

Investigate the economic consequences of injuries to female Australian footballers from a health sector and societal perspective.

METHODS

This prospective observational study invited 242 females to complete an online questionnaire 3-6 months following an Australian football injury which involved presentation to an ED in Victoria, Australia. The questionnaire inquired regarding healthcare use, time off work, return to playing football and extent of recovery following injury. Relevant information was also extracted from respondents' medical records regarding injury-type, body part injured, investigations and treatments. Healthcare costs were determined for each respondent's ED presentation, hospital admission/s (when relevant), and subsequent healthcare use. Societal costs were determined as lost income to the respondent and/or carer.

RESULTS

A total of 108 people responded to the questionnaire. Sprains/strains and fractures accounted for 84.2% of respondents' injuries. Sixteen respondents (14.8%) required admission to hospital at the time of injury and 81 (75.0%) required subsequent healthcare appointments following discharge from the ED or hospital. Time off work or school following the injury was common (64.8% of respondents) and 27.8% of respondents had a carer take time off work. More than 80% of respondents missed training and matches following the injury. The median healthcare cost per respondent was AUD$753 and the median cost due to work absence was AUD$1393. One-quarter of respondents reported a full recovery.

CONCLUSIONS

Injuries to female Australian footballers can produce substantial healthcare and societal costs, which has important implications for healthcare provision and prioritising and implementing injury prevention programmes and post-injury rehabilitation.

Imposing Compulsory Rugby Union on Schoolchildren: An Analysis of English State-Funded Secondary Schools

Objective

To establish the extent to which Rugby Union was a compulsory physical education activity in state-funded secondary schools in England and to understand the views of Subject Leaders for Physical Education with respect to injury risk.

Method

A cross-sectional research study using data obtained under the Freedom of Information Act (2000) from 288 state-funded secondary schools.

Results

Rugby Union was delivered in 81% (n = 234 of 288) of state-funded secondary school physical education curricula, including 83% (n = 229 of 275) of state-funded secondary school boys' and 54% (n = 151 of 282) of girls' physical education curricular. Rugby Union was compulsory in 91% (n = 208 of 229) of state-funded secondary schools that delivered it as part of the boys' physical education curriculum and 54% (n = 82 of 151) of state-funded secondary schools that delivered contact Rugby Union as part of the girls' physical education curriculum. Subject Leaders for Physical Education also perceived Rugby Union to have the highest risk of harm of the activities they delivered in their school physical education curriculum.

Conclusion

Notwithstanding discussions of appropriate measures (i.e., mandatory concussion training, Rugby Union specific qualifications and CPD) to reduce injury risk, it is recommended that Rugby Union should not be a compulsory activity given that it has a perceived high risk of injury and is an unnecessary risk for children in physical education.

Sports injuries patterns in children and adolescents according to their sports participation level, age and maturation

BACKGROUND

Growth can make young athletes more vulnerable to sports injuries. Increased knowledge about injury profile and its predictors is an important part of an overall risk management strategy but few studies have produced information.

METHODS

Information about injury profile and sports participation (SP) level was obtained by LESADO and RAPIL II questionnaires. They were distributed to 651 participants aged between 10 and 18 years attending four schools. Maturity measures were evaluated through maturity offset (MO) and Tanner-Whitehouse III method. Bivariate analysis was used to identify the set of candidate predictors for multinomial logistic regression analysis that was used to determine significant predictors of injury type and body area injury location.

RESULTS

Regarding injury type predictors recreative boys had more chances of having a sprain or a fracture than a strain. Also, recreative and scholar girls had more chances of having a sprain than a strain. As MO decreased, the chances of girls having a strain or a fracture when compared to sprains were higher. For body area location boys with 10-11 years were more likely to have upper limbs injuries than boys of other ages. This was also confirmed by MO. Spine and trunk injuries were more likely to occur in federate and no sports participation girls.

CONCLUSIONS

Injury type and body area injury location differed significantly by SP level, age group and MO.

Adolescent physical activity-related injuries in school physical education and leisure-time sports

Objective

The aims of this study were to investigate the prevalence of sports injuries in school physical education (PE) and leisure-time sports among 1011 15- to 16-year-old adolescents in relation to physical activity, and to examine goal orientation.

Methods

A survey was used with additional narrative descriptions.

Results

There was a higher prevalence of injuries in leisure time (645/993 = 65%) than in PE (519/998 = 52%). Two groups with high PE injury rates were identified: a) highly active (258/998 = 26%) in both school PE and leisure-time sports and b) highly inactive (180/998 = 18%) in both contexts. There were no differences between girls and boys. Task-oriented adolescents were more prone to injury.

