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AimTo evaluate differences in menstrual and pubertal history and trends in eating behaviours among women with and without a competitive sports background. Additionally, we investigated if menstrual history and eating behaviours are associated with sports career-related factors.MethodsThis retrospective study was conducted on 100 women with a competitive endurance sports background and their age-matched, gender-matched and municipality-matched controls (n=98). Data were collected using a questionnaire using previously validated instruments. Generalised estimating equations were used to calculate associations of menstrual history and eating behaviours with outcome variables (career length, participation level, injury-related harms and career termination due to injury).ResultsAthletes reported higher rates of delayed puberty and menstrual dysfunction than controls. No differences between the groups were observed in the Eating Disorder Examination Questionnaire short form (EDE-QS) scores at any age. Previous disordered eating (DE) was associated with current DE in both groups. Among athletes, higher EDE-QS scores during the sports career were associated with a shorter career (B=−0.15, 95% CI −0.26 to –0.05). Secondary amenorrhoea was associated with lower participation level (OR 0.51, 95% CI 0.27 to 0.95), injury-related harms during the career (OR 4.00, 95% CI 1.88 to 8.48) and career termination due to injury (OR 1.89, 95% CI 1.02 to 3.51).ConclusionThe findings indicate that DE behaviours and menstrual dysfunction, specifically secondary amenorrhoea, have a disadvantageous relationship with a sports career in women competing in endurance sports. DE during the sports career is associated with DE after the career.

Background Detailed injury data are not available for international ice hockey tournaments played by junior athletes. We report the incidence, type, mechanism and severity of injuries in males under ages 18 and 20 at junior ice hockey World Championships during 2006–2015. Methods All injuries in the International Ice Hockey Federation World Junior under-20 (WJ U20) Championship and under-18 (WJ U18) Championship were collected over a 9-year period using a strict injury definition, a standardised injury reporting system and diagnoses made by a team physician. Results 633 injuries were recorded in 1326 games over a 9-year period, resulting in an injury rate (IR) of 11.0 per 1000 player-games and 39.8/1000 player-game hours. The IRs in all tournaments were 4.3/1000 player-games for the head and face, 3.2 for the upper body, 2.6 for the lower body and 1.0 for the spine and trunk. A laceration was the most common injury type followed by a sprain. Lacerations accounted for 80% (IR 3.6) of facial injuries in WJ U20 tournaments. The shoulder was the most common injury site (IR 2.0) in WJ U18 tournaments. Board contact was the mechanism for 59% of these shoulder injuries. Concussion was the most common head and face injury (46%; IR 1.2) in WJ U18 tournaments. Conclusions and recommendations The risk of injury among male junior ice hockey players was lower than the reported rates in adult men but higher than that in women. Facial lacerations were common in U20 junior players (WJ U20) since most wear only partial facial protection (visor). The IR for shoulder injuries was high in U18 junior players (WJ U18). Suggested strategies for injury prevention include full facial protection for all players and flexible board and glass for all junior tournaments.

ObjectivesTo determine the inter-rater repeatability of a musculoskeletal examination and to compare findings between adolescent athletes and non-athletes in Finland.MethodsIn this cross-sectional study, a musculoskeletal examination assessing posture, mobility and movement control was carried out by a sports and exercise medicine physician on 399 athletes aged 14–17 years and 177 non-athletes. Within 2 weeks another sports and exercise medicine physician repeated the examination for 41 adolescents to test the inter-rater repeatability.ResultsIn total, 10 of the 11 tests performed had at least moderate inter-rater reliability (κ ≥0.4 or percentage agreement >80%). Athletes more often than non-athletes had one shoulder protruded (8.0% vs 4.0%, OR 2.81, 95% CI 1.16 to 6.81). Forty-six per cent of athletes had good knee control in the two-legged vertical drop jump test compared with 32% of non-athletes (OR 1.99, 95% CI 1.29 to 3.06). Athletes had better core muscle control with 86.3% being able to remain in the correct plank position for 30 s compared with 68.6% of non-athletes (OR 2.70, 95% CI 1.67 to 4.36). In the deep squat test, good lumbar spine control was maintained only by 35.8% of athletes and 38.4% of non-athletes.ConclusionA basic musculoskeletal examination is sufficiently reliable to be performed by trained physicians as a part of a periodic health evaluation. Shortfalls in mobility, posture and movement control are common in both athletes and non-athletes. These deficits could have been caused by sedentary behaviour, monotonous training, or both.

