Alison Brooks

The Effect of Lace-up Ankle Braces on Injury Rates in High School Basketball Players

Background: Ankle injuries are the most common injury in basketball players. However, no prospective studies have been performed to determine if wearing lace-up ankle braces will reduce the incidence of ankle injuries in high school athletes. Purpose: This trial was undertaken to determine if lace-up ankle braces reduce the incidence and severity of acute first-time and recurrent ankle injuries sustained by high school basketball players. Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 1460 male and female basketball players from 46 high schools were randomly assigned to a braced or control group. The braced group players wore lace-up ankle braces during the 2009-2010 basketball season. Athletic trainers recorded brace compliance, athlete exposures, and injuries. Cox proportional hazards models (adjusted for demographic covariates), accounting for intracluster correlation, were utilized to compare time to first acute ankle injury between groups. Injury severity (days lost) was tested with the Wilcoxon rank-sum test. Results: The rate of acute ankle injury (per 1000 exposures) was 0.47 in the braced group and 1.41 in the control group (Cox hazard ratio [HR] 0.32; 95% confidence interval [CI] 0.20, 0.52; P < .001). The median severity of acute ankle injuries was similar (P = .23) in the braced (6 days) and control group (7 days). For players with a previous ankle injury, the incidence of acute ankle injury was 0.83 in the braced group and 1.79 in the control group (Cox HR 0.39; 95% CI 0.17, 0.90; P = .028). For players who did not report a previous ankle injury, the incidence of acute ankle injury was 0.40 in the braced group and 1.35 in the control group (Cox HR 0.30; 95% CI 0.17, 0.52, P < .001). Conclusion: Use of lace-up ankle braces reduced the incidence but not the severity of acute ankle injuries in male and female high school basketball athletes both with and without a previous history of an ankle injury.

Subjective well-being and training load predict in-season injury and illness risk in female youth soccer players

Background The purpose of this study was to evaluate the effects of training load (TL) and well-being on injury and illness risk in youth soccer players. Methods Throughout a 20-week season, 75 female adolescent soccer players reported mood, fatigue, stress, soreness, sleep quality, sleep hours, TL, injuries and illnesses. Well-being measures were recorded from −3 (worst) to +3 (best). TL was expressed as daily, weekly and monthly, as well as an acute:chronic workload ratio (weekly divided by monthly). Variables were compared between days with and without an injury, and with or without an illness. Poisson regression models were developed to predict daily injuries and illnesses using well-being and TL (z-scores) as predictors. Results 36 injuries and 52 illnesses were recorded. Days with an injury had lower (worse) daily mood (1.24±0.2 vs 1.16±0.1, p=0.012) and higher daily TL (517±138 vs 440±158, p=0.010). Average monthly TL was higher preceding days with an illness (12 442 ±409 vs 12 627 ±403, p=0.043), while no differences were found with respect to other measures of TL or well-being. Worse daily mood (p=0.011, OR=0.012), higher daily TL (p<0.001, OR=1.98), and higher prior day TL (p=0.040, OR=1.34) were independent predictors of injury, while weekly (p=0.005, OR=1.50) and monthly TL (p=0.007, OR=1.54) were predictors of illness. Conclusions Lower mood and higher acute TL are associated with increased injury risk, while higher chronic TL increases the risk of illness. Monitoring well-being and TL may facilitate intervention to reduce in-season injury and illness.

Basketball Coaches’ Utilization of Ankle Injury Prevention Strategies

Background: Ankle injuries are the most common high school basketball injury. Little is known regarding the utilization of ankle injury prevention strategies in high school settings. Objective: To determine high school basketball coaches’ utilization of ankle injury prevention strategies, including prophylactic ankle bracing (PAB) or an ankle injury prevention exercise program (AIEPP). Study Design: Cross-sectional survey. Methods: The survey was distributed to all high school basketball coaches in Wisconsin. Fisher exact and Wilcoxon rank sum tests were used to determine if the injury prevention strategies utilized differed according to school size, sex of the team, years of coaching experience, and the coach’s education level. Results: Four hundred eighty (55%) coaches from 299 (74%) high schools completed the survey. Thirty-seven percent of the coaches encouraged or required their players to use PAB. School enrollment of the coaches’ teams did not affect their stance on the use of PAB (P = 0.30), neither did the sex of the team (P = 0.16), years coaching (P = 0.09), nor the coach’s education (P = 0.49). Fifty percent (n = 242) of the coaches indicated they do not utilize an AIEPP, with no difference based on school enrollment (P = 0.47), team sex (P = 0.41), years coaching (P = 0.78), or the education level (P = 0.44). Barriers to utilization of AIEPP included a lack of time, awareness, and expertise. Coaches preferred an AIEPP that was specific to basketball, combined injury prevention and performance enhancement components, was performed 2 to 3 days per week, and lasted 5 to 15 minutes. Conclusion: Less than half of the coaches encouraged use of PAB, and half did not utilize an AIEPP. Coaches had specific preferences for the type of AIEPP they would implement. Clinical Relevance: Sports medicine providers should promote ankle injury prevention strategies but need to address why prevention strategies may not be utilized in high school basketball settings.

