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"Athletic Injuries - prevention "
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Superior results with eccentric compared to concentric quadriceps training in patients with jumper’s knee: a prospective randomised study
Background: A recent study reported promising clinical results using eccentric quadriceps training on a decline board to treat jumper’s knee (patellar tendinosis). Methods: In this prospective study, athletes (mean age 25 years) with jumper’s knee were randomised to treatment with either painful eccentric or painful concentric quadriceps training on a decline board. Fifteen exercises were repeated three times, twice daily, 7 days/week, for 12 weeks. All patients ceased sporting activities for the first 6 weeks. Age, height, weight, and duration of symptoms were similar between groups. Visual analogue scales (VAS; patient estimation of pain during exercise) and Victorian Institute of Sport Assessment (VISA) scores, before and after treatment, and patient satisfaction, were used for evaluation. Results: In the eccentric group, for 9/10 tendons patients were satisfied with treatment, VAS decreased from 73 to 23 (p<0.005), and VISA score increased from 41 to 83 (p<0.005). In the concentric group, for 9/9 tendons patients were not satisfied, and there were no significant differences in VAS (from 74 to 68, p<0.34) and VISA score (from 41 to 37, p<0.34). At follow up (mean 32.6 months), patients in the eccentric group were still satisfied and sports active, but all patients in the concentric group had been treated surgically or by sclerosing injections. Conclusions: In conclusion, eccentric, but not concentric, quadriceps training on a decline board, seems to reduce pain in jumper’s knee. The study aimed to include 20 patients in each group, but was stopped at the half time control because of poor results achieved in the concentric group.
Journal Article
Making football safer for women: a systematic review and meta-analysis of injury prevention programmes in 11 773 female football (soccer) players
ObjectiveTo evaluate the effects of injury prevention programmes on injury incidence in any women’s football code; explore relationships between training components and injury risk; and report injury incidence for women’s football.DesignSystematic review and meta-analysis.Data sourcesNine databases searched in August 2019.Eligibility criteriaRandomised controlled trials evaluating any injury prevention programme (eg, exercise, education, braces) were included. Study inclusion criteria were: ≥20 female football players in each study arm (any age, football code or participation level) and injury incidence reporting.ResultsTwelve studies, all in soccer, met inclusion criteria, with nine involving adolescent teams (aged <18 years). All studies (except one) had a high risk of bias. Eleven studies examined exercise-based programmes, with most (9/11) including multiple (≥2) training components (eg, strength, plyometric, balance exercises). Multicomponent exercise programmes reduced overall (any reported) injuries (incidence rate ratio (IRR) 0.73, 95% CI 0.59 to 0.91) and ACL injuries (IRR 0.55, 95% CI 0.32 to 0.92). For exercise-based strategies (single-component and multicomponent), hamstring injuries were also reduced (IRR 0.40, 95% CI 0.17 to 0.95). While exercise-based strategies resulted in less knee, ankle and hip/groin injuries, and the use of multiple training components was associated with greater reductions in overall and knee injuries, further studies would be required to increase the precision of these results. The incidence of overall injuries in women’s football was 3.4 per 1000 exposure hours; with ankle injuries most common.ConclusionIn women’s football, there is low-level evidence that multicomponent, exercise-based programmes reduce overall and ACL injuries by 27% and 45%, respectively.PROSPERO registration numberCRD42018093527.
Journal Article
Effects of 4-week slackline training on lower limb joint motion and muscle activation
To investigate the effects of four weeks of slacklining on lower limb kinematics and muscle activity following a slip of the upright stance.
A randomized, gender matched study.
Twenty-four young healthy adults participated in the study and were assigned to either a training or a control group. The training group completed a 4-week training program on slacklines, while the control group received no slackline training. Before and after training, participants performed single leg standing tasks on a moveable platform. During medio-lateral platform perturbation, platform displacement, lower limb joint motion (ankle, knee and hip) and surface electromyography (EMG) measurements from six lower limb muscles were recorded.
