A multi-year injury epidemiology analysis of an elite national junior tennis program

Objectives

To profile multi-year injury incidence and severity trends in elite junior tennis players from a national program.

Combining physical performance and Functional Movement Screen testing to identify elite junior Australian Football athletes at risk of injury

The Functional Movement Screen (FMS) and physical performance testing are often suggested to be related to sports injury risk. This study explored if the combination of FMS and physical performance testing improved identification of non-contact injury risk over FMS testing alone in an elite junior Australian football cohort. Over a 3-year period, 573 players completed pre-season injury history questionnaires, FMS, physical performance testing (20-m sprint, vertical jump, planned agility testing, and shuttle run test), and subsequent in-season injury surveillance. Results: Neither previous injury or FMS score <14 were related to an increased risk of subsequent injury in isolation. The combination of FMS composite score ≤14 and previous injury moderately increased the risk of injury (Hazard ratio [HR] = 2.22 [1.09-4.54]). None of the physical performance measures improved the ability to predict injuries based on FMS composite score. FMS asymmetry was only associated with injury when combined with previous injury and vertical jump performance. Players with ≥1 FMS asymmetry and history of previous injury experienced a large increase in injury risk when vertical jump was poor (HR = 4.26 [1.35-13.42]) or good (HR = 3.17 [1.08-9.29]). Players with a combination of a good vertical jump, no previous injury, and no FMS asymmetries were also at moderately increased risk of injury (HR = 3.41 [1.11-10.42]). No physical performance tests improved the ability to identify non-contact injury risk using an FMS composite score threshold. However, a U-shaped relationship between vertical jump and injury risk was identified with both poor and good vertical jump height associated with a moderate-large increase in non-contact injury risk in the presence of ≥1 asymmetrical FMS sub-test.     

Teaching landing skills in elite junior Australian football: evaluation of an injury prevention strategy

Objective

To evaluate the effectiveness of a preseason physical training programme that taught landing and falling skills in improving landing skills technique and preventing injury in junior elite Australian football players.

Methods

723 male players who participated in an under 18 elite competition were studied prospectively in a non‐randomised controlled trial over two consecutive football seasons. There were 114 players in the intervention group and 609 control players. The eight session intervention programme taught players six landing, falling, and recovery skills, which were considered fundamental for safe landing in Australian football. Landing skills taught in these sessions were rated for competence by independent and blinded assessors at baseline and mid‐season.

Results

Evaluation of landing skills found no significant differences between the groups at baseline. Evaluation after the intervention revealed overall improvement in landing skills, but significantly greater improvement in the intervention group (z  =  −7.92, p  =  0.001). Players in the intervention group were significantly less likely (relative rate 0.72, 95% confidence interval 0.52 to 0.98) to sustain an injury during the season than the control group. In particular, the time to sustaining a landing injury was significantly less for the intervention group (relative rate 0.40, 95% confidence interval 0.17 to 0.92) compared with the control group.

Conclusions

Landing and falling ability can be taught to junior elite Australian football players. Players in the intervention group were protected against injury, particularly injuries related to landing and falls.     

The relationship between pre-season fitness testing and injury in elite junior Australian football players

ObjectivesAustralian Football (AF) is a collision sport containing high injury rates in junior competition. Successful performance at the elite junior level not only requires superior specific football knowledge and skills, but also well developed fitness qualities. However, no studies have examined the link between physical fitness qualities and injury in AF.DesignProspective cohort.MethodsInjury data were collected through the use of a Player Movement Record (PMR) and a standardized Injury Report Form (IRF). Fitness test data was collected during the pre-season of the 2010 and 2011 seasons.Results382 players consented to participate in the study. The cohort experienced an injury incidence rate of 24.29/standardized club (40 players/club). A faster 5-m sprint was associated with ‘injury status’ (p = 0.016) and a ‘knee’ region (p ≤ 0.001) injury. A faster planned agility score was associated with an increased risk of a ‘hip/groin/thigh’ region (p = 0.010) injury, and specifically a ‘quadriceps strain’ (p = 0.005). A lower 20-m shuttle run was associated with an increased risk of a ‘shin/ankle/foot’ (p = 0.045) injury. Increased injury severity was associated with a higher left foot running vertical jump (VJ) (p = 0.040), and faster 5-m sprint (p = 0.043).ConclusionsLower aerobic endurance, faster 5-m acceleration and greater planned agility were associated with an increased risk of various injury types in elite junior AF players. Furthermore, a higher left foot running VJ and faster 5-m acceleration were associated with injury severity. These results may largely relate to a greater work capacity placing a higher load upon the musculoskeletal system in contact and non-contact situations.     

