Epidemiology of Pediatric Gymnastics Injuries Reported in US Emergency Departments: Sex- and Age-Based Injury Patterns

The Incidence of Sports-Related Concussion in Children and Adolescents: A Systematic Review and Meta-Analysis

BACKGROUND

Sport-related concussions (SRC) are a concern for young athletes due to the potential for long-term health problems. This systematic review and meta-analysis aimed to provide a comprehensive overview of the literature exploring SRC incidence in youth sports to understand the associated risks.

METHODS

Medline, Embase, SPORTDiscus, PsycINFO, and Web of Science databases were searched without language restrictions up to September 2024. Studies were included if they (i) reported data for calculation of SRC incidence, (ii) were a prospective cohort study, and (iii) included a sample aged ≤ 18 years. Studies that reported Athlete Exposure (AE) or Player Hours (PH) as SRC incidence data measures were included in a multi-level random-effects meta-analysis. Additional analysis explored SRC incidence based on age, sex, country, year of data collection, setting, and level of contact.

RESULTS

Of the 6474 studies reviewed for eligibility, 116 studies were accepted for a systematic review and 99 in the meta-analysis. A total of 3,025,911 participants were included in the review (59% male, 41% female); however, 41% of studies did not report sample size. The pooled incidence rate of SRC per 1000 AE was found to be 1.41 across 21 sports, and 4.36 per 1000 PH across 7 sports. The highest incidence per 1000 AE were in taekwondo, rugby union, and ice hockey, and the highest incidence per 1000 PH were in rugby 7s, rugby league, and rugby union.

CONCLUSIONS

This systematic review and meta-analysis can serve as an updated baseline for risk of concussion among youth athletes across various sports.

TRIAL REGISTRATION

This systematic review was registered on OSF Registries ( https://osf.io/v298s ).

Injury differences between youth male and female American football players

OBJECTIVES

American football continues to be a popular and rapidly growing sport among both males and females, with relatively little research concerning injuries for the latter - especially in the youth population. The current study aims to evaluate the differences in the epidemiology of injured body parts and injury diagnoses between youth male and female American football players.

METHODS

Injury data for male and female American football players were collected over a 10- year period from the National Electronic Injury Surveillance System (NEISS) and retrospectively reviewed. Patients between ages 4 and 18 years with a medical injury/condition related to American football were included. Descriptive analyses were performed for all data including injured body parts, injury diagnoses and setting, demographics, and medical disposition. Odds ratio (OR), 95% CI, and p-values (p < 0.05) were used for the statistical significance between the two groups.

RESULTS

A total of 82,174 American football injuries were found in the NEISS dataset, 95.0% of which were male with a mean age of 13.0 ± 2.9 years. The most injured body parts were the head (17.7%), finger (13.8%), knee (9.2%), shoulder (8.7%), and ankle (8.0%). The most prevalent injury diagnoses were fractures (24.5%), sprains/strains (22.7%), contusions/bruises (12.2%), concussions (9.8%), and internal injuries (7.1%). Males were more likely to suffer head (OR = 1.32, p < 0.001), knee (OR = 1.23, p < 0.001) and shoulder (OR = 2.19, p < 0.001) injuries and females suffered more finger (OR = 3.22, p < 0.001) and ankle (OR = 1.25, p < 0.001) injuries. Males were more likely to suffer concussions (OR = 1.50, p < 0.001) whereas females sustained more sprains/strains (OR = 1.32, p < 0.001).

CONCLUSION

Youth male American football players had a greater likelihood of sustaining concussions and head, knee, and shoulder injuries, whereas females were more likely to have sprains/strains, finger, and ankle injuries. Future studies are warranted to further explore how these differences may be attributed to play style and sex-based physiologic and development differences.

The effect of safety modifications on head kinematics experienced during common skills in women's artistic gymnastics

The objective of this study was to evaluate the effect of skill modifications on head motion experienced during women's artistic gymnastics skills. Nine gymnasts (four beginner and five advanced) completed three trials of up to 24 skill progressions, each consisting of a skill and two progressive safety modifications. Gymnasts were instrumented with mouthpiece sensors embedded with an accelerometer and gyroscope collecting motion data at 200, 300, and 500 Hz during each skill performance. Peak-to-peak linear and rotational kinematics during contact phases and peak rotational kinematics during non-contact phases were computed. A mixed-effects model was used to compare differences in modification status nested within skill categories. Timer skills (i.e. drills that simulate performance of a gymnastics skill) resulted in the highest median ΔLA and ΔRA of all skill categories, and 132 skill performances exceeded 10 g ΔLA during a contact phase. Modifications were associated with significant reductions in head kinematics during contact phases of timers, floor skills, bar releases, and vault skills. Gymnasts can be exposed to direct and indirect head accelerations at magnitudes consistent with other youth contact sports, and common safety modifications may be effective at reducing head motion during contact and non-contact phases of gymnastics skills.

