D. Twomey

Preventing lower limb injuries: is the latest evidence being translated into the football field?

There is accumulating international evidence that lower limb injuries in sport can be prevented through targeted training but the extent to which this knowledge has been translated to real-world sporting practice is not known. A semi-structured questionnaire of all coaches from the nine Sydney Australian Football League Premier Division teams was conducted. Information was sought about their knowledge and behaviours in relation to delivering training programs, including their uptake of the latest scientific evidence for injury prevention. Direct observation of a sample of the coach-delivered training sessions was also undertaken to validate the questionnaire. Coaches ranked training session elements directly related to the game as being of most importance. They strongly favoured warming-up and cooling-down as injury prevention measures but changing direction and side-stepping training was considered to be of little/no importance for safety. Only one-third believed that balance training had some importance for injury prevention, despite accumulating scientific evidence to the contrary. Drills, set play, ball handling and kicking skills were all considered to be of least importance to injury prevention. These views were consistent with the content of the observed coach-led training sessions. In conclusion, current football training sessions do not give adequate attention to the development of skills most likely to reduce the risk of lower limb injury in players. There is a need to improve the translation of the latest scientific evidence about effective injury prevention into coaching practices.

Implementing an exercise-training programme to prevent lower-limb injuries: considerations for the development of a randomised controlled trial intervention delivery plan

Objective To identify important considerations for the delivery of an exercise training intervention in a randomised controlled trial to maximise subsequent participation in that randomised controlled trial and intervention uptake. Design A cross-sectional survey, with a theoretical basis derived from the Health Belief Model (HBM) and the Reach, Efficacy/Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. Participants 374 male senior Australian Football players, aged 17–38 years. Main outcome measurements Beliefs about lower-limb injury causation/prevention, and the relative value of exercise training for performance and injury prevention. The data are interpreted within HBM constructs and implications for subsequent intervention implementation considered within the RE-AIM framework. Ordinal logistic regression compared belief scores across player characteristics. Results 74.4% of players agreed that doing specific exercises during training would reduce their risk of lower-limb injury and would be willing to undertake them. However, 64.1% agreed that training should focus more on improving game performance than injury prevention. Younger players (both in terms of age and playing experience) generally had more positive views. Players were most supportive of kicking (98.9%) and ball-handling (97.0%) skills for performance and warm-up runs and cool-downs (both 91.5%) for injury prevention. Fewer than three-quarters of all players believed that balance (69.2%), landing (71.3%) or cutting/stepping (72.8) training had injury-prevention benefits. Conclusions Delivery of future exercise training programmes for injury prevention aimed at these players should be implemented as part of routine football activities and integrated with those as standard practice, as a means of associating them with training benefits for this sport.

Fielders and batters are injured too: A prospective cohort study of injuries in junior club cricket

Internationally, there is a lack of good quality, prospectively collected injury data reported for junior club cricketers. This study describes injury rates according to age level of play and playing positions in junior community-level club cricketers to identify priorities for prevention. A prospective cohort study was used to monitor injuries in 88 under 12 years (U12), 203 U14 and 120 U16 players from the Ballarat Junior Cricket Association, Australia over the 2007/2008 playing season. Injury rates were calculated per 1000 participations when batting, bowling or fielding in matches and training sessions. Injury rate ratios were used to compare rates across age levels of play and position of play. Overall, 47 injuries were reported. Injury rates increased with age level of play with only one U12 player injured. Match injury rates were 3.57 per 1000 U14 participations versus 4.80 per 1000 U16 participations. Training injury rates were 4.20 per 1000 U14 participations versus 5.11 per 1000 U16 participations. On a proportionate basis, injuries occurred equally to fielders, batters and bowlers. There was a trend towards more injuries occurring while batting and fielding in matches, and more injuries occurring while bowling and batting during training sessions. In conclusion, injury rates in junior cricket players are low, but increase with age level of play. Unlike adult forms of the game, injuries occur to fielders and batters at least as frequently as to bowlers, indicating that preventive strategies need to be developed for all junior players and not just bowlers, as has been the focus previously.

