Parachute ankle brace and extrinsic injury risk factors during parachuting

INTRODUCTION: This study examined the injury prevention effectiveness of the parachute ankle brace (PAB) while controlling for known extrinsic risk factors. METHODS: Injuries among airborne students who wore the PAB during parachute descents were compared with injuries among those who did not. Injury risk factors from administrative records included wind speed, combat loads, and time of day (day/night). Injuries were collected in the drop zone. RESULTS: A total of 596 injuries occurred in 102,784 parachute descents. In univariate analysis, students not wearing the PAB (Controls) were 2.00 [95% confidence interval (95% CI) = 1.32-3.02] times more likely to experience an ankle sprain, 1.83 (95% CI = 1.04-3.24) times more likely to experience an ankle fracture, and 1.92 (95% CI = 1.38-2.67) times more likely to experience an ankle injury of any type. PAB wearers and Controls had a similar incidence of lower body injuries exclusive of the ankle [risk ratio (Control/PAB) = 0.92, 95% CI = 0.65-1.30]. After accounting for known extrinsic injury risk factors, Controls were 1.90 (95% CI = 1.24-2.90) times more likely than PAB wearers to experience an ankle sprain, 1.47 (95% CI = 0.82- 2.63) times more likely to experience an ankle fracture, and 1.75 (95% CI = 1.25-2.48) times more likely to experience an ankle injury of any type. The incidence of parachute entanglements that persisted until the jumpers reached the ground were similar among PAB wearers and Controls IRR (Control/PAB) = 1.17, 95% CI = 0.61-2.29]. CONCLUSION: After controlling for known injury risk factors, the PAB protected against ankle injuries, and especially ankle sprains, while not influencing parachute entanglements or lower body injuries exclusive of the ankle.     

Community level australian football: a profile of injuries

Identification of injuries and their risk factors is required in order to develop risk controls within the context of sports injury prevention. The Australian Football Injury Prevention Project (AFIPP) was a randomised controlled trial (RCT) examining the effects of protective equipment on injury rates in Australian Rules Football. The aim of this paper is to describe the general injury profile of community level Australian Football players over one season, as recorded during this RCT. Players were recruited from the largest community football league in Victoria, Australia, during the 2001 playing season. A total of 301 players participated (64% response rate) and all injuries occurring during training and games were recorded. The overall injury incidence rate was 12.1/1000 player hours. Bruises/soft tissue injuries made up more than a quarter of all injuries (28%) and the leg (lower leg, ankle, thigh/hamstring and knee) was the most commonly injured body region. Most injuries occurred at the beginning of the season (April-May, 53% of injuries), during competition (77%) and through body contact (49.9%). Midfielders (OR = 3.39, 95% CI: 1.13, 10.14) and players aged at least 25 years (OR = 2.15, 95% CI: 1.06, 4.34) were significantly more likely to experience an injury than other playing positions and younger players. Although the injury rate in this study was lower than that in previous studies, the results are consistent with the finding that injuries tend to occur earlier in the season and more commonly during competition. Injury prevention efforts should be particularly targeted at midfielders and older players.     

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.     

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.     

Aetiology of handball injuries: a case--control study.

This article presents the results of a case--control study regarding the background to handball injuries among players of 12 years and older. Data were collected by means of a written questionnaire on the nature, location and direct causes of the injuries as well as information on risk factors. Injured players (n = 130) are compared with non-injured players (n = 512). The response for the cases was 67% and for the controls 75%. These injuries are frequently located at the lower extremities (54% of injuries), especially the ankle, and the majority involve distortions (35%) and strains (26%). Players greater than 20 years have a significantly greater risk of injury than players less than 20 years (odds ratio 1.9). Several factors seem to increase the injury risk, although not significantly: having greater than 5 years experience, not doing stretching exercises and not wearing tape or bandages. Another factor, not wearing elbow protectors, appears to decrease the injury risk significantly. It is advisable to interpret the results of this study with some caution, as selection and information bias might have influenced the validity to some extent. Furthermore, the reliability of the data is limited due to the relatively small number of injured players in the study. Some guidelines for future studies are formulated.     

