Conor Gissane

For Debate: Consensus Injury Definitions in Team Sports Should Focus on Encompassing all Injuries

Objective: The purpose of this paper is to highlight the most effective method of collecting injury data by using a definition that encompasses all injuries into the data collection system. The definition provides an accurate picture of injury incidence and also allows filtering of records so that data can be reported in a variety of comparable ways. Data Sources/Synthesis: A qualitative review of literature in team sports, plus expert opinion, served as the basis for data collection strategies. Articles were retrieved from SportsDiscus and PubMed using the terms “sports injury definition” and “injury definition.” These terms were searched for the period 1966 to November 2006. Results: One of the major results (from this paper) that supports the use of an all-encompassing injury definition is that 70% to 92% of all injuries sustained fall into the transient category-that is, by only recording injuries that result in missed matches, the majority of injuries are missed and therefore injury rates are underreported. Conclusion: An injury definition should be the most encompassing definition that enables a true, global picture of injury incidence to be seen in participation in any team sport.

Concussions in amateur rugby union identified with the use of a rapid visual screening tool

AIM To use the King-Devick (KD) test and Sports Concussion Assessment Tool 2 (SCAT2) in amateur rugby union players to identify witnessed and unrecognised episodes of concussion that occurred from match participation. METHODS A prospective observational cohort study was conducted on a premier club level amateur rugby union team during the 2012 competition in New Zealand. Every player completed a pre-competition questionnaire on concussion history, a baseline PCSS and two trials of the KD before they participated in any match activities. RESULTS For players reporting a concussion in the previous three years there was an average of 4.0±2.8 concussions per player. There were 22 concussive incidents recorded over the duration of the competition (46 per 1000 match hours). Five concussive incidents were witnessed (11 per 1000 match hours) and 17 unrecognised concussive incidents were identified with the KD (37 per 1000 match hours). Witnessed concussions recorded, on average, a longer KD on the day of injury (5.5±2.4s) than unrecognised concussions (4.4±0.9s) when compared with their baseline KD. DISCUSSION The KD was able to identify players that had not shown, or reported, any signs or symptoms of a concussion but who had meaningful head injury. The current rate of concussion reported was a ten-fold increase in previously reported concussion injury rates. This makes the KD suitable for rapid assessment in a limited time frame on the sideline such as a five-minute window to assess and review suspected concussed players in rugby union.

A Comparison Between Performance on Selected Directions of the Star Excursion Balance Test and the Y Balance Test

CONTEXT The Star Excursion Balance Test (SEBT) is a widely accepted method of assessing dynamic postural stability. The Y Balance Test (YBT) is a commercially available device for measuring balance that uses 3 (anterior, posteromedial, and posterolateral) of the 8 SEBT directions and has been advocated as a method for assessing dynamic balance. To date, no studies have compared reach performance in these tests in a healthy population. OBJECTIVE To determine whether any differences exist between reach distance performance for the anterior, posteromedial, and posterolateral directions of the SEBT and the YBT. DESIGN Descriptive laboratory study. SETTING University motion analysis laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 20 healthy active male participants (age = 22.50 ± 3.05 years, height = 1.78 ± 0.82 m, weight = 79.48 ± 11.32 kg, body mass index = 24.96 ± 2.56 kg/m²). INTERVENTION(S) Participants carried out 3 trials in each reach direction on each leg on the SEBT and the YBT a minimum of 1 week apart. MAIN OUTCOME MEASURE(S) The means of the 3 trials in each direction on each leg on both tests were calculated. Data were collected after 4 practice trials in each direction. Paired t tests and Bland-Altman plots were used to compare reach distances between the SEBT and the YBT. RESULTS Participants reached farther in the anterior direction on the SEBT than on the YBT. No differences were observed in the posteromedial and posterolateral directions. CONCLUSIONS Differing postural-control strategies may be used to complete these tasks. This finding has implications for the implementation and interpretation of these dynamic balance tests.