Priorities for Investment in Injury Prevention in Community Australian Football

Objective:High-quality sport-specific information about the nature, type, cause, and frequency of injuries is needed to set injury prevention priorities. This article describes the type, nature, and mechanism of injuries in community Australian Football (community AF) players, as collected through field-based monitoring of injury in teams of players. Data Sources:Compilation of published prospectively collected injury data from 3 studies in junior community AF (1202 injuries in 1950+ players) and 3 studies in adult community AF (1765 injuries in 2265 players). This was supplemented with previously unpublished data from the most recent adult community AF injury cohort study conducted in 2007 to 2008. Injuries were ranked according to most common body regions, nature of injury, and mechanism. Main Results:In all players, lower limb injuries were the most frequent injury in community AF and were generally muscle strains, joint sprains, and superficial injuries. These injuries most commonly resulted from incidental contact with other players, or from “overexertion.” Upper limb injuries were less common but included fractures, strains, and sprains that were generally caused by incidental contact between players and the result of players falling to the ground. Conclusions:Lower limb injuries are common in community AF and could have an adverse impact on sustained participation in the game. Based on what is known about their mechanisms, it is likely that a high proportion of lower limb injuries could be prevented and they should therefore be a priority for injury prevention in community AF.

Ground hardness and injury in community level Australian football.

OBJECTIVES To describe the risk and details of injuries associated with ground hardness in community level Australian football (AF). DESIGN Prospective injury surveillance with periodic objective ground hardness measurement. METHODS 112 ground hardness assessments were undertaken using a Clegg hammer at nine locations across 20 grounds, over the 2007 and 2008 AF seasons. Details of 352 injuries sustained by community level players on those grounds were prospectively collected as part of a large randomised controlled trial. The ground location of the injury was matched to the nearest corresponding ground hardness Clegg hammer readings, in gravities (g), which were classified from unacceptably low (<30 g) to unacceptably high hardness (>120 g). RESULTS Clegg hammer readings ranged from 25 to 301 g. Clegg hammer hardness categories from low/normal to high/normal were associated with the majority of injuries, with only 3.7% (13 injuries) on unacceptably high hardness and 0.3% (1 injury) on the unacceptably low hardness locations. Relative to the preferred range of hardness, the risk of sustaining an injury on low/normal hardness locations was 1.31 (95%CI: 1.06-1.62) times higher and 1.82 (95%CI: 1.17-2.85) times higher on locations with unacceptably high hardness. The more severe injuries occurred with low/normal ground hardness. CONCLUSIONS Despite the low number of injuries, the risk of sustaining an injury on low/normal and unacceptably hard grounds was significantly greater than on the preferred range of hardness. Notably, the severity of the injuries sustained on unacceptably hard grounds was lower than for other categories of hardness.

The reach and adoption of a coach-led exercise training programme in community football

Objective To determine the reach and adoption of a coach-led exercise training programme for lower limb injury prevention. Design Secondary analysis of data from a group-clustered randomised controlled trial. Setting A periodised exercise training warm-up programme was delivered to players during training sessions over an 8-week preseason (weeks 1–8) and 18-week playing season. Participants 1564 community Australian football players. Main outcome measurements Reach, measured weekly, was the number of players who attended training sessions. Adoption was the number of attending players who completed the programme in full, partially or not at all. Reasons for partial or non-participation were recorded. Results In week 1, 599 players entered the programme; 55% attended 1 training session and 45% attended > 1 session. By week 12, 1540 players were recruited but training attendance (reach) decreased to <50%. When players attended training, the majority adopted the full programme—ranging from 96% (week 1) to above 80% until week 20. The most common reasons for low adoption were players being injured, too sore, being late for training or choosing their own warm-up. Conclusions The training programmes reach was highest preseason and halved at the playing seasons end. However, when players attended training sessions, their adoption was high and remained close to 70% by season end. For sports injury prevention programmes to be fully effective across a season, attention also needs to be given to (1) encouraging players to attend formal training sessions and (2) considering the possibility of some form of programme delivery outside of formal training.

Preventing Australian football injuries with a targeted neuromuscular control exercise programme: comparative injury rates from a training intervention delivered in a clustered randomised controlled trial

