How injury prevention programs are being structured and implemented worldwide: An international survey of sports physical therapists

ObjectiveTo identify the role of sports physical therapists (PT) in the injury prevention process and to compare the structure of preventive programs and associated (organization) policies applied in athletic organizations and sports teams of varying gender and level world-wide.Design: cross-sectional study.SettingLimeSurvey platform.ParticipantsSports PT working with athletes invited through the International Federation of Sports Physical Therapy.Main outcome measuresSports injury prevention program (IPP) structure and implementation.Results414 participants fully participate in this survey study. Athlete's injury history (68.84%), the most common injuries within the sport modality (67.87%) and athlete's preseason screening results (64.01%) were most frequently used to customize IPPs. Warm-up (70.04%) and individually PT-guided exercise-therapy (70.04%) were the preferred methods to organize the prevention routine. The main barrier for IPP implementation was lack of time within the athlete's weekly training schedule (66.66%). The majority of the participants (72.84%) reported to evaluate the perception of IPP's effect by comparing current and preceding seasons' injury occurrences.ConclusionThese survey results are the first identifying contemporary sports injury prevention organization and implementation policies on an international level. This information might support the sports PT community in improving and standardizing IPP (implementation) strategies worldwide.     

How injury registration and preseason assessment are being delivered: An international survey of sports physical therapists

ObjectiveTo identify the role of sports physical therapists (PT) in the organization of injury registration and preseason assessment, applied in athletic organizations and sports teams of different gender and level world-wide.Designcross-sectional study.SettingLimeSurvey platform.ParticipantsSports PTs working with athletes invited through International Federation of Sports Physical Therapy.Main outcome measuresinjury registration and athlete's screening.Results414 sports PTs participated in this international survey (mean age of 37.66 (SD = 9.38) years). 340 participants indicated that the PT as the responsible for injury registration. Barriers to properly register injury throughout the season were indicated by 157 sports PT and 86 (54.77%) indicated a lack of time on their routine as the main factor. 93 participants (30.09%) indicated that they customize the prevention program based on the preseason assessment. Sports PTs who reported not performing a preseason assessment (92 participants - 22.22%) mainly indicated this to be consequence of lack of structure in the organization (44 participants – 47.82%).ConclusionThe majority of the sports PTs participate on injury registration and perform preseason assessment in athletes. However, lack of time in their routine and structure in the organization were recognized as the most important barriers to organize these properly.     

A qualitative study on overuse injuries: The beliefs of athletes and coaches

ObjectivesPreventive approaches for overuse injuries in sports will be more successful when synchronised with athletes’ and coaches’ beliefs. We interviewed athletes and coaches in order to better characterize their beliefs about the definition of an overuse injury, as well as the intrinsic and extrinsic risk factors that underlie overuse injuries.DesignQualitative study using in-depth interviews in athletes and coaches of different sports.MethodsAthletes who had experienced overuse injuries and coaches who trained athletes who had sustained overuse injuries from sports clubs were invited to participate through interview. We explored each participant's individual definition of an overuse injury and the beliefs concerning the intrinsic and extrinsic risk factors concerning overuse injuries were explored.ResultsAfter nine athletes and nine coaches, sample size saturation was confirmed. Athletes and coaches integrate somatic as well as psychological and sociological factors into the definition of and risk factors for overuse injuries. Intrinsic factors for an overuse injury were related to physical factors, technique, psychological factors and heredity. The extrinsic factors were related to situational, social and training factors, as well as the individual coach.ConclusionsAthletes and coaches have a holistic view on the definition of overuse injuries, and the intrinsic and extrinsic risk factors for overuse injuries. If preventive approaches for overuse injuries are developed and implemented, they should incorporate physical factors, as well as incorporate psychological and social factors. Based on the input of coaches and athletes, the latter are important risk factors for overuse injuries.     

