Incidence of acute volleyball injuries: a prospective cohort study of injury mechanisms and risk factors

The purpose of the study was to examine the incidence and mechanisms of acute volleyball injuries, with particular reference to possible risk factors for ankle injuries. Coaches and players in the top two divisions of the Norwegian Volleyball Federation were asked to keep records of exposure time and all acute volleyball injuries causing a player to miss at least one playing day during one season. We found 89 injuries among 272 players during 51 588 players hours, 45 837 h of training and 5751 h of match play. The total injury incidence was 1.7 ± 0.2 per 1000 h of play, 1.5 ± 0.2 during training and 3.5 ± 0.8 during match play. The ankle (54%) was the most commonly injured region, followed by the lower back (11%), knee (8%) shoulder (8%) and fingers (7%). Of the ankle injuries, 79% were recurrences, and the relative risk of injury was 3.8 ( P < 0.0001) for previously injured ankles (38 of 232) vs. non-injured ankles (10 of the 234). Moreover, a reinjury was observed in 21 of the 50 ankles that had suffered an ankle ankle sprain within the last 6 months (42.0 ± 7.0%; risk ratio: 9.8 vs. uninjured ankles; P < 0.000001). The data indicate that external supports should be worn for 6–12 months after an ankle sprain and that specific injury prevention programs may be developed for ankle sprains in volleyball.     

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.     

A prospective cohort study of anterior cruciate ligament injuries in elite Norwegian team handball

The purpose of this study was to examine gender differences in the incidence of anterior cruciate ligament (ACL) injuries in a population of highlevel team handball players. We also wanted to examine injury mechanisms and possible risk factors for ACL injuries, including menstrual status. The study was done prospectively during the 1993-94, 1994-95, and 1995–96 seasons. We found 28 ACL injuries, 23 among women (incidence: 0.31 ± 0.06 injuries per 1000 player hours) and 5 among men (0.06 ± 0.03 inj./1000 h; P < 0.001 vs women; risk ratio: 5.0). Of the 28 injuries, 24 occurred during competiton (0.91 ± 0.19 inj./1000 h; women: 1.60 ± 0.35 inj./1000 h; men: 0.23 ± 0.13 inj./1000 h; P ±0.001 vs. women; risk ratio: 7.0) and 4 during training (0.03 ± 0.02 inj./1000 h; P ±0.001 vs. competition; risk ratio: 29.9). Nearly all the injuries ( n = 25) occurred in noncontact situations when the players performed high-speed plant-and-cut movements which they were well accustomed to. A reliable menstrual history could be obtained in 17 of the 23 cases among females. Five of the injuries occurred in the menstrual phase, 2 in the follicular phase, 1 in the early luteal phase and 9 in the late luteal phase (chi-square_{3 d.f.}= 13.2; P ±0.01). The results suggest that there may be an increased risk of ACL injury during the week prior to or after the start of the menstrual period.     

A prospective study of kitesurfing injuries

BACKGROUND: To date, the pattern and rate of kitesurfing injuries are largely unclear. HYPOTHESIS: The pattern and rate of kitesurfing injuries are comparable to that of contact sports such as football and soccer. STUDY DESIGN: Prospective study. METHODS: The study was conducted over a 6-month period of 1 season and included 235 kitesurfers. RESULTS: The number of self-reported injuries was 124, for an overall self-reported injury rate of 7 per 1000 hours of practice. One fatal accident (polytrauma) and 11 severe injuries occurred during the study period (2 knee ligament injuries and 9 fractures at various sites). The most commonly injured sites were the foot and ankle (28%), skull (14%), chest (13%), and knee (13%). Fifty-six percent of the injuries were attributed to the inability to detach the kite from the harness in a situation involving loss of control over the kite. There was a tendency for athletes using a quick-release system to sustain fewer injuries than athletes without such a release system. CONCLUSION: Kitesurfing can be considered a high-risk sport. CLINICAL RELEVANCE: The use of a quick-release system that enables the surfers to detach the kite in case of an accident might aid in the prevention of injuries.     