Use of a rapid visual screening tool for the assessment of concussion in amateur rugby league: A pilot study

AIM This study undertook to use the K-D sideline test with the SCAT2 to see if concussions could be identified in amateur rugby league players over a representative competition period. METHOD A prospective cohort study was conducted on two teams participating in an amateur rugby league. All players were tested for signs of concussion utilising the K-D test and players with longer times than their baseline scores undertook a further concussion assessment with the SCAT2. RESULTS Five athletes with suspected concussion were evaluated by K-D testing. Three concussions were associated with witnessed events during the matches and two athletes were identified by the team medic as having longer K-D time scores incidentally post-match compared to baseline. Post-match K-D scores for all concussed athletes were worse than baseline for those with reported or witnessed concussion events (7s; 5.0-7.1; p=0.025) and for those identified incidentally (>5s; 8.9-9.1s). Both groups also reported more symptoms on the PCSS (a part of the SCAT2) post-match. DISCUSSION In this rugby cohort, the K-D test was not only useful in identifying changes in players with witnessed head trauma, but in identifying changes in players with an un-witnessed suspected concussion.

A 12 month prospective cohort study of injury in international rowers.

Objective In this study, the injury incidence and association with type and volume of training in international rowers were described. Design A prospective cohort design was used over a 12-month period. Patients 20 international rowers who were competing as part of the Irish Amateur Rowing Union squad system. Methods The rowers were interviewed monthly, and data were collected regarding their training and competition exposure as well as their injury experience. Results A mean injury rate of 3.67 per 1000 exposure hours was reported with a total of 44 injuries reported in a 12-month period. The mean number of injuries sustained per athlete was 2.2 (1.24) over the 12-month period. The area where the greatest number of injuries were reported was the lumbar spine (31.82% of total injuries, 95% CI 20 to 50) (fig 2) followed by the knee (15.91% of total injuries, 95% CI 10 to 30) and the cervical spine (11.36% of total injuries, 95% CI 5 to 24). Half of the injuries (22 injuries, 50% of total reported injuries) were to the spine (χ2 = 30.8, df = 9, p = 0.0003). Ergometer training load was the most significantly associated with injury risk (r = 0.68, p = 0.01). Conclusion International rowers are at higher risk of injury than most non-contact sports and some contact sports. The high risk of lumbar spine injury and the significant association of high volume of ergometer training merit further research to reduce time and competition lost to injury.

Incidence of Injury in Gaelic Football A 4-Year Prospective Study

Background: Gaelic football is a national sport of Ireland. While predominantly played in Ireland, it is recognized in North America, the United Kingdom, Europe, and Australasia. Its high-velocity, multidirectional, and high physical contact elements expose players to a risk of injury. To date, prospective injury data for Gaelic football has been of short duration. Purpose: To describe the incidence and nature of sport-related injuries in elite male Gaelic football players over 4 consecutive seasons. Study Design: Descriptive epidemiology study. Methods: Over the period 2007 to 2010, a total of 851 Gaelic football players were tracked. Players were members of county-level teams who volunteered to be included in the study. Team injury, training, and match play data were submitted by the team physiotherapist on a weekly basis through a dedicated web portal to the National Gaelic Athletic Association (GAA) injury database. Injury was defined using a time loss criterion, in accordance with consensus statements in sports applicable to Gaelic games. Results: A total of 1014 Gaelic football injuries were recorded. Incidence of injury was 4.05 per 1000 hours of football training. Match-play injury rates were 61.86 per 1000 hours. Muscle was the most frequently injured tissue (42.6%) and fractures accounted for 4.4% of Gaelic football injuries. Lower extremity injuries predominated (76.0%). Hamstring injuries were the single most common injury overall, representing almost one quarter (24%) of all injuries and over half of muscle injuries. Anterior cruciate ligament (ACL) injuries accounted for 13% of knee injuries. The majority of injuries were defined as new injuries (74.7%), with recurrent injuries constituting 23% of all injuries. The majority (59%) of match play injuries occurred in the second half of the match. Eighty six percent of injuries caused over one week’s absence from play. Conclusion: These findings illustrate injury patterns in Gaelic football using a prospective methodology, over 4 consecutive seasons. Comparison with published literature suggests that Gaelic football match play injury risk is greater than soccer but less than rugby union.

Injury in summer rugby league football: the experiences of one club.

OBJECTIVE: To investigate whether the movement of the playing season from winter to summer would alter the risk of injury to players taking part in first team European professional rugby league. METHODS: The study design was a historical cohort design comparing winter and summer seasons in first team European rugby league, which recorded injuries received by players during match play. Each injury was classified according to site, type, player position, activity at the time of injury, and time off as a result of injury. RESULTS: The risk of injury when playing summer rugby league was higher than when playing winter rugby league (relative risk = 1.67 (95% confidence interval 1.18 to 2.17)). Both forwards (1.08 (0.28 to 1.88)) and backs (2.36 (2.03 to 2.69)) experienced an increased risk of injury. CONCLUSIONS: Summer rugby may have resulted in a shift of injury risk factors as exhibited by a change in injury patterns. This may be due to playing conditions, but there were also some law changes. Changes in playing style, team tactics, player equipment, fitness preparation, and the reduced preseason break may also have had confounding effects on injury risk.

