Daniel Theisen

Injuries, risk factors and prevention initiatives in youth sport.

BACKGROUND Sports injuries in young athletes are a public health issue which deserves special attention. Effective prevention can be achieved with training programmes originating from the field of physical therapy and medicine. SOURCES OF DATA A systematic literature search on injury prevention in youth sport was performed in the MEDLINE database. AREAS OF AGREEMENT For prevention programmes to reduce sports injuries, critical factors must be considered, such as training content, duration and frequency, as well as athlete compliance. AREAS OF CONTROVERSY Home-based programmes could be inferior to supervised training, but are efficient if compliance is high. So far prevention programmes have focused on team sports and their efficiency in individual sports remains to be proven. GROWING POINTS Active prevention programmes focusing specifically on the upper extremity are scarce. Initiatives enhancing the awareness of trainers, athletes and therapists about risk factors and systematic prevention measures should be encouraged.

Complete inclusion of adaptive rowing only 1000 m ahead

Adaptive rowing (AR) at the Paralympic level is accessible for rowers with physical disability. AR was included for the first time in the Beijing 2008 Paralympic Games. Racing distance for all AR events is currently 1000 m, which impedes public recognition of this sport and leads to many organisational challenges during the inclusive World Rowing Championships. The aim of this report was to discuss the feasibility of increasing AR race distance to 2000 m from a sports injury and athletic health perspective. As limited data on injury and illness risks exist in AR, knowledge and experiences had to be taken from other Paralympic sports. The anticipated duration of 2000 m AR competitions is either comparable or considerably lower than that of the other Paralympic disciplines with similar characteristics. AR has inherent injury and health risks especially within thorax, shoulders and low back region, but they are not expected to be significantly modified by increased racing times. Specific considerations need to be taken into account for athletes with a spinal cord injury, like in other sport disciplines. There are no distinctive contra-indications for AR events of 2000 m based on the current literature review and a 10-year experience in this sport. Long-term follow-ups are needed to understand fully the injury and health risk associated with AR and to develop appropriate prevention strategies.

Patellar Instability in Football Players

Patellar instability is characterized by an abnormal, most of the time, lateral movement of the patella in the trochlear groove of the femur. The incidence rate has not yet been reported in football players. However, football is one of the most common sports to induce patellar dislocations as it involves twisting movements and contacts between players or with the ground. Many factors such as age, exercise, sex, family history, previous dislocation, and bony and soft tissue parameters can impact the risk of a patellar dislocation. The clinical examination therefore starts with an anamnesis including the exact mechanism and the family history of patellar dislocation. The physical examination must include palpation of relevant patellofemoral soft tissues, as well as evaluation of mediolateral mobility, apprehension, and J sign tests. To obtain a detailed description of the pathology, X-ray and CT scans or MRI are essential. The risk for recurrent dislocations is closely related to the patient’s age and the patellofemoral morphology. Nonoperative treatment is usually preferred for a primary dislocation without major structural risk factors (malalignment, dysplasia) or structural damage (static subluxation of the patella, osteochondral fragments). Conversely, surgery is recommended for secondary and recurrent dislocations. The current rehabilitation strategies aim to regain full range of motion, to stabilize patellar tracking and to strengthen the quadriceps. Players are allowed to return to sport when these rehabilitation targets are achieved, usually within 3–6 months after injury/surgery. However, many of them cannot return to their preoperative level.

IMPACT OF TRAINING CHARACTERISTICS ON RUNNING-RELATED INJURIES IN RECREATIONAL RUNNERS

Background Most running-related injuries (RRI) are attributed to training errors. Objective This study investigated which running training characteristics are potential risk factors for RRI. Design Prospective cohort study. Setting Recreational distance runners. Participants A total of 267 participants accepted to upload weekly all information about running training characteristics, other sport participation and injuries on a dedicated internet platform. Risk factor assessment This 9-month follow-up investigated if the risk for RRI was influenced by some of the following running training characteristics: weekly volume (hours/week), weekly frequency (session/week), self-reported session intensity (CR10-Borg Scale), week-to-week absolute change in distance (km/week) and the concomitant use of different pairs of shoes (parallel use of a minimum of 2 different pairs of running shoes). Main outcome measurements The primary outcome measure was total volume (hours) of running training and competitions (exposure) until the first RRI (Cox regression analyses). A RRI was defined as any physical complaint located at the lower limbs or lower back region, sustained during or as a result of running practice and impeding planned running activity for at least 1 day. Results Overall, 89 participants (33%) recorded an RRI. The total incidence was 6.05 injuries per 1000h of exposure. The adjusted Cox regression analysis revealed that participants who practiced more than 2 hours/week were at a lower risk of RRI (Hazard ratio (HR): 0.539; 95% Confident interval (CI): 0.295-0.986) even when controlling for running experience and training regularity during the previous 12 months. The parallel use of more than one pair of running shoes (HR=0.600; 95% CI=0.369–0.975) and the week-to-week absolute change in distance (HR: 0.882; 68% CI: 0.836–0.931) were also protective factors, while previous injury was a risk factor (HR=1.841; 95% CI=1.185–2.860). Conclusions This study identified training characteristics which are related to RRI risk.