Conclusions

The high prevalence of injuries in PE appears to have two mechanisms: renewed inadequately recovered leisure-time injuries among highly active adolescents, and injuries among fragile inactive adolescents unfamiliar with exercise. PE educators of these two groups with different injury patterns have a considerable didactic challenge. Knowledge of inadequately recovered injuries and consideration of the high volume and intensity of early sport-specific training in children and adolescents are important parameters in the design of lesson plans for PE.

Effects of Psychological Interventions on the Prevention of Sports Injuries: A Meta-analysis

Background:

Studies have shown that preventive psychological interventions can reduce the occurrence of sports injuries.

Purpose:

To systematically evaluate the published literature on the effects of psychological interventions on rates of sports injuries and propose a set of psychological interventions to reduce such injuries.

Study Design:

Systematic review; Level of evidence, 1.

Methods:

A total of 11 randomized controlled trials and intervention control trials involving 1287 participants were included. A random-effects model was used to analyze the data. Pooled results were expressed as effect sizes and 95% CIs. Bias and heterogeneity among the studies were assessed, and sensitivity and subgroup analyses were performed.

Results:

Meta-analysis suggested that preventive psychological interventions effectively prevented the occurrence of sports injuries (effect size = –0.55; P < .001), although the studies showed substantial heterogeneity (I² = 94.2%; P < .001), which could not be attributed to specific variables. Nevertheless, sensitivity analysis suggested that overall results were reliable. No significant risk of publication bias was found.

Conclusion:

Preventive psychological interventions moderately reduced the risk of sports injuries. Risk screening also significantly reduced the risk of sports injuries. These interventions should focus on cognitive behavior and be administered in 1 to 6 sessions over 7 to 12 weeks for 60 minutes per session.

Acute and overuse injuries among sports club members and non-members: the Finnish Health Promoting Sports Club (FHPSC) study

Background

Physical activity in adolescence is promoted for its multi-dimensional health benefits. However, too intensive sports participation is associated with an increased injury risk. Our aim was to compare the occurrence of acute and overuse injuries in Finnish sports club members and non-members and to report training and competing habits associated with a higher injury risk in sports club members.

Methods

In this cross-sectional survey targeted at 14–16-year-old adolescents, a structured questionnaire was completed by 1077 sports club members and 812 non-members. The main outcome measures were self-reported acute and overuse injuries, their location and type.

Results

At least one acute injury in the past year was reported by 44.0% of sports club members and 19.8% of non-members (P < 0.001). The sex-adjusted odds ratio (OR) for acute injury in sports club members compared to non-members was 3.13 (95% confidence interval (95% CI) 2.54–3.87). Thirty-five percent of sports club members and 17.4% of non-members (P < 0.001) reported at least one overuse injury during the past year. The overuse injury OR for sports club members was 2.61 (95% CI 2.09–3.26). Sports club members who trained 7–14 h per week during training (OR 1.61, 95% CI 1.21–2.12, P = 0.001) or competition season (OR 1.55, 95% CI 1.18–2.06, P = 0.002) were more likely to report an injury compared to members who trained 3–6 h per week. Those sports club members who participated in forty competitions or more compared to 7–19 competitions per year were more likely to report an acute injury (OR 1.55, 95% CI 1.05–2.08, P = 0.028) or for an overuse injury (OR 1.53, 95% CI 1.02–2.30, P = 0.038).

Conclusions

Both acute and overuse injuries are common among youth sports club members, and the number increases along with increasing amounts of training and competitions. More effective injury prevention is needed both for adolescents engaging in sports club activities and for other adolescents.

Electronic supplementary material

The online version of this article (10.1186/s12891-019-2417-3) contains supplementary material, which is available to authorized users.

Unintentional Injuries in Primary and Secondary Schools in the United States, 2001-2013

BACKGROUND

Unintentional injuries are the leading cause of youth morbidity. However, limited nationally representative data are available to characterize the occurrence of unintentional injuries at US schools. Given this paucity, we characterized secular trends in unintentional injuries at schools that led to emergency department (ED) visits.

METHODS

A retrospective analysis of the National Electronic Injury Surveillance System-All Injury Program from 2001 to 2013 compared injuries occurring at schools to injuries occurring elsewhere in youth ages 5-18 years. Incidence rates were calculated using weighted frequency estimates as numerators and US population estimates as denominators.

RESULTS

School injuries accounted for 21% of unintentional injury-related ED visits, with an estimated annual incidence rate of 1385 injuries per 100,000 5- to 18-year-olds. Middle school-aged youth (10-13 years) had the highest annual incidence rate (1640 per 100,000 youth) compared with younger and older counterparts. School injuries were more likely to be due to sports/recreation than nonschool injuries (55% vs 41%, p < .0001). Importantly, no detectable change in incidence rates of school injuries between 2001 and 2013 was found (p = .11).

