Carolyn A. Emery

Evaluation of Risk Factors for Injury in Adolescent Soccer Implementation and Validation of an Injury Surveillance System

Background There are limited data on the epidemiology of adolescent soccer injury across all levels of play. Hypothesis Through implementation and validation of an injury surveillance system in adolescent soccer, risk factors for injury will be identified. Study Design Descriptive epidemiology study. Methods The study population was a random sample of 21 adolescent soccer teams (ages 12-18). A certified athletic therapist completed preseason baseline measurements and did weekly assessments of any identified soccer injury. The injury definition included any injury occurring in soccer that resulted in 1 or more of the following: medical attention, the inability to complete a session, or missing a subsequent session. Results Based on completeness of data in addition to validity of time loss, this method of surveillance has proven to be effective. The overall injury rate during the regular season was 5.59 injuries per 1000 player hours (95% confidence interval, 4.42-6.97). Soccer injury resulted in time loss from soccer for 86.9% of the injured players. Ankle and knee injuries were the most common injuries reported. Direct contact was reported to be involved in 46.2% of all injuries. There was an increased risk of injury associated with games versus practices (relative risk = 2.89; 95% confidence interval, 1.69-5.21). The risk of injury in the under 14 age group was greatest in the most elite division. Having had a previous injury in the past 1 year increased the risk of injury (relative risk = 1.74; 95% confidence interval, 1.0-3.1). Conclusion There were significant differences in injury rates found by division, previous injury, and session type (practice vs game). Future research should include the use of such a surveillance system to examine prevention strategies for injury in adolescent soccer.

A dynamic model of etiology in sport injury: the recursive nature of risk and causation.

The purpose of this manuscript is to outline a new model representing a dynamic approach that incorporates the consequences of repeated participation in sport, both with and without injury. This model builds on the previous work, while emphasizing the fact that adaptations occur within the context of sport (both in the presence and absence of injury) that alter risk and affect etiology in a dynamic, recursive fashion. Regardless of the type of injury, it is often preceded by a chain of shifting circumstances that, when they come together, constitute sufficient cause to result in an injury. If we are to truly understand the etiology of injury and target appropriate prevention strategies, we must look beyond the initial set of risk factors that are thought to precede an injury and take into consideration how those risk factors may have changed through preceding cycles of participation, whether associated with prior injury or not. This model considers the implications of repeated exposure, whether such exposure produces adaptation, maladaptation, injury or complete/incomplete recovery from injury. When feasible, future studies on sport injury prevention should adopt a methodology and analysis strategy that takes the cyclic nature of changing risk factors into account to create a dynamic, recursive picture of etiology.

Risk factors for injury in child and adolescent sport: a systematic review of the literature.

ObjectiveThe objective of this systematic review of the literature is to identify risk factors and potential prevention strategies that may modify risk factors for injury in child and adolescent sport. Data SourcesSeven electronic databases were searched to identify potentially relevant articles. A combination of Medical Subject Headings and text words were used (athletic injuries, sports injury, risk factors, adolescent, and child). Study SelectionThis review is based on epidemiological evidence in which the data are original, an exposure and outcome are objectively measured, and an attempt is made to create a comparison group. Forty-five studies were selected for this review. Data ExtractionThe data summarized include study design, study population, exposures, outcomes, and results. Estimates of odds ratios or relative risks were calculated where study data were adequate to do so. The quality of evidence is based on internal validity, external validity, and causal association. Data SynthesisThere is some evidence that potentially modifiable risk factors including poor endurance, lack of preseason training, and some psychosocial factors are important risk factors for injury in child and adolescent sport. Concerns with study design, internal validity, and generalizability persist. The evidence is consistent, however, with more convincing evidence from adult population studies. The evidence for nonmodifiable risk factors for injury in adolescent sport (ie, age, sex, previous injury) is consistent among studies. ConclusionsSport participation and injury rates in child and adolescent sport are high. This review will assist in targeting the relevant groups and designing future research examining risk factors and prevention strategies in child and adolescent sport. Future clinical trials addressing modifiable risk factors to reduce the incidence of sports injury in this population are necessary.

Consensus statement on concussion in sport-the 5th international conference on concussion in sport held in Berlin, October 2016

The 2017 Concussion in Sport Group (CISG) consensus statement is designed to build on the principles outlined in the previous statements1–4 and to develop further conceptual understanding of sport-related concussion (SRC) using an expert consensus-based approach. This document is developed for physicians and healthcare providers who are involved in athlete care, whether at a recreational, elite or professional level. While agreement exists on the principal messages conveyed by this document, the authors acknowledge that the science of SRC is evolving and therefore individual management and return-to-play decisions remain in the realm of clinical judgement. This consensus document reflects the current state of knowledge and will need to be modified as new knowledge develops. It provides an overview of issues that may be of importance to healthcare providers involved in the management of SRC. This paper should be read in conjunction with the systematic reviews and methodology paper that accompany it. First and foremost, this document is intended to guide clinical practice; however, the authors feel that it can also help form the agenda for future research relevant to SRC by identifying knowledge gaps. A series of specific clinical questions were developed as part of the consensus process for the Berlin 2016 meeting. Each consensus question was the subject of a specific formal systematic review, which is published concurrently with this summary statement. Readers are directed to these background papers in conjunction with this summary statement as they provide the context for the issues and include the scope of published research, search strategy and citations reviewed for each question. This 2017 consensus statement also summarises each topic and recommendations in the context of all five CISG meetings (that is, 2001, 2004, 2008, 2012 as well as 2016). Approximately 60 000 published articles were screened by the expert panels for the Berlin …

