Central nervous system injuries in sport and recreation: a systematic review

Many sports have been associated with a variety of neurological injuries affecting the central nervous system (CNS), with some injuries specific to that sport. A systematic review of sport-specific CNS injuries has not been attempted previously, and could assist in the understanding of morbidity and mortality associated with particular sporting activities, either professional or amateur. A systematic review of the literature was performed using PubMed (1965-2003) examining all known sports and a range of possible CNS injuries attributable to that sport. Numerous sporting activities (45) have associated CNS injuries as reported within the literature. The sports most commonly associated with CNS injuries are: football, boxing, hockey, use of a trampoline, and various winter activities. A number of sporting activities are associated with unique CNS injuries or injury-related diseases such as heat stroke in auto racing, vertebral artery dissection in the martial arts, and dementia pugilistica in boxing. Neurological injuries of the CNS due to sport comprise a wide collection of maladies that are important for the neurologist, neurosurgeon, orthopaedic surgeon, physiatrist, sports medicine doctor, athletic trainer and general physician to recognise.     

Mehr als Nebenwirkungen: Ein theoretisches Modell zu den physischen,psychischen und sozialen Wirkungen des Sports

This review summarizes the current state of research about the physical, psychological and social effects of sport.A synoptic model divides sport into organized school and club sports and non-organized leisure time physical activities.The health benefit affects both the entire development of children and the biopsychosocial salutogenesis of adults.Thus, what is being learned in the framework of sporting activities (socialization in sport) can also be important for other domains of daily life (socialization through sport).     

Eye injuries in sports

In a retrospective study from 1988 to 1998, eye injuries were found in 553 patients. Seventy-six (13.7%) of these injuries were associated with sport. The mechanism of trauma was for the most part a ball (71.1%) or a club (13.2%). Most eye injuries occurred in soccer (35.5%), which is, by far, the most widespread sport in this region of Norway. A disproportionately high number of the injuries occurred in floorball (17.1%), bandy (13.2%), and squash (10.5%). The rules in these sports may, in theory, be strict enough to prevent eye injuries in most cases. However, these rules are often neglected in informal activities. Strategies for educating the general public about the potentially serious effect of eye injuries in sports exposed to such risk are of great importance.     

Lifetime injury prevention: the sport profile model

Participation in sporting activities carries an injury risk. Conversely, the increased awareness that physical inactivity is a major risk factor for disease has led government agencies and the medical community to encourage increased levels of physical activity. Many people will achieve this through participation in sport. Injury inevitably leads to a reduction in participation on a temporary or permanent basis, but the injury experience may also influence the lifelong physical activity behaviour. Few studies adequately examine the possible long-term consequences of sport participation after the competitive period has been completed, but by understanding the patterns of injuries in different sports one test can develop strategies to prevent and better manage the conditions that occur and promote lifelong physical activity. There is a need to develop models of understanding of injury risk at different life phases and levels of participation in a specific sport. The risk assessment of sport participation has to be relevant to a particular sport, the level of participation, skill, age and potential future health consequences. This article describes a sport-specific model which will improve guidance for coaches and healthcare professionals. It poses questions for sports physicians, healthcare providers, educators and for governing bodies of sports to address in a systematic fashion. Additionally the governing body, as an employer, will need to meet the requirements for risk assessment for professional sport and its ethical responsibility to the athlete.     

Sport accidents in childhood.

Injuries among children during sporting activities are common. This study is a one year study including children between five and fourteen years of age who sustained their injuries during sporting activities and were treated at Trondheim Regional and University Hospital. Sport accidents account for 27 per cent of all childhood accidents in this age group. Fifty-three per cent of the injured were boys, and 47 per cent were girls. The boys sustained more severe injuries than the girls. Soccer caused the greatest number of injuries. Horse riding and alpine skiing were the cause of the most severe injuries. A more widespread use of protective guards, better technique and body control, better coaching and not allowing the younger children to take part in technically advanced sporting activities might reduce the number and the severity of the sport injuries in children.     

Training and equipment to prevent athletic head and neck injuries

Due to the potential for catastrophic neurotraumas and cervical spine injuries in sport, the sports health care professional must take proper measures to prevent such injuries. Strength training of the cervical spine, teaching of proper sporting techniques, and use of protective sports equipment are three primary means of attempting to prevent neurotraumas and cervical spine injuries in sports. There are other avenues to assist in preventing these injuries, such as flexibility programs. The sports health care professional, therefore, must be knowledgeable of the needs of each individual athlete when developing prevention plans.     