CONCLUSIONS

Stagnant annual incidence rates of unintentional injuries at schools and large numbers of school-based injuries demonstrate that school-based injuries are a notable opportunity for future prevention efforts.

A Pain Reporting Tool for School-Aged Baseball Pitchers

Rates of injury to school-aged athletes are of concern to pediatric providers and can be prevented when players, coaches, and parents recognize and address pain. The aim of the present study was to evaluate the use of a pain-reporting tool. In this study, 34 baseball players aged 10-16 years reported pain surrounding 135 separate pitching experiences. Those participating in another sport on the same day as pitching rated pain intensity as significantly higher than those who did not. Approximately 19 pitches were thrown before participants noticed pain. Ice and analgesics were used appropriately to manage pain. School nurses are well positioned to discuss pain reporting and common injuries with young athletes, parents, and athletic coaches. Sharing proactive ways to elicit information about pain is suggested. Implications for future research include the study of young athlete experiences with pain and development of educational initiatives regarding the importance of reporting pain.

Epidemiology of Injury in Elite English Schoolboy Rugby Union: A 3-Year Study Comparing Different Competitions

CONTEXT

  Injury risks in professional and community rugby union have been extensively described; however, less is known about injury epidemiology at the schoolboy level.

OBJECTIVE

  To investigate the injury risk in English schoolboy rugby union matches, comparing an elite competition (Achieving Academic and Sporting Excellence [AASE]) with subelite matches (non-AASE).

DESIGN

  Retrospective cohort study.

SETTING

  Rugby union academy, consisting of 16- to 19-year-old males, based at an elite sports college in England.

PATIENTS OR OTHER PARTICIPANTS

  A total of 132 participants (mean age = 17.5 years) were included in the study; 64 athletes experienced a total of 103 time-loss injuries over a 3-season period (2012-2015). All injuries were assessed and recorded by the team therapist using consensus statement definitions.

MAIN OUTCOME MEASURE(S)

  Injury characteristics were recorded and compared between groups. Primary outcome measures were injury incidence (per 1000 h match exposure) and injury burden (days absent/1000 h), and rate ratios and 95% confidence intervals are presented throughout.

RESULTS

  A total of 131 matches were played (34 AASE, 97 non-AASE) and a total of 103 injuries were recorded (47 AASE, 56 non-AASE). The injury incidence in AASE matches (77/1000 h) was greater than in non-AASE matches (34/1000 h). The concussion incidence in AASE matches (20/1000 h) was 5 times that of non-AASE matches (4/1000 h). The head/face had the highest injury incidence for a specific location, followed by the shoulder region (AASE = 19/1000 h, non-AASE = 5/1000 h), which had the greatest injury burden (553/1000 h and 105/1000 h, respectively) for any specific body location. More than 50% of all injuries were associated with tackles.

CONCLUSIONS

  A much greater incidence of all injuries occurred at the highest level of competition, and the concussion incidence was greater than that reported in any previously published study of youth rugby. Given the high incidence and burden of concussions and shoulder injuries, prevention and management deserve specific focus.

Prevention of sports injuries in children at school: a systematic review of policies

Background

Participation in sports as a child improves physical and psychological health. Schools need to promote sport while protecting against injury. It is not clear whether increasing evidence on injury prevention generated from professional sport is influencing school sports practices. This study reviewed policies promoting sport safety in schools to determine whether exposure to injury risk is recognised and whether evidence based prevention and management are included.

Methods

A search strategy to identify policies for children aged 4–18 years was applied to electronic databases and grey literature sources. Safeguarding policies were excluded. Included policies were critically appraised and synthesised using modified framework analysis.

Results

Twenty-six policies were analysed. Most (57.7%) were from the USA. Ten (38.5%) focused solely on concussion. Synthesis identified primary, secondary and tertiary injury prevention measures relating to people (staff, students and parents), systems, school physical environment and national-level factors.

Conclusions

Robust, evidence-based policies for reducing injury risk in school sports are limited. Guidelines with the largest evidence base were focused on concussion, with other school sport guidelines showing limited inclusion of evidence. Where included, evidence focused on injury management rather than prevention and frequently applied evidence from adult to children. Guidance was not specific to the child’s age, gender or developmental stage.

Leisure-time sport and overuse injuries of extremities in children age 6-13, a 2.5 years prospective cohort study: the CHAMPS-study DK

OBJECTIVES

It is not known which sports are most likely to cause overuse injuries of the extremities in children. In this study, we report on the incidence of overuse injuries of the upper and lower extremities in children who participate in various leisure-time sports and relate this to the frequency of sport sessions.

DESIGN

Natural experiment including a prospective cohort study.

