Risk factors for noncontact ankle sprains in high school athletes: the role of hip strength and balance ability

BACKGROUND: Ankle sprains are among the most common sports injuries. HYPOTHESIS: Poor balance as measured on a balance board and weakness in hip abduction strength are associated with an increased risk of noncontact ankle sprains in high school athletes. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: One hundred sixty-nine high school athletes (101 male athletes, 68 female athletes) from football, men's basketball, men's soccer, women's gymnastics, women's basketball, and women's soccer were observed for 2 years. Balance in single-limb stance on an instrumented tilt board and hip flexion, abduction, and adduction strength (handheld dynamometer) were assessed in the preseason. Body mass, height, generalized ligamentous laxity, previous ankle sprains, and ankle tape or brace use were also documented. RESULTS: There were 20 noncontact inversion ankle sprains. Balance ability (P = .72), hip abduction strength (P = .66), hip adduction strength (P = .41), and hip flexion strength (P = .87) were not significant risk factors for ankle sprains. The incidence of grade II and grade III sprains was higher in athletes with a history of a previous ankle sprain (1.12 vs 0.26 per 1000 exposures, P < .05). A higher body mass index in male athletes was associated with increased risk (P < .05). The combination of a previous injury and being overweight further increased risk (P < .01). CONCLUSION: Balance as measured on a balance board and hip strength were not significant indicators for noncontact ankle sprains. The apparent high injury risk associated with the combination of a history of a previous ankle sprain and being overweight in male athletes warrants further examination.     

First-time inversion ankle ligament trauma: the effects of sex, level of competition, and sport on the incidence of injury

BACKGROUND: Inversion ankle trauma is disabling, yet little is known regarding the incidence rate of first-time ankle sprains and how it is influenced by factors including sex, level of competition, and sport. HYPOTHESIS: The incidence rates of first-time ankle ligament sprains are influenced by sex, level of competition (high school vs college), and type of sports participation (basketball, soccer, lacrosse, and field hockey). STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Between 1999 and 2003, high school and college athletes were evaluated before participation in their sports. Subjects were included in the study if they had not experienced a prior ankle or lower extremity injury and were then followed during participation in soccer, basketball, lacrosse, or field hockey to document their days of exposure to sport and injuries sustained. The relative risk associated with sex, level of competition, and sport was estimated by Cox regression. RESULTS: A total of 901 athletes had 50 680 person-days of exposure to sports, and 43 (4.8%) had an inversion injury that produced an ankle ligament sprain. Overall, the injury incidence rate was 0.85 sprains per 1000 person-days of exposure to sport. There were 0.68 and 0.97 ankle sprains per 1000 person-days of exposure to sport for the men and women, respectively. Although the risk of suffering an ankle sprain was higher for women than for men (relative risk, 1.51), the difference was not statistically significant (P = .21) and was owing to the increased risk in female basketball athletes compared to male basketball athletes (relative risk, 4.11; P = .045). Risk of injury was similar for the high school athletes in comparison to the college athletes (relative risk, 1.16). For the men, there was no difference in the risk of suffering an ankle sprain between the sports of basketball, soccer, and lacrosse, whereas for the women, the risk of suffering an ankle sprain was significantly greater during participation in basketball compared to lacrosse. CONCLUSION: In this study of first-time ankle sprains, for most sports, the incidence rate of inversion injury is less than 1 per 1000 days of exposure to sport, a value lower than previously reported. Among female athletes, ankle injury is associated with type of sport. Risk is highest for female basketball athletes, who are at significantly greater risk than male basketball athletes and female lacrosse athletes. The risk of first-time ankle injury is similar for high school and college-level athletes.     

The effect of a balance training program on the risk of ankle sprains in high school athletes

BACKGROUND: Ankle sprains are the most common musculoskeletal injuries that occur in athletes, and they have a profound impact on health care costs and resources. HYPOTHESIS: A balance training program can reduce the risk of ankle sprains in high school athletes. STUDY DESIGN: Randomized controlled clinical trial; Level of evidence, 1. METHODS: Seven hundred and sixty-five high school soccer and basketball players (523 girls and 242 boys) were randomly assigned to either an intervention group (27 teams, 373 subjects) that participated in a balance training program or to a control group (28 teams, 392 subjects) that performed only standard conditioning exercises. On-site athletic trainers recorded athlete exposures and sprains. RESULTS: The rate of ankle sprains was significantly lower for subjects in the intervention group (6.1%, 1.13 of 1000 exposures vs 9.9%, 1.87 of 1000 exposures; P = .04). Athletes with a history of an ankle sprain had a 2-fold increased risk of sustaining a sprain (risk ratio, 2.14), whereas athletes who performed the intervention program decreased their risk of a sprain by one half (risk ratio, 0.56). The ankle sprain rate for athletes without previous sprains was 4.3% in the intervention group and 7.7% in the control group, but this difference was not significant (P = .059). CONCLUSION: A balance training program will significantly reduce the risk of ankle sprains in high school soccer and basketball players.     

