For debate: consensus injury definitions in team sports should focus on missed playing time.

OBJECTIVE: To compare the most commonly used and proposed injury definitions for surveillance systems in team sports and attempt to assess their suitability for consensus definitions in terms of reliability and functionality. DATA SOURCES: The PubMed and SportDiscus databases were searched for papers on team sports that discussed consensus definitions or compared various definitions of injury. DATA SYNTHESIS: A continuum between the most broad "tissue damage" definition and the most narrow "match time loss only" definition was developed. RESULTS: A "match time loss only" injury definition can be reliably and accurately applied but only captures a small percentage of the total pool of all "tissue damage" injuries. There are some inherent biases in using a match time loss only definition (late season matches, matches with unequal breaks between games), but these are clearly visible. All other definitions improve the volume of data captured but suffer serious theoretical and/or practical flaws with respect to accuracy and reliability. No study using a broad definition has demonstrated good reliability to date (eg, using 2 independent recorders at the same team). CONCLUSION: A "match time loss only" injury definition is the most accurate and reliable of those commonly used in team sports. Other injury definitions are broader and may be more appropriate for individual team and specific injury studies. However, a match time loss definition is the most accurate and reliable tool for comparing injury rates at different teams and between different seasons within teams. Hence, we recommend this as the basis for the injury definition in a consensus statement.     

Epidemiology of injuries in typical Scandinavian team sports

An investigation by questionnaire was undertaken in a group of 480 football players and 288 handball players (768 players). Of these 803 were injured, giving a player incidence of 4.1 injury/1000 football hours and 8.3 injury/1000 handball hours. The lower extremities were involved in 82% of the football injuries, whereas handball injuries were evenly distributed on both upper and lower extremities. The football injury prevalence was 0.36 per player, the handball injury prevalence 0.71 per player. Medical attention was given to 62% of the injured footballers and 47% of the injured handballers. Based on the injury pattern, some modifications to the rules and equipment in the two sports is suggested: The "boot-type" footwear should be tried out, and the soles in both games should correspond to the different playing surfaces that may be encountered. Stricter enforcement of the rules, and the use of a maximum size playing ground in both sports. Last, but not least a modification of the football rules concerning substitution is a must.     

Consensus statement on injury definitions and data collection procedures for studies of injuries in rugby union.

Wide variations in the definitions and methodologies used for studies of injuries in rugby union have created inconsistencies in reported data and made interstudy comparisons of results difficult. The International Rugby Board established a Rugby Injury Consensus Group (RICG) to agree on appropriate definitions and methodologies to standardize the recording of injuries and reporting of studies in rugby union. The RICG reviewed the consensus definitions and methodologies previously published for football (soccer) at a meeting in Dublin to assess their suitability for and application to rugby union. Following this meeting, iterative draft statements were prepared and circulated to members of the RICG for comment; a follow-up meeting was arranged in Dublin at which time all definitions and procedures were finalized. At this stage, all authors confirmed their agreement with the consensus statement. The agreed-on document was presented to and approved by the International Rugby Board Council. Agreement was reached on definitions for injury, recurrent injury, nonfatal catastrophic injury, and training and match exposures together with criteria for classifying injuries in terms of severity, location, type, diagnosis, and causation. The definitions and methodology presented in this consensus statement for rugby union are similar to those proposed for football. Adoption of the proposals presented in this consensus statement should ensure that more consistent and comparable results will be obtained from studies of injuries within rugby union.     

Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries.