SETTING

10 state schools in 1 Danish municipality: Svendborg.

PARTICIPANTS

1270 children aged 6-13 years participating in the Childhood Health, Activity, and Motor Performance School Study Denmark.

OUTCOMES MEASURES

Over 2.5 years, parents answered weekly SMS-track messages (a) on type and frequency of leisure-time sports undertaken by their child, and (b) reporting if their child had experienced any musculoskeletal pain. Children with reported pain were examined by a clinician and diagnosed as having an overuse injury of an extremity or not. The incidence of diagnosed overuse injury was calculated for each of the 9 most common sports in relation to 5-week periods. Incidence by frequency of sessions was calculated, and multivariable analysis was performed taking into account age, sex and frequency of physical education classes at school.

RESULTS

Incidence of overuse injuries of the lower extremity ranged from 0.2 to 3.3 for the 9 sports, but was near 0 for overuse injuries of the upper extremities. There was no obvious dose-response. The multivariate analysis showed soccer and handball to be the sports most likely to result in an overuse injury.

CONCLUSIONS

Among a general population of schoolchildren, overuse injuries of the lower extremities were not common and overuse injuries of the upper extremities were rare. Organised leisure-time sport, as practised in Denmark, can be considered a safe activity for children.

Longitudinal influence of musculo-skeletal injuries and extra physical education on physical fitness in schoolchildren

The aims of this study were to investigate if (A) injuries and (B) increased physical education (PE) influenced the development of physical fitness in schoolchildren. Simultaneously, to investigate if a possible PE effect was modified by sport participation outside school hours. This was a longitudinal controlled school-based study. Six schools with 270 min of PE (extra PE) and four schools with 90 min of PE were followed up for 2.5 years. In total, 1054 children were included for analysis (normal PE = 443, extra PE = 611). Development in fitness was analyzed using composite z-scores from six fitness tests measured four times. Information of injury and sport was derived from weekly automated mobile phone text messages surveying the presence of musculo-skeletal pain and organized sport participation. Injury and extra PE both influenced the development of physical fitness. Injury decreased development of physical fitness with -1.01 composite z-score units (95% CI: -1.57; -0.45). Extra PE increased physical fitness development with 0.80 (95% CI: 0.49; 1.10) composite z-score units. The influence of injury was not dependent on extra PE. No modifying effect was found by mean weekly sport participation outside school hours. In conclusion, extra PE had a positive effect, whereas injuries had a negative effect on physical fitness development in schoolchildren.

Seasonal variation in musculoskeletal extremity injuries in school children aged 6-12 followed prospectively over 2.5 years: a cohort study

OBJECTIVES

The type and level of physical activity in children vary over seasons and might thus influence the injury patterns. However, very little information is available on the distribution of injuries over the calendar year. This study aims to describe and analyse the seasonal variation in extremity injuries in children.

DESIGN

Prospective cohort study.

SETTING

10 public schools in the municipality of Svendborg, Denmark.

PARTICIPANTS

A total of 1259 school children aged 6-12 years participating in the Childhood Health, Activity, and Motor Performance School Study Denmark.

METHODS

School children were surveyed each week during 2.5 school-years. Musculoskeletal injuries were reported by parents answering automated mobile phone text questions (SMS-Track) on a weekly basis and diagnosed by clinicians. Data were analysed for prevalence and incidence rates over time with adjustments for gender and age.

RESULTS

Injuries in the lower extremities were reported most frequently (n=1049). There was a significant seasonal variation in incidence and prevalence for lower extremity injuries and for lower and upper extremity injuries combined (n=1229). For the upper extremities (n=180), seasonal variation had a significant effect on the risk of prevalence. Analysis showed a 46% increase in injury incidence and a 32% increase in injury prevalence during summer relative to winter for lower and upper extremity injuries combined.

CONCLUSIONS

There are clear seasonal differences in the occurrence of musculoskeletal extremity injuries among children with almost twice as high injury incidence and prevalence estimates during autumn, summer and spring compared with winter. This suggests further research into the underlying causes for seasonal variation and calls for preventive strategies to be implemented in order to actively prepare and supervise children before and during high-risk periods.

Epidemiology of adolescent rugby injuries: a systematic review

OBJECTIVE

Despite recent increases in the volume of research in professional rugby union, there is little consensus on the epidemiology of injury in adolescent players. We undertook a systematic review to determine the incidence, severity, and nature of injury in adolescent rugby union players.

DATA SOURCES

In April 2009, we performed a computerized literature search on PubMed, Embase, and Cochrane Controlled Trials Register (via Ovid). Population-specific and patient-specific search terms were combined in the form of MEDLINE subject headings and key words (wound$ and injur$, rugby, adolescent$). These were supplemented with related-citation searches on PubMed and bibliographic tracking of primary and review articles.

