Prolonged restricted training,fixture congestion and player rotation: What the COVID-19 pandemic taught us about injury risk in professional collision sport

ObjectivesThe COVID19-induced suspension of the 2019-20 professional England rugby union season resulted in players being exposed to an extended restricted training period, coupled with a congested match schedule once competition resumed. We assessed the impact of these changes on match and training injuries in the final 20-weeks of the season following competition resumption.DesignEpidemiological study.MethodsThe 2019-20 season was compared to the previous three seasons (2016-19).ResultsThere was no significant difference in the mean incidence, severity and burden of training and match injuries in 2019-20 compared to 2016-19 period mean. The 2019-20 post-suspension mean match injury rate [77/1000 h (95%CIs [confidence intervals]: 67-89)] was comparable to the 2019-20 pre-suspension [93/1000 h (95%CIs: 85-101)] and significantly lower than the 2016-19 equivalent post-suspension period [97/1000 h (95CIs: 90-104) IRR [incidence rate ratio] 0.8 p=0.002]. In the 2019-20 season, there was a significantly higher rate of training injury post-suspension in comparison to pre-suspension [3.8/1000 h (95CIs: 3.3-4.4) vs 2.7/1000 h (95% CIs: 2.5-3.1) IRR 1.4 p=0.005]. There was no significant difference in the overall incidence, severity or burden of injuries sustained in fixtures with shorter (<6 days) turnarounds but there was a significantly higher burden of soft tissue injuries.ConclusionsThis is the first study to assess the effect of restricted training on injury risk in collision sports. Players were at an increased risk of training injury when returning from the suspension, but 10-weeks of preparatory training meant the incidence of match injury was not higher when competition resumed.     

Effect of prophylactic ankle taping on ankle and knee biomechanics during basketball-specific tasks in females

ObjectiveThe aim of this study was to investigate the effects of ankle taping on ankle and knee joint biomechanics during cutting and rebound activities in females.DesignCross-sectional.SettingLaboratory.ParticipantsTwenty semi-professional female basketball players performed a cut and rebound task under two conditions (taped and no-tape).Main Outcome MeasuresKinematic and ground reaction force data were collected during the deceleration phase of each movement task.ResultsTaping resulted in a significant reduction in peak ankle dorsiflexion, inversion and internal rotation angles and range of motion (ROM) at the ankle joint; and reduced knee ROM in the sagittal plane during the rebound task only. Taping significantly reduced peak knee flexion moment (0.29 Nm/kg, P = 0.013) and increased knee internal rotation moment (0.63 Nm/kg, P = 0.026) during the cutting task compared to control. Taping also significantly reduced the internal rotation moment (0.07 Nm/kg, P = 0.025), and medial shear forces (0.14 N/kg, P = 0.012) in the rebound task.ConclusionResults of the study suggest that ankle taping restrict ankle range of movement in the rebound task only and ankle taping appears to have upstream effects on the knee, which may have injury implications.     

Injuries in amateur soccer players on artificial turf: A one-season prospective study

BackgroundEpidemiological studies in soccer are important for injury prevention. However, most of the available information is limited to elite players.ObjectiveTo determine the epidemiology of injuries in amateur soccer players on artificial turf.DesignProspective cohort study during one competitive season (2010–2011).SettingAmateur soccer players. Participants: 231 players (aged 24.7; range: 18–38 years).Main outcome measuresInjury incidence was recorded prospectively according to the consensus statement for soccer.Results213 injuries were recorded; 57% of the players suffered injuries. Injury incidence was 5.1 (95% CI: 4.3–5.9) injuries/1000 h exposure. Injury incidence was higher in matches than in training (32.2 [95% CI: 23.1–41.3] vs. 2.4 [95% CI: 1.8–3.0] injuries/1000 h; p < 0.001). The thigh (22.1%), knee (20.2%), and ankle (19.2%) were the most affected regions. The most frequent diagnoses were thigh strain/muscle rupture (18.3%), and ankle and knee strain/ligament injury (17.3% and 11.3%, respectively). Time-loss due to injury was 20.3 (95% CI: 16.8–23.73) days. Most injuries (79%) were traumatic; 21% were overuse injuries. Re-injuries accounted for 10% of all injuries sustained during the season.ConclusionsInjury incidence in amateur soccer players is higher during matches played on artificial turf than during training sessions.     