Comparing the incidence of anterior cruciate ligament injury in collegiate lacrosse, soccer, and basketball players: implications for anterior cruciate ligament mechanism and prevention

BACKGROUND: Female college basketball and soccer athletes have higher rates of anterior cruciate ligament injury than do their male counterparts. Rates of anterior cruciate ligament injuries for women and men in collegiate lacrosse have not been examined. Understanding anterior cruciate ligament injury patterns in lacrosse, a full-contact sport for men and noncontact sport for women, could further injury prevention efforts. HYPOTHESES: Female anterior cruciate ligament injury rates will decrease over time owing to longer participation in sports. Lacrosse anterior cruciate ligament injury rates will be lower than rates in basketball and soccer possibly owing to beneficial biomechanics of carrying a lacrosse stick. STUDY DESIGN: Cohort study (Prevalence); Level of evidence, 2. METHODS: Data from the National Collegiate Athletic Association Injury Surveillance System were analyzed to compare men's and women's anterior cruciate ligament injuries in basketball, lacrosse, and soccer over 15 years. RESULTS: Anterior cruciate ligament injury rates in women's basketball and soccer were 0.28 and 0.32 injuries per 1000 athlete exposures, respectively, and did not decline over the study period. In men's basketball, injury rate fluctuated between 0.03 and 0.13 athlete exposures. Rates of anterior cruciate ligament injury did not significantly change in men's soccer over the study period. The rate of anterior cruciate ligament injury in men's lacrosse (0.17 athlete exposures, P < .05) was significantly higher than in men's basketball (0.08 athlete exposures) and soccer (0.12 athlete exposures). Injury rate in women's lacrosse (0.18 athlete exposures, P < .05) was significantly lower than in women's basketball and soccer. CONCLUSION: There was no discernable change in rate of anterior cruciate ligament injury in men or women during the study period. Men's lacrosse is a high-risk sport for anterior cruciate ligament injury. Unlike basketball and soccer, the rates of anterior cruciate ligament injury are essentially the same in men's and women's lacrosse. The level of allowed contact in pivoting sports may be a factor in determining sport-specific anterior cruciate ligament risk.     

Prior history of anterior cruciate ligament (ACL) reconstruction is associated with a greater risk of subsequent ACL injury in female collegiate athletes

ObjectivesThe risk of a subsequent anterior cruciate ligament (ACL) sprain is greater in high school aged female athletes with prior history of ACL reconstruction (ACLR) than in age-matched controls. The risk of a subsequent ACL injury in female collegiate athletes with prior ACLR is unknown. The primary purpose of this study was to determine the relative risk of a subsequent ACL injury in female collegiate athletes with prior ACLR when compared to age-matched controls. The secondary purpose of this study was to evaluate the ability of jump and hop tests to discriminate ACL injury risk.DesignProspective cohort.MethodsThree hundred and sixty female collegiate athletes (mean age 19.3 ± 1.4 years) representing the following sports: volleyball, soccer, and basketball were recruited.Subjects reported prior history of ACLR and standing long jump (SLJ) and single-leg hop (SLH) scores were collected during the preseason. Noncontact time-loss ACL and lower quadrant (i.e., low back and lower extremities) injuries were tracked by university athletic trainers.ResultsFemale collegiate athletes with a prior history of ACLR were 6 times (RR = 6.8 [95% CI: 1.4, 32.9] p-value = 0.007) more likely to experience an ACL injury than controls. Suboptimal performance on a battery of tests (SLJ ≤ 79% height, (B) SLH ≤ 69% height) was associated with a greater risk of lower quadrant injury (RR = 1.6 [95% CI: 1.1, 2.4] p-value = 0.028); however performance on these tests was not associated with ACL injury.ConclusionsFemale collegiate athletes should be screened for history of ACLR.     

