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.     

Soccer injuries: a review on incidence and prevention

Several investigators have studied the incidence and causes of soccer injuries in male professional players; however, epidemiological data on injuries in female soccer players are limited. From the data presented, it can be estimated that, on average, every elite male soccer player incurs approximately one performance-limiting injury each year. Nine studies on the prevention of soccer injuries were found in the literature. There is some evidence that multi-modal intervention programmes result in a general reduction in injuries. Ankle sprains can be prevented by external ankle supports and proprioceptive/coordination training, especially in athletes with previous ankle sprains. With regard to severe knee injuries, the results of prevention studies are partly inconclusive; however, training of neuromuscular and proprioceptive performance as well as improvement of jumping and landing technique seem to decrease the incidence of anterior cruciate ligament injuries in female athletes. Prevention programmes are likely to be more effective in groups with an increased risk of injury. More methodologically well-designed studies are required to evaluate the effects of specific preventive interventions.     

Volleyball injuries presenting in casualty: a prospective study.

During 1986, all sports injuries (n = 5222) were prospectively recorded at the two casualty departments in Arhus, Denmark. Volleyball injuries (n = 278) accounted for 5.3% of all sports injuries. An evaluation of the rehabilitation period and the consequences of the injuries was undertaken by questionnaire three years after the injury. The injury incidence was 1.9 injuries/1000 inhabitants/year. Hand, finger, and ankle sprains were the most frequent injuries. Female players had significantly more hand/finger injuries than male players, who incurred more ankle/foot injuries. Knee (6%) and ankle injuries (31%) were responsible for the longest duration of absence from sports participation. There were relatively few chronic injuries. The study suggests the need to enhance prophylactic measures with regard to blocking and overhand pass techniques, in order to reduce the number and extent of ankle and hand/finger injuries.     

Sports injuries in floorball: a prospective one-year follow-up study

Two hundred and ninety-five licensed floorball players from Finnish premier to fifth division were observed prospectively for one season to study the incidence, nature, causes and severity of floorball injuries. During the study period, 100 out of the 295 (34 %) players sustained 120 injuries. Thirty-seven percent (73/199) of the male players and 28 % (27/96) of the females suffered from an injury. The injury rate was 1.0 per 1000 practice hours for both sexes. The injury rates per 1000 game hours were 23.7 for men and 15.9 for women. One hundred injuries (83 %) were acute and the remaining 20 (17 %) were overuse injuries. Sprain was the most common type of injury in men while overuse injuries were the most frequent injury type in women. The lower extremity was involved in 62 %, spine or trunk in 19 % and upper extremity in 10 % of the injuries. The most commonly injured sites were the knee and ankle (22 % and 20 % of all injuries), followed by head and neck (8 %). In both sexes the majority of injuries were minor, level II, injuries. Ten of the knee injuries (38 %) were serious, level IV injuries, of which seven were ACL ruptures. In conclusion, the individual risk of injury in floorball is relatively low in game practice while rather high during the game itself. Before initiation of clinical trials on prevention of floorball injuries, an exact knowledge of the risk factors and mechanisms of floorball injuries are needed.     

Soccer injuries among youth

This study reports the quantitative and qualitative aspects of sports injuries in a 5-day youth soccer tournament with 12,907 players. A total of 132 injuries that resulted in at least one days' absence from soccer playing were of special interest. The overall injury rate was 3.6 for boys and 4.4 injuries per 1000 hours of play for girls. Statistically significantly higher injury rates between players in puberty and differences in type and location of injuries between boys and girls were found. In 77% of the cases, the injury happened while the injured player was in physical contact with another player, 59% had ball contact and 7% had no contact with any person or ball at all. Five months later a questionnaire was send out to the serious injured players. Of 85 injured players, 10 were absent from school or work on average 11.5 days. Five had surgery. Injury prophylaxis in soccer tournaments is proposed.     