Background Exercise-based training programmes are commonly used to prevent sports injuries but programme effectiveness within community mens team sport is largely unknown. Objective To present the intention-to-treat analysis of injury outcomes from a clustered randomised controlled trial in community Australian football. Methods Players from 18 male, non-elite, community Australian football clubs across two states were randomly allocated to either a neuromuscular control (NMC) (intervention n=679 players) or standard-practice (control n=885 players) exercise training programme delivered as part of regular team training sessions (2× weekly for 8-week preseason and 18-week regular-season). All game-related injuries and hours of game participation were recorded. Generalised estimating equations, adjusted for clustering (club unit), were used to compute injury incidence rates (IIRs) for all injuries, lower limb injuries (LLIs) and knee injuries sustained during games. The IIRs were compared across groups with cluster-adjusted Injury Rate Ratios (IRRs). Results Overall, 773 game injuries were recorded. The lower limb was the most frequent body region injured, accounting for 50% of injuries overall, 96 (12%) of which were knee injuries. The NMC players had a reduced LLI rate compared with control players (IRR: 0.78 (95% CI 0.56 to 1.08), p=0.14.) The knee IIR was also reduced for NMC compared with control players (IRR: 0.50 (95% CI 0.24 to 1.05), p=0.07). Conclusions These intention-to-treat results indicate that positive outcomes can be achieved from targeted training programmes for reducing knee and LLI injury rates in mens community sport. While not statistically significant, reducing the knee injury rate by 50% and the LLI rate by 22% is still a clinically important outcome. Further injury reductions could be achieved with improved training attendance and participation in the programme.

What do community football players think about different exercise-training programmes? Implications for the delivery of lower limb injury prevention programmes

Background Players are the targeted end-users and beneficiaries of exercise-training programmes implemented during coach-led training sessions, and the success of programmes depends upon their active participation. Two variants of an exercise-training programme were incorporated into the regular training schedules of 40 community Australian Football teams, over two seasons. One variant replicated common training practices, while the second was an evidence-based programme to alter biomechanical and neuromuscular factors related to risk of knee injuries. This paper describes the structure of the implemented programmes and compares players’ end-of-season views about the programme variants. Methods This study was nested within a larger group-clustered randomised controlled trial of the effectiveness of two exercise-training programmes (control and neuromuscular control (NMC)) for preventing knee injuries. A post-season self-report survey, derived from Health Belief Model constructs, included questions to obtain players’ views about the benefits and physical challenges of the programme in which they participated. Results Compared with control players, those who participated in the NMC programme found it to be less physically challenging but more enjoyable and potentially of more benefit. Suggestions from players about potential improvements to the training programme and its future implementation included reducing duration, increasing range of drills/exercises and promoting its injury prevention and other benefits to players. Conclusions Players provide valuable feedback about the content and focus of implemented exercise-training programmes, that will directly inform the delivery of similar, or more successful, programmes in the future.

Reliability of equipment for measuring the ground hardness and traction

The aim of this paper is to report the inter-rater reliabilities and intra-rater reliabilities of the Clegg hammer, penetrometer, and studded-boot apparatus used for measuring the mechanical properties of natural turf, and to determine whether the level of experience influences the reliability. Three experienced and three novice testers measured the surface hardness and rotational traction at nine locations on a community-level Australian football oval. A repeated-measures analysis of variance tested for significant differences between the six testers for all equipment, and intra-class correlation coefficients (ICCs) were calculated to determine the inter-rater reliabilities and intra-rater reliabilities. The ICCs for the reliability between the six testers ranged between 0.77 and 0.87 for the Clegg hammer, ranged between 0.55 and 0.73 for the penetrometer, and equalled 0.51 for the studded-boot apparatus. The inter-rater reliabilities and intra-rater reliabilities were greater for the experienced testers than for the novice testers for the Clegg hammer and penetrometer but the novice testers produced greater inter-rater reliabilities for the studded-boot apparatus. This study highlights the potential variability that can exist between testers using the ground hardness and traction equipment, which has implications for future research involving multiple testers both in agronomic-based studies and in linking the surface properties to the injury risk across multiple venues.

The relationship between ground conditions and injury: What level of evidence do we have?

OBJECTIVES To identify studies which address the relationship between ground conditions and injury, in a sporting context and to evaluate current practice and provide recommendations for future studies that measure ground conditions and injury risk. DESIGN Systematic review. METHODS A comprehensive search of electronic databases from the earliest records available until the end of 2011, and supplemental hand searching was conducted to identify relevant studies. A classification scale was used to rate the methodological quality of studies. RESULTS 79 potentially relevant articles were identified, and 27 met all inclusion criteria. They varied in methodological quality, with analytical observational studies the most common design, although four descriptive observational studies, considered to be of lower quality were also identified. Only five studies objectively measured ground conditions, and of studies that used subjective assessment, only one provided descriptors to explain their classifications. It appears that harder/drier grounds are associated with an increased injury risk but the presence of major limitations necessitates cautious interpretation of many key findings. CONCLUSIONS There is limited high quality evidence of the relationship between injury risk and ground conditions. Further research with high quality designs, and measurement of ground conditions are required to draw more definitive conclusions regarding this relationship.