Participation in sporting activities following knee replacement: total versus unicompartmental

Few studies have been published assessing patients sporting activity after total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA). Common concerns of patients undergoing TKA or UKA are whether they can continue with sporting activities after surgery. This study compares the sporting activity of TKA and UKA patients preoperatively and postoperatively. A total of 110 patients were surveyed by questionnaire. Seventy-six patients had undergone TKA and 34 patients had undergone UKA. They were assessed for their participation in low-impact sport preoperatively and postoperatively at a mean follow up of 21.6 +/- 5.3 and 22.3 +/- 7.8 months, respectively. Low-impact sports are those which a surgeon would expect patients to be able to participate in postoperatively. Data were separately analysed for older and younger patients and women and men, respectively. The results were as follows: before surgery, 55 of 76 patients in the TKA group participated in an average of 1.3 different sports and postoperatively, 35 of 76 patients participated in an average of 0.7 different sports. In the UKA group, 30 of 34 patients participated in an average of 1.5 different sports preoperatively and postoperatively, 29 of 34 patients participated in an average of 1.4 different sports. The return to sport rate was 96.7% in the UKA group and 63.6% in the TKA group. In the TKA group, the average frequency of sport preoperatively was 3.0 sessions per week (62.7 min) and postoperatively it decreased to 2.0 sessions per week (37.5 minutes). In the UKA group, the average frequency of sport preoperatively was 3.2 sessions per week (85.0 min) and postoperatively it increased to 3.4 sessions per week (92.1 min). The average time before resuming sport after surgery was 4.1 months in the TKA group and 3.6 months in the UKA group; 42.9% of patients in the TKA group and 24.1% of patients in the UKA group reported pain during sports after surgery; 80.3% of the patients in the TKA group and 88.2% of the patients in the UKA group felt that surgery had increased or maintained their sporting ability. Oxford knee scores decreased significantly one year after surgery in both the TKA group and the UKA group. In conclusion, the patients in our study had a significantly greater return to sport rate after UKA than patients who had undergone TKA. A large proportion of patients in the TKA group did not return to sport which their surgeon would have expected them to including golf and bowls. Patients in the UKA group also took part in more sporting sessions and for a longer period of time than patients in the TKA group. Moreover, patients undergoing UKA also returned to sport more quickly than patients undergoing TKA.     

Physeal injuries in children's and youth sports: reasons for concern?

A systematic review of the literature on the frequency and characteristics of sports related growth plate injuries affecting children and youth in organised sport was carried out. Both acute and chronic physeal injuries related to participation in sports have been reported to occur, although injury incidence data are somewhat limited. Of particular concern is the growing number of stress related physeal injuries, including those affecting the lower extremities. Although most physeal injuries appeared to resolve with treatment and rest, there is also evidence of growth disturbance and deformity. Possible injury risk factors and countermeasures are discussed, and suggestions for directing future research provided.     

Return to sport after patellar dislocation or following surgery for patellofemoral instability

Patellofemoral instability may occur in a young population as a result of injury during sporting activities. This review focuses on return to sport after one episode of dislocation treated no operatively and as well after surgery for chronic patellofemoral instability. With or without surgery, only two-thirds of patients return to sports at the same level as prior to injury. A high-quality rehabilitation programme using specific exercises is the key for a safe return to sporting activities. To achieve this goal, recovery of muscle strength and dynamic stability of the lower limbs is crucial. The focus should be directed to strengthen the quadriceps muscle and pelvic stabilizers, as well as lateral trunk muscle training. Patient education and regularly performed home exercises are other key factors that can lead to a successful return to sports. The criteria for a safe return to sports include the absence of pain, no effusion, a complete range of motion, almost symmetrical strength, and excellent dynamic stability. Level of evidence IV.     

The public health impact of injury during sport and active recreation

Injuries can be an adverse outcome of participation in sport and recreational activities. The aim of this study was to determine the public health impact of injury during sports and active recreation injury in a select population in Australia. A random household telephone survey was conducted quarterly over a 12-month period in a well-defined geographic region, the Latrobe Valley, Australia. Information was collected on participation in sport and active recreation and associated injuries over the previous 2 weeks for all household members aged over 4 years. Injury rates were calculated per 10,000 population and per 1000 sports participants. Data were collected on 1084 persons from 417 households. Overall, 648 people reported participating in at least one sport or active recreation and 34 (5.2%, 95% CI: 4.8, 5.6%) of these sustained an injury during this activity. Overall, 51.4% of injured cases had a significant impact: 26.5% sought treatment, 34.4% had their activities of daily living adversely affected and 36.0% had their performance/participation limited. Cricket (51 injuries/10,000 population), horse riding (29/10,000 population) and basketball (25/10,000 population) had the highest injury rates. After adjusting for participation, cricket (242 injuries/1000 participants), horse riding (122/1000 participants) and soccer (107/1000 participants) had the highest injury rates. Cricket and soccer were the sports most associated with ‘significant’ injuries. Injury prevention efforts should be aimed at team ball sports (especially cricket, soccer and netball) because of their comparatively high rate of both overall and ‘significant’ injury.     