Injury prevention behaviour in community-level soccer players

Objective: To adapt and pilot test a method for undertaking routine surveillance of injury prevention behaviour in community-level soccer. Design: Surveillance system using a cohort design. Methods: Simple random samples were drawn from the player registration databases of two soccer federations. All players aged 13 years or over who intended to play in a school or club competition during the 2006 winter season were eligible. The cohort consisted of 687 male and 193 female players. The players were contacted each week and asked about their adherence to nationally recommended injury prevention measures. Results: No more than 20% of players completed any form of pre-season screening. Almost all players warmed-up for player-matches (97%) and player-training sessions (93%). Eighty-one percent of players undertook some form of physical conditioning on at least one occasion in the off-season. Very few players (13%) reported receiving instruction on tackling technique pre-season. Shin-guards were worn in 99% of matches. For 61% of match injury events, the injured player continued to play after the injury occurred and in 65% of these cases, the player reported that in hindsight they should not have returned to play. Conclusions: The results provide a baseline measure of injury prevention behaviour in community-level soccer players. Future research, employing comparable surveillance methods, could be used to monitor progress on adherence to the injury prevention measures canvassed in this study.     

“Is it fun and does it enhance my performance?” – Key implementation considerations for injury prevention programs in youth handball

ObjectivesWe aimed to determine the use of injury prevention exercises and injury prevention exercise programs in Danish youth handball and investigate coach and player experiences, beliefs and attitudes of injury and their prevention.DesignA mixed-methods design consisting of cross-sectional quantitative surveys and qualitative interviews.MethodsWe surveyed 481 youth (14–18 years old) handball players and their 33 coaches about their use of injury prevention exercises, and attitudes towards injury and their prevention. Additionally, we interviewed five coaches and three players about barriers and motivational factors for implementing injury prevention programs.ResultsPlayers (71%) and almost all coaches reported performing injury prevention exercises for the shoulder, knee, and ankle. Yet few players (4%) and coaches (1%) reported performing the established full injury prevention programs systematically. Players were willing to implement programs to reduce injury risk (84% agreed) and enhance performance (88% agreed). Key factors influencing program uptake were lack of awareness of evidence-based injury prevention programs and lack of handball-specific exercises. Coaches and players identified continued education and training as vital facilitators in this setting, and all coaches agreed that injury prevention should be an essential part of coach education.ConclusionsWhile Danish youth handball players and coaches seemed to recognize the importance of injury prevention, the use of established programs was marginal. Experiences, beliefs, and attitudes about injury and injury prevention influenced program uptake and should be addressed through continued education and training in this context in combination with making the programs more handball specific.     

Perceived barriers to implementation of injury prevention programs among collegiate women’s soccer coaches

ObjectivesKnee injury prevention programs (IPPs) reduce knee and anterior cruciate ligament (ACL) injury rates in female athletes, however, implementation of IPPs is low. The purpose of this study was to identify barriers to implementation of IPPs among collegiate women’s soccer coaches.DesignCross-sectional survey.MethodsA custom survey based on the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework and existing literature was sent to 151 out of 153 women’s National Collegiate Athletic Association (NCAA) soccer coaches in the NCAA’s Eastern Region.ResultsTen respondents reported that they did not use an IPP (Non-users), and nineteen respondents reported that they did use an IPP (Users). “Cost” was the most highly ranked barrier (median rank: 2) to implementing an IPP among Non-users. For the statement, “Who should be responsible for completing an IPP,” Users said “Coaches” (47%) and “Other” (21%), while Non-users said “Strength and conditioning” (50%) and “Athletic trainers” (30%). Respondents who marked “Other”, elaborated that it was the responsibility of coaches, athletes, and additional staff members.ConclusionsCost was the primary barrier to implementation of an IPP. Since the majority of Non-users indicated that implementation of an IPP was the responsibility of a non-coaching staff member, cost may be a surrogate for the expense of hiring an additional staff member rather than the cost of performing the IPP itself. Additionally, using a team-based approach that encompasses athletes, coaches, and non-coaching staff members may support long-term implementation of IPPs.     

Rhythm Abnormalities in a Young Executive

In brief: While exercise and physical training generally have a beneficial effect on bone growth, excessive physical loading may disrupt normal osseous development and inflict injury. The latter is particularly applicable to young female gymnasts, who seem predisposed because of their physical immaturity and for whom the injury rate is astonishingly high when they train and compete at advanced levels. This literature review indicates grounds for concern and points to the need for research that will provide a more extensive data base. It also indicates the need to examine the relationships between an injury and the athlete's characteristics, types of skills, and training regimens. The authors recommend a longitudinal approach to such research.     