The effect of neuromuscular training on the incidence of knee injury in female athletes. A prospective study

To prospectively evaluate the effect of neuromuscular training on the incidence of knee injury in female athletes, we monitored two groups of female athletes, one trained before sports participation and the other not trained, and a group of untrained male athletes throughout the high school soccer, volleyball, and basketball seasons. Weekly reports included the number of practice and competition exposures and mechanism of injury. There were 14 serious knee injuries in the 1263 athletes tracked through the study. Ten of 463 untrained female athletes sustained serious knee injuries (8 noncontact), 2 of 366 trained female athletes sustained serious knee injuries (0 noncontact), and 2 of 434 male athletes sustained serious knee injuries (1 noncontact). The knee injury incidence per 1000 athlete-exposures was 0.43 in untrained female athletes, 0.12 in trained female athletes, and 0.09 in male athletes (P = 0.02, chi-square analysis). Untrained female athletes had a 3.6 times higher incidence of knee injury than trained female athletes (P = 0.05) and 4.8 times higher than male athletes (P = 0.03). The incidence of knee injury in trained female athletes was not significantly different from that in untrained male athletes (P = 0.86). The difference in the incidence of noncontact injuries between the female groups was also significant (P = 0.01). This prospective study demonstrated a decreased incidence of knee injury in female athletes after a specific plyometric training program.     

Comparison of 3 preventive methods to reduce the recurrence of ankle inversion sprains in male soccer players

BACKGROUND: Ankle sprains are frequent injuries in soccer. Several strategies can be used to prevent further ankle sprains in athletes: the most common are proprioceptive training, strength training, and orthoses. OBJECTIVE: To investigate which of these 3 interventions is the most effective in preventing ankle sprains in athletes with previous ankle inversion sprain. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS AND MEASURES: Eighty male soccer players (age, 24.6 +/- 2.63 years; height, 175.60 +/- 4.36 cm; weight, 64.26 +/- 8.37 kg) in the first division of a men's league who had experienced previous ankle inversion sprain were randomly selected from an original population of 120 players. The subjects were individually and randomly assigned to 4 study groups: group 1 (n = 20) followed the proprioceptive program, group 2 (n = 20) followed the strength program, group 3 (n = 20) used orthoses, and group 4 (n = 20) was the control group. Data on the frequency of ankle sprain reinjury were collected at the end of the session. RESULTS: There were no significant differences among the groups in the number of exposures. The incidence of ankle sprains in players in the proprioception training group was significantly lower than in the control group (relative risk of injury, 0.13; 95% confidence interval, 0.003-0.93; P = .02). The findings with respect to the strength and orthotic groups in comparison with the control group were not significant (relative risk of injury, 0.5; 95% confidence interval, 0.11-1.87; P = .27 for strength; relative risk of injury, 0.25; 95% confidence interval, 0.03-1.25; P = .06 for orthotic group). CONCLUSION: Proprioceptive training, compared with no intervention, was an effective strategy to reduce the rate of ankle sprains among male soccer players who suffered ankle sprain.     

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.     

Risk factors for noncontact ankle sprains in high school football players: the role of previous ankle sprains and body mass index

BACKGROUND: In a previous study, we noted a possible connection between an athlete's weight and risk of ankle sprain. HYPOTHESIS: A high body mass index and a history of a previous ankle sprain increase the risk of a subsequent noncontact sprain. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: One hundred fifty-two athletes from 4 football teams were observed (2 varsity and 2 junior varsity). Two teams were observed for 3 seasons, and 2 teams were observed for 1 season. Before each season, body mass, height, history of previous ankle sprains, and ankle tape or brace use were recorded. RESULTS: There were 24 ankle sprains, of which 15 were noncontact inversion sprains (11 grade I, 3 grade II, 1 grade III; incidence, 1.08 per 1000 athlete-exposures). Injury incidence was higher in athletes with previous ankle injuries (2.60 vs 0.39; P < .001). Body mass index was also a risk factor (P < .05): injury incidence was 0.52 for players with a normal body mass index, 1.05 for players at risk of overweight, and 2.03 for overweight players. Injury incidence was 0.22 for normal-weight players with no previous ankle sprain compared with 4.27 for overweight players who had a previous sprain. CONCLUSION: An overweight player who had a previous ankle sprain was 19 times more likely to sustain a noncontact ankle sprain than was a normal-weight player with no previous ankle sprain. CLINICAL RELEVANCE: Ankle sprain prevention strategies should be targeted at football players with a high body mass index and a history of previous ankle sprains.     

