Kristen L. Kucera

Injury history as a risk factor for incident injury in youth soccer

Objectives: To determine if athletes with a self reported history of previous injury have a higher incident injury rate than athletes without a self reported injury history. Methods: A prospective cohort study of Classic League soccer players playing at the level under 12 through under 18. Injury history forms were mailed to all registering Classic League soccer players in the North Carolina Youth Soccer Association during 1997–2000 (n  =  7000); 1483 (19%) returned the baseline questionnaire and were followed up for injuries. Results: There were 5139 player-seasons of follow up and an estimated 171 957 athlete-exposures. More than half self reported an injury history (59.7%). Overall, the unadjusted incidence rate was 4.6 (95% confidence interval (CI) 4.3 to 4.9) incident injuries per 1000 athlete-exposures. Multivariate generalised Poisson regression modelling indicated that players with one previous injury had a twofold greater risk of incident injury (IRR  =  2.6; 95% CI 2.0 to 3.3), and those with two or more previous injuries had a threefold greater risk of incident injury (IRR  =  3.0; 95% CI 2.3 to 3.8) compared with athletes with no previous injuries. Conclusions: Injury history was associated with an increased injury rate. This suggests that, even in these youth soccer players, those with an injury history may be at higher risk.

Validity of Soccer Injury Data from the National Collegiate Athletic Association's Injury Surveillance System

CONTEXT Few validation studies of sport injury-surveillance systems are available. OBJECTIVE To determine the validity of a Web-based system for surveillance of collegiate sport injuries, the Injury Surveillance System (ISS) of the National Collegiate Athletic Associations (NCAA). DESIGN Validation study comparing NCAA ISS data from 2 fall collegiate sports (mens and womens soccer) with other types of clinical records maintained by certified athletic trainers. SETTING A purposive sample of 15 NCAA colleges and universities that provided NCAA ISS data on both mens and womens soccer for at least 2 years during 2005-2007, stratified by playing division. PATIENTS OR OTHER PARTICIPANTS A total of 737 mens and womens soccer athletes and 37 athletic trainers at these 15 institutions. MAIN OUTCOME MEASURE(S) The proportion of injuries captured by the NCAA ISS (capture rate) was estimated by comparing NCAA ISS data with the other clinical records on the same athletes maintained by the athletic trainers. We reviewed all athletic injury events resulting from participation in NCAA collegiate sports that resulted in 1 day or more of restricted activity in games or practices and necessitated medical care. A capture-recapture analysis estimated the proportion of injury events captured by the NCAA ISS. Agreement for key data fields was also measured. RESULTS We analyzed 664 injury events. The NCAA ISS captured 88.3% (95% confidence interval = 85.9%, 90.8%) of all time-lost medical-attention injury events. The proportion of injury events captured by the NCAA ISS was higher in Division I (93.8%) and Division II (89.6%) than in Division III (82.3%) schools. Agreement between the NCAA ISS data and the non-NCAA ISS data was good for the majority of data fields but low for date of full return and days lost from sport participation. CONCLUSIONS The overall capture rate of the NCAA ISS was very good (88%) in mens and womens soccer for this period.

Epidemiology of Overuse Injuries in Collegiate and High School Athletics in the United States

Background: Overuse injuries result from microtrauma due to repetitive loading combined with insufficient tissue recovery time and can result in both immediate and long-term time loss from sports. Hypothesis: Overuse injury rates and patterns differ across college and high school populations, sport, and sex. Study Design: Descriptive epidemiology study. Methods: Surveillance data for 16 sports from the National Collegiate Athletic Association’s Injury Surveillance System (NCAA ISS; 2004-2005 through 2008-2009) and 14 sports from High School Reporting Information Online (High School RIO; 2006-2007 through 2012-2013) were analyzed. All reported injuries had an injury mechanism of overuse/gradual onset (college) or overuse/chronic (high school). Overuse injury incidence rates were calculated, and rate ratios with 95% CIs were used to compare subgroups. Results: The rate of overuse injury was 3.28 times higher in college than high school sports (95% CI, 3.12-3.44). The rate of overuse injury among sex-comparable sports was higher in female than male athletes in both populations (college rate ratio, 1.25; 95% CI, 1.16-1.35; high school rate ratio, 1.55; 95% CI, 1.43-1.68). The lower extremity was the most commonly injured body site (college, 69.4%; high school, 70.4%). A larger proportion of overuse injuries among college athletes resulted in time loss of more than 21 days (college, 20.4%; high school, 7.7%) and surgery (college, 5.2%, high school, 2.5%). Conclusion: Overuse injuries can impose a significant burden on college and high school athletes. Interventions addressing prevention of overuse injury are needed.