Ground reaction forces and osteogenic index of the sport of cyclocross

Abstract Weight-bearing activity has been shown to increase bone mineral density. Our purpose was to measure vertical ground reaction forces (GRFs) during cyclocross-specific activities and compute their osteogenic index (OI). Twenty-five healthy cyclocross athletes participated. GRF was measured using pressure-sensitive insoles during seated and standing cycling and four cyclocross-specific activities: barrier flat, barrier uphill, uphill run-up, downhill run-up. Peak and mean GRF values, according to bodyweight, were determined for each activity. OI was computed using peak GRF and number of loading cycles. GRF and OI were compared across activities using repeated-measures ANOVA. Number of loading cycles per activity was 6(1) for barrier flat, 8(1) barrier uphill, 7(1) uphill run-up, 12(3) downhill run-up. All activities had significantly (P < 0.01) higher peak GRF, mean GRF values and OI when compared to both seated and standing cycling. The barrier flat condition (P < 0.01) had highest peak (2.9 times bodyweight) and mean GRF values (2.3 times bodyweight). Downhill run-up (P < 0.01) had the highest OI (6.5). GRF generated during the barrier flat activity is similar in magnitude to reported GRFs during running and hopping. Because cyclocross involves weight bearing components, it may be more beneficial to bone health than seated road cycling.

We need to talk about manels: the problem of implicit gender bias in sport and exercise medicine

In 2015, a website (www.allmalepanels.tumblr.com/) began documenting instances of all-male panels (colloquially known as a ‘manel’). This, along with the Twitter hashtag #manel, has helped drive recognition of the persistent and pervasive gender bias in the composition of experts assembled to present at conferences and other events. Recent social media discussions have similarly highlighted the prevalence of all-male panels in Sport and Exercise Medicine (SEM). While, to our knowledge, all-male panel trends in SEM have not yet formally been documented or published, one need look no further than SEM conference committees, keynote speaker lists, panels and other events to see that it exists in practice. Why, in 2018, is SEM and its related disciplines still failing to identify and acknowledge the role that implicit bias plays in the very structure of our own research, practice and education? SEM is, after all, a profession that contains experts, and serves populations, of all genders. This editorial will introduce the definition, implications and manifestations of implicit gender bias and then explore how the SEM community can begin to address this issue, advance the discussion and develop a more equitable global community. Social cognitive theory describes ‘implicit bias’ as the unconscious …

Comparison of Head Impact Exposure Between Concussed Football Athletes and Matched Controls: Evidence for a Possible Second Mechanism of Sport-Related Concussion

Studies of football athletes have implicated repetitive head impact exposure in the onset of cognitive and brain structural changes, even in the absence of diagnosed concussion. Those studies imply accumulating damage from successive head impacts reduces tolerance and increases risk for concussion. Support for this premise is that biomechanics of head impacts resulting in concussion are often not remarkable when compared to impacts sustained by athletes without diagnosed concussion. Accordingly, this analysis quantified repetitive head impact exposure in a cohort of 50 concussed NCAA Division I FBS college football athletes compared to controls that were matched for team and position group. The analysis quantified the number of head impacts and risk weighted exposure both on the day of injury and for the season to the date of injury. 43% of concussed athletes had the most severe head impact exposure on the day of injury compared to their matched control group and 46% of concussed athletes had the most severe head impact exposure for the season to the date of injury compared to their matched control group. When accounting for date of injury or season to date of injury, 72% of all concussed athletes had the most or second most severe head impact exposure compared to their matched control group. These trends associating cumulative head impact exposure with concussion onset were stronger for athletes that participated in a greater number of contact activities. For example, 77% of athletes that participated in ten or more days of contact activities had greater head impact exposure than their matched control group. This unique analysis provided further evidence for the role of repetitive head impact exposure as a predisposing factor for the onset of concussion. The clinical implication of these findings supports contemporary trends of limiting head impact exposure for college football athletes during practice activities in an effort to also reduce risk of concussive injury.