A prospective study of injuries in basketball: A total profile and comparison by gender and standard of competition

The study aimed to determine prospectively a basketball injury profile, including severity of injury, and to compare the injury profile by gender and standard of competition. Trained observers viewed basketball games, noting the occurrence of injuries, and confirmed injuries by questioning all players on site after the game. Injured players completed a questionnaire and the progress of their injury was monitored by telephone interview. A total of 10,393 basketball participations were observed. An overall injury rate was documented of 18.3 per 1,000 participations (24.7 per 1,000 playing hours), and was comparable by gender and standard of competition. Serious injuries (missing one or more weeks of play) occurred at a rate of 2.89/1,000 participations; with the ankle joint the most common serious injury (1.25/1,000 participations), followed by the calf/anterior leg (0.48/1,000 participations) and knee joint (0.29/1,000 participations). The severity of the injury was significantly associated with the body region injured, with more serious injuries incurred to the lower limb than other body regions (p <.05). The severity of the injury incurred was not related to the standard of competition, gender, age, height, number of games played per week, amount of training undertaken, type of injury, or the mechanism of injury (p> .05).     

Incidence and nature of the most common rugby injuries sustained in Argentina (1991-1997)

OBJECTIVE: To study the incidence of the most commonly sustained injuries in Argentine rugby and analyse them according to type, position and age of the players, and phase and time of play. METHODS: A prospective registry of injuries was constructed in different provincial unions of Argentina. Data were collected during a whole weekend each year from 1991 to 1997. Chi2 with Yates correction test, contingency tables, odds ratios (OR), and 95% confidence intervals (CI) were calculated (Epi Info Version 6.04a). RESULTS: A total of 924 injuries were registered in 1296 rugby games, involving 38 933 players. The mean (SD) incidence per weekend was 2.4 (0.2)% (95% CI 2.22 to 2.53), and the number of injuries per season was 24,188. Overall, senior players suffered more injuries than those in younger divisions (OR = 1.53; 95% CI 1.34 to 1.76; p<0.0001). The most common type of injury was pulled muscles of the lower limbs (11.7%, p<0.0001). Overall, the knee was the most susceptible to injury (14.1%, p<0.0001). Senior players suffered more pulled muscles of the lower limbs (OR = 2.99; 95% CI 2.01 to 4.46; p<0.0001), ankle ligament distension (OR = 1.69; 95% CI 1.12 to 2.53; p = 0.01), knee trauma (OR = 1.69; 95% CI 1.06 to 2.68; p = 0.02), bleeding wounds on the face (OR = 3.86; 95% CI 2.24 to 6.70; p<0.0001), and knee ligament distension (OR = 2.14; 95% CI 1.16 to 3.96; p = 0.01). Younger players had a greater risk of suffering muscular or ligament injuries of the cervical column (OR = 3.0; 95% CI 1.05 to 10.08; p = 0.04). The forwards had a higher risk of injury (OR = 1.41; 95% CI 1.23 to 1.61; p<0.0001). The most commonly injured player was the flanker (15.5%, p<0.01), and the most common mechanism was in open play (33%). More injuries were sustained in the second half (OR = 1.17; 95% CI 1.03 to 1.34; p = 0.01). CONCLUSIONS: Injuries are the cause of significant morbidity among rugby players in Argentina. A more thorough investigation and a greater understanding of the mechanisms are crucial in order to update the rugby laws and reduce this high injury incidence.     