Ergonomic risk factors for low back pain in North Carolina crab pot and gill net commercial fishermen

BACKGROUND The objective of this research was to determine the association between LBP that limited or interrupted fishing work and ergonomic low back stress measured by (1) self-reported task and (2) two ergonomic assessment methods of low back stress. METHODS Eligible participants were from a cohort of North Carolina commercial fishermen followed for LBP in regular clinic visits from 1999 to 2001 (n = 177). Work history, including crab pot and gill net fishing task frequency, was evaluated in a telephone questionnaire (n = 105). Ergonomic exposures were measured in previous study of 25 fishermen using two methods. The occurrence rate of LBP that limited or interrupted fishing work since last visit (severe LBP) was evaluated in a generalized Poisson regression model. RESULTS Predictors of severe LBP included fishing with crew members and a previous history of severe LBP. Among crab pot and gill net fishermen (n = 89), running pullers or net reels, sorting catch, and unloading catch were associated with an increased rate of LBP. Percent of time in forces >20 lb while in non-neutral trunk posture, spine compression >3,400 N, and National Institute of Occupational Safety and Health lifting indices >3.0 were associated with LBP. CONCLUSIONS Tasks characterized by higher (unloading boat and sorting catch) and lower (running puller or net reel) ergonomic low back stress were associated with the occurrence of severe LBP. History of LBP, addition of crew members, and self-selection out of tasks were likely important contributors to the patterns of low back stress and outcomes we observed. Based on the results of this study, a participatory ergonomic intervention study is currently being conducted to develop tools and equipment to decrease low back stress in commercial crab pot fishing.

Occupational Health Outcomes for Workers in the Agriculture, Forestry and Fishing Sector: Implications for Immigrant Workers in the Southeastern US

BACKGROUND Workers in the Agriculture, Forestry, and Fisheries (AgFF) sector experience exposures directly related to the work itself, as well as the physical environment in which the work occurs. Health outcomes vary from immediate to delayed, and from acute to chronic. METHODS We reviewed existing literature on the health outcomes of work in the AgFF sector and identified areas where further research is needed to understand the impact of these exposures on immigrant Latino workers in the southeastern US. RESULTS Outcomes related to specific body systems (e.g., musculoskeletal, respiratory) as well as particular exposure sources (e.g., pesticides, noise) were reviewed. The most extensive evidence exists for agriculture, with a particular focus on chemical exposures. Little research in the southeastern US has examined health outcomes of exposures of immigrant workers in forestry or fisheries. CONCLUSION As the AgFF labor force includes a growing number of Latino immigrants, more research is needed to characterize a broad range of exposures and health outcomes experienced by this population, particularly in forestry and fisheries.

Prospective study of incident injuries among southeastern United States commercial fishermen