Is it possible to prevent sports injuries? Review of controlled clinical trials and recommendations for future work.

Sports injuries are one of the most common injuries in modern western societies. Treating sports injuries is often difficult, expensive and time consuming, and thus, preventive strategies and activities are justified on medical as well as economic grounds. A successful injury surveillance and prevention requires valid pre- and post-intervention data on the extent of the problem. The aetiology, risk factors and exact mechanisms of injuries need to be identified before initiating a measure or programme for preventing sports injuries, and measurement of the outcome (injury) must include a standardised definition of the injury and its severity, as well as a systematic method of collecting the information. Valid and reliable measurement of the exposure includes exact information about the population at risk and exposure time. The true efficacy of a preventive measure or programme can be best evaluated through a well-planned randomised trial. Until now, 16 randomised, controlled trials (RCT) have been published on prevention of sports injuries. According to these RCT, the general injury rate can be reduced by a multifactorial injury prevention programme in soccer (relative risk 0.25, p < 0.001, in the intervention group), or by ankle disk training, combined with a thorough warm-up, in European team handball [odds ratio 0.17; 95% confidence interval (CI) 0.09 to 0.32, p < 0.01]. Ankle sprains can be prevented by ankle supports (i.e. semirigid orthoses or air-cast braces) in high-risk sporting activities, such as soccer and basketball (Peto odds ratio 0.49; 95% CI 0.37 to 0.66), and stress fractures of the lower limb by the use of shock-absorbing insoles in footwear (Peto odds ratio 0.47; 95% CI 0.30 to 0.76). In future studies, it is extremely important for researches to seek consultation with epidemiologists and statisticians to be certain that the study hypothesis is appropriate and that the methodology can lead to reliable and valid information. Further well-designed randomised studies are needed on preventive actions and devices that are in common use, such as preseason medical screenings, warming up, proprioceptive training, stretching, muscle strengthening, taping, protective equipment, rehabilitation programmes and education interventions (such as increasing general injury awareness among a team). The effect of a planned rule change on the injury risk in a particular sport could be tested via a RCT before execution of the change. The most urgent needs are in commonly practised or high-risk sports, such as soccer, American football, rugby, ice hockey, European team handball, karate, floorball, basketball, downhill skiing and motor sports.     

Overcoming the organization–practice barrier in sports injury prevention: A nonhierarchical organizational model

The organization of sports at the national level has seldom been included in scientific discussions of sports injury prevention. The aim of this study was to develop a model for organization of sports that supports prevention of overuse injuries. The quality function deployment technique was applied in seminars over a two‐season period to develop a national organizational structure for athletics in Sweden that facilitates prevention of overuse injuries. Three central features of the resulting model for organization of sports at the national level are (a) diminishment of the organizational hierarchy: participatory safety policy design is introduced through annual meetings where actors from different sectors of the sporting community discuss training, injury prevention, and sports safety policy; (b) introduction of a safety surveillance system: a ubiquitous system for routine collection of injury and illness data; and (c) an open forum for discussion of safety issues: maintenance of a safety forum for participants from different sectors of the sport. A nonhierarchical model for organization of sports at the national level – facilitated by modern information technology – adapted for the prevention of overuse injuries has been developed. Further research is warranted to evaluate the new organizational model in prospective effectiveness studies.     

The epidemiology of foot and ankle injuries in sports

A 6 1/2-year review of 16,754 injuries seen in a multispecialty sports medicine clinic found that 25 per cent of the 12,681 injuries in the top 19 sports occurred at the ankle and foot. The percentages of foot and ankle injuries varied substantially from sport to sport, as did the proportion of sprains versus overuse injuries at each location. An appreciation of the patterns and numbers of injuries presenting to a sports medicine facility can be helpful in patient management and can aid the planning of both clinical investigations and educational programs.     