STUDY SELECTION

Prospective epidemiologic studies in adolescent rugby union players.

DATA SYNTHESIS

A total of 15 studies were included, and the data were analyzed descriptively. Two independent reviewers extracted key study characteristics regarding the incidence, severity, and nature of injuries and the methodologic design.

CONCLUSIONS

Wide variations existed in the injury definitions and data collection procedures. The incidence of injury necessitating medical attention varied with the definition, from 27.5 to 129.8 injuries per 1000 match hours. The incidence of time-loss injury (>7 days) ranged from 0.96 to 1.6 per 1000 playing hours and from 11.4/1000 match hours (>1 day) to 12-22/1000 match hours (missed games). The highest incidence of concussion was 3.3/1000 playing hours. No catastrophic injuries were reported. The head and neck, upper limb, and lower limb were all common sites of injury, and trends were noted toward greater time loss due to upper limb fractures or dislocations and knee ligament injuries. Increasing age, the early part of the playing season, and the tackle situation were most closely associated with injury. Future injury-surveillance studies in rugby union must follow consensus guidelines to facilitate interstudy comparisons and provide further clarification as to where injury-prevention strategies should be focused.

Sport injuries in adolescents

In spite of the wide range of injuries in adolescents during sports activities, there are only a few studies investigating the type and frequency of sport injuries in puberty. However, this information may help to prevent, diagnose and treat sports injuries among teens. 4468 injuries in adolescent patients were treated over a ten year period of time: 66,97% were boys and 32.88% girls. The most frequent sports injuries were football (31.13%) followed by handball (8.89%) and sports during school (8.77%). The lower extremity was involved in 68.71% of the cases. Knee problems were seen in 29.79% of the patients; 2.57% spine and 1.99% head injuries. Injuries consisted primarily of distortions (35.34%) and ligament tears (18.76%); 9,00% of all injuries were fractures. We found more skin wounds (6:1) and fractures (7:2) in male patients compared to females. The risk of ligament tears was highest during skiing. Three of four ski injuries led to knee problems. Spine injuries were observed most often during horse riding (1:6). Head injuries were seen in bicycle accidents (1:3). Head injuries were seen in male patients much more often then in female patients (21:1). Fractures were noted during football (1:9), skiing (1:9), inline (2:3), and during school sports (1:11). Many adolescents participate in various sports. Notwithstanding the methodological problems with epidemiological data, there is no doubt about the large number of athletes sustain musculoskeletal injuries, sometimes serious. In most instances, the accident does not happened during professional sports and training. Therefore, school teachers and low league trainer play an important role preventing further accidence based on knowledge of individual risk patterns of different sports.It is imperative to provide preventive medical check-ups, to monitor the sport-specific needs for each individual sports, to observe the training skills as well as physical fitness needed and to evaluation coaches education.

Epidemiology of US high school sports-related fractures, 2005-2009

OBJECTIVE

To describe the epidemiology of fractures among US high school athletes participating in 9 popular sports.

DESIGN

Descriptive epidemiologic study.

SETTING

Sports injury data for the 2005-2009 academic years were collected using an Internet-based injury surveillance system, Reporting Information Online (RIO).

PARTICIPANTS

A nationally representative sample of 100 US high schools.

ASSESSMENT OF RISK FACTORS

Injuries sustained as a function of sport and sex.

MAIN OUTCOME MEASURES

Fracture injury rates, body site, outcome, surgery, and mechanism.

RESULTS

Fractures (n = 568 177 nationally) accounted for 10.1% of all injuries sustained by US high school athletes. The highest rate of fractures was in football (4.61 per 10 000 athlete exposures) and the lowest in volleyball (0.52). Boys were more likely than girls to sustain a fracture in basketball (rate ratio, 1.35,; 95% confidence interval, 1.06-1.72) and soccer (rate ratio, 1.34; 95% confidence interval, 1.05-1.71). Overall, the most frequently fractured body sites were the hand/finger (28.3%), wrist (10.4%), and lower leg (9.3%). Fractures were the most common injury to the nose (76.9%), forearm (56.4%), hand/finger (41.7%), and wrist (41.6%). Most fractures resulted in >3 weeks' time lost (34.3%) or a medical disqualification from participation (24.2%) and were more likely to result in >3 weeks' time lost and medical disqualification than all other injuries combined. Fractures frequently required expensive medical diagnostic imaging examinations such as x-ray, computed tomographic scan, and magnetic resonance imaging. Additionally, 16.1% of fractures required surgical treatment, accounting for 26.9% of all injuries requiring surgery. Illegal activity was noted in 9.3% of all fractures with the highest proportion of fractures related to illegal activity in girls' soccer (27.9%).