Background We report the incidence, type, mechanism and severity of ice hockey injuries in women9s international ice hockey championships. Methods All injuries in the International Ice Hockey Federation World Women9s Championship, World Women9s under-18 Championship and Olympic Winter Games tournaments were analysed over an 8-year period using a strict injury definition, standardised reporting and team physician diagnosis. Results 168 injuries were recorded in 637 games over an 8-year period resulting in an injury rate (IR) of 6.4 per 1000 player-games and 22.0/1000 player-game hours. The IRs were 2.7/1000 player-games for the lower body, 1.4 for the upper body, 1.3 for the head and face and 0.9 for the spine and trunk. Contusion was the most common injury followed by a sprain. The most commonly injured site was the knee (48.6% of lower body injuries; IR 1.3/1000 player-games). The Medial collateral ligament sprain occurred in 37.1% and ACL rupture in 11.4% of knee injuries. A concussion (74.3%; IR 1.0/1000 player-games) was the most common head injury. Conclusions and recommendations The risk of injury to female ice hockey players at World Championship and Olympic tournaments was about half of that observed in the men9s Championships. Full facial protection decreases the risk of lacerations and should be continued in all future female tournaments. More effective prevention strategies for knee, ankle and shoulder injuries are needed in women9s ice hockey. Improved concussion education is necessary to promote more consistent diagnosis and return to play protocols.

Background Information on ice hockey injuries at the international level is very limited. The aim of the study was to analyse the incidence, type, mechanism and severity of ice hockey injuries in men’s international ice hockey tournaments. Methods All the injuries in men’s International Ice Hockey Federation World Championship tournaments over a 7-year period were analysed using a strict definition of injury, standardised reporting strategies and an injury diagnosis made by a team physician. Results 528 injuries were recorded in games resulting in an injury rate of 14.2 per 1000 player-games (52.1/ 1000 player-game hours). Additionally, 27 injuries occurred during practice. For WC A-pool Tournaments and Olympic Winter Games (OWG) the injury rate was 16.3/1000 player-games (59.6/1000 player-game hours). Body checking, and stick and puck contact caused 60.7% of the injuries. The most common types of injuries were lacerations, sprains, contusions and fractures. A laceration was the most common facial injury and was typically caused by a stick. The knee was the most frequently injured part of the lower body and the shoulder was the most common site of an upper body injury. Arenas with flexible boards and glass reduced the risk of injury by 29% (IRR 0.71, (95% CI 0.56 to 0.91)). Conclusions The incidence of injury during international ice hockey competition is relatively high. Arena characteristics, such as flexible boards and glass, appeared to reduce the risk of injury.

Background Childhood injuries are a major public health problem worldwide, injuries being the leading cause of death and disability from early childhood through adolescence. Objective To examine the 40-year nationwide trends in the number and incidence of fatal injuries among children aged 0–14 years in Finland, a country with a white European population of 5.3 million. Methods Data were obtained from the Official Cause-of-Death Statistics of Finland during 1971–2010. The main categories for unintentional injury deaths were road traffic injury, water traffic injury, falls, drowning and poisoning. For intentional injury deaths, the main categories were suicide and homicide. Results In 1971, there were 109 fatal injuries involving girls and 207 involving boys, and in 2010, these numbers were 10 and 16. The corresponding incidence rates (per 100 000 children per year) were 20.1 and 2.3 (girls), and 36.7 and 3.5 (boys). The reduction in fatal injuries was mostly due to fewer unintentional injuries. The greatest decline occurred in the number of fatal motor vehicle injuries: from 57 (girls) and 92 (boys) in 1971 to 5 (girls) and 2 (boys) in 2010. Drownings followed a similar pattern. Violence-related deaths also showed a decreasing trend. In 1971, there were 14 intentional deaths in girls and 15 in boys, while in 2010 these numbers were 0 and 3, respectively. Conclusions This nationwide study confirms a decline in childhood injury deaths over the last four decades, with the greatest declines occurring in the number of fatal motor vehicle injuries, drownings and intentional injuries.