The validity and relevance of tests used for the assessment of sports surfaces

Inappropriate cushioning and/or tractional characteristics of sports surfaces are assumed to increase surface-related injuries in various sports activities. Various tests assessing cushioning and frictional properties are currently in use to evaluate sports surfaces with respect to their potential to reduce the number of surface-related injuries. A critical review of the currently used test procedures showed that most of them are not relevant. The main shortcomings are 1) errors in the measured test results by not correcting for inertia terms due to moving test foot or surface sample, 2) use of inadequate material test procedures where the test procedure influences significantly the test result, and 3) use of material test procedures where the used materials or the applied forces are not representative of the actual situation during sport activities. It is suggested that appropriate test batteries should include 1) test procedures that determine the material properties (stress-strain relation and traction coefficients) relevant for the surface-shoe interaction and 2) subject tests that describe the adaptation of the athlete to the surface-shoe-athlete situation.     

Injuries to athletes with disabilities: identifying injury patterns

Participation in sport activities for people with disabilities continues to gain in popularity. With participation in sports, there is an inherent risk of injury. A review of current sport epidemiological studies was used and we concluded that injury patterns for this population are similar to those for athletes without disabilities. Injury data from Paralympic competitions dating back to 1976 indicate that most elite athletes with disabilities seek medical care for illness and musculo-skeletal injuries. However, there are very limited injury data regarding Winter Paralympic events or skiing injuries. For those athletes who participate in Summer Paralympic events, abrasions, strains, sprains and contusions are more common than fractures and dislocations. However, location of injuries appears to be disability and sport dependent. Lower extremity injuries are more common in ambulatory athletes (visually impaired, amputee, cerebral palsy) and upper extremity injuries are more frequent in athletes who use a wheelchair. While it appears that the majority of the injuries occurring in this population are minor in nature, inconsistencies in the definition of injury in the literature make this conclusion tenuous. When injuries are expressed as time lost in participation, 52% of injuries resulted in 7 days lost or less, 29% in 8 to 21 days lost and 19% in greater than 22 days lost. The only prospective study addressing injury rates of athletes with disabilities in a manner consistent with other sport epidemiological studies found an injury rate of 9.3 injuries per 1000 athlete-exposures (AE). This injury rate is less than American football (10.1 to 15/1000 AE) and soccer (9.8/1000 AE), and greater than basketball (7.0/1000 AE). It is unclear whether comparative statistics such as these take into consideration the number of illness and injury episodes that resulted from the disability. Further complicating epidemiological studies for athletes with disabilities is the definition of the population and samples of convenience which are frequently used. These samples are often not representative of the multiplicity of disability conditions, levels of competition and range of sport activities available. Prospective studies comparing athletes to sedentary control individuals to measure differences in injury rates, type and frequency between and within disability groups, sports and levels of competition are desperately needed to further the knowledge of injury trends and develop and establish accurate injury prevention programmes.     

Over 90 % of children and adolescents return to sport after anterior cruciate ligament reconstruction: a systematic review and meta-analysis

Purpose

To evaluate the rate at which children and adolescent athletes return to sporting activities after anterior cruciate ligament (ACL) reconstruction.

Methods

Three databases, PubMed, MEDLINE, and EMBASE, were searched from database inception until September 9, 2017 by two reviewers independently and in duplicate. The inclusion criteria were English language studies that reported return to sport outcomes. Book chapters, conference papers, review articles, and technical reports were excluded. The rate of return to sports was combined in a meta-analysis of proportions using a random-effects model.

Results

Overall, 20 studies with a combined total of 1156 ACL reconstructions met the inclusion criteria, with a mean age of 14.3 years (range 6–19) and a mean follow-up time of 6.5 years (range 1–22). All studies were level IV evidence (14 retrospective case series and 6 prospective case series). The pooled rate of return to any sport participation was 92.0% [95% confidence interval (CI), 86–96%]. The pooled rate of return to pre-injury level of sport was 78.6% (95% CI 71–86%) and that to competitive level of sport was 81.0% (95% CI 62–94%). A total of 93 of the 717 assessed athletes (13%) sustained re-injuries with graft ruptures, and in 91 of 652 patients (14%), contralateral ACL injuries were reported on final follow-up.

Conclusion

Pooled results suggest a high rate of return to sport following ACL reconstruction in children and adolescent athletes; however, this is associated with a relatively high rate of graft rupture and a similar rate of contralateral ACL injury. This study provides clinicians with evidence-based data on the ability of children and adolescent athletes to return to sport after ACL reconstruction, an important consideration for athletes of this population with ACL injuries.

Level of evidence

IV, systematic review of level IV studies.