Static Rotational Knee Laxity Measurements

Static rotational knee laxity measurements have the advantages of precisely quantifying laxity and are thus potentially more objective than manual tests. Moreover, they can help to establish the diagnosis of knee injuries and to evaluate the success of reconstruction procedures after surgical intervention. As a consequence, they may systematically be part of follow-up to knee injuries (i.e. anterior cruciate ligament injuries). Numerous devices to measure knee rotation in a non-invasive manner exist. Although further efforts are necessary to improve the use of rotational laxity measurements in daily clinical practice, existing data on static rotational knee laxity measurements is encouraging to further investigate it in healthy and injured persons. Rotational knee laxity measurements allow (1) for the evaluation of the physiological knee laxity as a risk factor for knee injuries and poor reconstruction outcomes, (2) for the diagnosis of knee injuries (i.e. anterior cruciate ligament injuries) and (3) to follow knee ligament reconstructions postoperatively. The lack of knowledge of rotational knee laxity measurements in injured/reconstructed knees, however, prevents us to conclude the best treatment or reconstruction techniques. The present chapter aims to analyse the current knowledge and the potential for rotational knee laxity measurements to follow and individualise care for knee injuries and diseases.

Instrumented Static Laxity Evaluation

Knee laxity is a highly complex issue, depending on an individual’s soft tissue quality and bony configuration. It can be evaluated both in a single and in multiple directions or statically and dynamically. Knee laxity is difficult to assess clinically, because it is highly dependent on the examiner’s experience, which in addition does not allow a precise quantification of knee laxity. Therefore, several devices have been developed to measure static knee laxity. In the early stages, they were limited to measurements in the sagittal plane. Over the last decade, static rotational laxity measurement devices have been added and are currently under development. Despite the fact that instrumented laxity assessments have been performed over several decades, limited knowledge is available on multidirectional static laxity assessments in large populations. Laxity evaluations in large groups followed over time could allow (1) for the study of physiological laxity and risk factors for knee injuries, (2) to confirm the diagnosis of soft tissue injuries, (3) to help distinguish between the different subtypes of anterior cruciate ligament (ACL) tears as well as associated injuries and (4) to follow patients who have had ACL reconstruction. This chapter will provide an overview of currently existing laxity devices and new findings on static knee laxity evaluations. Despite recent advances, there is still much work to be done to improve the use of arthrometers in the daily clinical practice.

Sportverletzungen des Kniegelenks im Kindesalter

ZusammenfassungRegelmäßige sportliche Aktivität im Kindes- und Jugendalter sollte wegen verschiedener positiver gesundheitlicher Effekte gefördert werden, kann aber auch mit Knieverletzungen einhergehen, die zum Sportabbruch und zu gesundheitlichen Langzeitfolgen führen. Aufgrund der physiologischen Wachstumsprozesse im Rahmen der biologischen Reifung unterscheiden sich Knieverletzungen bei Kindern von denen bei Jugendlichen und Erwachsenen. Allgemein gesehen sind sie häufiger bei Jungen, wobei im Rahmen von sportlicher Aktivität Mädchen häufiger betroffen sind. Folgende unterschiedliche Risikofaktoren für Sportverletzungen konnten gefunden werden: Alter, Vorverletzung, Sportart und -kontext, Trainingsumfang, Koordination sowie psychologischer Zustand. Die beeinflussbaren Faktoren sollten dabei in die primäre und sekundäre Verletzungsprävention einbezogen werden.AbstractActive sport participation should be encouraged in children and adolescents because of a variety of beneficial effects on health. However, regular physical activity also generates a significant proportion of knee injuries, which will affect future involvement and may have detrimental long-term health consequences. Because of the physiological processes related to biological maturation, knee injuries in children have a different pattern compared to adolescents and adults. Knee lesions are generally more common in boys, but in a sport context girls are more frequently affected. A series of other risk factors for sports injuries have been identified, such as age, injury history, context and type of sport, training volume, coordination and psychological factors. Those factors which are modifiable should be targeted for primary and secondary injury prevention.