Objective: To investigate whether a 6-month neuromuscular warm-up programme could improve muscle power, balance, speed and agility. Design: Cluster randomised controlled study. Setting: 27 top level female floorball teams in Finland. Participants: 222 players (mean age 24 years); 119 in the intervention group and 103 in the control group were followed-up for one league season (6 months). Intervention: A neuromuscular warm-up programme included sports-specific running technique, balance, jumping and strengthening exercises. The teams were advised to use the programme 1–3 times per week through the league season. One training session took ∼25 min. Main outcome measures: Performance tests were assessed before and after the 6-month intervention and included static jump, countermovement jump, jumping over a bar, standing on a bar and figure-of-eight running. Results: At 6 months, significant between-group differences were found in two outcome measures: jumping over a bar (number of jumps in 15 s) and standing on a bar (number of balance losses in 60 s). These differences were 2.3 jumps (95% CI 0.8 to 3.8, p = 0.003), favouring the intervention group, and −0.4 balance losses (95% CI −0.8 to 0.0, p = 0.050), again in favour of the intervention group. Conclusion: A neuromuscular warm-up programme improved the floorball players’ sideways jumping speed and static balance. The exercises were also safe to perform and can thus be recommended for weekly training of floorball players. Trial registration number: ISRCTN26550281.

Objective To investigate whether a neuromuscular training programme is effective in preventing non-contact leg injuries in female floorball players. Design Cluster randomised controlled study. Setting 28 top level female floorball teams in Finland. Participants 457 players (mean age 24 years)—256 (14 teams) in the intervention group and 201 (14 teams) in the control group—followedup for one league season (six months). Intervention A neuromuscular training programme to enhance players’ motor skills and body control, as well as to activate and prepare their neuromuscular system for sports specific manoeuvres. Main outcome measure Acute non-contact injuries of the legs. Results During the season, 72 acute non-contact leg injuries occurred, 20 in the intervention group and 52 in the control group. The injury incidence per 1000 hours playing and practise in the intervention group was 0.65 (95% confidence interval 0.37 to 1.13) and in the control group was 2.08 (1.58 to 2.72). The risk of non-contact leg injury was 66% lower (adjusted incidence rate ratio 0.34, 95% confidence interval 0.20 to 0.57) in the intervention group. Conclusion A neuromuscular training programme was effective in preventing acute non-contact injuries of the legs in female floorball players. Neuromuscular training can be recommended in the weekly training of these athletes. Trial registration Current Controlled Trials ISRCTN26550281.

Objectives: The knee joint is the most common site for injury among younger people, the injury often resulting in expensive (surgical) treatment, long-term rehabilitation and permanent functional impairment and disability. Methods: We investigated the incidence and risk factors for a major knee-ligament injury in an adolescent Finnish population. A population-based cohort of 46 472 adolescents was followed for an average of 9 years. All patients hospitalised with the diagnosis of anterior or posterior cruciate ligament injury (ACL or PCL injury) were included in the analysis. Results: 265 (0.6%) people (194 male and 71 female subjects) from the total cohort of 46 472 were treated for a cruciate ligament injury of the knee during the follow-up period, giving an injury incidence of 60.9 (95% CI 53.6 to 68.2) per 100 000 person-years. When the socioeconomic, health and lifestyle background variables were taken into account, the adjusted hazard ratio for a cruciate ligament injury of the knee was 8.5 (95% CI 4.3 to 16.4) for female and 4.0 (95% CI 2.7 to 6.1) for male subjects who participated in organised sports ⩾4 times/week. Conclusions: The general risk for a cruciate ligament injury of the knee is relatively low among adolescents and young adults, but participation in organised sports increases the risk significantly. The risk is especially high in active young women. Preventive measures should be adopted to decrease the short-term and long-term burden of these severe injuries.