Match running performance in elite Australian Rules Football

There is little information describing the match running demands of elite-level Australian Rules Football (AF). The aims of this study were to examine: (1) match running demands; and (2) the influence of periods of increased physical activity on subsequent running performance in the Australian Football League. Time-motion analyses were performed 1–9 times per player from 16 professional AF players from the same club during games in 2005–2007, using portable global positioning systems during 65 matches. Game movements (standing, walking, jogging, running, higher-speed running, and sprinting) and distances (total distance covered [TD]; low-intensity activity [LIA, distance <14.4 km h^?1]; and, high-intensity running distance [HIR, distance > 14.4 km h^?1]) were collected. The influence of the first half physical activities on second half activities, and each quarter on the subsequent quarter were analysed. The mean (±SD) TD and HIR distance covered during the games were 12,939 ± 1145 m and 3880 ± 663 m respectively. There were reductions in TD in the second (?7.3%), third (?5.5%) and fourth (?10.7%) quarters compared to the first quarter (p < 0.01). The HIR was reduced after the first quarter (p < 0.001). Players that covered larger TD or HIR during the first half or quarter decreased distance in the next half and quarter, respectively (p < 0.001). These results show that a reduction in exercise intensity is inevitable during an AF match and that higher intensity activities reduce towards the end of games. High average speed during each half or quarter also affects subsequent running performance in elite-level AF.     

The playing habits and other commitments of elite junior Australian football players

The Victorian Football League Under 18 (VFL U18) competition provides a pathway to the elite senior level of Australian football. Players involved in the VFL U18 competition also play football in other contexts, including for school and local clubs, and can have considerable additional work and educational demands. A total of 103 elite junior Australian football players from six VFL U18 clubs participated in a survey that asked about their football playing habits and other commitments. The median age of players when they first joined their VFL U18 squad was 16.3 years. The players participated in a median of five weekly training sessions during the last two weeks of the 1999 preseason and played a median of five preseason games. Fifty percent of the players expected to participate in 3-4 training sessions per week and 25% expected to play more than two games per week during the 1999 season. Half of the players reported ambitions to play Australian Football League (AFL) football. Further research is needed to determine whether or not high participation levels have negative impacts on performance and injury risk in these players.     

The incidence,prevalence, severity,mechanism and body region of injury in elite junior Australian football players: A prospective cohort study over one season

Objectives

To describe the incidence, prevalence, severity, mechanism and body region of injuries in elite junior Australian football (AF) players over one competitive season in order to help inform injury prevention interventions.

Balance and injury in elite Australian footballers

This project measured pre-season balance ability and determined its relationship to knee and ankle ligament injuries during the season for professional Australian footballers. The balance test involved the players stepping onto a foam balance mat on top of a force plate and maintaining single limb balance. Throughout the playing season, injuries were monitored. The results from two hundred and ten players participating in this project were analysed. During the 2003 season, 8 % (17 out of 210) sustained a knee ligament injury and 10 % (21 out of 210) sustained an ankle ligament injury. Multivariate analysis revealed that pre-season balance ability was a significant independent predictor of ankle ligament injury. Players with low balance ability had at least twice as many ankle ligaments injuries as those with average or good balance ability. Balance ability was not a significant predictor of knee ligament injuries. The height of the players was the only significant independent predictor of knee ligament injuries. Low pre-season balance ability was associated with an increased risk of ankle ligament injury. A modifiable injury risk factor has been identified. Research is now required to determine the optimal training regime to enhance balance ability and whether this translates to a reduction in the incidence of ankle injuries.     

The association of padded headgear with concussion and injury risk in junior Australian football: A prospective cohort study

ObjectivesTo assess whether padded headgear was associated with incidence of suspected sports-related concussion, non-sports-related concussion head injury, and injuries to other body regions in junior Australian football.DesignProspective cohort injury surveillance.MethodsThere were 400 junior players (42.5% female) enrolled across two seasons. Suspected sports-related concussion was defined by detection of observable signs on the field and medical assessment or missed match(es) due to suspected sports-related concussion. Non-sports-related concussion head injury and injuries to other body regions were defined as those that received medical assessment or resulted in a missed match.ResultsThere were 20 teams monitored over 258 matches. 204 players (2484 player hours) wore mandated headgear throughout the season and 196 (2246 player hours) did not. The incidence rate of suspected sports-related concussion was 3.17 (95% confidence interval: 3.04–3.30) per 1000 player-hours and no differences were observed between males and females (risk ratio 1.11; 95% confidence interval: 0.40–3.06). Headgear use was not associated with suspected sports-related concussion (risk ratio 1.09; 95% confidence interval: 0.41–2.97), non-sports-related concussion head injury (risk ratio 0.27; 95% confidence interval: 0.06–1.31), or injuries to other body regions (risk ratio 1.41; 95% confidence interval: 0.79–2.53).ConclusionsHeadgear use was not associated with reduced risk of suspected sports-related concussion, non-sports-related concussion head injury or injuries to other body regions. There was no difference in the rate of suspected sports-related concussion in female compared to male players, however, rates of non-sports-related concussion head injury and injuries to other body regions were higher in male players.     