Structural measures as predictors of injury basketball players

The purpose of this study was to investigate the relationship between structure and injury in basketball players, with the goal of developing equations to predict injury. We examined 45 subjects who were participating in a community center basketball league. Each subject was measured prior to the season for bilateral weight, quadricep girth, calf girth, Q-angle of the knee, dorsiflexion of the ankle, forefoot varus, rearfoot valgus, and true and apparent leg length. All lower extremity injuries causing a game to be missed were recorded during the 16-game season. Average values for bilateral weight, quadricep girth, Q-angle, rearfoot valgus, and leg length measures for the injured players were all larger than the average for the non-injured players by at least one standard deviation. A logistic regression equation using three of the variables correctly predicted the injury status of 91% of the players. The three-variable equation was then used prospectively to predict injury status for members of a small college basketball team. Only one player missed a game due to injury, and the equation identified that player as the most likely to be injured. This study demonstrates a strong relationship between structural measures and lower extremity injury in basketball players.     

Epidemiology of all-complaint injuries in youth basketball

This study evaluated the incidence and characteristics of all-complaint injuries, including acute and overuse injuries, in female and male youth basketball players. A total of 518 players (16 ± 1.4 years; 38.6% females), from 63 teams, participated in this prospective cohort study. Players were observed through one competitive high school or club basketball season to record exposure and all-complaint injuries, defined as any complaint resulting from participating in basketball-related activities, including but irrespective of the need for medical attention or time loss. Injury incidence rates and rate ratios were derived from Poisson's regression with 99.4% CI (Bonferroni's correction for multiple comparisons). The overall injury incidence rate was 14.4 (99.4% CI: 12.2-17.0) injuries/1000 h; 13.8 (99.4% CI: 11.2-16.8) in females and 14.8 (99.4% CI: 11.7-18.8) in males. While the incidence of injury was similar across injury classifications for female and male players, a potential lower overuse knee injury rate was noted for females vs males [IRR = 0.61 (99.4% CI: 0.34-1.07)]. The most commonly injured body location was the ankle (45%) in females and the knee (51%) in males. Overuse (vs acute) injuries were about 2x more common in the knee while acute (vs overuse) injuries were about 3x more common in the ankle, overall, and for female and male players. Based on an all-complaint injury definition, injury rates in competitive female and male youth basketball players are much higher than previously reported. This study provides an evidence base to inform more tailored interventions to reduce injuries in youth basketball.     

Effectiveness of rugby headgear in preventing soft tissue injuries to the head: a case-control and video cohort study

OBJECTIVE: To determine if headgear use by rugby players was associated with a reduced risk of head or facial laceration, abrasion, or fracture. METHODS: An emergency department based case-control study in South Wales, UK, with cases being rugby players treated for superficial head and facial injuries and controls being their matched opponents during the game. A review of videos of the 41 games in the 1999 Rugby World Cup was also carried out to compare with the case-control study. Odds ratios (OR) and 95% confidence intervals (95% CI) were used to measure association between exposure (headgear wearing) and outcome (head and facial injuries). RESULTS: In the case-control study, 164 pairs were analysed, with headgear worn by 12.8% of cases and 21.3% of controls. Headgear use was associated with substantial but non-significant reductions in superficial head (OR = 0.43, 95% CI 0.13 to 1.19) and facial (OR = 0.57, 95% CI 0.21 to 1.46) injuries. The video study followed 547 players over 41 games, during which there were 47 bleeding injuries to the head. Headgear use significantly reduced the risk of bleeding head injury in forwards (OR = 0.14, 95% CI 0.01 to 0.99, p = 0.02), but not in backs. There was also a higher risk of facial injury among forwards, but this was not significant. CONCLUSIONS: The combined results suggest that headgear can prevent certain types of superficial head injuries in players at all levels of the game, but the evidence is strongest for superficial head injury in elite forwards. A randomised controlled trial would be the best way to study this further.     