Objectives: To compare the injury risk in pivoting indoor sports between two different surfaces: artificial floors and wooden floors. Methods: Female players (n = 331) from 26 top-level Finnish floorball teams were followed for one competitive season (6 months). All traumatic game related time-loss injuries were recorded. Injury incidences were calculated as the number of injuries per 1000 game hours for both surfaces. Incidence rate ratios (IRRs) were obtained from Poisson regression models. Results: Over the competitive season, 62 traumatic injuries occurred during the games. The injury incidence per 1000 playing hours was 59.9 (95% CI 43.2 to 83.0) on artificial floors and 26.8 (95% CI 18.2 to 39.3) on wooden floors, the adjusted IRR being twofold higher (IRR = 2.1; 95% CI 1.2 to 3.5, p = 0.005) on artificial floors than wooden floors. The risk for non-contact injuries (adjusted IRR = 12.5; 95% CI 2.9 to 54.9, p = 0.001) and severe injuries (adjusted IRR = 3.3; 95% CI 0.9 to 10.9, p = 0.052) was especially high when playing on artificial floors. Conclusions: The study attested that the risk of traumatic injury in pivoting indoor sports is higher when playing on artificial floors than wooden floors. The higher shoe–surface friction on the former surface is likely to explain the higher injury risk.

Objective To examine the relation between day of injury concussion symptomology and prolonged recovery. Design Prospective cohort. Setting Finnish professional ice hockey league. Participants SCAT3 baseline and post-injury testing has been mandatory in the Finnish ice hockey league since 2013. Of the reported injuries, between seasons 2013-2016, all cases with a day of injury SCAT3 symptom scale completed were selected. The teams’ medical staff confirmed 28 concussions, which were assessed on the day of injury. Outcome measures The SCAT3 symptom scale was completed on the day of injury. All 22 symptoms were analysed separately. Team medical staff followed up all concussed players and the day of return to play (RTP) was recorder for each athlete. Concussion recovery was considered prolonged if the time of RTP was over 10 days. RTP was analysed as a continuous and a dichotomized variable. Main results All concussed players (n=28) were Caucasian. The average age was 26.4 years (SD=4.3). The mean Symptom Score was 12.1 (SD=4.3) and the Symptom Severity 26.4 (SD=13.5), respectively. The median time to RTP was 9 days (M=21, SD=47, range=4–248) with 36% of the players being out of play for more than 10 days. There was a significant correlation between Symptom Severity and RTP (p=0.046). Symptom Score was not related to RTP. Dizziness was the only symptom with a consistent statistical relation to longer RTP (Spearman rho=0.4, p=0.029; Mann-Whitney U=4.9, p=0.038; Binary univariate logistic regression: OR=2.6, p=0.04). Conclusions Acute day of injury dizziness was related to prolonged recovery following concussion. Competing interests Teemu M. Luoto, Timo Hnninen, Jari Parkkari, Markku Tuominen, Matti Vartiainen, Juha hman: None. Grant L. Iverson has been reimbursed by the government, professional scientific bodies, and commercial organisations for discussing or presenting research relating to mild TBI and sport-related concussion at meetings, scientific conferences, and symposiums. He has a clinical and consulting practice in forensic neuropsychology involving individuals who have sustained mild TBIs (including professional athletes). He has received research funding from several test publishing companies, including ImPACT Applications, Inc., CNS Vital Signs, and Psychological Assessment Resources (PAR, Inc.). He has not received research support from a test publishing company in the past 5 years. None.

Objective To characterise the baseline to post-concussion variation of each SCAT3 symptom. Design Prospective cohort. Setting Finnish professional ice hockey league. Participants SCAT3 baseline testing has been mandatory in the Finnish hockey league since 2013. The league recommends day of injury testing for all players with suspected concussion. Of the reported day of injury SCAT3s, between seasons 2013–2016, a total of 29 concussions were confirmed by the teams’ medical staff. Intervention Outcome measures The day of concussion symptom severities for each of the 22 symptoms were compared to (i) the league’s normative reference values [based on 2013–2014 preseason baselines (n=270)] and (ii) the baseline scores of the 29 concussed players. The change between day of concussion score and players’ individual baseline score was compared to: (i) the reference variation of the league’s two preseason baselines [2013–2014 and 2014–2015 (n=179)], and (ii) the variation between two preseason baselines of the concussed players. Main results The most prevalent post-concussion symptoms were: “Don’t feel right” (100%), headache (97%), and pressure in the head (90%). In addition, these symptoms were the most common to worsen on the day of concussion compared to players’ individual baseline. “Feeling like in a fog”, confusion, and dizziness were common on the day of injury (each reported by 72%) but rare on baselines (1–2%). Fatigue or low energy and neck pain were the most common and unstable baseline symptoms in the league. Conclusions Headache and “Don’t feel right” were the most useful symptoms on the SCAT3 in acute concussion recognition. Competing interests None. Timo Hnninen, Jari Parkkari, Markku Tuominen, Matti Vartiainen, Juha hman, Teemu M. Luoto: None. Grant L. Iverson has been reimbursed by the government, professional scientific bodies, and commercial organisations for discussing or presenting research relating to mild TBI and sport-related concussion at meetings, scientific conferences, and symposiums. He has a clinical and consulting practice in forensic neuropsychology involving individuals who have sustained mild TBIs (including professional athletes). He has received research funding from several test publishing companies, including ImPACT Applications, Inc., CNS Vital Signs, and Psychological Assessment Resources (PAR, Inc.). He has not received research support from a test publishing company in the past 5 years.