Immediate Removal From Activity After Sport-Related Concussion Is Associated With Shorter Clinical Recovery and Less Severe Symptoms in Collegiate Student-Athletes:

Background: Timely removal from activity after concussion symptoms remains problematic despite heightened awareness. Previous studies indicated potential adverse effects of continuing to participate in physical activity immediately after sustaining a concussion. Hypothesis/Purpose: The purpose was to determine the effect of timing of removal from play after concussion on clinical outcomes. It was hypothesized that immediate removal from activity after sport-related concussion (SRC) would be associated with less time missed from sport, a shorter symptomatic period, and better outcomes on acute clinical measures. Study Design: Cohort study; Level of evidence, 3. Methods: Data were reported from the National Collegiate Athletic Association and Department of Defense Grand Alliance: Concussion Awareness, Research, and Education (CARE) Consortium. Participants with 506 diagnosed SRCs from 18 sports and 25 institutions and military service academies were analyzed and classified as either immediate removal from activity (I-RFA) or delayed removal from activity (D-RFA). Outcomes of interest included time missed from sport attributed to their SRC, symptom duration, and clinical assessment scores. Results: There were 322 participants (63.6%) characterized as D-RFA. I-RFA status was associated with significantly less time missed from sport (R2 change = .022-.024, P < .001 to P = .001) and shorter symptom duration (R2 change = .044-.046, P < .001 [all imputations]) while controlling for other SRC recovery modifiers. These athletes missed approximately 3 fewer days from sport participation. I-RFA athletes had significantly less severe acute SRC symptoms and were at lower risk of recovery taking ≥14 days (relative risk = .614, P < .001, small-medium effect size) and ≥21 days (relative risk = .534, P = .010, small effect size). Conclusion: I-RFA is a protective factor associated with less severe acute symptoms and shorter recovery after SRC. Conveying this message to athletes, coaches, and others involved in the care of athletes may promote timely injury reporting.

Neurocognitive Performance and Increased Risk of Lower Extremity Injury after Concussion: 2264 Board #4 June 2, 3: 15 PM - 5: 15 PM.

Recent studies have shown increased risk of musculoskeletal injury for athletes returning to play from concussion. It is possible that subtle deficits in neurocognition and neuromuscular control, such as inhibited concentration, balance, or prolonged reaction times could increase risk of subsequent injury. However, there is little understanding of the variables that may help characterize risk during this time of vulnerability.

The effect of a lace-up ankle brace on ankle injury rates in adolescent basketball players

Background It is widely accepted by many adolescent basketball players and their coaches that wearing a lace-up ankle brace will reduce the incidence of acute ankle injuries. To date there have been no prospective studies to determine if lace-up ankle braces reduce the incidence of ankle injuries in adolescent basketball players. Objectives To determine whether a lace-up ankle brace reduces the incidence and severity of acute ankle injuries sustained by adolescent basketball players during one season. Design Prospective randomised controlled study using stratified cluster (school) randomisation. Participants 1460 adolescent male and female (age 13–18) basketball players from 46 USA high schools. Intervention Lace-up ankle brace. Main outcome measures (1) Rate and incidence of acute ankle injuries, (2) Ankle injury severity (days lost from participation). Injury rates were estimated using Kaplan-Meier survival analysis and compared between the intervention and control group using a log-rank test. The Cox Proportional Hazards model was utilised to examine the relationship between injury rate and ankle bracing while controlling for covariate. Injury severity was compared using the Wilcoxon Rank-Sum test. Results The acute ankle injury rate (per 1000 exposures) was 1.41 in the control group, compared to 0.47 in the braced group. 75 controls (10.4%) sustained an acute ankle injury, compared to 26 athletes (3.5%) in the braced group (Cox HR 0.31, 95% CI 0.20 to 0.49). Lace-up ankle braces reduced the number of injuries in athletes with (HR 0.35, 95% CI 0.17 to 0.71) and without (HR 0.30, 95% CI 0.17 to 0.53) history of previous ankle injury. There was no difference (p=0.223) in the median number of days lost (braced group=5, controls=6). Conclusion Lace-up ankle braces reduced the incidence of acute ankle injuries in male and female adolescent basketball players, independent of previous injury status.