High ankle injury rate in adolescent basketball: A 3‐year prospective follow‐up study

This prospective study investigated the incidence and pattern of acute time‐loss injuries in young female and male basketball players. Eight basketball teams (n=201; mean age 14.85±1.5) participated in the follow‐up study (2011‐2014). The coaches recorded player participation in practices and games on a team diary. A study physician contacted the teams once a week to check new injuries and interviewed the injured players. In total, 158 injuries occurred. The overall rate of injury (per 1000 hours) was 2.64 (95% CI 2.23‐3.05). Injury rate was 34.47 (95% CI 26.59‐42.34) in basketball games and 1.51 (95% CI 1.19‐1.82) in team practices. Incidence rate ratio (IRR) between game and practice was 22.87 (95% CI 16.71‐31.29). Seventy‐eight percent of the injuries affected the lower limbs. The ankle (48%) and knee (15%) were the most commonly injured body sites. The majority of injuries involved joint or ligaments (67%). Twenty‐three percent of the injuries were severe causing more than 28 days absence from sports. Number of recurrent injuries was high (28% of all injuries), and most of them were ankle sprains (35 of 44, 79%). No significant differences were found in injury rates between females and males during games (IRR 0.88, 0.55, to 1.40) and practices (IRR 1.06, 0.69, to 1.62). In conclusion, ankle and knee ligament injuries were the most common injuries in this study. Moreover, the rate of recurrent ankle sprains was alarming.     

The identification of risk factors for ankle sprains sustained during netball participation

ObjectivesAnkle sprains account for a large percentage of injuries sustained in netball. The identification of risk factors for ankle sprain is the preliminary action required to inform future prevention strategies.DesignProspective study.ParticipantsNinety-four netball players from club and inter-district teams.MethodsPreseason data were collected for; vertical jump height, perceived ankle instability, sprain history, arthrometry inversion-eversion angles, star excursion balance test reach distances, the number of foot lifts during unilateral stance and demi-pointe balance test results. Participants were followed for the duration of one netball season and ankle sprains were recorded.ResultsEleven sprains were recorded for eleven players using a time-loss definition of injury. Ankle sprains occurred at an incidence rate of 1.74/1000 h of netball exposure. One risk factor was identified to increase the odds of sustaining an ankle sprain during netball participation – a reach distance in the posterior-medial direction of the star excursion balance test of less than or equal to 77.5% of leg length (OR = 4.04, 95% CI = 1.00–16.35).ConclusionsThe identified risk factor can be easily measured and should be considered for preseason injury risk profiling of netball players. Netball players may benefit from training programs aimed at improving single leg balance.     

The incidence,prevalence, nature,severity and mechanisms of injury in elite female cricketers: A prospective cohort study

ObjectivesIncidence, prevalence, nature, severity and mechanisms of injury in elite female cricketers over two seasons from March 2014 to March 2016, inclusive.DesignProspective cohort study.MethodsInjury data collected via Cricket Australia’s Athlete Management System on all elite female players over two seasons were analysed. Profiles of the nature, anatomical location and mechanism of injuries were presented according to dominant player position. Injury incidence rates were calculated based on match playing hours.ResultsThere were 600 medical-attention injuries; with 77.7% players reporting ≥1 injury. There were 79.5% acute injuries compared to gradual onset injuries. Of the all medical-attention injuries, 20.2% led to time-loss; 34.7% were match-time-loss injuries. Match injury incidence was 424.7 injuries/10,000 h for all injuries and 79.3 injuries/10,000 h for time-loss injuries. Of all the injuries, 31.8% were muscle injuries and 16.0% joint sprains. Wrist and hand (19.8%), lumbar spine (16.5%) and knee (14.9%) injuries were the most common time-loss injuries. Six players sustained lumber spine bone stress injury that resulted in the most days missed due to injury (average 110.5 days/injury).ConclusionsThere is a need to focus on specific injuries in female cricket, including thigh, wrist/hand and knee injuries because of their frequency, and lumbar spine injuries because of their severity.     