Effectiveness of a home-based balance-training program in reducing sports-related injuries among healthy adolescents: a cluster randomized controlled trial

Background: Sport is the leading cause of injury requiring medical attention among adolescents. We studied the effectiveness of a home-based balance-training program using a wobble board in improving static and dynamic balance and reducing sports-related injuries among healthy adolescents. Methods: In this cluster randomized controlled trial, we randomly selected 10 of 15 high schools in Calgary to participate in the fall of 2001. We then recruited students from physical education classes and randomly assigned them, by school, to either the intervention (n = 66) or the control (n = 61) group. Students in the intervention group participated in a daily 6-week and then a weekly 6-month home-based balance-training program using a wobble board. Students at the control schools received testing only. The primary outcome measures were timed static and dynamic balance, 20-m shuttle run and vertical jump, which were measured at baseline and biweekly for 6 weeks. Self-reported injury data were collected over the 6-month follow-up period. Results: At 6 weeks, improvements in static and dynamic balance were observed in the intervention group but not in the control group (difference in static balance 20.7 seconds, 95% confidence interval [CI] 10.8 to 30.6 seconds; difference in dynamic balance 2.3 seconds, 95% CI 0.7 to 4.0 seconds). There was evidence of a protective effect of balance training in over 6 months (relative risk of injury 0.2, 95% CI 0.05 to 0.88). The number needed to treat to avoid 1 injury over 6 months was 8 (95% CI 4 to 35). Interpretation: Balance training using a wobble board is effective in improving static and dynamic balance and reducing sports-related injuries among healthy adolescents.

A prevention strategy to reduce the incidence of injury in high school basketball: a cluster randomized controlled trial.

Objective:To examine the effectiveness of a sport-specific balance training program in reducing injury in adolescent basketball. Design:Cluster randomized controlled trial. Setting:Twenty-five high schools in Calgary and surrounding area. Subjects:Nine hundred and twenty high school basketball players (ages 12-18). Intervention:Subjects were randomly allocated by school to the control (n = 426) and training group (n = 494). Both groups were taught a standardized warm-up program. The training group was also taught an additional warm-up component and a home-based balance training program using a wobble board. Main Outcome Measures:All injuries occurring during basketball that required medical attention and/or caused a player to be removed from that current session and/or miss a subsequent session were then recorded and assessed by a team therapist who was blinded to training group allocation. Results:A basketball-specific balance training program was protective of acute-onset injuries in high school basketball [RR = 0.71 (95% CI; 0.5-0.99)]. The protective effect found with respect to all injury [RR = 0.8 (95% CI; 0.57-1.11)], lower-extremity injury [RR = 0.83 (95% CI; 0.57-1.19)], and ankle sprain injury [RR = 0.71 (95% CI; 0.45-1.13)] were not statistically significant. Self-reported compliance to the intended home-based training program was poor (298/494 or 60.3%). Conclusions:A basketball-specific balance training program was effective in reducing acute-onset injuries in high school basketball. There was also a clinically relevant trend found with respect to the reduction of all, lower-extremity, and ankle sprain injury. Future research should include further development of neuromuscular prevention strategies in addition to further evaluation of methods to increase compliance to an injury-prevention training program in adolescents.

Injury Rates, Risk Factors, and Mechanisms of Injury in Minor Hockey

Background Hockey is one of the top sports for participation in youth in Canada. There are limited data on the epidemiology of injury in youth hockey. Purpose Through implementation and validation of an injury surveillance system, youth ice hockey injury rates, risk factors, and mechanisms of injury will be examined. Study Design Descriptive epidemiology study. Methods During the 2004-2005 season in minor hockey in Calgary, Alberta, Canada, 71 hockey teams (N = 986) were studied, including teams from each age group (Atom, 9/10 years; Pee Wee, 11/12 years; Bantam, 13/14 years; Midget, 15/16 years) and division of play (7-10 divisions per age group). A certified athletic therapist or candidate did weekly assessments of any identified hockey injury. Injury definition included any injury occurring during the regular hockey season that required medical attention, removal from a session, or missing a subsequent session. Results Of the 986 participating players, 216 players sustained a total of 296 injuries in the 2004-2005 season. The overall injury rate was 30.02 injuries per 100 players per season (95% confidence interval, 27.17-32.99) or 4.13 injuries per 1000 player hours (95% confidence interval, 3.67-4.62). Forty-five percent of all injuries occurred during body checking. Compared with the youngest age group, Atom, the risk of injury was greater in Pee Wee (relative risk, 2.97; 95% confidence interval, 1.63-5.8), Bantam (relative risk, 3.72; 95% confidence interval, 2.08-7.14), and Midget (relative risk, 5.43; 95% confidence interval, 3.14-10.17) leagues. The risk of injury in Pee Wee was greatest in the most elite divisions (relative risk, 2.45; 95% confidence interval, 1.15-5.81). Concussion, shoulder sprain/dislocation, and knee sprain were the most common injuries. Conclusion Significant differences in injury rates were found by age and division of play. The public health significance of body checking injury in minor hockey is great. Future research will include expansion of surveillance to further examine body checking injuries and prevention strategies in minor hockey.