BACKGROUND: Variations in definitions and methodologies have created differences in the results and conclusions obtained from studies of football (soccer) injuries; this has made interstudy comparisons difficult. PROCEDURE: An Injury Consensus Group was established under the auspices of Fédération Internationale de Football Association Medical Assessment and Research Centre. Using a nominal group consensus model approach, a working document that identified the key issues related to definitions, methodology, and implementation was discussed by members of the group during a 2-day meeting. After this meeting, iterative draft statements were prepared and circulated to the members of the group for comment before the final consensus statement was produced. RESULTS: Definitions of injury, recurrent injury, severity, and training and match exposures in football, together with criteria for classifying injuries in terms of location, type, diagnosis, and causation are proposed. Proforma for recording players' baseline information, injuries, and training and match exposures are presented. Recommendations are made on how the incidence of match and training injuries should be reported and a checklist of issues and information that should be included in published reports of studies of football injuries is presented. CONCLUSIONS: The definitions and methodology proposed in the consensus statement will ensure that consistent and comparable results will be obtained from studies of football injuries.     

Psychological issues related to injury in athletes and the team physician: a consensus statement

This document provides an overview of selected medical issues that are important to team physicians who are responsible for the care and treatment of athletes. It is not intended as a standard of care, and should not be interpreted as such. This document is only a guide, and as such, is of a general nature, consistent with the reasonable, objective practice of the healthcare profession. Adequate insurance should be in place to help protect the physician, the athlete, and the sponsoring organization.     

The Harstad injury prevention study: the epidemiology of sports injuries. An 8 year study.

OBJECTIVE--To describe the epidemiology of sports injuries occurring in a community during 8 years and to evaluate the outcome of an intervention implemented against injuries occurring in downhill skiing. METHODS--Hospital treated sports injuries occurring in Harstad, Norway (population 22 600) were recorded prospectively during an 8 year period. A prevention programme targeting downhill skiing injuries was evaluated. RESULTS--2234 sports injuries accounted for 17.2% of recorded unintentional injuries. Two out of three injuries occurred in team sports. Soccer accounted for 44.8% of all sports injuries. Downhill skiing injuries had higher mean score on the abbreviated injury scale than all other sports analysed combined (P < 0.01). Postintervention injury rates for downhill skiing were reduced by 15% when adjusting for exposure (P = 0.24). Further observations are needed for assessing the effectiveness of the downhill skiing safety programme. CONCLUSIONS--Strategies for future sports injury prevention include community involvement, particularly sports organisations. Local data analysis seems to justify some priorities, for example, promotion of helmet use in downhill skiing for young adolescents and prevention of lower limb fractures in male soccer players 15+ years old. Prospective hospital recording of injuries provides a tool for the design and outcome evaluation of sports injury intervention research.     

Skiing and snowboarding injuries: a review with a focus on mechanism of injury

Skiing and snowboarding are ever increasing in popularity, with participation across a wide patient demographic. This article focuses on common skiing and snowboarding injuries, with an emphasis on unique mechanisms of injury and discusses the contribution of equipment design to evolving patterns of injury. Knowledge of mechanisms of injury and injury patterns allows a targeted approach to the interpretation of imaging modalities in this patient population.     

Epidemiology of tendon injuries in sports.

During the last few decades, the role of sports and physical activity has become more and more important in all modern communities. Conditioning sports are generally considered positive by many governments because of their beneficial effect on human well-being. The risk of injury is increased, for both acute traumas and overuse injuries, and prevention has also become more important in sports. Epidemiologic studies are important when planning prevention programs for sports injuries. Because of individual sport cultures and different sport habits in different countries, national epidemiologic studies are of importance in each individual country.     