CONCLUSIONS

Fractures are a major concern for US high school athletes. They can severely affect the athlete's ability to continue sports participation and can impose substantial medical costs on the injured athletes' families. Targeted, evidence-based, effective fracture prevention programs are needed.

Effectiveness of a school-based physical activity-related injury prevention program on risk behavior and neuromotor fitness a cluster randomized controlled trial

BACKGROUND

To investigate the effects of a school-based physical activity-related injury prevention program, called 'iPlay', on risk behavior and neuromotor fitness.

METHODS

In this cluster randomized controlled trial 40 primary schools throughout the Netherlands were randomly assigned in an intervention (n = 20) or control group (n = 20). The study includes 2,210 children aged 10-12 years.The iPlay-intervention takes one school year and consists of a teacher manual, informative newsletters and posters, a website, and simple exercises to be carried out during physical education classes.Outcomes measures were self-reported injury preventing behavior, self-reported behavioral determinants (knowledge, attitude, social-influence, self-efficacy, and intention), and neuromotor fitness.

RESULTS

The iPlay-program was not able to significantly improve injury-preventing behavior. The program did significantly improve knowledge and attitude, two determinants of behavior. The effect of the intervention-program on behavior appeared to be significantly mediated by knowledge and attitude. Improved scores on attitude, social norm, self-efficacy and intention were significantly related to changes in injury preventing behavior. Furthermore, iPlay resulted in small non-significant improvements in neuromotor fitness in favor of the intervention group.

CONCLUSION

This cluster randomized controlled trial showed that the iPlay-program did significantly improved behavioral determinants. However, this effect on knowledge and attitude was not strong enough to improve injury preventing behavior. Furthermore, the results confirm the hypothetical model that injury preventing behavior is determined by intention, attitude, social norm and self-efficacy.

TRIAL NUMBER

ISRCTN78846684.

Understanding acute ankle ligamentous sprain injury in sports

This paper summarizes the current understanding on acute ankle sprain injury, which is the most common acute sport trauma, accounting for about 14% of all sport-related injuries. Among, 80% are ligamentous sprains caused by explosive inversion or supination. The injury motion often happens at the subtalar joint and tears the anterior talofibular ligament (ATFL) which possesses the lowest ultimate load among the lateral ligaments at the ankle. For extrinsic risk factors to ankle sprain injury, prescribing orthosis decreases the risk while increased exercise intensity in soccer raises the risk. For intrinsic factors, a foot size with increased width, an increased ankle eversion to inversion strength, plantarflexion strength and ratio between dorsiflexion and plantarflexion strength, and limb dominance could increase the ankle sprain injury risk. Players with a previous sprain history, players wearing shoes with air cells, players who do not stretch before exercising, players with inferior single leg balance, and overweight players are 4.9, 4.3, 2.6, 2.4 and 3.9 times more likely to sustain an ankle sprain injury. The aetiology of most ankle sprain injuries is incorrect foot positioning at landing – a medially-deviated vertical ground reaction force causes an explosive supination or inversion moment at the subtalar joint in a short time (about 50 ms). Another aetiology is the delayed reaction time of the peroneal muscles at the lateral aspect of the ankle (60–90 ms). The failure supination or inversion torque is about 41–45 Nm to cause ligamentous rupture in simulated spraining tests on cadaver. A previous case report revealed that the ankle joint reached 48 degrees inversion and 10 degrees internal rotation during an accidental grade I ankle ligamentous sprain injury during a dynamic cutting trial in laboratory. Diagnosis techniques and grading systems vary, but the management of ankle ligamentous sprain injury is mainly conservative. Immobilization should not be used as it results in joint stiffness, muscle atrophy and loss of proprioception. Traditional Chinese medicine such as herbs, massage and acupuncture were well applied in China in managing sports injuries, and was reported to be effective in relieving pain, reducing swelling and edema, and restoring normal ankle function. Finally, the best practice of sports medicine would be to prevent the injury. Different previous approaches, including designing prophylactice devices, introducing functional interventions, as well as change of games rules were highlighted. This paper allows the readers to catch up with the previous researches on ankle sprain injury, and facilitate the future research idea on sport-related ankle sprain injury.

Sport-related ankle injuries attending an accident and emergency department

INTRODUCTION

This study investigated the sport-related ankle injuries attending an accident and emergency (A&E) department during a 1-year period.

METHODS

A total of 1715 sports injuries cases attending an A&E department from 1 January 2005 to 31 December 2005 were prospectively recorded. Details of each classified case were recorded in a computerised record system by the triage nurse. At the end of the study period, all sport-related ankle injury cases were analysed.