Lifeguarding: The Sport,the Profession,the Hazards

In brief Lifeguarding is a special combination of several athletic activities and a grueling test of physical fitness. The very nature of rescuing—the “cold starts,” the running on soft sand, the stress on back and shoulders, and other characteristics—may make lifeguards more vulnerable to injury than other athletes. Since lifeguarding combines aspects of several sports, lifeguards sustain common but unrelated sports injuries such as “swimmer's shoulder” and shin splints. Lifeguards can also suffer from injuries peculiar to lifeguarding, such as foot lacerations. Proper conditioning and protection can be the keys to reducing incidence of injuries among lifeguard athletes.     

Overuse Injury in the Young Athlete: Reasons for Concern

In brief: More children are becoming intensely involved in competitive sports programs at younger ages. These children must cope with the psychological stress of competing as well as the physical stress of training during growth periods. A survey of the literature available on overuse injuries in children's sports showed few long-term studies on causes and prevention but isolated several factors that contribute to injury. Guidelines for people who direct youth sports programs emphasize adjustment of training to the child's physical and social development.     

Injury surveillance and prevention practices across Rugby schools in Ireland

ObjectivesTo ascertain the extent of injury surveillance and prevention practices currently in operation and the availability of qualified personnel across Rugby playing schools in the Republic of Ireland.DesignCross-sectional survey design.SettingRugby playing schools across Ireland.ParticipantsThe Rugby games master, head Rugby coach or teacher/coach with knowledge of all Rugby activities in the school.ResultsNinety-three Rugby playing schools responded and reported 356 (97% male, 3% female) school Rugby teams. Rugby injuries were formally monitored in 86% of schools. Injury recorders were primarily coaches (61%). Physiotherapy provision was available in 28% of schools, 14% of schools provided access to a medical doctor and 44% of schools provided access to an S&C coach. Structured warm-ups were undertaken in 66% of schools, weekly gym sessions in 49% of schools and 31% of schools did not implement any formal injury prevention measures.ConclusionsInjury monitoring practices, medical personnel accessibility and the frequency of injury prevention practices varies considerably across Rugby playing schools in Ireland. Future injury surveillance and prevention systems should be suitable for use by non-medical personnel and reflect the structural organisation of the school Rugby game so that data are not solely representative of the elite, well-resourced schools.     

Reductions in pre-season training loads reduce training injury rates in rugby league players

Objectives: To investigate if reductions in pre-season training loads reduced the incidence of training injuries in rugby league players, and to determine if the reductions in training loads compromised the improvements in physical fitness obtained during the pre-season preparation period.

Methods: A total of 220 sub-elite rugby league players participated in this 3 year prospective study. Players underwent measurements of speed, muscular power, and maximal aerobic power before and after three 4 month (December to March) pre-season preparation periods (2001–2003). A periodised skills and conditioning program was implemented, with training loads progressively increased in the general preparatory phase of the season (December to February) and reduced slightly in March in preparation for the competitive phase of the season. Training loads were calculated by multiplying the training session intensity by the duration of the training session. Following the initial season (2001), training loads were reduced through reductions in training duration (2002) and training intensity (2003). The incidence of injury was prospectively recorded over the three pre-season periods.

Results: The training loads for the 2002 and 2003 pre-season periods were significantly lower (p<0.001) than those in 2001. The incidence of injury was significantly higher in the 2001 pre-season than the 2002 and 2003 pre-season periods. The increases in maximal aerobic power progressively improved across the three seasons with a 62–88% probability that the 2002 and 2003 pre-season improvements in maximal aerobic power were of greater physiological significance than the 2001 pre-season improvements in maximal aerobic power.

Conclusions: These findings demonstrate that reductions in pre-season training loads reduce training injury rates in rugby league players and result in greater improvements in maximal aerobic power.

     

Acute effects of a neuromuscular warm-up on potential re-injury risk factors associated with unanticipated jump landings after anterior cruciate ligament reconstruction: A crossover trial