Epidemiology of injuries during the Wheelchair Basketball World Championships 2018: A prospective cohort study

Several international sports federations have implemented a standardized injury reporting system during their championships. However, very few studies have investigated athletes with disabilities during major championships apart from the Paralympic Games. Therefore, the aim of this study was to assess the rate and characteristics of injuries during the Wheelchair Basketball World Championships 2018 (WBWC). This prospective cohort study was conducted during the WBWC held in Hamburg, Germany, from August 16 to August 26, 2018. Physicians or physiotherapists of all 28 participating teams (total 336 players) were asked to report all newly incurred injuries (with location, diagnosis, cause, and estimated duration of absence) daily on a standardized injury report form. Prevalence and incidence rates were calculated. Medical staff of 11 teams (132 players) reported 100 injuries, equivalent to 75.8 per 100 players (95% CI: 60.9-90.7) or 68.9 per 1000 player-days (55.4-82.4). Eight time-loss injuries were reported (6.1 injuries per 100 players [95% CI: 1.9-10.3] or 5.5 injuries per 1000 player-days [1.7-9.3]). More injuries were incurred during matches (n = 68) than during training. Most injuries affected the neck/cervical spine (16%), thoracic spine/upper back (15%), and shoulder (14%). The most frequent diagnosis was muscle spasms (25%), the most frequent cause was overuse (52%). A high rate of non–time-loss injuries compared to Paralympic Games was reported. Future studies should focus on the etiology of muscle spasms and further identify injury mechanisms of traumatic and overuse injuries in wheelchair basketball players to develop adequate preventive measures.     

Prognosis and prognostic factors of running-related injuries in novice runners: A prospective cohort study

Objectives

To investigate the prognosis and possible prognostic factors of running-related injuries (RRIs) in novice runners.

Risk factors for leg injuries in female soccer players: a prospective investigation during one out-door season

The following possible risk factors for leg injuries in female soccer players were studied: age, anatomical alignment, generalized joint laxity, thigh muscle torque, muscle flexibility, ligamentous laxity of the knee and ankle joints, recent injuries, and duration of soccer exposure. A total of 146 players from 13 teams in the second and third Swedish divisions underwent clinical examination, isokinetic measurements of quadriceps and hamstring torques, and testing of postural sway of the legs. All soccer-related leg injuries resulting in absence from at least one scheduled practice session or game were recorded during one outdoor season (April-October). In 50 players there were 61 traumatic injuries, and 17 players sustained 19 overuse injuries. The overall injury incidence rate (traumatic and overuse) was 5.49/1000 h of soccer. Variables significantly increasing the risk of traumatic leg injuries included generalized joint laxity, low postural sway of the legs, hyperextension of the knee joint, and a low hamstring-to-quadriceps ratio during concentric action. Multivariate logistic regression showed hyperextension of the knee joint, a low postural sway, reduced H/Q ratio during concentric action, and a higher exposure to soccer to significantly increase the risk of traumatic leg injury. All five players who suffered an anterior cruciate ligament injury during the study period had a lower hamstring-to-quadriceps ratio during concentric action on the injured side than on their noninjured side.     

Risk factors for patellar tendinopathy in volleyball and basketball players: A survey‐based prospective cohort study

Patellar tendinopathy (PT) is a common overuse injury of the patellar tendon in jumping athletes. In a recent large cross‐sectional study from 2008 several factors were identified that may be associated with the etiology of PT. However, because of the study design no conclusions could be drawn about causal relations. The primary aim of the current study is to investigate whether the factors identified in the previous 2008 study can also be prospectively recognized as predictors of symptomatic PT in 2011. Nine hundred twenty‐six Dutch elite and non‐elite basketball and volleyball players from the previous study were invited again to complete an online survey about knee complaints and risk factors for PT in 2011. The logistic regression included 385 athletes of which 51 (13%) developed PT since 2008. Male gender [odds ratio (OR) 2.0, 95% confidence interval (CI) 1.1–3.5] was found to be a risk factor for developing PT. No sports‐related variables could be identified to increase the risk of developing PT, but some evidence was found for performing heavy physically demanding work, like being a nurse or a physical education teacher (OR 2.3, 95% CI 0.9–6.3). These findings indicate that, when considering preventive measures, it is important to take into account the total tendon load.     

Spinal injuries in professional rugby union: a prospective cohort study.