Objective To describe the occurrence and trend of concussions during the international ice hockey tournaments. Design Register study. Setting The International Ice Hockey Federation (IIHF) World Championships and Olympic Winter Games. Participants A total of 3293 games were played in the 169 tournaments by 1212 teams (26130 players) comprising 142244 athletic game exposures. Outcome measures One hundred and sixty concussions were observed. Main Results The average injury rate (IR) for concussion was 1.1 per 1000 ice hockey player-games for all IIHF World Championship tournaments (WC). The injury rate was highest in men9s WC A-pool tournaments and Olympic Winter Games (OWG) (IR 1.6), and lowest in women9s WC and OWG (IR 0.9). However, the annual injury rate for concussion in men9s tournament has been lower than that in World Junior tournaments since 2012. When concussion occurred in a contact with a flexible board injury rate was 0.2 per 1,000 player games and 1.1 if a board and glass were traditional [RR 6.4, (95% CI 1.50–27.61]. In men9s tournaments the trend of concussions caused by illegal hits decreased over a study period. After the 2012 Zurich Consensus Guidelines none of the concussed players returned to a play during a same day in men9s WC tournaments. Conclusions The risk of concussion was significantly lower if games were played on rinks with flexible board and glass. Between 2006 and 2015, the annual risk of concussion in men9s WC has been decreasing most likely due to the decreasing number of concussions caused by illegal hits.

Background Stiff landings with less knee flexion and high vertical ground reaction force have shown to be associated with increased risk of ACL injuries (Leppanen et al. 2016). The association between other sagittal plane measures and the risk of ACL injuries is less studied in prospective study designs. Objective To investigate the relationship between selected sagittal plane hip, knee, and ankle biomechanics and the risk of ACL injuries in young female team sport players. Design Prospective cohort study. Setting Female youth team sports. Participants A total of 171 female basketball and floorball players (aged 12–21) participated in a VDJ test using 3D motion analysis. All new ACL injuries, as well as match and training exposure, were recorded for 1 to 3 years. Assessment of Risk Factors The following biomechanical variables were analysed: 1) peak knee extension moment, 2) peak hip flexion angle, 3) peak hip extension moment, and 4) peak ankle dorsiflexion angle. Cox regression models were used to calculate hazard ratios (HRs, adjusted for 10 unit change) and 95% confidence intervals (CIs). Main Outcome Measurements Non-contact ACL injuries. Results Subjects suffered a total of 15 ACL injuries during the follow-up (0.2 injuries per 1 000 player hours). Of the investigated variables, landing with decreased hip flexion was significantly associated with increased risk of ACL injury (HR 0.60; 95% CI 0.37 to 0.97, P=0.038). Peak knee extension moment (HR 1.13; 95% CI 0.79 to 1.62, P=0.490), peak hip extension moment (HR 0.88; 95% CI 0.77 to 1.01, P=0.065), and peak ankle dorsiflexion angle (HR 0.70; 95% CI 0.33 to 1.51, P=0.360) were not significantly associated with ACL injuries. Conclusions Landing with less hip flexion may increase the risk of ACL injury in young female team sport players. More studies with large study populations are needed to confirm these findings.

