Injury surveillance in community sport: Can we obtain valid data from sports trainers?

A lack of available injury data on community sports participants has hampered the development of informed preventive strategies for the broad‐base of sports participation. In community sports settings, sports trainers or first‐aiders are well‐placed to carry out injury surveillance, but few studies have evaluated their ability to do so. The aim of this study was to investigate the reporting rate and completeness of sports trainers' injury records and agreement between sports trainers' and players' reports of injury in community Australian football. Throughout the football season, one sports trainer from each of four clubs recorded players' injuries. To validate these data, we collected self‐reported injury data from players via short message service (SMS). In total, 210 discrete injuries were recorded for 139 players, 21% by sports trainers only, 59% by players via SMS only, and 21% by both. Completeness of injury records ranged from 95% to 100%. Agreement between sports trainers and players ranged from K = 0.32 (95% confidence interval: 0.27, 0.37) for date of return to football to K = 1.00 for activity when injured. Injury data collected by sports trainers may be of adequate quality for providing an understanding of the profile of injuries. However, data are likely to underestimate injury rates and should be interpreted with caution.     

The Football Association Medical Research Programme: an audit of injuries in professional football: an analysis of ankle sprains

AIM: To conduct a detailed analysis of ankle sprains sustained in English professional football over two competitive seasons. METHODS: Club medical staff at 91 professional football clubs annotated player injuries. A specific injury audit questionnaire was used together with a weekly form that documented each club's current injury status. RESULTS: Completed injury records for the two competitive seasons were obtained from 87% and 76% of the participating clubs. Ankle ligament sprains accounted for 11% of the total injuries over the two seasons, with over three quarters (77%) of sprains involving the lateral ligament complex. A total of 12 138 days and 2033 matches were missed because of ankle sprains. More sprains were caused by contact mechanisms than non-contact mechanisms (59% v 39%) except in goalkeepers who sustained more non-contact sprains (21% v 79%, p<0.01). Ankle sprains were most often observed during tackles (54%). More ankle sprains were sustained in matches than in training (66% v 33%), with nearly half (48%) observed during the last third of each half of matches. A total of 44% of sprains occurred during the first three months of the season. A high number of players (32%) who sustained ankle sprains were wearing some form of external support. The recurrence rate for ankle sprains was 9% (see methodology for definition of reinjury). CONCLUSION: Ankle ligament sprains are common in football usually involving the lateral ligament complex. The high rate of occurrence and recurrence indicates that prevention is of paramount importance.     

Injuries among male and female elite football players

All 12 female football clubs (228 players) and 11 of 14 male clubs (239 players) in the Swedish premier league were followed prospectively during the 2005 season. Individual exposure (playing time), injuries (time loss), and injury severity (days lost due to injury) were recorded by the team medical staffs. Injury incidence was higher for male players during both training (4.7 vs 3.8 injuries/1000 h, P=0.018) and match play (28.1 vs 16.1, P<0.001). However, no difference was found in the incidence of severe injury (absence >4 weeks) (0.7/1000 h in both groups). The thigh, especially the hamstrings, was the overall most commonly injured region in both sexes, while the hip/groin was more commonly injured in male players and the knee in female players. Knee ligament injuries accounted for 31% and 37% of the total time lost from football for male and female players, respectively. In conclusion, male elite players had a higher injury incidence than their female counterparts although no difference was observed in the incidence of moderate to severe injury. We recommend that preventive measures should be focused on hamstring and knee ligament injury in order to reduce the overall injury burden.     

Injury patterns in women's intramural flag football

A prospective study of women's flag football injuries was carried out over a 4 year period at Mississippi State University. Data was gathered on 114 injuries. Organized intramural flag football activities caused 93% of the injuries observed (7% were injured in pick-up games). The finger accounted for 39%, knee for 16%, and ankle for 8% of these injuries. The type of injury was closely distributed among sprains, fractures, contusions, and strains. Collisions, with other players and objects, resulted in 64% of these injuries. Offensive ball handlers (running backs and receivers) had the greatest probability of being injured. From this data, it is obvious that women's injury patterns are not the same as men's and that varsity injury data cannot be extrapolated to recreational injuries.     

