Injury profile in junior tennis players: a prospective two year study

The aim of this study was to prospectively make a survey of injuries in junior players from a Swedish local tennis club during a 2-year period in relation to gender, anatomic location, month of the year when injured, injury type and injury severity. All 12–18 years old members in a tennis club playing more than twice weekly were asked to participate. Fifty-five junior tennis players, 35 boys and 20 girls accepted to participate. All tennis-related injuries were prospectively registered and evaluated. Time of exposure for playing tennis was recorded. Thirty-nine players sustained 100 injuries, 73 in boys and 27 in girls. Injury incidence for boys was 1.7 injuries/1000 h of tennis playing time and for girls 0.6 injuries/1000 h. Ankle sprains, low back pain and knee injuries were the most common ones. Sixty-five percent were new injuries, and the majority of these injuries were located at the knee joint followed by the ankle joint, while most of the recurrent injuries were found in the lumbar spine. Boys suffered mainly from low back pain and ankle injuries and girls from low back pain and knee injuries. Forty-three percent of the injuries caused absence from tennis for more than 4 weeks and 31% more than 1 week.     

Risk factors for football injuries in young players aged 7 to 12 years

Football (soccer) is very popular among children. Little is known about risk factors for football injuries in children. The aim was to analyze potential injury risk factors in 7‐ to 12‐year‐old players. We collected prospective data in Switzerland and the Czech Republic over two seasons. Coaches reported exposure of players (in hours), absence, and injury data via an Internet‐based registration system. We analyzed time‐to‐injury data with extended Cox models accounting for correlations on team‐ and intra‐person levels. We analyzed injury risk in relation to age, sex, playing position, preferred foot, and regarding age‐independent body height, body mass, and BMI . Further, we analyzed injury risk in relation to playing surface. In total, 6038 player seasons with 395 295 hours of football exposure were recorded and 417 injuries occurred. Injury risk increased by 46% (Hazard Ratio 1.46 [1.35; 1.58]; P  < .001) per year of life. Left‐footed players had a higher injury risk (Hazard Ratio 1.53 [1.07; 2.19]; P  = .02) for training injuries compared to right‐footed players. Injury risk was increased in age‐adjusted taller players (higher percentile rank). Higher match‐training ratios were associated with a lower risk of match injuries. Injury risk was increased on artificial turf (Rate Ratio 1.39 [1.12; 1.73]; P  < .001) and lower during indoor sessions (Rate Ratio 0.68 [0.52; 0.88]; P  < .001) compared to natural grass. Age is known as a risk factor in older players and was confirmed to be a risk factor in children's football. Playing surface and leg dominance have also been discussed previously as risk factors. Differences in injury risks in relation to sex should be investigated in the future.     

Risk factors for acute and overuse sport injuries in Swedish children 11 to 15 years old: What about resistance training with weights?

To determine the 1‐year self‐reported incidence of overuse and traumatic sport injuries and risk factors for injuries in children participating in a summer sports camp representing seven different sports. 4363 children, 11 to 15 years old participating in a summer camp in seven different sports answered a questionnaire. Injury in this cross‐sectional study was defined as a sport‐related trauma or overload leading to pain and dysfunction preventing the person from participation in training or competition for at least 1 week. A number of risk factors for injury were investigated such as sex, age, number of hours spent on training in general, and on resistance training with weights. Nearly half [49%, 95% confidence interval (CI) 48–51%] of the participants had been injured as a result of participation in a sport during the preceding year, significantly more boys than girls (53%, 95% CI 50–55% vs 46%, 95% CI 43–48%; P < 0.001). Three factors contributed to increased incidence of sport injuries: age, sex, and resistance training with weights. Time spent on resistance training with weights was significantly associated with sport injuries in a logistic regression analysis. In children age 11 to 15 years, the risk of having a sport‐related injury increased with age and occurred more often in boys than in girls. Weight training was the only modifiable risk factor that contributed to a significant increase in the incidence of sport injuries.     