The prevention of ankle sprains in sports. A systematic review of the literature

To assess the published evidence on the effectiveness of various approaches to the prevention of ankle sprains in athletes, we used textbooks, journals, and experts in the field of sports medicine to identify citations. We identified 113 studies reporting the risk of ankle sprains in sports, methods to provide support, the effect of these interventions on performance, and comparison of prevention efforts. The most common risk factor for ankle sprain in sports is history of a previous sprain. Ten citations of studies involving athletes in basketball, football, soccer, or volleyball compared alternative methods of prevention. Methods tested included wrapping the ankle with tape or cloth, orthoses, high-top shoes, or some combination of these methods. Most studies indicate that appropriately applied braces, tape, or orthoses do not adversely affect performance. Based on our review, we recommend that athletes with a sprained ankle complete supervised rehabilitation before returning to practice or competition, and those athletes suffering a moderate or severe sprain should wear an appropriate orthosis for at least 6 months. Both coaches and players must assume responsibility for prevention of injuries in sports. Methodologic limitations of published studies suggested several areas for future research.     

The relationship between neurocognitive function and noncontact anterior cruciate ligament injuries

BACKGROUND: Biomechanical analyses suggest that the loss of neuromuscular control is associated with noncontact anterior cruciate ligament sprains; however, previous research has not explored the link between neurocognitive function and unintentional knee injuries. PURPOSE: To determine if athletes who suffer a noncontact anterior cruciate ligament injury demonstrate decreased baseline neurocognitive performance when compared with matched controls. STUDY DESIGN: Case control study; Level of evidence, 3. METHODS: The baseline scores from a computerized neurocognitive test battery (ImPACT) were analyzed to compare verbal memory, visual memory, processing speed, and reaction time. Eighty intercollegiate athletes who, subsequent to testing, experienced noncontact anterior cruciate ligament injuries, were matched with 80 controls based on height, weight, age, gender, sport, position, and years of experience at the collegiate level. RESULTS: Statistical differences were found between the noncontact anterior cruciate ligament injury group and the matched controls on all 4 neurocognitive subtests. Noncontact anterior cruciate ligament-injured athletes demonstrated significantly slower reaction time (F(1,158) = 9.66, P = .002) and processing speed (F(1,158) = 12.04, P = .001) and performed worse on visual (F(1,158) = 19.16, P = .000) and verbal memory (F(1,158) = 4.08, P = .045) composite scores when compared with controls. CONCLUSION: Neurocognitive differences may be associated with the loss of neuromuscular control and coordination errors, predisposing certain intercollegiate athletes to noncontact anterior cruciate ligament injuries.     

Injuries in adolescent female players in European football: a prospective study over one outdoor soccer season

In this prospective study, injuries in 153 adolescent female soccer players were recorded during one outdoor season (April-October). The overall injury incidence rate was 6.8 per 1000 h soccer (games and practice) and the incidence rate of traumatic injury 9.1 and 1.5 per 1000 player-hours in games and practice, respectively. Sixty-three players (41%) sustained 79 injuries. Sixty-six percent of the injuries were traumatic and 34% were overuse injuries. Most of the traumatic injuries occurred during games. Eighty-nine percent of the injuries were located in the lower extremities and 42% occurred in the knee or ankle. The most frequent type of injury was ankle sprain (22.8%). Forty-one percent of the traumatic injuries and 56% of the ankle sprains were re-injuries. Most of the injuries were of moderate severity (52%), while 34% were minor and 14% were major. Most of the major injuries were traumatic such as knee ligament injuries and ankle sprains.     

Previous injuries and persisting symptoms in female soccer players

One hundred and fifty players in a female senior soccer division, starting up a new season, were examined for past injuries and persisting symptoms. An incidence of 0.18 injury/player/year was found, which is not significantly different from previously reported injury rates for male soccer. Sprains to the lower extremity and shin-splints were the most common previous injuries. Forty-three percent of the players had some kind of persistent symptom as a result of a past injury. Symptoms from previous ankle and knee sprains and from overuse injuries were the most common. Players who had sustained an ankle joint injury were more prone to have persistent symptoms (p less than 0.05) if they had persistent mechanical instability. Compared to previous retrospective studies on men's soccer, the women showed a higher rate of previous patellar dislocations. These injuries often caused persistent symptoms. The women showed fewer serious knee injuries. This might depend on a real difference in incidence or is just a reflection of female players ceasing to play soccer after a severe knee injury.     