Community level australian football: a profile of injuries

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

Ankle injuries in basketball players

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

Australian football: Injury profile at the community level

Successful injury prevention relies on injury surveillance to establish the extent of the problem, to monitor injury patterns and to evaluate prevention strategies. Despite the popularity of participation in Australian football at the community level, few injury surveillance studies have been published describing the pattern of injuries at this level of participation. In contrast, ongoing injury surveillance at the elite-level is well established. Reliance on injury data from the elite-level of Australian football to guide injury prevention at the community level may not be appropriate due to differences across the levels with respect to exposure, fitness and skill level. Therefore, specific injury surveillance at the community level of Australian football is warranted. This study describes the epidemiology of community level Australian football injuries. Injury surveillance was undertaken in five amateur Australian football clubs over the 1999 season. The 320 participating players sustained 421 injuries over the season. The overall rate of injury was 27 injuries per 1000 player hours. Injuries were most commonly sustained at the start of the season and during the second quarter of match participation. Hamstring muscle strains were the most common injury sustained, followed by thigh haematomas and lateral ligament sprains of the ankle. The injury surveillance system used in this study was well accepted by the clubs and provides detailed data for the prioritisation of future injury prevention research at the community level of Australian football.     

How valid is a self reported 12 month sports injury history?

BACKGROUND: A past injury history is one of the most commonly cited risk factors for sports injury. Often, injury history data are collected by self report surveys, with the potential for recall bias. OBJECTIVE: To assess the accuracy of a 12 month injury history recall in a population of 70 community level Australian football players. METHODS: The retrospective, self reported injury histories of 70 community level Australian football players were compared with prospective injury surveillance records for the same 12 month period. The accuracy of the players' recall of the number of injuries, injured body regions, and injury diagnosis was assessed. RESULTS: Recall accuracy declined as the level of detail requested increased. All players could recall whether or not they were injured during the previous year. Almost 80% were able to accurately recall the number of injuries and body regions injured, but not the diagnoses, whereas only 61% were able to record the exact number, body region, and diagnosis of each injury sustained. DISCUSSION: The findings of this study highlight the difficulty of using retrospectively collected injury data for research purposes. Any injury research relying on self reported injury history data to establish the relation between injury history and injury risk should consider the validity of the self report injury histories.     

Injuries in elite-level women’s football—a two-year prospective study in the Irish Women’s National League

We investigated the pattern of injuries in elite-level women’s football in Ireland, during a two-season prospective injury surveillance study in the Women’s National League (WNL). Seven out of the eight clubs (271 players) in the WNL were followed prospectively during the 2018 and 2019 seasons. The injury incidence rate in matches (19.2/1000 h) was 7.5 times higher than in training (2.5/1000 h). Players, on average, sustained 0.69 injuries per season (266 injuries/383 player seasons), which equates to 15 time-loss injuries per season for a squad of 22 players. The majority of the injuries sustained by players were lower extremity injuries (85%), of which, 46% had a non-contact injury mechanism. Muscle, ligament, and contusion injuries were the most common injury types, while the ankle, knee, and thigh were the most commonly injured body sites. The most common injuries sustained over the two seasons were lateral ankle sprains (13.9%), hamstring strains (12.4%), knee meniscus/cartilage injuries (7.5%), adductor strains (6%), quadriceps strains (4.5%), and ankle contusions (4.5%). The injuries with the highest injury burden were ACL injuries (59 days lost/1000 h), knee meniscus/cartilage injuries (23/1000 h), lateral ankle sprains (21/1000 h), hamstring strains (12/1000 h), MCL sprains (11/1000 h), and quadriceps strains (11/1000 h). There were 8 ACL tears documented over the 2 seasons, which accounted for 28% of all time lost to injury with a mean days lost per injury of 247. We recommend that clubs in the WNL in Ireland should implement injury risk mitigation strategies, with a particular focus on injuries with a high injury burden.     

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.     

A one season prospective cohort study of volleyball injuries

Objective: To estimate the overall incidence of acute and overuse volleyball injuries, and to describe factors associated with ankle sprains.

Methods: 486 players from the second and third Dutch national volleyball divisions participated in the study and were followed prospectively during a whole season. Three measurements were made during the season (baseline, follow up 1, and follow up 2), where all players completed a questionnaire on demographic variables (only at baseline), sports participation, use of preventive measures, and previous injuries. Volleyball exposure during training and matches was recorded for each individual player by the coach on a weekly exposure form. In case of injury the coach provided the injured player with an injury registration form, which had to be completed within one week after the onset of injury.

Results: 100 injuries were reported, resulting in an overall injury incidence of 2.6 injuries/1000 hours. The incidence of acute injuries was 2.0/1000 hours. Ankle sprains (n = 41) accounted for most of the acute injuries, and 31 (75%) of all players with an ankle sprain reported a previous ankle sprain. Twenty five overuse injuries were reported. The overall incidence of overuse injuries was 0.6/1000 hours; the back and the shoulder were the most common sites.

