James G. Garrick

The frequency of injury, mechanism of injury, and epidemiology of ankle sprains*

Few injuries in sports are more ubiquitous than those involving the ankle. Athletes in some endeavors, notably football and basketball, routinely have their ankles prophylacticly taped at a cost of hundreds of thousands of dollars and, probably, millions of man hours. Other sports, such as skiing, involve encasement of the foot, ankle, and lower leg in plastic and foam to the extent of almost complete exclusion of motion. In spite of these rather heroic measures, ankle injuries continue to constitute a significant threat to athletes in these and most other activities.

Role of external support in the prevention of ankle sprains.

ABSTRACTTwo thousand five hundred and sixty-two participants in a college intramural basketball program were studied during two successive intramural “seasons” with regard to the frequency of ankle and knee sprains, as related to the use of external ankle support. The influence on injury rates of hi

Disability days in Major League Baseball

We have examined the injury experience in Major League Baseball as reflected by the disabled list, based on data presented by American Specialty Companies in their publications, to examine any changes in injury rates over the past 11 years. It is reasonable to expect that improvements in training and conditioning, diagnostic methods, and surgical treatment over the last 11 years would have reduced injuries and resulted in fewer players on the disabled list. Yet, such does not appear to be the case. There is no evidence that the number of injuries in Major League Baseball has declined over the last decade; on the contrary, it appears that both the number of players and player days on the disabled list have increased. Team membership, injury location, and position do not appear to be related to the increase. Nor does it appear that the increase in injuries is a result of more sensitive diagnostic tests allowing the diagnoses of previously unrecognized injuries. Whatever the reason, it is significant that publicly available data, when viewed over an 11-year period, reveal a gradual and consistent increase in reported injuries—suggesting a problem that deserves attention.

Epidemiology of women's gymnastics injuries

Injury information from 98 participants in 2 years of interscho lastic womens gymnastics competition in four Seattle area high schools was collected by certified athletic trainers. During the 2nd year of data collection, the study was expanded to include an additional 12-team high school league, 2 college teams, and 3 private clubs. A wide variety of injuries was observed, the total time loss injury rate was 39.8 injuries per 100 participant-seasons. Strains and sprains involving the back, particularly the lumbar region, appeared to occur more fre quently than in most other interscholastic athletic activities. Ankle sprains were also common, and a relatively high fre quency of thigh and leg strains and overuse problems of the leg were seen. This suggests that there may well be room for improvement in conditioning and other preventive programs in womens gymnastics.

Medial collateral ligament injuries in football Nonoperative management of grade I and grade II sprains

During four academic years (1974-1978) at a major university, 51 of 70 knee injuries sustained by football players were Grade I or II sprains of the medial collat eral ligament of the knee. All were managed identically with an active rehabilitation program involving partial or no immobilization. Players with Grade I sprains returned to full, unprotected participation after an average of 10.6 days of time loss; those with Grade II sprains returned after 19.5 days. Neither group showed an appreciably increased likelihood of rein- jury. The likelihood of sustaining any knee injury was more than three times greater during spring as op posed to fall football.

Injuries to pitchers in women's collegiate fast-pitch softball

An injury survey of eight college softball teams ranked among the top 15 during the 1989 womens NCAA tournament championship by their athletic trainers found 26 injuries and complaints in 20 of 24 players. There were 15 grade I (nontime-loss) injuries, all mus culotendinous except for a leg contusion and an ankle sprain. The 6 grade II injuries (altered play) were also musculotendinous except for 2 sprains to the hand and wrist. The 5 grade III (stopped play) injuries were some what more varied in type and resulted in an average of almost 7 weeks of time lost per injured player. Eighty- two percent of the time-loss injuries (grades II and III) involved the upper extremity. This survey suggests that there are likely to be a significant number of injuries involving loss of time from practice or games among elite womens fast-pitch softball pitchers.

Injuries in recreational adult fitness activities

Volunteers (986) from fitness clubs and studios were recruited and followed for a 3-month period to docu ment the injury consequences of adult recreational fitness participation. Participants were telephoned each week and their activities as well as any injuries that occurred were recorded. Of the 525 injuries and complaints reported during 60,629 hours of activity, 475 occurred as a result of sports participation for an overall rate of 7.83 per 1000 hours of participation. Seventy-six percent of these episodes caused the patient to alter or miss 1 or more activities, while 9.5% involved a physician visit. The rate for time-loss injuries was less than 2 per person per year (1.76 per 298 hours) or 5.92 per 1000 hours. Running had a higher risk of injury compared with most other individual sports. Cardiovascular fitness activities had low to medium rates, as did weight work; compet itive sports were higher. For 6 of the most commonly injured areas, the reinjury rate was about twice that reported for those with no history of previous injury. The risks of injury from most recreational fitness activities were relatively modest, particularly if the ac tivities were not competitive. Physicians might help patients reduce their risks of injury by encouraging suitable activities and by reducing the risks of reinjury by implementing appropriate rehabilitation programs.

The epidemiology of aerobic dance injuries

Aerobic dance is currently the largest organized fitness activity primarily for women in the United States. In an attempt to identify and characterize the health problems associated with it, 351 students and 60 instructors from six facilities were followed for 16 weeks with weekly telephone calls. Of the 327 medical complaints reported during 29,924 hours of documented activity, only 84 (0.28 per hundred hours) resulted in any disa bility and only 2.1% required medical care. The shin/ leg, foot and ankle accounted for nearly two-thirds of the injuries. Instructors were twice as likely to be injured as students. Both a history of prior orthopaedic prob lems and a lack of involvement in other fitness activities resulted in higher injury rates. Injury rates were influ enced by the design and conduct of the aerobic pro gram but not by brand of shoe or type of flooring. Aerobic dance appears to offer students the potential for fitness enhancement with a minimal risk of injury.

Thoracic outlet compression in athletes a report of four cases.

Four cases of thoracic outlet compression have been presented. The occurrence of this syndrome in athletes has not to our knowledge been previously reported. We do not feel eliminating athletic participation is a viable option for our patients. We have been satisfied with nonoperative treatment but would not hestitate offering surgery if indicated, since most authors have had good results in those who have failed conservative care. Thoracic outlet compression should be considered in all patients with upper extremity pain including athletes.

Prophylactic knee bracing

Six studies to determine the effectiveness of prophy lactic knee braces in preventing medial collateral liga ment (MCL) injury in football are compared. Criteria useful in evaluating studies are discussed, such as the probability of confounding factors, bias in selecting cases and controls, and variations in defining injury and exposure. Cost, as well as some ethical issues asso ciated with mandated use are discussed. While four of these studies found a reduction in MCL injuries asso ciated with using a brace, two of them reported in creases. No consensus arises from these studies, con flicting results as well as methodological problems in some make it impossible to state with assurance the role of prophylactic knee bracing in football at this time.