OBJECTIVES: To determine the incidence, severity, nature, and causes of cervical, thoracic, and lumbar spine injuries sustained during competition and training in professional rugby union. DESIGN: A 2 season prospective cohort design. SETTING: Twelve English Premiership rugby union clubs. PARTICIPANTS: Five hundred and forty-six male rugby union players of whom 296 were involved in both seasons. MAIN OUTCOME MEASURES: Location, diagnosis, severity (number of days unavailable for training and matches), and cause of injury: incidence of match and training injuries (injuries/1000 player-hours). RISK FACTORS: Player age, body mass, stature, playing position, use of headgear, and activity and period of season. RESULTS: The incidences of spinal injuries were 10.90 (9.43 to 12.60) per 1000 player match-hours and 0.37 (0.29 to 0.47) per 1000 player training-hours. No player sustained a catastrophic spinal injury, but 3 players sustained career-ending injuries. Overall, players were more likely to sustain a cervical injury during matches and a lumbar injury during training. Forwards were significantly more likely to sustain a spinal injury than backs during both matches (P < 0.01) and training (P = 0.02). During matches, injuries to the cervical (average: 13 days; P < 0.01) and lumbar (13 days; P < 0.01) spine were more severe than injuries to the thoracic (5 days) spine; during training, injuries to the lumbar spine (26 days) were more severe than injuries to the cervical (13 days; P = 0.10) or thoracic (12 days; P = 0.06) spine. A total of 4037 days were lost to competition and training through spinal injuries with lumbar disc injuries sustained during training accounting for 926 days (23%) and cervical nerve root injuries sustained during matches for 621 days (15%). During matches, more injuries were caused by tackles (37%), and during training more injuries were caused by weight-training (33%). CONCLUSIONS: The results showed that rugby union players were exposed to a high risk of noncatastrophic spinal injury during tackling, scrummaging, and weight-training activities; injury prevention strategies, therefore, should be focused on these activities.     

Musculoskeletal injuries in the Norwegian National Ballet: a prospective cohort study

The purpose of the present study was to determine the incidence of musculoskeletal injuries among professional ballet dancers in the Norwegian National Ballet. A 19 weeks prospective study with registration and clinical assessment of dancers with injuries was conducted. Medical staff working for the National Ballet registered incidence of injuries. In addition the dancers filled out a questionnaire about previous injuries, their work situation, and factors they believed increased the risk of injuries. Of the 41 dancers (80% response rate), 31 dancers experienced one injury or more. The majority of injuries involved foot and ankle. Twenty-two per cent of the injuries were acute injuries. Seventy-five per cent of the injuries were soft tissue injuries. Most injuries were of mild to moderate severity. Sixteen per cent of the injuries resulted in absence from work. Factors, the dancers believed were associated with risk of injuries were related to training, organizational factors and environmental factors. Seventy-eight per cent of the dancers experienced "negative" stress at work. Sixty-four per cent experienced that they had little influence on their work conditions. This study showed, however, no significant association between these psychological factors and musculoskeletal injuries. It is concluded that there is a high incidence of musculoskeletal injuries in the Norwegian National Ballet.     

A comparison of injuries in elite male and female football players: A five‐season prospective study

The aim was to compare the epidemiology of injuries between elite male and female football players from the same club. Injuries and individual exposure time in a male team and a female team, both playing in the Spanish first division, were prospectively recorded by the club's medical staff for five seasons (2010‐2015) following the FIFA consensus statement. Total, training, and match exposure hours per player‐season were 20% higher for men compared to women (P< .01). Total, training, and match injury incidence were 30%‐40% higher in men (P≤ .04) mainly due to a 4.82 (95% confidence interval [CI ] 2.30‐10.08) times higher incidence of contusions, as there were no differences in the incidence of muscle and joint/ligament injuries (P≥ .44). The total number of absence days was 21% larger in women owing to a 5.36 (95% CI 1.11‐25.79) times higher incidence of severe knee and ankle ligament injuries. Hamstring strains and pubalgia cases were 1.93 (95% CI 1.16‐3.20) and 11.10 (95% CI 1.48‐83.44) times more frequent in men, respectively; whereas quadriceps strains, anterior cruciate ligament ruptures, and ankle syndesmosis injuries were 2.25 (95% CI 1.22‐4.17), 4.59 (95% CI 0.93‐22.76), and 5.36 (95% CI 1.11‐25.79) times more common in women, respectively. In conclusion, prevention strategies should be tailored to the needs of male and female football players, with men more predisposed to hamstring strains and hip/groin injuries, and women to quadriceps strains and severe knee and ankle ligament injuries.     