Injury profiles in elite women’s T20 cricket

ObjectivesTo Describe the injury incidence and prevalence during two years of a professional women’s T20 cricket tournament.DesignProspective cohort study.MethodsInjuries were recorded prospectively for 68 matches during a professional women’s T20 tournament in 2016 and 2017. There were six teams of 15 players. Participants were female, aged between 16–38 years (mean 23.4 ± 4.8). Time-loss and non time-loss incidence and prevalence were calculated for match days, region, skill group, mode and activity at time of injury.ResultsThe greatest incidence occurred in the shoulder (1.8 injuries per 100 match days), lower back (1.7 injuries per 100 match days) and knee (1.7 injuries per 100 match days). The highest time-loss prevalence occurred in hand (1.7%), head/face (0.8%) and thigh (0.6%). All head injuries were concussion. Catching related injuries caused the most time-loss (2.5% prevalence) and throwing related shoulder injury had the highest incidence (2.3 injuries per 100 match days). Gradual onset injuries had the highest overall incidence (7.9 injuries per 100 match days).ConclusionsIn elite female T20 cricket, time-loss injuries, particularly impact/traumatic injuries are most likely to occur during fielding, suggesting pitch side support and trauma training is a priority. The high incidence of gradual onset injuries, particularly throwing related shoulder pain, indicates that managing workload and ensuring physical preparedness is vital.     

Injuries in England and Wales elite men’s domestic cricket: A nine season review from 2010 to 2018

ObjectivesThis study primarily aimed to explore injury incidence rates in the three main domestic competition formats in England and Wales (First-Class, One-Day and Twenty20 [T20]). For the first time, the study also describes the epidemiology of elite men’s domestic cricket injuries across nine seasons (2010–2018 inclusive).DesignProspective cohort analysis.MethodsInjury incidence and prevalence from all injuries calculated according to the updated international consensus statement on injury surveillance in cricket, with statistical process control charts (SPC) used to detect trends in the data.ResultsThe average match injury incidence was 102 injuries/1000 days of play, with highest incidence in One-Day (254 injuries/1000 days of play), followed by T20 (136 injuries/1000 days of play) and First-Class Cricket (68 injuries/1000 days of play). Most match injuries were sustained during bowling (41.6 injuries/1000 days of play), followed by fielding (26.8 injuries/1000 days of play) and batting (22.3 injuries/1000 days of play). The thigh was the body area most commonly injured (7.4 injuries/100 players per season), with lumbar spine injuries the most prevalent (1.3% of players unavailable on any given day during the season). On average, 7.5% of players were unavailable on any given day during the domestic season when all injuries were considered (match and training). The SPC charts showed relatively consistent match injury incidence for all competitions, reproduced across all nine seasons.ConclusionThese findings provide a robust empirical base for the extent of the injury problem in domestic cricket played in England and Wales, with similar injury profiles across the three formats.     

Risk of acute and overuse injuries in youth elite soccer players: Body size and growth matter

ObjectivesThis study investigated anthropometric measures and growth as risk factors for overuse and acute injuries in younger (U10–U12) and older (U13–U15) elite level soccer players.DesignProspective cohort study.MethodsHeight, weight, and sitting height were measured at the start and the end of the 2016–2017 competitive season and growth velocities were calculated. Throughout the season, injuries were registered continuously by the (para-)medical staff of the included clubs. We analyzed the injury risk using multilevel Poisson regression models, accounting for club and team clustering.ResultsOf the included 314 players (11.7 ± 1.7 years of age), 160 players sustained 133 overuse and 163 acute injuries (i.e. 106 injuries in 69 players of the younger group, 190 in 91 players of the older group). In the younger group, risk of overuse injuries was associated with an increase in leg length over the season (incidence rate ratio (IRR) 1.620 [95% CI 1.230–2.117]) and risk of acute injuries with relatively younger age (IRR 1.003 [95% CI 1.000–1.006]). In the older group, a higher leg length was associated with an increased risk of overuse injuries (IRR 1.055 [95% CI 1.011–1.108]), and a higher weight and a lower growth rate with an increased risk of acute injuries (IRR 1.043 [95% CI 1.021–1.067] and 0.903 [95% CI 0.831–0.981], respectively).ConclusionsInjury risk factors differ by age group and type of injury. The age-specific anthropometric and growth-related risk factors should be monitored and these risk profiles should be considered to manage injury risk effectively.     

Knieverletzungen bei männlichen und weiblichen adoleszenten Fußballspielern

BackgroundAim of the study was analyze knee injuries in male and female youth soccer players.Materials and MethodsWith a web-based survey data of 1110 male and female players aged 12 to 19 years of all German youth leagues were collected.ResultsA total of 285 knee injuries in male and 83 knee injuries in female players occurred. The most common injury types were injuries of joint & ligament (32.4%). Strikers (40.2%) showed the highest rates. The confounders gender, level, age and weekly training load showed no influence whereby increasing training experience increased the injury rate.ConclusionsIn order to reduce or prevent risk of knee injuries further univariate and multivariate testing is needed.Level of evidenceLevel IV.     