Performance and anthropometric characteristics of prospective elite junior Australian footballers: A case study in one junior team

The aim of the study was to compare anthropometric and physical performance data of players who were selected for a Victorian elite junior U18 Australian rules football squad. Prior to the selection of the final training squad, 54 players were assessed using a battery of standard anthropometric and physical performance tests. Multivariate analysis (MANOVA) showed significant (p<0.05) differences between selected and non-selected players when height, mass, 20-m sprint, agility and vertical jump height were considered collectively. Univariate analysis revealed that the vertical jump was the only significant (p<0.05) individual test and a near significant trend (p=0.07) for height differentiating between selected and non-selected players with medium effect sizes for all other tests except endurance. In this elite junior football squad, physical characteristics can be observed that discriminate between players selected and non-selected, and demonstrates the value of physical fitness testing within the talent identification process of junior (16-18 years) players for squad and/or team selection. Based on MANOVA results, the findings from this study suggest team selection appeared to be related to a generally higher performance across the range of tests. Further, age was not a confounding variable as players selected tended to be younger than those non-selected. These findings reflect the general consensus that, in state-based junior competition, there is evidence of promoting overall player development, selecting those who are generally able to fulfil a range of positions and selecting players on their potential.     

Life after the game – Injury profile of past elite Australian Football players

ObjectivesTo investigate the long-term health and well-being of past elite Australian Football League (AFL) players, with particular emphasis on the effect of playing injuries on current lifestyle.DesignCross sectional survey.MethodsA health and well-being survey, completed by past AFL players (n = 592) with mean (±SD) age of 55.1 y (±15.8) and playing career of 7.7 y (±4.1) sought information on demographics, education and employment, subjective well-being, lifestyle behaviours, physical health, disease prevalence, community and social structures, and playing history.ResultsA majority of past players experienced serious injuries (76%) and concussion (73%) throughout their career, both increasing significantly with the number of games played. Of those who received injuries, 60% require on-going treatment, yet only 6% receive treatment costs covered by their club or the AFL Players’ Association. A large proportion (64%) of respondents are affected in daily life from previous AFL injuries.ConclusionsAFL careers are compounded by high injury rates, including loss of consciousness with a high incidence of multiple concussions amongst those players reporting a serious injury. Greater number of injuries received will further the likelihood of requiring on-going treatment and being affected later in life. Additional research and planning may be important in assisting other improvements in the quality of life of past AFL players.     

The Yo-Yo Intermittent Recovery Test (Level 1) to discriminate elite junior Australian football players

The Yo-Yo Intermittent Recovery (IR) Test is currently used to assess endurance performance in team sport athletes. However, to date, no data has been presented on its application to an elite junior Australian football (AF) playing group. Therefore, the aim of this study was to evaluate the Yo-Yo Intermittent Recovery Test Level 1 (IR1) ability to discriminate between junior AF players at two different playing standards and a group of non-athletic healthy males. Sixty age matched participants (16.6 ± 0.5 years) spread over three groups (20 per group): elite junior footballers; sub-elite junior footballers; and non-athletic healthy males participated in this study. Participants undertook a single Yo-Yo test performance on an indoor basketball court for each group. A one-way ANOVA with Scheffe's post hoc analysis revealed the elite junior footballers covered a significantly greater total distance (p < 0.001) and completed a significantly greater number of high-intensity efforts (p < 0.001) in comparison to their sub-elite counterparts, whilst both AF groups performed significantly better (p < 0.001) than the non-athletic healthy males. This study demonstrates the ability of the Yo-Yo IR1 to discriminate endurance performance between elite and sub-elite AF players, whilst further distinguishing AF players from a non-athletic healthy control group.     

Grade III acromioclavicular joint injury in Australian Rules Football

We have reviewed fourteen Australian Rules Football players who were seen consecutively by a single surgeon with grade III acromioclavicular joint injuries between January 1993-June 1997. After discussion at initial consultation eight players elected for non-operative management and six for operative management. Two players in the non-operative group subsequently underwent surgical reconstruction after failure of non-operative treatment. The mean return time to non-contact training was 2.4 weeks (range 1-4, S.D. 1.52) in the non-operative group and 6.3 weeks (range 3.5-10, S.D. 2.99) in the operative group. However return to sports specific training (contact training) was at a mean of 20.8 weeks (range 10-32. S.D. 8.56) in the non-operative group and 13.6 weeks (range 6-24. S.D. 7.06) in the operative group. Return to competitive football matches for the non-operative group was at a mean of 26.2 weeks (range 10-34,S.D. 8.84) and 18.8 weeks (9.5-28. S.D. 8.05) for those treated operatively. These results were not statistically significant. At final follow up the subjective scores for the current overall condition of the shoulder when compared to the uninjured side, were 72.5 (range 20-100, S:D.24.9) for the non operative group and 87.3 (range 75-100, S:D.10.61) for the operative group and this difference was also not statistically significant. Conclusions in this study are limited by small numbers and lack of statistically significant results. The results show a trend towards faster return to ARF and a more satisfactory outcome for patients undergoing surgery compared to their non operative cohorts.