Modulation of prelanding lower-limb muscle responses in athletes with multiple ankle sprains

PURPOSE: The objective of this study was to investigate modulation in prelanding muscle responses and its associated impact force on landing from unexpected and self-initiated drops in male basketball players with a history of bilateral multiple ankle sprains (BMAS). METHODS: Prelanding EMG responses were recorded in four lower-limb muscles, together with the impact force on landing, while 20 healthy and 19 basketball players with BMAS performed unexpected, self-initiated drops from a height of 30 cm. RESULTS: Group differences were detected after self-initiated but not unexpected drops. Two main changes in prelanding EMG responses were observed in the injured basketball players during the self-initiated drops. First, tibialis anterior (TA) was activated significantly earlier in the injured group, whereas left tensor fascia latae appeared closer to the moment of landing (P < 0.025) than in the healthy players. Second, cocontraction indexes between left TA and peroneus longus, and left TA and medial gastrocnemius, were significantly greater in the injured than in the healthy players (P < 0.025). On landing, higher magnitude-of-impact forces were observed in the injured players on the right leg (by 23%, P = 0.012). CONCLUSION: In basketball players with BMAS, modulation of prelanding muscle response latencies occurred in injured (ankle) and uninjured (hip) joints during self-initiated but not unexpected drops. Greater cocontraction index between the left ankle muscle pairs in preparation for landing from self-initiated drops, and a significantly higher magnitude of impact force in the right leg on landing, were observed in the injured players.     

Retrospective comparison of taping and ankle stabilizers in preventing ankle injuries

The effectiveness of taping and the effectiveness of wearing a laced stabilizer in preventing ankle injuries and reinjuries over six seasons of collegiate football practices and games were assessed retrospectively. For 1 1/2 years the players all had taped ankles, and for the remaining 4 1/2 years the players chose their type of ankle support. Over the entire period, the players chose high-top or low-top shoes as preferred. During 51,931 exposures to injury (46,789 practice-exposures and 5,142 game-exposures), the 297 players sustained 224 ankle injuries and 24 reinjuries. Tape was worn during 38,658 exposures to injury (233 players), stabilizers during 13,273 exposures (127 players). Tape had been worn when 159 of the injuries and 23 of the reinjuries occurred; a stabilizer had been worn when 37 of the injuries (P = 0.003) and one of the reinjuries occurred. The combination allowing the fewest injuries overall was low-top shoes and laced ankle stabilizers.     

Incidence and risk factors of injuries in Brazilian elite handball players: A prospective cohort study

The aim of this study was to investigate the incidence and risk factors for handball injuries in Brazilian elite handball players. Overall, 339 athletes from 21 handball teams who participated in the two main Brazilian championships were followed up during a season. In total, 312 injuries were reported by 201 athletes. The injury incidence rate during training was 3.7/1000 h, and during matches was 20.3/1000 matches. Ankle (19.4%, n = 46) and knee (13.5%, n = 32) were the body regions most affected by traumatic injuries. Shoulders (44.0%, n = 33) and knee (26.7%, n = 20) were the body regions most affected by overuse injuries. Muscle injuries (27.1%, n = 68) was the traumatic injury type most reported. Tendinopathy (91.8%, n = 56) was the overuse injury type most observed. Previous injury (OR: 2.42, CI 95%: 1.51–3.89) and an additional match per week (OR: 1.31, CI 95%: 1.05–1.62) were associated with a higher risk of overuse injury. Female athletes (OR: 1.56, CI 95%: 1.08–2.25) and an additional hour of training per week (OR: 1.09, CI 95%: 1.02–1.15) were associated with a higher risk of traumatic injury. This study showed that athletes with previous injury have shown a high risk of developing an overuse injury.     

A preliminary investigation of injury prevention strategies in netball: Are players heeding the advice?

All netball players who sought treatment for injury during the three-day 1995 New South Wales State Netball Championships were surveyed. Of 940 participants, 131 incurred injuries (139.4 injuries per 1,000 players; 23.8 injuries per 1,000 playing hours). Ankle and knee injuries were most frequent, with ligament sprains, bruising/contusions, and muscle strains presenting as the most common injury types. The most frequent causes of injury were incorrect landings, collisions with players, being struck by the ball, or repetitive movements. Although most players heeded advice pertaining to warm-up, occurrence of injuries during warm-up and cool-down suggested that activities performed during these periods may be inappropriate. To reduce risk of ankle ligament sprain in netball, high-cut netball shoes have been advocated. However, only 5.1% of players surveyed wore high-cut shoes. Furthermore, although players have been advised to seek immediate treatment when injured, 54.7% of players finished the game before seeking treatment. Relative to previous netball injury investigations, the frequency and nature of injuries, and the injury prevention behaviours of players have not changed. Therefore, wider promotion of injury prevention resources, combined with research into the effectiveness of these resources and how players can be encouraged to adopt appropriate injury prevention strategies in netball, is recommended.     