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.     

Sports injuries in adolescents' ball games: soccer, handball and basketball.

In a prospective study of 302 adolescent players in three ball games (soccer, handball and basketball), 119 incurred injuries. The injury incidence (number of injuries per 1000 playing hours) was 5.6 in soccer, 4.1 in handball and 3.0 in basketball. Ankle sprains accounted for 25 per cent of the injuries, finger sprains 32 per cent, strains in the thigh and leg 10 per cent, and tendinitis/apophysitis 12 per cent. The most serious injuries were four fractures, one anterior cruciate ligament rupture, and two meniscus lesions. The most serious injuries, with the longest rehabilitation period, occurred in soccer. In soccer, many injuries occurred during tackling and contact with an opposing player, while the injuries in handball and basketball were often caused by ball contact and running.     

Exercise and Sudden Death

Abstract

High school and collegiate female athletes have a significantly increased risk of sustaining a noncontact anterior cruciate ligament injury compared with male athletes participating in the same sport. This review summarizes the current knowledge of the risk factors hypothesized to influence this problem, and the neuromuscular training programs designed to correct certain biomechanical problems noted in female athletes. The risk factors include a genetic predisposition for sustaining a knee ligament injury, environmental factors, anatomical indices, hormonal influences, and neuromuscular factors. The greatest amount of research in this area has studied differences between female and male athletes in movement patterns during athletic tasks; muscle strength, activation, and recruitment patterns; and knee joint stiffness under controlled, preplanned, and reactive conditions in the laboratory. Neuromuscular retraining programs have been developed in an attempt to reduce these differences. The successful programs teach athletes to control the upper body, trunk, and lower body position; lower the center of gravity by increasing hip and knee flexion during activities; and develop muscular strength and techniques to land with decreased ground reaction forces. In addition, athletes are taught to preposition the body and lower extremity prior to initial ground contact to obtain the position of greatest knee joint stability and stiffness. Two published programs have significantly reduced the incidence of noncontact anterior cruciate ligament injuries in female athletes participating in basketball, soccer, and volleyball. Other programs were ineffective, had a poor study design, or had an insufficient number of participants, which precluded a true reduction in the risk of this injury. In order to determine which risk factors for noncontact anterior cruciate ligament ruptures are significant, future investigations should include larger cohorts of athletes in multiple sports, analyze factors from all of the major risk categories, and follow athletes for at least one full athletic season. Future risk assessment studies should incorporate reactive tasks under more realistic sports conditions.     

女运动员前交叉韧带损伤调查分析

在对 47个运动队共 6 810名现役集训运动员运动创伤流行病学研究的基础上 ,对女姓运动员膝关节前交叉韧带 (ACL)的损伤进行了研究 ,并与男性相比较。结果表明女运动员ACL损伤发生率 (0 71% )是男运动员ACL损伤发生率 (0 30 % )的 2 37倍。女运动员ACL损伤多见于柔道、篮球、足球、排球等项目。对女运动员ACL损伤的病因、发生机制和预防等进行了分析探讨。     

Gender differences in the kinematics of unanticipated cutting in young athletes

PURPOSE: Anterior cruciate ligament (ACL) injuries occur at a greater rate in adolescent females compared with males who participate in the same pivoting and jumping sports. The purpose of this study was to compare knee and ankle joint angles between males and females during an unanticipated cutting maneuver. The hypotheses were that female athletes would display increased knee abduction, increased ankle eversion and decreased knee flexion during the unanticipated cutting maneuver compared with males. METHODS: Fifty-four male and 72 adolescent female middle and high school basketball players volunteered to participate in this study. Knee and ankle kinematics were calculated using three-dimensional motion analysis during a jump-stop unanticipated cut (JSUC) maneuver. RESULTS: Females exhibited greater knee abduction (valgus) angles compared with males. Gender differences were also found in maximum ankle eversion and maximum inversion during stance phase. No differences were found in knee flexion angles at initial contact or maximum. CONCLUSION: Gender differences in knee and ankle kinematics in the frontal plane during cutting may help explain the gender differences in ACL injury rates. Implementation of dynamic neuromuscular training in young athletes with a focus on frontal plane motion may help prevent ACL injuries and their long-term debilitating effects.