Instrumented mouthguard acceleration analyses for head impacts in amateur rugby union players over a season of matches

Background: Direct impacts with the head (linear acceleration or pressure) and inertial loading of the head (rotational acceleration or strain) have been postulated as the 2 major mechanisms of head-related injuries such as concussion. Although data are accumulating for soccer and American football, there are no published data for nonhelmeted collision sports such as rugby union. Purpose: To quantify head impacts via instrumented mouthguard acceleration analyses for rugby union players over a season of matches. Study Design: Descriptive epidemiology study. Methods: Data on impact magnitude and frequency were collected with molded instrumented mouthguards worn by 38 premier amateur senior rugby players participating in the 2013 domestic season of matches. Results: A total of 20,687 impacts >10g (range, 10.0-164.9g) were recorded over the duration of the study. The mean ± SD number of impacts per player over the duration of the season of matches was 564 ± 618, resulting in a mean ± SD of 95 ± 133 impacts to the head per player, per match over the duration of the season of matches. The impact magnitudes for linear accelerations were skewed to the lower values (Sp = 3.7 ± 0.02; P < .001), with a mean linear acceleration of 22.2 ± 16.2g. Rotational accelerations were also skewed to the lower values (Sp = 2.0 ± 0.02; P < .001), with a mean rotational acceleration of 3902.9 ± 3948.8 rad/s2. Conclusion: The acceleration magnitudes and number of head impacts in amateur rugby union players over a season of matches, measured via instrumented mouthguard accelerations, were higher than for most sports previously reported. Mean linear acceleration measured over a season of matches was similar to the mean linear accelerations previously reported for youth, high school, and collegiate American football players but lower than that for female youth soccer players. Mean rotational acceleration measured over a season of matches was similar to mean rotational accelerations for youth, high school, and collegiate American football players but less than those for female youth soccer players, concussed American collegiate players, collegiate American football players, and professional American football players.

An operational model to investigate contact sports injuries.

PURPOSE A cyclical operational model is proposed to examine the interrelationship of a number of factors that are involved in sports injury epidemiology. In sports injury research, investigations often attempt to identify a unique risk factor that distinguishes an injured player. However, a wide variety of factors can contribute to a sports injury occurring, and an understanding of the cause of injury is important to advance knowledge. METHODS The proposed model identifies a healthy/fit player initially, although the player may exhibit a number of intrinsic risk factors for sports injury. Before exposure to extrinsic risk factors, there is the opportunity for implementation of prevention strategies by coaching personnel and the sports medicine team. These strategies might include, among others, appropriate warm-up, adequate hydration, wearing protective equipment, and prophylactic taping. Additionally, preventative screening could take place to assess the various intrinsic and extrinsic risk factors that could lead to sports injury. DISCUSSION Two examples of how the operational model relates to contact sports injury cases are presented. Participating in sport inevitably exposes the player to external risk factors that predispose toward injury. The treatment of the injured player aims to restore the player to preinjury playing status and to prevent the injury from becoming chronic. CONCLUSIONS It is suggested that the application of this proposed cyclical model may lead to greater success in understanding the multifaceted nature of sports injuries and furthermore help minimize injury risk and support the rehabilitation of injured contact sports participants.

Epidemiological studies of injuries in rugby league: Suggestions for definitions, data collection and reporting methods

Studies on rugby league injuries use a variety of definitions and methodologies. Consequently, comparisons of published studies are difficult. Researchers with an interest in understanding the epidemiology of rugby league injury participated in a majority agreement process. This paper provides suggestions for the definitions, data collection and reporting methods for future studies of rugby league injuries. The proposed methods and definitions were developed through the use of a majority agreement process on draft versions by all authors. Recommended definitions for injury incidence, recurrence, severity and match exposure are provided as well as injury site, type, diagnosis and causation. Suggestions for match and training injury incidence calculations are also provided for the purposes of comparison. This paper provides standard definitions that, if utilised, will enable meaningful comparison of future rugby league injury surveillance data from different countries and playing levels.