RESULTS

A total of 240 sport-related ankle injury cases were reported. Most cases were sustained from basketball (32.9%), soccer (31.7%) and hiking (5.8%) sports. The majority of the cases was ligamentous sprains (81.3%) and fractures (10.4%). The mean age of all patients was 24.6 years (S.D. = 12.3). Four fifths (80.4%) were male patients. All cases were not life threatening. Most cases (99.2%) were referred to orthopedics specialty. Radiography was routinely employed in 99.2% of the cases. Ligamentous sprains were mostly sustained in basketball (37.4%) and soccer (28.7%), and were often treated with bandaging (60.0%) and analgesics (48.7%). Most cases were discharged with or without referral to physiotherapy and specialty clinic (95.4%). Fractures were mostly sustained in soccer (52.0%), basketball (20.0%) and hiking (16.0%), and were very often admitted to hospital wards (84.0%). The estimated A&E attendance rate for all sports injuries, ankle injuries, ligamentous sprains and fractures were 1.68, 0.24, 0.19 and 0.02/1000 person-year.

CONCLUSIONS

The results of this study together with the previous study on ankle sprain epidemiology suggested the following sports ankle injury pattern in Hong Kong-major and serious ankle ligamentous sprains and fractures were sustained from basketball, soccer and hiking, leading to A&E attendance, while minor sprains were sustained in running and jogging and racquet sports. We suggested that the Sports medicine specialists in Hong Kong should emphasise the ankle injury prevention strategies in these sports.

Strategies to prevent injury in adolescent sport: a systematic review

This systematic review set out to identify randomised controlled trials and controlled intervention studies that evaluated the effectiveness of preventive strategies in adolescent sport and to draw conclusions on the strength of the evidence. A literature search in seven databases (Medline, SportDiscus, EMBASE, CINAHL, PEDro, Cochrane Review and DARE) was carried out using four keywords: adolescent, sport, injury and prevention (expanded to capture any relevant literature). Assessment of 154 papers found 12 studies eligible for inclusion. It can be concluded that injury prevention strategies that focus on preseason conditioning, functional training, education, balance and sport-specific skills, which should be continued throughout the sporting season, are effective. The evidence for the effectiveness of protective equipment in injury prevention is inconclusive and requires further assessment.

A prevention strategy to reduce the incidence of injury in high school basketball: a cluster randomized controlled trial

OBJECTIVE

To examine the effectiveness of a sport-specific balance training program in reducing injury in adolescent basketball.

DESIGN

Cluster randomized controlled trial.

SETTING

Twenty-five high schools in Calgary and surrounding area.

SUBJECTS

Nine hundred and twenty high school basketball players (ages 12-18).

INTERVENTION

Subjects were randomly allocated by school to the control (n = 426) and training group (n = 494). Both groups were taught a standardized warm-up program. The training group was also taught an additional warm-up component and a home-based balance training program using a wobble board.

MAIN OUTCOME MEASURES

All injuries occurring during basketball that required medical attention and/or caused a player to be removed from that current session and/or miss a subsequent session were then recorded and assessed by a team therapist who was blinded to training group allocation.

RESULTS

A basketball-specific balance training program was protective of acute-onset injuries in high school basketball [RR = 0.71 (95% CI; 0.5-0.99)]. The protective effect found with respect to all injury [RR = 0.8 (95% CI; 0.57-1.11)], lower-extremity injury [RR = 0.83 (95% CI; 0.57-1.19)], and ankle sprain injury [RR = 0.71 (95% CI; 0.45-1.13)] were not statistically significant. Self-reported compliance to the intended home-based training program was poor (298/494 or 60.3%).

CONCLUSIONS

A basketball-specific balance training program was effective in reducing acute-onset injuries in high school basketball. There was also a clinically relevant trend found with respect to the reduction of all, lower-extremity, and ankle sprain injury. Future research should include further development of neuromuscular prevention strategies in addition to further evaluation of methods to increase compliance to an injury-prevention training program in adolescents.