ObjectiveTo investigate acute effects of a single bout of football specific neuromuscular injury preventive warm-up on potential anterior cruciate ligament (ACL) re-injury risk factors during anticipated and unanticipated jump-landings.DesignCrossover.MethodsFourteen participants (mean ± SD age, 23.4 ± 4.1 years) 6–24 months after ACL reconstruction performed the Prevent Injury and Enhance Performance (PEP) and bicycle ergometer warm-up in a randomised sequence. Washout phase was one week. Countermovement jumps with anticipated and unanticipated single-leg-landings were assessed. Decision-making quality was measured using landing error count.ResultsNo carry-over effects occurred (p > 0.05). The unanticipated task produced significantly higher peak ground reaction forces (Δ+4%, F₍₁₁₎ = 3.46, p < 0.001, eta² = 0.21) after PEP warm-up compared to ergometer warm-up. A lower number of decision (Δ+12%, F ₍₅₎ = 17.1, p < 0.001, eta² = 0.57) and cumulated (Δ+15%, F ₍₃₎ = 17.2, p < 0.001, eta² = 0.57) errors were recorded during the unanticipated condition following PEP compared to ergometer warm-up.ConclusionsEvaluating unanticipated jump-landing ability prior to return to sports clearance may provide information on potential re-injury risk factors. PEP warm-up may be superior to bicycle ergometer warm-up at improving unanticipated decision-making quality among athletes cleared to return to sports.     

Injuries to Athletes Outside Their NCAA Sports

In brief: In this two-year study of athletic injuries, 92 of 1,232 (7.5%) injuries were to athletes participating in sports that were not their major college varsity sports. Many of these athletes were participating for off-season conditioning. The authors suggest that coaches help the athletes choose an off-season sport that doesn't pose a high risk of injury.     

Pre-season adductor squeeze test and HAGOS function sport and recreation subscale scores predict groin injury in Gaelic football players

ObjectiveTo determine if pre-season adductor squeeze test and HAGOS function, sport and recreation subscale scores can identify Gaelic football players at risk of developing groin injury.DesignProspective study.SettingSenior inter-county Gaelic football team.ParticipantsFifty-five male elite Gaelic football players (age = 24.0 ± 2.8 years, body mass = 84.48 ± 7.67 kg, height = 1.85 ± 0.06 m, BMI = 24.70 ± 1.77 kg/m²) from a single senior inter-county Gaelic football team.Main outcome measuresOccurrence of groin injury during the season.ResultsTen time-loss groin injuries were registered representing 13% of all injuries. The odds ratio for sustaining a groin injury if pre-season adductor squeeze test score was below 225 mmHg, was 7.78. The odds ratio for sustaining a groin injury if pre-season HAGOS function, sport and recreation subscale score was < 87.5 was 8.94. Furthermore, for each additional point on the numerical rating scale pain rating during performance of the adductor squeeze test, the odds of groin injury increased by 2.16.ConclusionThis study provides preliminary evidence that pre-season adductor squeeze test and HAGOS function, sport and recreation subscale scores can be used to identify Gaelic football players at risk of developing groin injury.     

The Fitness Facility as a Rehabilitation Care Extender

In brief: Fitness facilities can play an important role in the postacute rehabilitation of injured recreational athletes, especially now that sports medicine practitioners are widely accessible. Such facilities offer special equipment necessary for rehabilitation; their hours suit the recreational athlete's schedule; they can reduce the cost of rehabilitation; and they can help make the injured person the primary agent rather than a passive participant in re habilitation. But patients need supervision by a practitioner to pursue such active rehabilitation safely. The practitioner should know what equipment the patient's health club has and should give him or her detailed instructions for rehabilitative exercises.     

Athletes and Their Families: Adapting to the Stresses of Professional Sports

In brief: Professional athletes and their families face many unique stresses associated with geographic relocation, dramatic increase in income, and balancing the demands of the sport with family life. Often the athlete's spouse feels especially isolated without the advantage of team affiliation. The children may feel that the athlete is only a “part-time” parent. When the pressures become too great, the athlete and the family may benefit from a treatment program. This article presents a fictitious case, discusses the problems faced by professional athletes and their families, and suggests ways in which the athlete's physician can help. Indeed, the physician has the opportunity at the initial history-taking and physical examination to make the athlete feel that the physician's office is a safe place to discuss these problems and start resolving them.     

brief reports

Hypertrophic cardiomyopathy (HCM) is a rare cause of death among the many participants in sports and recreational athletics, but it attracts widespread attention because the deaths occur in young, apparently healthy people. Differentiating HCM from conditioning hypertrophy (athlete's heart) remains a challenge. Routine detection of HCM patients is most commonly done with family history, physical examination, electrocardiography, and echocardiograhy. Keys to the differential diagnosis include evidence of heterogenous left ventricle hypertrophy, left atrial enlargement, unusual ECG patterns, and family history or gene mutations. Molecular detection methods for known defective genes in HCM have not yet become routine clinical tools. Athletes with unequivocal HCM should not participate in competitive sports, except for perhaps some low-intensity ones.