Background Single-leg squat (SLS) is a clinical tool used to assess knee control. Previous studies have proposed that knee valgus motion in the SLS could be related to injury risk, but this association has not been previously examined. Objective The objective of this study was to investigate the association between acute lower extremity injuries and frontal plane knee control in young athletes. Design This study is part of a prospective cohort study (PROFITS-study). As part of the baseline test battery, we measured frontal plane projection angles during SLS. We also measured the athlete9s height and weight, and the athletes filled out a questionnaire describing their time-loss injuries during the past 12 months. We registered new time-loss injuries in the following 12 months on a weekly basis. Only athletes free from lower extremity injuries during the 12 months prior to baseline were included in the analyses. Setting Research institute, youth sports. Participants Ten local basketball and ten local floorball teams were invited to the study. Out of these, 9 basketball and 9 floorball teams agreed to participate. Only athletes who were 21 years or younger and were free from injury during baseline were eligible. Complete data were obtained from 306 athletes. Assessment of Risk Factors A generalized linear mixed model was used to analyse the potential risk factors. Main Outcome Measurements Acute time loss lower extremity injuries sustained during the 12 month period after baseline. Results Displaying a frontal plane projection angle greater than 1 standard deviation above the mean (>23.8°) in the SLS was associated with a higher risk of lower extremity injuries (OR 5.57, 95% CI 1.61–19.32) and ankle injuries (OR 2.37, 95% CI 1.13–4.98). Conclusions Based on this study, athletes who display large frontal plane projection angles during the SLS have an elevated risk of lower extremity injuries.

Background Number of sports injuries has increased in Finland during the past decades. Today sports injuries are the most common injury type. Children, youth and especially young men are at high risk. Objective The purpose of the LiVE program is to increase safety of sports and exercise in a nationwide setting. Results Implementation of the national and international study findings are conducted in three main projects; Healthy Athlete (2006-), Safety in School Sports (2010-) and Smart Moves (2014-). The primary target groups are young athletes, their coaches and parents, elementary and vocational school pupils and their teachers. Programs main communication channels are websites: www.terveurheilija.fi, www.tervekoululainen.fi and www.smartmoves.fi. The program has educated over 80 tutors and 50 sport nutritionist. The Tutor Network and Sport Nutrition Society share the same education materials and injury prevention strategies. Purposes of networks are to implement preventive strategies against sport injuries among target groups by offering education and counselling by local experts. LiVE program has also introduced itself to projects’ target groups in numerous events and organised several seminars. LiVE websites and expert intranet offers a large source of information and practical tools. Conclusion Successful development and implementation of preventive strategies against sports injuries are likely to reduce athletes’ health problems, sport, work and school absenteeism, and medical costs. The effects of the LiVE programme will be seen within five to ten years. Funding The Finnish Ministry of Social Affairs and Health & The Finnish Ministry of Education and Culture

Background The Sports and Exercise Safety (LiVE) program (2006–) aims to reduce sport injuries in Finland. The program is coordinated by the Tampere Research Centre of Sports Medicine at the UKK Institute. Every year over 350,000 sports injuries occur in Finland and the trend is increasing. Athletes are in high risk to be injured. Up to 50% of the injuries could be prevented. Methods Healthy Athlete (HA) aims to foster coaching and training culture that promotes good health and safety in sports. Target groups are young athletes and their coaches, instructors, team managers and families. National and international study findings are delivered to the field by communication and education. Program focuses on 10 segments in Ten-point Circle. Main communication channels are website www.terveurheilija.fi, Facebook, Twitter, and YouTube channel. Website offers information packages, exercise videos, campaign materials, tutor network information etc. All materials are free of charge. Website attracts over 10000 visits per month and YouTube videos have been watched over 270 000 times. HA also arranges several seminars and tutor meetings with national partners. Results Program has educated over 80 HA-instructors (1-year education) and created the national Sport Nutrition Society (50 sport nutritionists). Purposes of the networks are to implement preventive strategies against sport injuries among target groups by offering education and counselling for coaches and athletes at their local environments. Tutors share the same education materials and injury prevention strategies and they meet annually for re-education. Conclusions Successful development and implementation of preventive strategies against sports injuries in sport club settings continues. HA is currently planning new, modern strategies for implementation e.g. developing technological solutions (mobile and web applications) and webinars. Project is funded by Finnish Ministry of Education and Culture.