Return to Play in Youth Athletes: Role of the Radiologist with Focus on the Upper Extremity

Increase in youth sports participation, longer duration of play, and earlier starting points have increased the prevalence of acute and repetitive overuse musculoskeletal injuries. This rise in injury rates has led to increased efforts to better understand the susceptible sites of injury that are unique to the growing immature skeleton. Upper extremity injuries are currently the best studied, particularly those that occur among pediatric baseball players and gymnasts. The weak link in skeletally immature athletes is the growth plate complex that includes those injuries located at the epiphyseal and apophyseal primary physes and the peripherally located secondary physes. This article reviews the anatomy and function of these growth plate complexes, followed by a discussion of the pathophysiologic mechanisms, spectrum of imaging findings, and existing evidence-based guidelines for injury prevention and return to play.

Physical fitness of Tibetan adolescents at different high altitudes in Tibet, China: A comparative study

OBJECTIVE

High altitude hypoxic environment has a certain negative impact on physical fitness of adolescents. We aimed to understand the physical fitness status of Tibetan adolescents in different high-altitude areas in Tibet, China.

METHODS

Physical fitness items, such as grip strength, standing long jump, sit and reach, 50 m dash, 1000 m run for boys, and 800 m run for girls were tested on 3806 Tibetan adolescents by using stratified whole group sampling method in class units. The mean age of the participants was (15.51 ± 1.69) years for Tibetan males and (15.54 ± 1.69) years for females. One-way analysis of variance (ANOVA) and other methods were used to make cross-sectional comparisons of physical fitness performance of Chinese Tibetan adolescents in different high-altitude regions.

RESULTS

The standing long jump scores of boys (203.37 ± 28.36) were higher than that of girls (152.97 ± 19.46) and the lowest standing long jump scores of adolescents in Shigatse region (166.39 ± 35.04). The highest level of sit and reach was found among boys (10.69 ± 5.34) in Nyingchi and the lowest level of sit and reach was found among girls (8.42 ± 5.84) in Shigatse. Shigatse region adolescents had the lowest performance in 50 m dash (9.09 ± 1.72) while the best performance in 1000 m run (266.23 ± 35.82) and 800 m run (245.40 ± 27.92).

CONCLUSION

There is variability in the physical fitness of Tibetan adolescents in different high-altitude regions of Tibet, China. Targeted physical fitness interventions should be carried out for Tibetan adolescents in different high-altitude regions. The focus should be on improving the endurance quality of Tibetan adolescents in Lhasa and the lower limb muscle strength, flexibility, and speed quality of adolescents in Shigatse.

The Risk Factors Associated with Grip Lock Injuries in Artistic Gymnasts: A Systematic Review

Artistic gymnastics (AG) is a sport that demands grace, strength, and flexibility, leading to a broad spectrum of injuries. The dowel grip (DG) is widely used by gymnasts to securely hold onto the high bar or uneven bars. However, incorrect usage of the DG can result in grip lock (GL) injuries. This systematic review aims to (1) identify studies that have investigated the risk factors related to GL injuries among gymnasts and (2) synthesize the key evidence. A comprehensive electronic search was conducted in the following databases: PubMed, ScienceDirect, Elsevier, SportDiscus, and Google Scholar, covering the period from their inception until November 2022. The data extraction and analysis were independently completed by two investigators. A total of 90 relevant studies were initially identified, out of which seven clinical trials met the eligibility criteria. For the quantitative synthesis, five studies were included. The details extracted from each article include: the sample characteristics (number, gender, age, and health status), the study design, the instrumentation or intervention used, and the final results. Our results revealed that the underlying causes of the risk factors of GL injuries were the irregular checking of the dowel grip and the mating surface of the bar, the tearing of the dowel of the leather strap, and the use of the dowel grip in different competition apparatuses. In addition, GL injuries may occur either as severe forearm fractures or mild injuries. Excessive flexion of the forearm and overpronation of the wrist during rotational movements, such as the swing or backward/forward giant circle, may increase the possibility of GL injury on the high bar. Future studies should focus on GL injury prevention strategy and rehabilitation protocol for GL injuries. Further high-quality research is required to establish the validity of these findings.

Comparing Musculoskeletal Injuries across Dance and Gymnastics in Adolescent Females Presenting to Emergency Departments

(1) Background: Studies have yet to identify if there are any differences in musculoskeletal injury patterns between dance and gymnastics. This study aimed to determine if different injury patterns exist in adolescent females participating in those two popular sports. (2) Methods: A cross-sectional study was conducted using data collected from patients presenting to U.S. emergency departments participating in the publicly available, de-identified U.S. Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS) throughout the year 2020. Regression analyses were performed to explore if injury patterns were predictive of gymnastics or dancing participation. (3) Results: 518 adolescent females with dance-related injuries and 597 adolescent females with gymnastics-related injuries in 2020 were examined. Strain/sprains (33.3%) and fractures (37.3%) were the most reported dance- and gymnastics-related diagnoses, respectively. Participants were 74% less likely to have a strain/sprain diagnosis in gymnastics compared to dance (OR = 0.26, 95% CI [0.18, 0.38]) and were 3.84 times more likely to have a fracture diagnosis from gymnastics compared to dance (OR = 3.84, 95% CI [2.67, 5.57]), even after adjusting for body party injured. (4) Conclusions: Dance is associated with more sprains while gymnastics typically resulted in a greater likelihood for fractures.