Objective The purpose of this study was to describe occupational exposures and the incidence of non-fatal injuries among a group of southeastern US small-scale fishermen. Methods Participants (n=219) were enrolled in a prospective cohort study and followed from August 1999 to May 2002. Demographic information was obtained at baseline, and weekly and biweekly telephone interviews elicited information on number of days worked, fishery, fishing gear used, maintenance work, glove use and any work-related injury events. Incidence rate ratios (IRR) and 95% CIs were calculated with Poisson regression for each factor and multivariate models controlled for potential confounders. Results Over a third of participants (81/217) reported 125 injury events over 46 153 work-days for rate of 2.74 per 1000 work-days (95% CI 2.19 to 3.41). The majority of injuries were penetrating wounds to the hand, thumb and finger (35%) or back sprains and strains (8%); most required no medical care or time off work (67%). Injury rates were similar for on and off the water work (1.9 per 1000 work-days). Injury rates differed by fishery, water location and month. Factors associated with an increased injury rate included working on someone elses boat and maintenance work. Glove use was protective. Conclusion Similar injury characteristics were observed in small-scale fishing as compared to large-scale. For small-scale fishermen, off and on the water work locations, and particularly maintenance work, were important predictors of injury. Despite the protective association for glove use, penetrating wounds to the hand, thumb and finger were common.

A case crossover study of triggers for hand injuries in commercial fishing

Objectives: Previous studies estimate hand and wrist injuries are common in commercial fishing. Risk factors including working with catch, handling gear and slips or falls, have been identified from activity and injury contact reports, but no studies have examined the influence of transient risk factors, or triggers. This case crossover study design was conducted to investigate triggers for acute hand trauma in commercial fishing. Methods: A case crossover study was nested within a previously established prospective cohort of 217 southeastern United States commercial fishermen followed from April 1999 through October 2001. Hand injury cases and controls were matched using three control selection strategies. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated to determine if transient risk factors such as glove use, engaging in more than one type of fishing, maintenance activities and other covariates of interest increased the risk of occupational traumatic hand/wrist/digit injuries. Results: 21% (46/217) of fishermen reported one or more hand/wrist/digit injuries, yielding 65 eligible cases. Performing maintenance work (any vs none) (OR 3.1, 95% CI 1.8 to 5.5) and using multiple types of fishing equipment in comparison to using only one type (OR 1.9, 95% CI 0.9 to 3.8) were associated with increased risk of hand/wrist/digit injury. There was no evidence glove use was protective (any vs none) for hand/wrist/digit injury (OR 0.9, 95% CI 0.5 to 1.7). Conclusions: The case crossover design is a useful method to determine triggers of commercial fishing-related hand/wrist/digit injuries. Maintenance work was strongly associated with hand/wrist/digit injury for these fishermen.

Evaluating Ergonomic Stresses in North Carolina Commercial Crab Pot and Gill Net Fishermen

There are challenges in evaluating physical demands of commercial fishing, including identifying sources of exposure variability. Low back biomechanical stresses associated with crab pot and gill net fishing were estimated; the variability was partitioned between and within fishing type, crew size, job title, and worker to improve understanding of risk factors for low back injury. The authors observed 162 person-hours of work among 25 North Carolina commercial fishermen on 16 crews. Postures and forces during fishing tasks were measured through direct and indirect observation using two methods to determine the percentage of time fishermen were exposed to high levels of low back stress. A multilevel linear model estimated exposure variability for the dependent variables by four nesting variables: fishing type, crew size, job title, and worker. Fishermen set and pulled crab pots or gill nets for 80% of the workday. Twenty-five percent of that time was spent handling gear. For both fishing types, handling heavy loads produced high peak compression values (3586 N to 5315 N) and high NIOSH lifting index values (3.3 to 5.4), but these tasks represent a small percentage of the overall work time (0 to 14%). The majority of exposure variation in non-neutral trunk posture and/or force > 9 kg, handling materials, NIOSH Lifting Index > 1, and Lumbar Motion Monitor probability of high-risk group membership > 70% was accounted for by fishing type (range 60 to 91%). Crew size was not an important source of variability for these six variables when fishing type and job title were accounted for in the model; but in the model restricted to crab pot fishing, crew size accounted for 51 to 88% of the variability in low back stress. For both models, job title comprised the majority of exposure variability for NIOSH Lifting Index > 3.0 (46 and 65%) and worker comprised the majority of variability for spine compression > 3400 N (54 and 65%). The magnitude and duration of musculoskeletal loads experienced by fishermen vary by the type of fishing and the tasks performed by the worker. Understanding this variability may help researchers target ergonomic interventions for this work population.