In the training group, a decrease in platform mean and maximum velocity (all p<0.05) was detected, but no changes were observed for the release time and maximum deflection (all p>0.05) of the platform. Regarding lower limb kinematics, a reduced corrective action was detected in the knee joint (p<0.05), whereas only a trend towards a decrease could be observed in the ankle joint (p<0.1). EMG data revealed an enhanced activation of the rectus femoris (p<0.05), as well as a trend to increased rectus femoris to biceps femoris co-activation (p=0.06) in the preparatory phase for training group.
The data strongly support that slacklining can improve postural control and enhance functional knee joint stability, which seems to be induced by enhanced preparatory muscle activation of the rectus femoris.
Journal Article
Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: a systematic review and meta-analysis of 8459 athletes
Research questionDoes the Nordic hamstring exercise (NHE) prevent hamstring injuries when included as part of an injury prevention intervention?DesignSystematic review and meta-analysis.Eligibility criteria for selecting studiesWe considered the population to be any athletes participating in any sporting activity, the intervention to be the NHE, the comparison to be usual training or other prevention programmes, which did not include the NHE, and the outcome to be the incidence or rate of hamstring injuries.AnalysisThe effect of including the NHE in injury prevention programmes compared with controls on hamstring injuries was assessed in 15 studies that reported the incidence across different sports and age groups in both women and men.Data sourcesMEDLINE via PubMed, CINAHL via Ebsco, and OpenGrey.ResultsThere is a reduction in the overall injury risk ratio of 0.49 (95% CI 0.32 to 0.74, p=0.0008) in favour of programmes including the NHE. Secondary analyses when pooling the eight randomised control studies demonstrated a small increase in the overall injury risk ratio 0.52 (95% CI 0.32 to 0.85, p=0.0008), still in favour of the NHE. Additionally, when studies with a high risk of bias were removed (n=8), there is an increase of 0.06 in the risk ratio to 0.55 (95% CI 0.34 to 0.89, p=0.006).ConclusionsProgrammes that include the NHE reduce hamstring injuries by up to 51%. The NHE essentially halves the rate of hamstring injuries across multiple sports in different athletes.Trial registration numberPROSPERO CRD42018106150.
Journal Article
2016 consensus statement of the International Ankle Consortium: prevalence, impact and long-term consequences of lateral ankle sprains
The Executive Committee of the International Ankle Consortium presents this 2016 position paper with recommendations for information implementation and continued research based on the paradigm that lateral ankle sprain (LAS), and the development of chronic ankle instability (CAI), serve as a conduit to a significant global healthcare burden. We intend our recommendations to serve as a mechanism to promote efforts to improve prevention and early management of LAS. We believe this will reduce the prevalence of CAI and associated sequelae that have led to the broader public health burdens of decreased physical activity and early onset ankle joint post-traumatic osteoarthritis. Ultimately, this can contribute to healthier lifestyles and promotion of physical activity.
Journal Article
Anterior Cruciate Ligament Injury Risk in Sport: A Systematic Review and Meta-Analysis of Injury Incidence by Sex and Sport Classification
To evaluate sex differences in incidence rates (IRs) of anterior cruciate ligament (ACL) injury by sport type (collision, contact, limited contact, and noncontact).
A systematic review was performed using the electronic databases PubMed (1969-January 20, 2017) and EBSCOhost (CINAHL, SPORTDiscus; 1969-January 20, 2017) and the search terms
AND
AND (
OR
OR
).
Studies were included if they provided the number of ACL injuries and the number of athlete-exposures (AEs) by sex or enough information to allow the number of ACL injuries by sex to be calculated. Studies were excluded if they were analyses of previously reported data or were not written in English.
Data on sport classification, number of ACL injuries by sex, person-time in AEs for each sex, year of publication, sport, sport type, and level of play were extracted for analysis.