     

Incidence, severity, aetiology and prevention of sports injuries. A review of concepts.

Notwithstanding the healthy influence of sporting activities on risk factors, in particular those of cardiovascular disease, it is becoming increasingly apparent that sports can present a danger to health in the form of sports injuries. The extent of the sports injury problem calls for preventative action based on the results of epidemiological research. For the interpretation of these facts uniform definitions are needed and limitations of research designs should be known. Measures to prevent sports injuries form part of what is called the 'sequence of prevention'. Firstly the extent of the sports injury problem must be identified and described. Secondly the factors and mechanisms which play a part in the occurrence of sports injuries have to be identified. The third step is to introduce measures that are likely to reduce the future risk and/or severity of sports injuries. This measure should be based on the aetiological factors and the mechanism as identified in the second step. Finally the effect of the measures must be evaluated by repeating the first step. In this review some aspects of the first and second step of the sequence of prevention are discussed. The extent of the sports injury problem is often described by injury incidence and by indicators of the severity of sports injuries. Sports injury incidence should preferably be expressed as the number of sports injuries per exposure time (e.g. per 1000 hours of sports participation) in order to facilitate the comparability of research results. However, one should realise that the outcome of research applying this definition of sports injury incidence is highly dependent on the definitions of 'sports injury' and 'sports participation'. The outcome of such research also depends on the applied research design and research methodology. The incidence of sports injuries depends on: the method used to count injuries (e.g. prospective vs retrospective); the method used to establish the population at risk; and on the representativeness of the sample. Severity of sports injuries can be described on the basis of 6 criteria: the nature of the sports injury; the duration and nature of treatment; sporting time lost; working time lost; permanent damage; and cost. Here also uniform definitions are important and necessary in order to enhance the comparability of research data. In the second step of the 'sequence of prevention' the aetiological factors that play a role in the occurrence of a sports injury have to be identified by epidemiological studies. Epidemiological research on the aetiology of sports injuries requires a conceptual model.(ABSTRACT TRUNCATED AT 400 WORDS)     

The impact of stretching on sports injury risk: a systematic review of the literature

PURPOSE: We conducted a systematic review to assess the evidence for the effectiveness of stretching as a tool to prevent injuries in sports and to make recommendations for research and prevention. METHODS: Without language limitations, we searched electronic data bases, including MEDLINE (1966-2002), Current Contents (1997-2002), Biomedical Collection (1993-1999), the Cochrane Library, and SPORTDiscus, and then identified citations from papers retrieved and contacted experts in the field. Meta-analysis was limited to randomized trials or cohort studies for interventions that included stretching. Studies were excluded that lacked controls, in which stretching could not be assessed independently, or where studies did not include subjects in sporting or fitness activities. All articles were screened initially by one author. Six of 361 identified articles compared stretching with other methods to prevent injury. Data were abstracted by one author and then reviewed independently by three others. Data quality was assessed independently by three authors using a previously standardized instrument, and reviewers met to reconcile substantive differences in interpretation. We calculated weighted pooled odds ratios based on an intention-to-treat analysis as well as subgroup analyses by quality score and study design. RESULTS: Stretching was not significantly associated with a reduction in total injuries (OR = 0.93, CI 0.78-1.11) and similar findings were seen in the subgroup analyses. CONCLUSION: There is not sufficient evidence to endorse or discontinue routine stretching before or after exercise to prevent injury among competitive or recreational athletes. Further research, especially well-conducted randomized controlled trials, is urgently needed to determine the proper role of stretching in sports.     

Sport and delinquency: an examination of the deterrence hypothesis in a longitudinal study.

OBJECTIVE: To determine whether involvement in sporting activity in mid-adolescence would deter delinquent behaviour in late adolescence. METHODS: Members of a longitudinal cohort study were interviewed at ages 15 and 18 years and, among other topics, were asked questions relating to involvement in physical activity and delinquent behaviour. Logistic regression models were used to examine the relation between sports involvement and delinquency at age 15 years and delinquency at age 18. RESULTS: After controlling for delinquent behaviour and psychosocial factors at age 15, females with moderate or high levels of sporting activity, and males with high levels of sporting activity, were significantly more likely to be delinquent at age 18 years than those with low levels of sporting activity. No significant association was found between sporting activity and aggressive behaviour, team sport participation and delinquency, and team sport participation and aggressive behaviour. CONCLUSIONS: This study did not support the deterrence hypothesis and showed that high involvement in sporting activity, but not team sport, was associated with a subsequent increase in delinquent behaviour.