Conclusions: Ankle sprain is the most common injury in volleyball, accounting for 41% of all volleyball related injuries. Previous injury seems to be an important risk factor for an ankle sprain. Injury prevention programmes should focus on ankle sprains and concentrate on players with previous ankle sprains.

     

The distribution of injuries in men's Canada West university football. A 5-year analysis

We conducted a prospective cohort study from 1993 to 1997 to determine the frequency and severity of injury in men's Canada West university football. The Canadian Intercollegiate Sport Injury Registry was used to document baseline preseason data, daily athlete participation, and subsequent injury from five varsity football teams. An injury was defined as "any injury resulting in one or more complete or partial sessions of time loss" or "any concussion or transient neck neurologic injury." The annual proportion of injured athletes ranged from 53.5% to 60.4%, with a 5-year total of 1,811 injuries. Regression analysis indicated that the rate of nonconcussion, nonneck neurologic injuries increased. Concussion (N = 110), hamstring strain (N = 88), and brachial plexus (N = 84) injuries were the most common, specific injury diagnoses. Knee injuries resulted in the highest rate of severe (greater than or equal to 7 sessions of time loss) injury and resulted in the most time loss (3,350.5 sessions). Ligament sprains and muscle strains and spasms accounted for approximately half of all injury diagnoses. A total of 1,173 injuries (65%) were related to contact between players or between players and other obstacles. Future studies should be conducted to identify risk factors for the ultimate purpose of implementing injury prevention strategies.     

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.     

Sport and active recreation injuries in Australia: evidence from emergency department presentations

OBJECTIVE: Despite the rise in specialist clinical services for the management of sports and active recreation injury, many patients attend hospital emergency departments for treatment. The purpose of this study was to describe sports injury cases presented to selected hospital emergency departments around Australia for the period 1989-1993. METHODS: Routinely collected emergency department injury presentation data from the Australian National Injury Surveillance Unit were examined. Data on 98,040 sports and active recreation emergency department presentations were analysed. Sports and active recreation activities were ranked according to frequency of presentation. Relative proportions of injury type and body region injured were determined. Data are presented separately for children (<15 years of age) and adults (>15 years of age). RESULTS: Among the 10 activities that most commonly led to a sports or active recreation injury presentation for all ages were cycling, Australian football, basketball, soccer, cricket, netball, and rugby. For children, injuries were also commonly associated with roller skating/blading, skateboarding, and trampolining. Hockey, martial arts, and dancing injuries were frequent in adults. Most sporting injuries occurred during organised competition or practice whereas the active recreation injuries occurred in a variety of settings. Fractures, strains, and sprains, particularly to the lower and upper extremities, were common types of injury. CONCLUSION: The rich, but nevertheless limited, information available about sports and active recreation injuries from data collected in emergency departments indicates that these activities are a common context for injury at the community level in Australia.


     

Ankle syndesmosis sprains in national hockey league players

BACKGROUND: Although syndesmosis sprains are less common in sports than lateral ankle sprains, they represent a significant source of morbidity. Several studies have described the increased recovery time for these injuries in a variety of sports. No previous study has described this injury in hockey players. HYPOTHESIS: Syndesmosis ankle sprains require a longer recovery time and are less common than lateral ankle sprains in elite hockey players. STUDY DESIGN: Uncontrolled retrospective review. METHODS: The medical records of the St Louis Blues (1994-2001) and Dallas Stars (1991-2001) National Hockey League teams were reviewed by the head athletic trainers. Ankle sprains were identified and divided into 2 groups: syndesmosis and lateral sprains. Player demographics, treatment, and time lost to play were recorded for each injury. RESULTS: Fourteen players were diagnosed with syndesmosis sprains, and 5 players sustained lateral sprains during this time period. Mean time to return to play in games was 45 days (range, 6-137 days) for syndesmosis sprains versus 1.4 days (range, 0-6 days) for lateral sprains. CONCLUSIONS: Syndesmosis sprains represent a significant injury in hockey players with an extended time lost and, unlike in other sports, are a more common injury than lateral ankle sprains.     