Soccer injuries in Iceland

We investigated the frequency, cause and location of injuries in Icelandic elite soccer in 1991. The incidence of injuries for the individual player was 34.8 ± 5.7 per 1000 game-hours and 5.9 ± 1.1 per 1000 practice-hours. The most common types of injuries were muscle strains (29%), ligament sprains (22%), contusions (20%), and other injuries (29%). The frequency of reinjury was markedly high, where 44% of the strains and 58% of the sprains were registered as reinjuries. Strains occurred mainly during sprinting, sprains by tackling, and contusion during other contact. Significantly more injuries occurred on artificial turf than on grass or gravel in correlation to number of hours in games and practices. Teams who had the longest pre-season preparation period obtained significantly fewer injuries during the season.     

Soccer injuries in childhood

A prospective study of soccer injuries, involving 287 male youth players, from the ages of 12-15 was conducted in 24 Greek soccer clubs, during the course of one year. A total of 193 players sustained 209 injuries. The incidence of injuries was 4.0 injuries per 1000 h of soccer time per player, and the most common types of injuries were sprains and strains. Surprisingly, it was found that an increase of injury incidences occurred during practice. Fifty-eight injuries required medical assistance. The majority of injuries (80%) were located in the lower extremities. Collision with other players was the most common activity at the time of injury, accounting for 40% of all injuries. The conclusion of this study and the evidence from other studies suggests that youth soccer is a relatively low risk sport. However, a substantial amount of injuries could be prevented. It is necessary to identify the risk factors, which are associated with these types of injuries.     

Pontomedullary lacerations and concomitant head and neck injuries: their underlying mechanism. A prospective autopsy study

It is a well-documented fact that pontomedullary lacerations (PML) occur as a result of severe craniocervical injury, but their underlying mechanism has yet to be fully clarified. The aim of this prospective study has been to give greater insight into the underlying mechanism of PML through determining the site of blunt head-impact, as well as the presence of concomitant head and neck injuries in cases of brainstem PML. A total of 56 cases with partial PML have been analysed for this study. The case group was composed of 40 men and 16 women, averaging in age 44.2 ± 19.2 years and consisting of 7 motorcyclists, 4 bicyclists, 18 car occupants, 16 pedestrians, and 10 victims of falls from a height, as well as 1 victim of a fall from standing height. The presented study has shown that there are several possible mechanisms of PML. Impact to the chin, with or without a skull base fracture, most often leads to this fatal injury, due to the impact force transmission either through the jawbone or vertebral column; most likely in combination with a fronto-posterior hyperextension of the head. Additionally, lateral head-impacts with subsequent hinge fractures and PML may also be a possible mechanism. The jawbone and other facial bones are able to act as shock absorbers, and their fracture may diminish the energy transfer towards the skull and protect the brain and brainstem from injury. The upper cervical spine can act as damper and energy absorber as well, and may prevent any occurrence of fracture to the base of the skull.     

High school football injuries: a prospective study and pitfalls of data collection

A 4 year prospective study (1982 to 1985) of high school varsity football injuries from the four Peoria high school football teams was undertaken. Two hundred fifty-one injuries were recorded among a player population of 598, resulting in an injury rate of 42.1% per 100 players. All of the players followed a prescribed preseason summer conditioning program that was endorsed by the Illinois High School Athletic Association. The injuries were recorded on an athletic injury profile and entered into a computer for data analysis and retrieval. The injury distribution by player position showed that halfbacks, tackles, linebackers, and guards had a higher risk of injury than other positions. The knee was the body part injured most frequently (20.3%). A matrix of injuries to halfbacks was set up to examine the relationship of body part injured to type of play, time of injury, and activity during injury. An anthropometric study using the Quetelet index did not reveal any correlation between injury and body size when the injured players were compared with the non-injured players. Experience since 1969 has taught us many of the errors and pitfalls involved in injury surveillance. Strict adherence to recording of data will ensure an accurate and useful injury surveillance program.     