Risk of Injury Associated With Body Checking Among Youth Ice Hockey Players

CONTEXT Ice hockey has one of the highest sport participation and injury rates in youth in Canada. Body checking is the predominant mechanism of injury in leagues in which it is permitted. OBJECTIVE To determine if risk of injury and concussion differ for Pee Wee (ages 11-12 years) ice hockey players in a league in which body checking is permitted (Alberta, Canada) vs a league in which body checking is not permitted (Quebec, Canada). DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study conducted in Alberta and Quebec during the 2007-2008 Pee Wee ice hockey season. Participants (N = 2154) were players from teams in the top 60% of divisions of play. MAIN OUTCOME MEASURES Incidence rate ratios adjusted for cluster based on Poisson regression for game- and practice-related injury and concussion. RESULTS Seventy-four Pee Wee teams from Alberta (n = 1108 players) and 76 Pee Wee teams from Quebec (n = 1046 players) completed the study. In total, there were 241 injuries (78 concussions) reported in Alberta (85 077 exposure-hours) and 91 injuries (23 concussions) reported in Quebec (82 099 exposure-hours). For game-related injuries, the Alberta vs Quebec incidence rate ratio was 3.26 (95% confidence interval [CI], 2.31-4.60 [n = 209 and n = 70 for Alberta and Quebec, respectively]) for all injuries, 3.88 (95% CI, 1.91-7.89 [n = 73 and n = 20]) for concussion, 3.30 (95% CI, 1.77-6.17 [n = 51 and n = 16]) for severe injury (time loss, >7 days), and 3.61 (95% CI, 1.16-11.23 [n=14 and n=4]) for severe concussion (time loss, >10 days). The estimated absolute risk reduction (injuries per 1000 player-hours) that would be achieved if body checking were not permitted in Alberta was 2.84 (95% CI, 2.18-3.49) for all game-related injuries, 0.72 (95% CI, 0.40-1.04) for severe injuries, 1.08 (95% CI, 0.70-1.46) for concussion, and 0.20 (95% CI, 0.04-0.37) for severe concussion. There was no difference between provinces for practice-related injuries. CONCLUSION Among 11- to 12-year-old ice hockey players, playing in a league in which body checking is permitted compared with playing in a league in which body checking is not permitted was associated with a 3-fold increased risk of all game-related injuries and the categories of concussion, severe injury, and severe concussion.

Survey of sport participation and sport injury in Calgary and area high schools

Objective:To examine (1) sport participation and (2) sport injury in adolescents. Design, Setting, and Participants:This was a retrospective survey design. In total, 2873 adolescents were recruited from a random sample of classes from 24 Calgary and area high schools. Each subject completed an in-class questionnaire in March 2004. Main Outcome Measurements:Overall and sport-specific participation rates (number of sport participants/number of students completing survey). Overall and sport-specific injury rates (number of injuries/number of participants). Results:In the previous 1 year, 94% of students participated in sport. The top 5 sports by participation for males were basketball, hockey, football, snowboarding, and soccer, and for females, basketball, dance, volleyball, snowboarding, and soccer. The injury rate including only injuries requiring medical attention was 40.2 injuries/100 adolescents/y (95% CI, 38.4-42.1), presenting to a hospital emergency department was 8.1 injuries/100 adolescents/y (95% CI, 7.1-9.2), resulting in time loss from sport was 49.9 injuries/100 adolescents/y (95% CI, 48-51.8), and resulting in loss of consciousness was 9.3 injuries/100 adolescents/y (95% CI, 8.3-10.5). The greatest proportion of injuries occurred in basketball, hockey, soccer, and snowboarding. The top 5 body parts injured were the ankle, knee, head, back, and wrist. The top 5 injury types were sprain, contusion, concussion, fracture, and muscle strain. A previous injury was associated with 49% of the injuries and direct contact with 45% of injuries. Conclusions:Rates of participation in sport and sport injury are high in adolescents. Future research should focus on prevention strategies in sports with high participation and injury rates to maximize population health impact.

International Olympic Committee consensus statement on youth athletic development

The health, fitness and other advantages of youth sports participation are well recognised. However, there are considerable challenges for all stakeholders involved—especially youth athletes—in trying to maintain inclusive, sustainable and enjoyable participation and success for all levels of individual athletic achievement. In an effort to advance a more unified, evidence-informed approach to youth athlete development, the IOC critically evaluated the current state of science and practice of youth athlete development and presented recommendations for developing healthy, resilient and capable youth athletes, while providing opportunities for all levels of sport participation and success. The IOC further challenges all youth and other sport governing bodies to embrace and implement these recommended guiding principles.