Ankle injuries in basketball players

We carried out a retrospective study of the frequency of ankle sprains in basketball players. A questionnaire about previous ankle injuries, time off after such injuries, current ankle problems, personal data, number of practice hours and the use of prophylactic measures was sent out to 102 basketball players in a second division league in Sweden. Ninety-six players answered. 92% of them had suffered an ankle sprain while playing basketball, and of these 83% reported repeated sprains of one ankle. In the last two seasons, 78% of the players had injured at least one ankle. The injury frequency in the investigation was 5.5 ankle injuries per 1000 activity hours. 22% of the players used some kind of prophylactic support of their ankle joints. Because of the great number of ankle sprains and the disability in terms of time away from sports that they cause, prevention of these injuries is essential.     

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.

     

A prevention strategy to reduce the incidence of injury in high school basketball: a cluster randomized controlled trial.

OBJECTIVE: To examine the effectiveness of a sport-specific balance training program in reducing injury in adolescent basketball. DESIGN: Cluster randomized controlled trial. SETTING: Twenty-five high schools in Calgary and surrounding area. SUBJECTS: Nine hundred and twenty high school basketball players (ages 12-18). INTERVENTION: Subjects were randomly allocated by school to the control (n = 426) and training group (n = 494). Both groups were taught a standardized warm-up program. The training group was also taught an additional warm-up component and a home-based balance training program using a wobble board. MAIN OUTCOME MEASURES: All injuries occurring during basketball that required medical attention and/or caused a player to be removed from that current session and/or miss a subsequent session were then recorded and assessed by a team therapist who was blinded to training group allocation. RESULTS: A basketball-specific balance training program was protective of acute-onset injuries in high school basketball [RR = 0.71 (95% CI; 0.5-0.99)]. The protective effect found with respect to all injury [RR = 0.8 (95% CI; 0.57-1.11)], lower-extremity injury [RR = 0.83 (95% CI; 0.57-1.19)], and ankle sprain injury [RR = 0.71 (95% CI; 0.45-1.13)] were not statistically significant. Self-reported compliance to the intended home-based training program was poor (298/494 or 60.3%). CONCLUSIONS: A basketball-specific balance training program was effective in reducing acute-onset injuries in high school basketball. There was also a clinically relevant trend found with respect to the reduction of all, lower-extremity, and ankle sprain injury. Future research should include further development of neuromuscular prevention strategies in addition to further evaluation of methods to increase compliance to an injury-prevention training program in adolescents.     

Intrinsic risk factors for acute knee injuries among male football players: a prospective cohort study

This prospective cohort study was conducted to identify the risk factors for acute knee injuries among male football players. A total of 508 players representing 31 amateur teams were tested during the 2004 preseason for potential risk factors for knee injury through a questionnaire on previous injury, Knee Osteoarthritis Outcome Score (KOOS) and a clinical examination. 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 football season, 61 acute knee injuries, affecting 57 legs (53 players), were registered. Univariate analyses revealed the KOOS subscores "Pain" and "Function in daily living" (OR for a 10-point difference in score: 1.26, 95% CI 1.03-1.55 and 1.35, 95% CI 0.98-1.85, respectively), any findings at clinical examination (OR: 2.62, 95% CI 1.03-6.68), flexion contraction in range of motion testing (OR: 0.96, 95% CI 0.93-1.00) and varus stress tests in full extension (OR: 8.50, 95% CI 1.85-39.0) and 30° flexion (OR: 5.69, 95% CI 1.73-18.8) as candidate factors. However, in a multivariate analysis, none of these factors were associated with an increased injury risk.