Skiing safety in children: a prospective study of downhill skiing injuries and their relation to the skier and his equipment

A prospective analysis was made of 31 children who sustained an injury of the lower extremity during downhill skiing. They were compared with a control population of 183 skiers. The injured children were to a large extent less skillful skiers and tended to be injured at the start of their skiing season. In general, the risk of having an injury did not seem to be influenced by the question of where or by whom the bindings were adjusted. Nevertheless, beginners predominantly had had their bindings adjusted in ski shops. The heel mechanism functioned well in most cases, while the function of the toe mechanism was poor in the control population and even poorer in the injury group. The results indicate that many of the present release bindings used by children are of poor quality and should be improved. At present, a reasonable recommendation for children should be to set the heel mechanism according to the standard scale and the toe mechanism as loosely as possible without having a release during ordinary skiing. Increased use of testing devices is advocated. In Sweden, improved education of personnel in ski shops, with the children in focus, seems important, and training and supervision of the beginners should be intensified.     

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.     

Soccer injuries of youth.

During a soccer tournament with participation of 6,600 boys and girls (9-19 years) all injuries were evaluated, 5.2% of the players were injured; out of these 51% had "slight injuries", 42% "moderate injuries" and 7% "severe injuries". For the individual player the incidence of injury was 19.1/1,000 playing hours including all degrees of injuries; if "slight injuries" were excluded the incidence was 9.4/1,000 playing hours. The incidence rose with increasing age, girls were injured more often than boys. There were 81% of all injuries localised to the lower extremity, especially the ankle and foot. Contusion was the most frequent diagnosis, amounting to a third of all injuries. Blisters and exoriations amounted to nearly a fifth, 4% of the injuries were fractures, especially in the upper extremity; overuse injuries were seen only in 5.2% of the cases. Based on examination of the injury pattern in these children, injuries of youth seem to be relatively rare and mostly of a non-severe character.     

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.     

Back injuries to fast bowlers in cricket: a prospective study.

Eighty-two high performance young male fast bowlers (mean age 16.8 years) were tested immediately prior to the season for selected kinanthropometric and physiological data. Subjects were also filmed both laterally (200 Hz) and from above (100 Hz) while bowling so that their front foot impacted a force platform during the delivery stride. The players then completed a log book over the ensuing season that detailed their training and playing programmes. All cricket related injuries over this season were assessed by a sports physician who used computerized tomography to assist in the diagnosis of spinal injuries. At the completion of this season the players were grouped according to their injury status (Group 1--bony injury to a vertebra; Group 2--soft tissue injury to the back that caused the player to miss at least one game, and Group 3--no injuries). A one-way analysis of variance was used to identify if any variables were significantly (P less than 0.05) different between the three groups, and a Scheffe post hoc comparison was used to determine which groups were significantly different. Eleven per cent of the players sustained a stress fracture to a vertebra(e) (L4 to S1), while 27 per cent sustained a soft tissue injury to the back. Bowlers with a low longitudinal foot arch were more likely to develop a stress fracture than those with a high arch. Shoulder depression and horizontal flexion strength for the preferred limb and quadriceps power in the non-preferred limb were also significantly related to back injuries. Results suggest that bowlers with the above physical characteristics, who bowl with these biomechanical techniques for extended periods, are predisposed to back injuries.     

Soccer injuries in Saudi Arabia

Soccer injuries which were seen at the King Fahd University Hospital over a period of 12 months were analyzed. The majority of the patients were under 20 years of age. Two-thirds of the injuries involved soft tissue, while those to the bone and joint comprised one-third. The lower extremity was involved in 59%. Sixteen percent of the injuries were considered severe enough to require inpatient treatment. We feel the high incidence of injuries can be reduced by better guidance and coaching at school and other training levels. At present, these patients are seen in the emergency room of our hospital and subsequently in the orthopaedic and fracture clinics. A specialized sports injury clinic staffed with medical and paramedical personnel with special interest in sports medicine would enable early and effective treatment returning athletes to play without undue delay.