Injury risk factors in female European football. A prospective study of 123 players during one season

The purpose of this study was to register prospectively the injuries in female soccer and to study their correlation to potential risk factors. A total of 123 senior players from eight teams of different levels were followed during one season. Isokinetic knee muscle strength at 60 and 180 degrees/s, one-leg-hop, vertical jump, square-hop, and continuous multistage fitness test (MFT) were tested at the end of the pre-season. In addition, Body Mass Index (BMI) and general joint laxity were measured. During the season, April-October, all injuries resulting in absence from one practice/game or more were registered. Forty-seven of the 123 players sustained altogether 65 injuries. The total injury rate was 14.3 per 1000 game hours and 3.7 per 1000 practice hours. The knee (26%) was the most commonly injured region followed by the foot (12%), ankle (11%), thigh (11%) and back (11%). The risk of sustaining moderate and major injuries increased in the later part of the game or practice. Significant risk factors for injuries were an increased general joint laxity (odds ratio (OR)=5.3, P<0.001), a high performance in the functional test square-hop (OR=4.3, P=0.002), and an age over 25 years (OR=3.7, P=0.01). The injury rate was not different compared to male soccer, but knee injuries were more common, which is in accordance with previous studies. None of the risk factors identified in this study is easily applicable for future intervention studies in the attempts to reduce the injury rate in female soccer.     

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 three-year epidemiological prospective cohort study of rugby league match injuries from the European Super League

Objectives

Conduct a comprehensive epidemiological study of match injury characteristics (incidence, severity, causes, diagnostics, and temporal trends) in professional rugby league.

A prospective study of high school wrestling injuries

We performed a prospective study to evaluate injury patterns in a large population of high school wrestlers during one season. Preseason screening was performed on 458 male wrestlers from 14 different high schools. Certified athletic trainers submitted detailed weekly team and individual injury reports. There were 219 injuries in 418 wrestlers followed throughout the season for an overall injury incidence of 52 injuries per 100 wrestlers per season and an injury rate of 6.0 injuries per 1,000 exposures. The most commonly injured areas were the shoulder (24%) and knee (17%). Injured wrestlers were an average of 5 months older and had a 32% higher experience level than noninjured wrestlers. Wrestlers with ligamentous laxity suffered fewer shoulder injuries than the other wrestlers. The majority of injuries occurred in practice (63%), although the injury rate was higher in match competitions. Sixty-eight percent of practice injuries occurred during hard wrestling, 23% during drills, and 9% during conditioning. The most common wrestling situation resulting in injury was the takedown position (68%). Our results show that the older and more experienced wrestler may be at greater risk of injury. Hard wrestling during practice and the takedown position resulted in the highest occurrence of injury.     

Knee injuries in volleyball

The knee is the most frequent site of injury in volleyball players. More than 40% of high level players suffer overuse injuries during this activity; this particularly painful syndrome is caused by the amount of jumping typical in volleyball play, and in its training which aims at strengthening the quadriceps muscle. In volleyball players the extensor apparatus is subject to continuously high stress and the bone tendon junction, being the weakest point, is susceptible to lesion. The prevention and treatment of 'jumper's knee' requires a high degree of cooperation among trainers, doctors and athletes. Although volleyball is a sport without contact between players, traumatic acute injuries are more frequent and more serious than would be expected. It is therefore important to emphasise that volleyball must be considered among the high risk sports that expose the knee not only to twisting, but also to contact with other players. Generally, the lesions are caused by frequent jumps with loss of balance and a consequent 'one-footed' landing. There is no specific method of preventing knee instability. Accurate diagnoses, rest and rapid surgical treatment after the first injury are recommended in order to avoid chronic knee instability with subsequent meniscal lesions and post-traumatic osteoarthritis.