Epidemiology of musculoskeletal injury in the tennis player

Tennis is a popular sport with tens of millions of players participating worldwide. This popularity was one factor leading to the reappearance of tennis as a medal sport at the 1988 Summer Olympics in Seoul, South Korea. The volume of play, combined with the physical demands of the sports, can lead to injuries of the musculoskeletal system. Overall, injury incidence and prevalence in tennis has been reported in a number of investigations. The sport creates specific demands on the musculoskeletal system, with acute injuries, such as ankle sprains, being more frequent in the lower extremity while chronic overuse injuries, such as lateral epicondylitis, are more common in the upper extremity in the recreational player and shoulder pain more common in the high-level player. This review discusses the epidemiology of injuries frequently experienced in tennis players and examines some of these injuries' correlation with the development of osteoarthritis. In addition, player-specific factors, such as age, sex, volume of play, skill level, racquet properties and grip positions as well as the effect of playing surface on the incidence and prevalence of injury is reported. Finally, recommendations on standardisation of future epidemiological studies on tennis injuries are made in order to be able to more easily compare results of future investigations.     

Low back pain and other overuse injuries in a group of Japanese triathletes.

OBJECTIVE: To document the incidence of low back pain and other overuse injuries in a group of triathletes, and to investigate any associations with various physical and triathlon related factors. METHODS: By means of a questionnaire, the physical characteristics, training habits, and the incidences of overuse injuries of 92 Japanese triathletes (70 males, 22 females) were documented. Student's t and chi 2 tests were used to determine the significance of any associations with injury incidence, as well as differences between subjects experiencing or not experiencing low back pain in the previous year. RESULTS: Low back pain was experienced by 32% of subjects in the previous year. The majority (54%) of low back pain episodes lasted under seven days, suggesting mainly soft tissue involvement, and 19% lasted over three months, suggesting involvement of the intervertebral discs. Weekly trunk flexor muscle training frequency was significantly greater (P = 0.035) for the low back pain subjects. Close to significant differences for average weekly cycling time, trunk flexor muscle training time, and low intensity aerobic training, as well near significant associations for weight training and average weekly triathlon training load, were also found. No other factors were significantly associated with low back pain. Low back injuries accounted for 28% of all injuries. Only the knee was a more common single site of injury (33%). CONCLUSIONS: The three most common injuries suffered by the triathletes were of the knee, back and shoulder. The low back pain suffered by many triathletes could be of a potentially serious nature. It is suggested that cycling is a major risk factor for low back pain in triathletes.     

Epidemiology of injuries in Danish championship tennis

During the outdoor tennis season of 1984 a prospective injury registration was done in 104 randomly chosen elite tennis players, of whom 86% could be followed. We found 46 injuries: an incidence of 2.3 injuries/player/1000 tennis hours. Men were more frequently injured than women. The prevalence was 0.3 injury/player. Upper extremity injuries were most frequent - 45.7% (21/46). Shoulder injuries were the single most frequent injury - 17% (8/46). The pathophysiology was overuse in 67% (28/42), strains in 14% (6/42), sprains in 17% (7/42), fractures in 2% (1/42), and blisters in 5% (2/42). Players using conventional rackets had more injuries to the upper extremity compared with players using mid/oversized rackets, though the difference was nonsignificant. The importance of impact forces from the tennis stroke in the mechanism of upper extremity injuries is discussed.     

Exercise program for prevention of groin pain in football players: a cluster‐randomized trial

Groin injuries cause major problems in sports and particularly in football. Exercise is effective in treating adductor‐related groin pain, but no trials have been published regarding the specific prevention of groin pain or prevention specifically targeting overuse injuries in sport using exercise programs. We performed a cluster‐randomized trial including 55 football clubs representing 1211 players. The clubs were randomized to an exercise program aimed at preventing groin injuries (n=27) or to a control group training as usual (n=28). The intervention program consisted of six exercises including strengthening (concentric and eccentric), coordination, and core stability exercises for the muscles related to the pelvis. Physiotherapists assigned to each club registered all groin injuries. Twenty‐two clubs in each group completed the study, represented by 977 players. There was no significant effect of the intervention (HR=0.69, 95% CI 0.40–1.19). The risk of a groin injury was reduced by 31%, but this reduction was not significant. A univariate analysis showed that having had a previous groin injury almost doubles the risk of developing a new groin injury and playing at a higher level almost triples the risk of developing a groin injury.     