Acute injuries in Finnish junior floorball league players

Objectives

To investigate the incidence and characteristics of acute time-loss injuries in Finnish junior floorball league players.

Training habits and injuries of masters' level football players: A preliminary report

ObjectiveTo profile training habits and injuries in football players participating in a national Masters tournament.MethodsA cross-sectional retrospective study design was used to survey male football players attending the 2008 New Zealand Masters Games. Information regarding player demographics, football injuries, football related training, and risk factors for injury were collected.Results199 Players were recruited, with a median age of 44 yrs (range 35–73) and a median football playing history of 15 yrs (range 0–66). Irrespective of age, 112 (84%) players included a warm-up and 104 (78%) included a stretching regime in their regular training programme. In the 12 months prior to the tournament, 128 football related injuries were reported by 93 players (64 injuries/100 players or 46 injured players/100 players). The most frequently injured region was the lower limb; specifically the lower leg (n = 23), ankle (n = 18), hamstring (n = 17), knee (n = 15), and Achilles tendon (n = 15).ConclusionThis study provides a preliminary insight into the training habits and injury profiles of Masters football players. Despite all players including some form of injury prevention strategy in their training, a significant number of players experienced an injury in the 12 months prior to the tournament.     

Match injuries in Sri Lankan junior cricket: A prospective,longitudinal study

ObjectivesUnderstanding the nature of injuries in cricket is key to mitigate injury risks and prioritise preventive measures. This study aimed to identify the incidence and nature of match injuries among Sri Lankan junior cricketers.DesignLongitudinal follow-up study with prospective in-season data collection.MethodsA national survey of schoolboy, division-1 cricket teams in under-15 and under-17 age groups. Using a paper-based questionnaire, distributed to school-teams at the start of the 2016 cricket season, respondents recorded any injuries, including the site, type and mechanism. Match injury incidence rates (match-IIR) (injuries/100 match-player-days) were calculated overall, by position and for match time loss (MTL) and non-MTL injuries.ResultsFrom 59 school-teams, 573 players responded, with 404 players reporting 744 injuries in 648 matches. The match-IIR was 28.0 injuries/100 match-player-days (95% CI = 26.0–30.2). The highest match-IIR was reported among fielders (46.0% of all injuries sustained; match-IIR = 12.9) compared with batters (25.4%; match-IIR = 7.1) and bowlers (20.3%; match-IIR = 5.7). Abrasions and bruises to the knee or elbow were the most common injuries among fielders, with the majority being non-MTL injuries.ConclusionsAlmost half (46.0%) of all injuries were to fielders, and more research into their severity and mechanisms is needed to identify the need for, and design of, preventive measures. Batters sustained a relatively large number of facial-organ injuries from being struck by the ball, presenting a need to evaluate the use and appropriateness of helmets by Sri Lankan junior cricketers. Similar to other junior cricket studies, the most common injuries among bowlers were strains and sprains, mainly affecting the lower limbs and lower back.     

Injury history as a risk factor for incident injury in youth soccer

Objectives: To determine if athletes with a self reported history of previous injury have a higher incident injury rate than athletes without a self reported injury history.

Methods: A prospective cohort study of Classic League soccer players playing at the level under 12 through under 18. Injury history forms were mailed to all registering Classic League soccer players in the North Carolina Youth Soccer Association during 1997–2000 (n = 7000); 1483 (19%) returned the baseline questionnaire and were followed up for injuries.

Results: There were 5139 player-seasons of follow up and an estimated 171 957 athlete-exposures. More than half self reported an injury history (59.7%). Overall, the unadjusted incidence rate was 4.6 (95% confidence interval (CI) 4.3 to 4.9) incident injuries per 1000 athlete-exposures. Multivariate generalised Poisson regression modelling indicated that players with one previous injury had a twofold greater risk of incident injury (IRR = 2.6; 95% CI 2.0 to 3.3), and those with two or more previous injuries had a threefold greater risk of incident injury (IRR = 3.0; 95% CI 2.3 to 3.8) compared with athletes with no previous injuries.

Conclusions: Injury history was associated with an increased injury rate. This suggests that, even in these youth soccer players, those with an injury history may be at higher risk.