Injury Surveillance in Young Athletes

As participation in junior, high-school and college sports has increased dramatically over the last three decades, sports injuries have increased commensurately. In the US alone, sports-related injuries account for 2.6 million visits to the emergency room made by children and young adults (aged 5-24 years). Injuries sustained by high-school athletes have resulted in 500000 doctor visits, 30000 hospitalisations and a total cost to the healthcare system of nearly 2 billion dollars per year. Sports injury surveillance studies have long formed the backbone of injury prevention research, serving to highlight the types and patterns of injury that merit further investigation. Injury surveillance studies have been integral in guiding rule changes, equipment improvement and training regimens that prevent injury. Despite findings that the methodology of injury surveillance studies may significantly influence the design and efficacy of preventative interventions, relatively few sources address epidemiological considerations involved in such studies. The purpose of this review is 3-fold. First, to perform a review of the current injury surveillance literature in order to identify key epidemiological and methodological issues that arise when reading or conducting an injury surveillance study. Second, to identify and describe how injury surveillance studies have addressed these issues. Third, to provide recommendations about the identified issues in order to guide clinicians in the interpretation of data presented in such studies. Searches of Ovid MEDLINE (1966-present) and PubMed were performed. Thirty-three descriptive and review articles addressing epidemiological and methodological considerations in injury surveillance were selected, as well as 54 cohort studies and studies with an experimental design. Data with respect to each study's treatment of the three epidemiological issues of interest were extracted and synthesised into a table. This review identifies the following three key epidemiological issues to consider when reading injury surveillance literature or when designing an injury surveillance study: (i) the definition of a sports injury; (ii) the denominator with which injuries are reported; and (iii) the method of data collection. A meaningful definition of injury should incorporate time lost from participation in order to reduce the bias associated with estimates of incidence. The use of multiple denominators (e.g. both athlete-hours of exposure and total athletes) provides the most precise information about injury rate and injury risk. The method of data collection that captures the widest range of injuries, while also allowing for the collection of exposure data, will vary depending on geographical location and the organisation of youth sports in that area.

A study of childhood attendance at emergency departments in the West Midlands region

INTRODUCTION

Research into childhood attendance at EDs in the UK has focused mainly on injury rather than medical conditions and studies have been relatively small. This study looks at all types of ED attendance by children across a large population.

DATA AND METHODS

Routine data on all new attendances by children under 16 years were available for 12 EDs in the West Midlands (period: 1 April 2002 to 31 March 2004, 365 695 records). The data were split into four age groups (<1, 1-4, 5-9, and 10-15 years).

RESULTS

Injury related conditions increased with age (with the exception of head injury). Respiratory and gastrointestinal were the most common medical conditions decreased with age. 11.5% of children were admitted to hospital and this varied from 8.2% (10-15 years) to 24.2% (<1 year).

CONCLUSIONS

This study has shown substantial variations in ED attendance by age and has given an insight into the variation among hospitals. This is the largest study of childhood ED attendance undertaken in the UK, and it is hoped that the questions raised will prompt more research in this field.

Sports and recreational injuries: regional rural injury study-II: impact on agricultural households and operations

OBJECTIVES

To identify the incidence, severity, and potential risk factors for sports/recreational injuries incurred by children and adults in a five state, rural, Midwest, agricultural household population.

METHODS

Computer assisted telephone interviews that included questions about all injuries were completed for eligible, participating households for 1999; 16,538 people participated, including 8488 children less than 20 years of age. Rates and 95% confidence intervals were calculated, and causal models guided multivariate models.

RESULTS

Of a total of 2586 injuries, 1301 (50%) were not related to agricultural activity. Among these, 733 (28%) were associated with sports/recreational activities including multiple person sports (64%), general play activities (19%), and single person sports (14%). The overall rate was 46.4 injury events per 1000 persons per year. Rates for children were 99.4 for boys and 64.3 for girls. For adults (aged 20 and above), rates were 11.9 for men and 4.8 for women. For children, 93% received health care, 44% were restricted for seven or more days, and 18% lost agricultural work time of seven or more days; the respective proportions for adults were 88%, 45%, and 17%. Multivariate analysis for children showed increased risks for Nebraska residents, males, and those 10-14 or 15-19 years. For adults, increased risks were identified for males and those 20-24 years; decreased risks were observed for Nebraska residents and those 45-54 years.

CONCLUSIONS

Sports/recreational activities are an important source of injury with relevant consequences for this population, including significant restricted daily activity and lost agricultural work time. Key findings provide a basis for further study to address these burdens.

Assessment of functional capacity of the musculoskeletal system in the context of work, daily living, and sport: a systematic review

The aim of this systematic review was to survey methods to assess the functional capacity of the musculoskeletal system within the context of work, daily activities, and sport. The following key words and synonyms were used: functional physical assessment, healthy/disabled subjects, and instruments. After applying the inclusion criteria on 697 potential studies and a methodological quality appraisal, 34 studies were included. A level of reliability > 0.80 and of > 0.60 resp 0.75 and 0.90, dependent of type of validity, was considered high. Four questionnaires (the Oswestry Disability Index, the Pain Disability Index, the Roland-Morris Disability Questionnaire, and the Upper Extremity Functional Scale) have high levels on both validity and reliability. None of the functional tests had a high level of both reliability and validity. A combination of a questionnaire and a functional test would seem to be the best instrument to assess functional capacity of the musculoskeletal system, but need further examined.