A one‐season prospective study of injuries and illness in elite junior tennis

The objective of this study was to estimate the incidence and prevalence of injury and illness among elite junior tennis players. A cohort of 73 players (11–14 years) in the 2012–2013 Dutch national high‐performance program was followed for 32 weeks; all participants completed the study. The OSTRC Questionnaire on Health Problems was used to record self‐reported injuries and illnesses and to record training and match exposure. Main outcome measures were average prevalence of overuse injury and illness and incidence density of acute injury. On average, players practiced 9.1 h/week (SD 0.6; range 2.3–12.0) and had 2.2 h of match play (SD 0.6; range 2.3–12.0). During the course of the study, 67 players reported a total of 187 health problems. The average weekly prevalence of all health problems was 21.3% (95% CI: 19.2–22.9), of which 12.1% (95% CI: 10.9–13.3) constituted overuse injuries and 5.8% (95% CI: 4.6–6.9) illnesses. The incidence of acute injuries was 1.2/1000 h of tennis play (95% CI: 0.7–1.7). The high occurrence of overuse injuries among elite junior tennis players suggests that an early focus on preventative measures is warranted, with a particular focus on the monitoring and management of workload.     

Intrinsic risk factors for acute ankle injuries among male soccer players: a prospective cohort study

This prospective cohort study was conducted to identify risk factors for acute ankle injuries among male soccer players. A total of 508 players representing 31 amateur teams were tested during the 2004 pre‐season through a questionnaire on previous injury and function score (foot and ankle outcome score; FAOS), functional tests (balance tests on the floor and a balance mat) and a clinical examination of the ankle. Generalized estimating equations were used in univariate analyses to identify candidate risk factors, and factors with a P‐value <0.10 were then examined in a multivariate model. During the season, 56 acute ankle injuries, affecting 46 legs (43 players), were registered. Univariate analyses identified a history of previous acute ankle injuries [odds ratio (OR) per previous injury: 1.25, 95% confidence interval (CI) 1.09–1.43] and the FAOS sub‐score “Pain” (OR for a 10‐point difference in score: 0.81, 95% CI 0.62–1.04) as candidate risk factors. In a multivariate analysis, only the number of previous acute ankle injuries proved to be a significant (adjusted OR per previous injury: 1.23; 95% CI 1.06–1.41, P=0.005) predictor of new injuries. Function scores, functional tests and clinical examination could not independently identify players at an increased risk in this study.     

Investigation of knee control as a lower extremity injury risk factor: A prospective study in youth football

This prospective study in youth football examined the relationship between frontal plane knee projection angle (FPKPA ) during the single‐leg squat and sustaining an acute lower extremity injury or acute non‐contact lower extremity injury. Secondly, side‐to‐side asymmetry in FPKPA and sex as injury risk factors were explored. In addition, we investigated the influence of age, sex, and leg dominance on the FPKPA . A total of 558 youth football players (U11 to U14) participated in the single‐leg squat test and prospective injury registration. FPKPA was not found as a risk factor for injuries at this age. There was no difference in the mean FPKPA between sexes. However, FPKPA was associated with age; oldest subjects displayed the smallest FPKPA . Among boys, the frontal plane knee control improved by age. Among girls, the relationship between age and FPKPA was not as clear, but the oldest girls displayed the smallest mean FPKPA in the study (12.2° ± 8.3°). The FPKPA was greater on the dominant kicking leg compared to the non‐dominant support leg (P  <  .001 for boys, P  =  .001 for girls). However, side‐to‐side asymmetry in FPKPA was not associated with future injuries. In conclusion, frontal plane knee control in the single‐leg squat was not associated with lower extremity injuries among young football players. As the single‐leg squat to 90° knee flexion was too demanding for many subjects, easier single‐leg squat test procedure or a different movement control test, such as a double‐legged squat, could be more suitable for the young football players.     