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

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

High ankle injury rate in adolescent basketball: A 3‐year prospective follow‐up study

This prospective study investigated the incidence and pattern of acute time‐loss injuries in young female and male basketball players. Eight basketball teams (n=201; mean age 14.85±1.5) participated in the follow‐up study (2011‐2014). The coaches recorded player participation in practices and games on a team diary. A study physician contacted the teams once a week to check new injuries and interviewed the injured players. In total, 158 injuries occurred. The overall rate of injury (per 1000 hours) was 2.64 (95% CI 2.23‐3.05). Injury rate was 34.47 (95% CI 26.59‐42.34) in basketball games and 1.51 (95% CI 1.19‐1.82) in team practices. Incidence rate ratio (IRR) between game and practice was 22.87 (95% CI 16.71‐31.29). Seventy‐eight percent of the injuries affected the lower limbs. The ankle (48%) and knee (15%) were the most commonly injured body sites. The majority of injuries involved joint or ligaments (67%). Twenty‐three percent of the injuries were severe causing more than 28 days absence from sports. Number of recurrent injuries was high (28% of all injuries), and most of them were ankle sprains (35 of 44, 79%). No significant differences were found in injury rates between females and males during games (IRR 0.88, 0.55, to 1.40) and practices (IRR 1.06, 0.69, to 1.62). In conclusion, ankle and knee ligament injuries were the most common injuries in this study. Moreover, the rate of recurrent ankle sprains was alarming.     

Does a balance deficit persist in Australian football players with previous lower limb ligament injury?

A history of lower limb ligament injury is a commonly-cited risk factor for another similar injury. During the acute phase of injury, there is a balancing skill deficit in the injured limb. It has been unclear as to whether this deficit persists in the medium-to-long term for previously injured Australian footballers, contributing to the risk of re-injury. This study compared the balance ability of footballers with and without previous lower limb ligament injury and, for previously injured players, the balance ability of the previously injured limb to the opposite uninjured limb. A total of 216 players from 6 teams from the Australian Football League were tested. The balance task comprised stepping on to a foam mat on top of a force plate and maintaining one-legged balance. The subjects were divided into 4 groups based on their injury history: all ankle injuries to only one limb, recent ankle injuries to only one limb (within the last 12 months), knee ligament injury only to one limb, and no previous ankle or knee ligament injury. Statistical analysis revealed that there was no significant difference between the balance scores of any of the previously injured players and those with no previous lower limb ligament injury. There was no significant difference between the balance score of the previously injured limb with the opposite uninjured limb. It appears that a balance deficit does not persist in Australian Football players with previous lower limb ligament injury.     

Soccer injuries and their mechanisms: a prospective study

In order to study the incidence and mechanisms of injury in soccer and to recommend prophylactic measures, 180 players in a senior male soccer division were followed prospectively for 1 yr. Attendance records for games and practice sessions were kept, and all injuries were examined and treated by the same orthopaedic surgeon. One hundred twenty-four players incurred 256 injuries, mostly sprains and strains of the lower extremities. Of these, 62% were considered minor with ankle sprains being the most common (17%), while 11% were considered major with knee ligament sprains being the most frequent (32%). Overuse injuries were most frequent in the preseason training period. Traumatic leg injuries involved players with inadequate or no shin guards. Of the traumatic knee injuries, 11 of 18 (61%) occurred during a collision; non-contact knee injuries were frequently seen in those players with a history of knee injury and existing instability. Study of injury sequence disclosed that a minor injury was often followed within two months by a major one. In addition, with severe injuries incurred during fouls, the individual causing the penalty was injured. This prospective study suggested that those with knee instability and those allowed to resume play with poorly rehabilitated or clinically unhealed injuries are more apt to sustain further injury. Some injuries can be avoided by using better equipment and by observance of the rules.     

A systematic review on ankle injury and ankle sprain in sports

This article systematically reviews epidemiological studies on sports injury from 1977 to 2005 in which ankle injury was included. A total of 227 studies reporting injury pattern in 70 sports from 38 countries were included. A total of 201,600 patients were included, with 32,509 ankle injuries. Ankle injury information was available from 14,098 patients, with 11 847 ankle sprains. Results show that the ankle was the most common injured body site in 24 of 70 included sports, especially in aeroball, wall climbing, indoor volleyball, mountaineering, netball and field events in track and field. Ankle sprain was the major ankle injury in 33 of 43 sports, especially in Australian football, field hockey, handball, orienteering, scooter and squash. In sports injuries throughout the countries studied, the ankle was the second most common injured body site after the knee, and ankle sprain was the most common type of ankle injury. The incidence of ankle injury and ankle sprain was high in court games and team sports, such as rugby, soccer, volleyball, handball and basketball. This systematic review provides a summary of the epidemiology of ankle injury in sports.