We conducted IR and IR ratio (IRR) meta-analyses, weighted for study size and calculated. Female and male athletes had similar ACL injury IRs for the following sport types: collision (2.10/10 000 versus 1.12/10 000 AEs, IRR = 1.14,
= .63), limited contact (0.71/10 000 versus 0.29/10 000 AEs, IRR = 1.21,
= .77), and noncontact (0.36/10 000 versus 0.21/10 000 AEs, IRR = 1.49,
= .22) sports. For contact sports, female athletes had a greater risk of injury than male athletes did (1.88/10 000 versus 0.87/10 000 AEs, IRR = 3.00,
< .001). Gymnastics and obstacle-course races were outliers with respect to IR, so we created a sport category of fixed-object, high-impact rotational landing (HIRL). For this sport type, female athletes had a greater risk of ACL injury than male athletes did (4.80/10 000 versus 1.75/10 000 AEs, IRR = 5.51,
< .001), and the overall IRs of ACL injury were greater than all IRs in all other sport categories.
Fixed-object HIRL sports had the highest IRs of ACL injury for both sexes. Female athletes were at greater risk of ACL injury than male athletes in contact and fixed-object HIRL sports.
Journal Article
Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study
BackgroundKnee reinjury after ACL reconstruction is common and increases the risk of osteoarthritis. There is sparse evidence to guide return to sport (RTS) decisions in this population.ObjectivesTo assess the relationship between knee reinjury after ACL reconstruction and (1) return to level I sports, (2) timing of RTS and (3) knee function prior to return.Methods106 patients who participated in pivoting sports participated in this prospective 2-year cohort study. Sports participation and knee reinjury were recorded monthly. Knee function was assessed with the Knee Outcome Survey—Activities of Daily Living Scale, global rating scale of function, and quadriceps strength and hop test symmetry. Pass RTS criteria were defined as scores >90 on all tests, failure as failing any.ResultsPatients who returned to level I sports had a 4.32 (p=0.048) times higher reinjury rate than those who did not. The reinjury rate was significantly reduced by 51% for each month RTS was delayed until 9 months after surgery, after which no further risk reduction was observed. 38.2% of those who failed RTS criteria suffered reinjuries versus 5.6% of those who passed (HR 0.16, p=0.075). More symmetrical quadriceps strength prior to return significantly reduced the knee reinjury rate.ConclusionsReturning to level I sports after ACL reconstruction leads to a more than 4-fold increase in reinjury rates over 2 years. RTS 9 months or later after surgery and more symmetrical quadriceps strength prior to return substantially reduce the reinjury rate.
Journal Article
Effect of Injury Prevention Programs that Include the Nordic Hamstring Exercise on Hamstring Injury Rates in Soccer Players: A Systematic Review and Meta-Analysis
Background
Hamstring injuries are among the most common non-contact injuries in sports. The Nordic hamstring (NH) exercise has been shown to decrease risk by increasing eccentric hamstring strength.
Objective
The purpose of this systematic review and meta-analysis was to investigate the effectiveness of the injury prevention programs that included the NH exercise on reducing hamstring injury rates while factoring in athlete workload.
Methods
Two researchers independently searched for eligible studies using the following databases: the Cochrane Central Register of Controlled Trials via OvidSP, AMED (Allied and Complementary Medicine) via OvidSP, EMBASE, PubMed, MEDLINE, SPORTDiscus, Web of Science, CINAHL and AusSportMed, from inception to December 2015. The keyword domains used during the search were Nordic, hamstring, injury prevention programs, sports and variations of these keywords. The initial search resulted in 3242 articles which were filtered to five articles that met the inclusion criteria. The main inclusion criteria were randomized controlled trials or interventional studies on use of an injury prevention program that included the NH exercise while the primary outcome was hamstring injury rate. Extracted data were subjected to meta-analysis using a random effects model.
Results
The pooled results based on total injuries per 1000 h of exposure showed that programs that included the NH exercise had a statistically significant reduction in hamstring injury risk ratio [IRR] of 0.490 (95 % confidence interval [CI] 0.291–0.827,
p
= 0.008). Teams using injury prevention programs that included the NH exercise reduced hamstring injury rates up to 51 % in the long term compared with the teams that did not use any injury prevention measures.
Conclusions
This systematic review and meta-analysis demonstrates that injury prevention programs that include NH exercises decrease the risk of hamstring injuries among soccer players. A protocol was registered in the International Prospective Register of Systematic Reviews, PROSPERO (CRD42015019912).
Journal Article