Risk factors for lower extremity injuries among male marathon runners

The aim of this study is to identify risk factors for lower extremity injuries in male marathon runners. A random sample of 1500 recreational male marathon runners was drawn. Possible risk factors were obtained from a baseline questionnaire 1 month before the start of the marathon. Information on injuries sustained shortly before or during the marathon was obtained using a post-race questionnaire. Of the 694 male runners who responded to the baseline and post-race questionnaire, 28% suffered a self-reported running injury on the lower extremities in the month before or during the marathon run. More than six times race participation in the previous 12 months [odds ratio (OR) 1.66; confidence interval (CI) 1.08-2.56], a history of running injuries (OR 2.62; CI 1.82-3.78), high education level (OR 0.73; CI 0.51-1.04) and daily smoking (OR 0.23; CI 0.05-1.01) were associated with the occurrence of lower extremity injuries. Among the modifiable risk factor studies, a training distance <40 km a week is a strong protective factor of future calf injuries, and regular interval training is a strong protective factor for knee injuries. Other training characteristics appear to have little or no effect on future injuries.     

Self‐reported previous knee injury and low knee function increase knee injury risk in adolescent female football

Knee injuries are common in adolescent female football. Self‐reported previous knee injury and low Knee injury and Osteoarthritis Outcome Score (KOOS) are proposed to predict future knee injuries, but evidence regarding this in adolescent female football is scarce. The aim of this study was to investigate self‐reported previous knee injury and low KOOS subscale score as risk factors for future knee injuries in adolescent female football. A sample of 326 adolescent female football players, aged 15–18, without knee injury at baseline, were included. Data on self‐reported previous knee injury and KOOS questionnaires were collected at baseline. Time‐loss knee injuries and football exposures were reported weekly by answers to standardized text‐message questions, followed by injury telephone interviews. A priori, self‐reported previous knee injury and low KOOS subscale scores (< 80 points) were chosen as independent variables in the risk factor analyses. The study showed that self‐reported previous knee injury significantly increased the risk of time‐loss knee injury [relative risk (RR): 3.65, 95% confidence (CI) 1.73–7.68; P < 0.001]. Risk of time‐loss knee injury was also significantly increased in players with low KOOS subscale scores (< 80 points) in Activities of Daily Living (RR: 5.0), Sport/Recreational (RR: 2.2) and Quality of Life (RR: 3.0) (P < 0.05). In conclusion, self‐reported previous knee injury and low scores in three KOOS subscales significantly increase the risk of future time‐loss knee injury in adolescent female football.     

Is risk‐taking in talented junior tennis players related to overuse injuries?

Overuse injuries are a serious problem in junior tennis. Gaining insight in age‐specific risk factors can contribute to prevention. The developmental cognitive processes that take place during adolescence make talented players more inclined to take risks. This may be even more pronounced in the high performance culture in which they move. Therefore, this study focuses on the relationship between risk‐taking and overuse injuries in talented tennis players. Seventy‐three talented tennis players (45 boys and 28 girls, age 11–14 years) were monitored for 32 weeks, using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems. Risk‐taking was measured at the start of the season with the Iowa Gambling Task. Linear regression analyses were executed to predict (a) overuse injuries, (b) time loss overuse injuries and (c) overuse severity, by risk‐taking, exposure time, and injury history. In boys, risk‐taking contributed significantly to time loss overuse injuries [F(1,39) = 7.764, P = 0.008, R² = 0.15] and to overuse severity [F(1,39) = 5.683, P = 0.022, with an R² of 0.13] In girls, time loss overuse injuries [F(1,23) = 6.889, P = 0.018, R² = 0.20] and overuse severity [F(1,23) = 7.287, P = 0.013, R² = 0.24] were predicted by exposure time. Coaches and trainers should be aware that talented male tennis players who are inclined to take risks, are more likely to maintain risky behavioral patterns related to overuse injuries.     

A one season prospective cohort study of volleyball injuries

Objective: To estimate the overall incidence of acute and overuse volleyball injuries, and to describe factors associated with ankle sprains.

Methods: 486 players from the second and third Dutch national volleyball divisions participated in the study and were followed prospectively during a whole season. Three measurements were made during the season (baseline, follow up 1, and follow up 2), where all players completed a questionnaire on demographic variables (only at baseline), sports participation, use of preventive measures, and previous injuries. Volleyball exposure during training and matches was recorded for each individual player by the coach on a weekly exposure form. In case of injury the coach provided the injured player with an injury registration form, which had to be completed within one week after the onset of injury.