Background Poor knee alignment is associated with increased loading of the joints, ligaments and tendons, and may increase the risk of injury. The study purpose was to compare differences in knee kinematics between basketball and floorball players during a vertical drop jump (VDJ) task. We wanted to investigate whether basketball players, whose sport includes frequent jump-landings, exhibited better knee control compared with floorball players, whose sport involves less jumping. Methods Players (aged 12–21 years) were recruited from six basketball and floorball clubs of the Tampere City district, Finland. Complete data was obtained from 173 basketball and 141 floorball players. Peak knee valgus and flexion angles during the VDJ were analysed by 3 D motion analysis. Results Larger knee valgus angles were observed among basketball players (−3.2o, 95% CI: −4.5 to −2.0) compared with floorball players (−0.9o, 95% CI: −2.3 to 0.6) ( P = 0.022). Basketball players landed with a decreased peak knee flexion angle (83.1o, 95% CI: 81.4 to 84.8) compared with floorball players (86.5o, 95% CI: 84.6 to 88.4) ( P = 0.016). There were no significant differences in height, weight or BMI between basketball and floorball players. The female athletes exhibited significantly (P Conclusions This study revealed that proper knee control during jump-landing does not seem to develop in young athletes simply by playing the sport, despite the fact that jump-landings occur frequently in practice and games. Poor knee control was especially common among young female athletes. An important clinical implication of these findings is that young team sport athletes need to be taught a safer technique for landing and also need specific neuromuscular training in order to avoid potentially harmful movement patterns. (Int J Sports Med 2015, accepted for publication)

Background Floorball is a popular team sport in Finland. Previous studies have revealed that injuries are a significant problem in adult floorball. However, epidemiological studies of injuries in youth floorball are lacking. The aim of this study was to investigate the incidence, type, and severity of injuries in young floorball players. Methods One-hundred-fifty-six female (n = 57) and male players (n = 99) (mean age 17.1 ± 1.6 years) from nine floorball teams participated in the study. Injury data as well as practice and game exposures were collected over the 12-months period (from May 2013 to April 2014). An injury was defined as having occurred in an organised floorball practice or game, and having resulted in the inability to participate in floorball training or playing for one or more days. Severity of injury was measured by number of days lost from floorball training and playing. Results The players reported a total of 136 injuries, of which 63% were traumatic and 37% were from overuse. The overall incidence of injuries in female and male players per 1000 practice and game hours was 4.5 (95% CI: 3.48 to 5.79) and 3.0 (95% CI: 2.41 to 3.76), respectively. Incidence of traumatic game-related injuries in females was 45.1 per 1000 game hours (95% CI: 30.98 to 65.67), and 19.9 (95% CI: 12.87 to 30.65) in males. The majority (76%) of injuries occurred in the lower extremity, and the most commonly injured body part was the ankle (24%), followed by the knee (23%) and the lower back (13%). Thirty-three percentages of all injuries resulted in less than 1 week time-loss, 30% in 1 to 4 weeks time-loss, and 37% in more than 4 weeks time-loss from sports. Thirty-one players had over 8-week absence from training due to a severe injury. Conclusions The injury risk in youth floorball is high. The lower limb is the most commonly injured body area. Rather many of the injuries are severe resulting in long-term absence from sports.

Background In Finnish schools sport injuries happen mostly in physical education (PE) classes and in recess. A remarkable part of the injuries can be prevented. TEKO – Safety in School Sports (2010–) is part of the Sports and Exercise Safety program LiVE. The primary target group for TEKO is PE and health education (HE) teachers in secondary schools. Safety promotion focuses on 10 segments; physical activity (PA), sports skills, maturation, nutrition, rest and sleep, environment and equipment, health care, atmosphere and rules, injuries and support network. Objective TEKO has produced free of charge educational material and methods to internet to encourage PA, to increase quality and contents of PE and to promote safety of sports widely in school settings. TEKO has built up education material e.g. information packages, electric homeworks, videos and PP-slides for teaching. The main delivery channel is www.tervekoululainen.fi. Results After 6 years websites ha 10000 visits per month and YouTube videos have been watched 43000 times. TEKO has kept over 60 education events. TEKO has also built up a large collaborator network, which enables the spreading of sports safety message. A web-based project evaluation survey was done in 2013 to PE and HE teachers (n = 900). The response rate was 20%. The survey will be repeated in November 2015. According to the survey 54% of the PE and HE teachers knew TEKO. 50% estimated that the content they use in sports safety education has been expanded and the methods are now more diverse. Teachers who had used TEKO material at schools were pleased to it, mean grades (scale of 4–10): expertise 9.0, exterior 8.7, feasibility 8.6 and suitability for the target group 8.3. Conclusions The reach of teachers has been rather good with the used methods and financial investment 120000 € per year (mostly funded by the Ministry of Education and Culture). The repeated survey will give more information about the stabilisation of TEKO to the basic school work.