Overuse injuries in sports. A review

Because knowledge of overuse syndromes is limited, the diagnosis and treatment of these conditions are a challenge to sports medicine physicians. Trial and error methods of treatment and too little attention to basic research have resulted in less than optimum solutions. We do know that these maladies most frequently result from overload or repetitive microtrauma stemming from extrinsic factors such as training errors, poor performance, poor techniques and inappropriate surfaces or intrinsic factors including malalignment and muscle imbalance. Overuse injuries involving the muscles include compartment syndromes and muscle soreness; while those involving the tendons result from a variety of degenerative and inflammatory processes. Overstress of bone results in stress fractures, apophysitis and periostitis. Bursitis and joint overstress problems are also discussed briefly. General guidelines for establishing the appropriate diagnosis are: the initial stages of therapy require rest, often a modification or scaled down exposure to the athlete's usual performance rather than complete abstinence; in acutely symptomatic cases pain medications and various measures to control inflammation may be necessary; an exercise programme should start early with range of motion exercises and isometric muscle contractions; when pain allows, dynamic muscle and flexibility exercises can resume together with a conditioning programme; if possible, eccentric exercises should be performed. The treatment may also include other conservative treatment modalities and surgery in special cases. Overuse injuries constitute a great diagnostic and therapeutic problem because the symptoms are often diffuse and uncharacteristic. An appropriate diagnosis followed by adequate treatment can improve or eliminate most of these conditions, but perhaps even more importantly a proper understanding of overuse syndromes should allow physicians to assist athletes, trainers, and coaches in preventing them.     

Spinal injuries in sports in the UK.

An analysis was made of 150 rugby, trampolining, gymnastics and horse-riding injuries between 1952 and 1985, resulting in severe spinal injury. The individual analyses of the separate sports had been published previously. There are common factors to all these sports. Of those injured 121 had cervical injuries often as a result of participation in sport by young impetuous people, and causes included: inadequate supervision; motivation to attempt tasks beyond their abilities; a mismatch between the abilities of the performer and the task attempted.     

Consensus statement on injury definitions and data collection procedures for studies of injuries in rugby union

Wide variations in the definitions and methodologies used for studies of injuries in rugby union have created inconsistencies in reported data and made interstudy comparisons of results difficult. The International Rugby Board established a Rugby Injury Consensus Group (RICG) to reach an agreement on the appropriate definitions and methodologies to standardise the recording of injuries and reporting of studies in rugby union. The RICG reviewed the consensus definitions and methodologies previously published for football (soccer) at a meeting in Dublin in order to assess their suitability for and application to rugby union. Following this meeting, iterative draft statements were prepared and circulated to members of the RICG for comment; a follow-up meeting was arranged in Dublin, at which time all definitions and procedures were finalised. At this stage, all authors confirmed their agreement with the consensus statement. The agreed document was presented to and approved by the International Rugby Board Council. Agreement was reached on definitions for injury, recurrent injury, non-fatal catastrophic injury, and training and match exposures, together with criteria for classifying injuries in terms of severity, location, type, diagnosis and causation. The definitions and methodology presented in this consensus statement for rugby union are similar to those proposed for football. Adoption of the proposals presented in this consensus statement should ensure that more consistent and comparable results will be obtained from studies of injuries within rugby union.     

A survey of sports injuries in Birmingham.

7% of the injuries presenting to the Birmingham Accident Hospital during 1975 occurred during sport. Of those injuries which could be classified 98.3% were due to extrinsic causes. These figures would not seem to justify a sports injury clinic. However we believe that this presents the service available rather than the service required.     

Comparing sports injuries in men and women.

OBJECTIVE: To compare the pattern of injury between men and women in seven collegiate sports to determine if gender-specific factors exist which could be modified to reduce the risk of injury to female athletes. DESIGN: Retrospective cohort study of injury reports compiled by certified athletic trainers between Fall 1980 and Spring 1995. SETTING: An NCAA division III College. PARTICIPANTS: Eighteen to 22 year-old male and female college athletes competing in seven like sports (basketball, cross-country running, soccer, swimming, tennis, track and water polo) at the intercollegiate level, playing similar number of contests and using the same facilities. MAIN OUTCOME MEASURES: Analyses of injury patterns, classified by sport and anatomic location, for men and women in seven like sports. RESULTS: A total of 3,767 participants were included in the study, with 1874 sports-related injuries reported among the men and women's teams. Of these injuries, 856 (45.7%) were sustained by female and 1018 (54.3%) by male athletes. Overall, no statistically significant gender difference was found for injuries per 100 participant-years (52.5 for female athlete versus 47.7 for males). A statistically significant gender difference in injury incidence (p < 0.001) was seen for two sports: swimming and water polo. Female swimmers reported more back/neck, shoulder, hip, knee and foot injuries: and female water polo players reported more shoulder injuries. When evaluating all sports concurrently, female athletes reported a higher rate of hip, lower-leg and shoulder injuries, while male athletes reported a higher rate of thigh injuries. CONCLUSION: Except for some minor gender differences in total injuries for two sports and several differences in total injuries by anatomic location, our data suggest very little difference in the pattern of injury between men and women competing in comparable sports. The increased rate of shoulder injury among female swimmers probably resulted from the more rigorous training philosophy of their coach. Thus, no gender-specific recommendations can be suggested for decreasing the incidence of injury to female athletes competing in these sports.     

Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries

Variations in definitions and methodologies have created differences in the results and conclusions obtained from studies of football (soccer) injuries, making interstudy comparisons difficult. Therefore an Injury Consensus Group was established under the auspices of Fédération Internationale de Football Association Medical Assessment and Research Centre. A nominal group consensus model approach was used. A working document on definitions, methodology, and implementation was discussed by the group. Iterative draft statements were prepared and circulated to members of the group for comment before the final consensus statement was produced. Definitions of injury, recurrent injury, severity, and training and match exposures in football together with criteria for classifying injuries in terms of location, type, diagnosis, and causation are proposed. Proforma for recording players' baseline information, injuries, and training and match exposures are presented. Recommendations are made on how the incidence of match and training injuries should be reported and a checklist of issues and information that should be included in published reports of studies of football injuries is presented.     

Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries

Variations in definitions and methodologies have created differences in the results and conclusions obtained from studies of football injuries; this has made inter-study comparisons difficult. An Injury Consensus Group was established under the auspices of FIFA Medical Assessment and Research Centre. Using a nominal group consensus model approach, a working document that identified the key issues related to definitions, methodology and implementation was discussed by members of the group during a 2-day meeting. Following this meeting, iterative draft statements were prepared and circulated to members of the group for comment before the final consensus statement was produced. Definitions of injury, recurrent injury, severity and training and match exposures in football together with criteria for classifying injuries in terms of location, type, diagnosis and causation are proposed. Proforma for recording players' baseline information, injuries and training and match exposures are presented. Recommendations are made on how the incidence of match and training injuries should be reported and a checklist of issues and information that should be included in published reports of studies of football injuries is presented. The definitions and methodology proposed in the consensus statement will ensure that consistent and comparable results will be obtained from studies of football injuries.     

Influence of injuries on team playing performance in Rugby League.

All injuries have the potential to impact on individual sporting performance and as a result may influence team playing performance. However, the influence of injuries on team playing performance is unclear. The purpose of this study was to investigate the influence of injuries on team playing performance in Rugby League. All injuries sustained by one semi-professional first grade Rugby League team were prospectively studied during the 2001 competitive season. An injury was defined as any pain or disability suffered by a player during a match. Team playing performance for each match was estimated from the metres gained while in possession of the football, points scored, points conceded, the final points differential and the completion rates of attacking sets of tackles. A total of 294 injuries were recorded. The average metres gained for all matches was 1471 (95% confidence interval, CI: 1383 to 1559) m. The team averaged 42 (95% CI: 32 to 51) points in attack each match and conceded an average of 15 (95% CI: 9 to 21) points in defence. The average completion rate for the season was 65.3 (95% CI: 60.6 to 70.0)%. There was no significant association (p>0.05) between the number of injuries sustained and team-playing performance. These findings suggest that injuries have minimal impact on team-playing performance in Rugby League. Further research on a larger sample (including winning and losing teams), is required to provide a detailed analysis of the influence of injuries on team playing performance in Rugby League.