Results: 100 injuries were reported, resulting in an overall injury incidence of 2.6 injuries/1000 hours. The incidence of acute injuries was 2.0/1000 hours. Ankle sprains (n = 41) accounted for most of the acute injuries, and 31 (75%) of all players with an ankle sprain reported a previous ankle sprain. Twenty five overuse injuries were reported. The overall incidence of overuse injuries was 0.6/1000 hours; the back and the shoulder were the most common sites.

Conclusions: Ankle sprain is the most common injury in volleyball, accounting for 41% of all volleyball related injuries. Previous injury seems to be an important risk factor for an ankle sprain. Injury prevention programmes should focus on ankle sprains and concentrate on players with previous ankle sprains.

     

An epidemiologic and traumatologic study of injuries in handball

To identify the risk factors of injuries in handball, 221 players were followed during one indoor season. The injury incidence was 4.6/1000 playing hours and 11.4/1000 game hours. The upper extremity was involved in 41% of the injuries including 21% finger sprains. Ankle sprains were the most common injury (33%), and overuse injuries accounted for 18%. The risk of reinjury was 32%. Contact with opponent players during running or shooting caused 31% of the injuries. Errors during grasping the ball were the reason for most of the finger injuries. Forty percent of the injuries was treated by the players themselves. After the injury 73% were absent from handball for more than 1 week. Forty-one percent of the injured players had complaints 6 months after the end of the season. The study shows that injuries in handball are serious and cause extensive consequences for the players. In most of the injuries both intrinsic and extrinsic factors were involved, and prophylactic intervention in these cases demands changes in more fields.     

Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review

The purpose of this study was to present a systematic overview of published reports on the incidence and associated potential risk factors of lower extremity running injuries in long distance runners. An electronic database search was conducted using the PubMed-Medline database. Two observers independently assessed the quality of the studies and a best evidence synthesis was used to summarise the results. The incidence of lower extremity running injuries ranged from 19.4% to 79.3%. The predominant site of these injuries was the knee. There was strong evidence that a long training distance per week in male runners and a history of previous injuries were risk factors for injuries, and that an increase in training distance per week was a protective factor for knee injuries.     

Influence of preseason training, fitness, and existing injury on subsequent rugby injury

OBJECTIVES: To examine the influence of preseason fitness, existing injury, and preseason rugby training on subsequent injury. METHODS: Players were eligible for the survey if they were a member of a Scottish Rugby Union (SRU) affiliated rugby club in the Border Reivers District of the SRU during the 1997-1998 season. A total of 803 (84%) players from 22 (88%) participating clubs provided details of rugby training, injuries sustained, and physical activity undertaken during the 16 week summer period (26 April to 16 August 1997) and their perceived fitness before the start of the season. Observers at participating clubs reported all injury episodes occurring to club players throughout the 1997-1998 season. RESULTS: One fifth of players did not attend any rugby training during the 16 week summer period; the remainder attended a median of 14 sessions. Throughout the 1997-1998 season, 675 injury episodes occurred to 423 (53%) players during training or in matches. After adjustment for whether players held a professional contract or were amateurs, Cox regression showed a 3.9% relative increase (95% confidence interval (CI) 1.9 to 5.9%) in the risk of injury over the season for each additional preseason training week attended, and a 61% relative increase (95% CI 32 to 97%) for those players who had been injured or were carrying an injury at the end of the previous season. CONCLUSIONS: Injury risk is more likely to be related to rugby training (type of activities undertaken in rugby training, or personalities and characteristics of players undertaking training more frequently) than to overall player fitness. Players who were injured at the end of the previous season were more likely to be injured in the following season. This may be because they do not allow previous injuries to heal sufficiently before returning to the game, or the intensity of their participation may increase their risk of injury.     