Association of injury history and incident injury in cadet basic military training

PURPOSE This study aimed to determine the association between injury history at enrollment and incident lower extremity (LE) injury during cadet basic training among first-year military cadets. METHODS Medically treated LE injuries during cadet basic training documented in the Defense Medical Surveillance System were ascertained in a prospective cohort study of three large US military academies from 2005 to 2008. Both acute injuries (International Classification of Disease, Ninth Revision, codes in the 800-900s, including fracture, dislocations, and sprains/strains) and injury-related musculoskeletal injuries (International Classification of Disease, Ninth Revision, codes in the 700s, including inflammation and pain, joint derangement, stress fracture, sprain/strain/rupture, and dislocation) were included. Risk ratio (RR) and 95% confidence interval (CI) were computed using multivariate log-binomial models stratified by gender. RESULTS During basic training, there were 1438 medically treated acute and 1719 musculoskeletal-related LE injuries in the 9811 cadets. The most frequent LE injuries were sprains/strains (73.6% of acute injuries) and inflammation and pain (89.6% of musculoskeletal-related injuries). The overall risk of incident LE injury was 23.2% (95% CI = 22.3%-24.0%). Cadets with a history of LE injury were at increased risk for incident LE injury. This association was identical in males (RR = 1.74, 95% CI = 1.55-1.94) and females (RR = 1.74, 95% CI = 1.52-1.99). In site-specific analyses, strong associations between injury history and incident injury were observed for hip, knee ligament, stress fracture, and ankle sprain. Injury risk was greater (P < 0.01) for females (39.1%) compared with males (18.0%). The elevated injury risk in females (RR = 2.19, 95% CI = 2.04-2.36) was independent of injury history (adjusted RR = 2.09, 95% CI = 1.95-2.24). CONCLUSION Injury history upon entry to the military is associated with the incidence of LE injuries sustained during cadet basic training. Prevention programs targeted at modifiable factors in cadets with a history of LE injury should be considered.

Comparison of Upper Extremity Physical Characteristics Between Adolescent Competitive Swimmers and Nonoverhead Athletes.

CONTEXT Alterations to upper extremity physical characteristics of competitive swimmers (posture, range of motion [ROM], and subacromial-space distance) are commonly attributed to cumulative training load during a swimmers competitive career. However, this accepted clinical belief has not been established in the literature. It is important to understand whether alterations in posture and associated physical characteristics occur as a result of sport training or factors other than swimming participation to better understand injury risk and possible interventions. OBJECTIVE To compare posture, subacromial-space distance, and glenohumeral external-rotation, internal-rotation, and horizontal-adduction ROM between adolescent competitive swimmers and nonoverhead athletes. DESIGN Cross-sectional study. SETTING Local swimming pools and high school athletic training rooms. PATIENTS OR OTHER PARTICIPANTS Forty-four competitive adolescent swimmers and 31 nonoverhead athletes who were not currently experiencing any elbow, shoulder, neck, or back pain that limited their sport activity. INTERVENTION(S) Posture, subacromial-space distance, and glenohumeral ROM were measured using photography, diagnostic ultrasound, and a digital inclinometer, respectively. MAIN OUTCOME MEASURE(S) Forward shoulder posture, forward head posture, normalized subacromial-space distance, internal-rotation ROM, and external-rotation ROM. RESULTS No clinically significant differences existed between swimmers and nonoverhead athletes for posture, normalized subacromial-space distance, or external- or internal-rotation ROM. Swimmers presented with less horizontal-adduction ROM than nonoverhead athletes. CONCLUSIONS Factors other than swimming participation, such as school and technology use, play important roles in the adaptation of physical characteristics in adolescents. Adolescents, regardless of swimming participation, presented with postural deviations. It is important to consider factors other than swimming participation that contribute to alterations in physical characteristics to understand injury risk and injury-prevention strategies in competitive adolescent swimmers.