Sports injuries in physical education teacher education students

Sports injuries could be highly detrimental to the career of a physical education teacher education (PETE) student. To enable the development of future sports injury prevention programs, sports injuries in 128 first‐year academic bachelor PETE students were registered prospectively during one academic year. Common risk factors for sports injuries, taken from the literature, were also evaluated by means of logistic regression analysis. We found an incidence rate of 1.91 and an injury risk of 0.85, which is higher than generally found in a sports‐active population. Most injuries involved the lower extremities, were acute, newly occurring injuries, and took place in non‐contact situations. More than half of all injuries lead to an inactivity period of 1 week or more and over 80% of all injuries required medical attention. A major part of these injuries happened during the intracurricular sports classes. Few differences were seen between women and men. A history of injury was a significant risk factor (P = 0.018) for the occurrence of injuries, and performance of cooling‐down exercises was significantly related to a lower occurrence of ankle injuries (P = 0.031). These data can inform future programs for the prevention of sports injuries in PETE students.     

A prospective investigation to evaluate risk factors for lower extremity injury risk in male youth soccer players

There is an inherent risk of injury in male youth football; however, pertinent risk factors for injury have yet to be examined. This study used a prospective cohort design with 357 elite male youth football players (aged 10‐18 years) assessed during the preseason period and then monitored during the season recording all non‐contact lower extremity injuries. Screening tests included single leg hop for distance (SLHD ); 75% of maximum hop and stick (75%Hop); single leg countermovement jump (SLCMJ ); and the tuck jump assessment (TJ ). Players were divided into subgroups based on chronological age. SLCMJ peak landing vertical ground reaction force (pVGRF ) asymmetry was the most prominent risk factor (U11‐U12s, OR 0.90, P  = .04; and U15‐U16s, OR 0.91, P  < .001). Maturational offset (OR 0.58, P  = .04), lower right leg SLCMJ pVGRF relative to body weight (OR 0.36, P  = .03), and advanced chronological age (OR 3.62, P  = .04) were also significantly associated with heightened injury risk in the U13‐U14s, U15‐U16s, and U18s, respectively. Univariate analyses showed combinations of anthropometric and movement screening risk factors were associated with heightened risk of lower extremity injury; however, there was variability across the different chronological age groups. Greater SLCMJ pVGRF asymmetry, lower right leg SLCMJ pVGRF %BW , later maturation, and advanced chronological age are potential risk factors for injury in elite male youth football players, although the strength of these relationships was often low to moderate. In addition, risk factors are likely to change at different stages of development.     

Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 2: A review of prevention programs aimed to modify risk factors and to reduce injury rates

Soccer is the most commonly played sport in the world, with an estimated 265 million active soccer players participating in the game as on 2006. Inherent to this sport is the higher risk of injury to the anterior cruciate ligament (ACL) relative to other sports. ACL injury causes a significant loss of time from competition in soccer, which has served as the strong impetus to conduct research that focuses to determine the risk factors for injury, and more importantly, to identify and teach techniques to reduce this injury in the sport. This research emphasis has afforded a rapid influx of literature aimed to report the effects of neuromuscular training on the risk factors and the incidence of non-contact ACL injury in high-risk soccer populations. The purpose of the current review is to sequence the most recent literature relating the effects of prevention programs that were developed to alter risk factors associated with non-contact ACL injuries and to reduce the rate of non-contact ACL injuries in soccer players. To date there is no standardized intervention program established for soccer to prevent non-contact ACL injuries. Multi-component programs show better results than single-component preventive programs to reduce the risk and incidence of non-contact ACL injuries in soccer players. Lower extremity plyometrics, dynamic balance and strength, stretching, body awareness and decision-making, and targeted core and trunk control appear to be successful training components to reduce non-contact ACL injury risk factors (decrease landing forces, decrease varus/valgus moments, and increase effective muscle activation) and prevent non-contact ACL injuries in soccer players, especially in female athletes. Pre-season injury prevention combined with an in-season maintenance program may be advocated to prevent injury. Compliance may in fact be the limiting factor to the overall success of ACL injury interventions targeted to soccer players regardless of gender. Thus, interventional research must also consider techniques to improve compliance especially at the elite levels which will likely influence trickle down effects to sub-elite levels. Future research is also needed for male soccer athletes to help determine the most effective intervention to reduce the non-contact ACL injury risk factors and to prevent non-contact ACL injuries.