The effects of methods to prevent injuries have been studied in several systematic reviews. However, no meta-analysis taking into account all randomised controlled intervention trials aiming at the prevention of sports injuries has been published.To summarise the effects of sports injury prevention interventions.Systematic review and meta-analysis of randomised controlled trials.PubMed, MEDLINE, SPORTDiscus, the Cochrane Central Register of Controlled Trials, CINAHL, PEDro, and Web of Science, searched in September 2013. The reference lists of retrieved articles and reviews were hand searched.To be selected articles had to examine the effects of any preventive intervention on sports injuries, be randomised/quasi-randomised and controlled trials, published in a peer-reviewed journal. The outcome of the trial had to be injury rate or the number of injured individuals.Of the 5580 articles retrieved after a search of databases and the relevant bibliography, 68 randomised controlled trials were included in the systematic review and 60 trials were included in the meta-analysis. Insoles (OR 0.51, 95% CI 0.32-0.81), external joint supports (OR 0.40, 95% CI 0.30-0.53), and specific training programmes (OR 0.55, 95% CI 0.46-0.66) appeared to be effective in reducing the risk of sports injuries. Stretching (OR 0.92, 95% CI 0.80-1.06), modified shoes (OR 1.23, 95% CI 0.81-1.87), and preventive videos (OR 0.86, 95% CI 0.44-1.68) seemed not to be effective.This meta-analysis showed that certain interventions can reduce the risk of sports injuries. There were limitations regarding the quality of the trials, generalisability of the results, and heterogeneity of the study designs. In future, the mechanisms behind effective methods and the most beneficial elements of preventive training programmes need to be clarified.

Background Knee valgus angles have been identified as important predictors of ACL injury risk. To screen for athletes with poor dynamic knee stability simple field tests are needed. Objective Purpose of this study was to find out if the subjective assessment of knee control in the single-leg squat task correlates with the two-dimensional video analysis of frontal plane knee angles. Design Single-measure. Setting The study took place at the UKK Institute, in Tampere, Finland from April 2011 to May 2013. Participants 480 floorball, basketball, ice-hockey and volleyball players, out of which 283 were females (mean age 17 years, SD 4) and 197 were males (mean age 16 years, SD 2) . Risk factor assessment The subject9s ability to control the knee during the single-leg squat was assessed by an observer from the front side of the subject. The subjects squatted down to a 90 degree knee flexion angle. A scale from 0 to 2, where 0 equals “good performance” and 2 “poor performance”, was used. Frontal plane knee angles were calculated for each valid trial from the video image. Main outcome measurements Subjective assessment of knee control, mean frontal plane knee angle. Results The mean frontal plane knee angles were different among subjects rated “good performance” (right 2°, SD 7; left 1°, SD 7), “reduced performance” (right 10°, SD 9; left 8°, SD 7) or “poor performance” (right 20°, SD 9; left 18°, SD 9). These differences were statistically significant (P Conclusions This study suggests that the subjective assessment on knee control during a single-leg squat task is a suitable tool to screen for athletes with reduced knee control. In future, studies it is necessary to study if the athletes identified having poor or reduced control are in greater risk of knee injury.

Background Low back pain (LBP) is a common complaint in general population affecting both genders and almost all age-groups. LBP is a common problem in sports as well, even in younger populations. LBP is prone to recur, thus there is a need for studies on the early phases of the problem in different sports. Objective To investigate the prevalence, nature, severity and risk factors of self-reported LBP in young team sport players. Design A retrospective cross-sectional study. Setting Finnish female and male basketball, floorball, ice hockey and volleyball teams. Participants This study is a part of an ongoing cohort study exploring risk factors for sports injuries. Players from 22 teams, a total of 464 young players (16±1.9 years), have been included. Risk factor assessment Players9 gender, age, sport and family LBP history were assessed as risk factors. Main outcome measurements Prevalence of LBP provided by a standardized Nordic questionnaire. LBP was defined: ache, pain or discomfort of lumbar region with or without radiation to one or both legs. Results 255 (54.9 %) of all players had suffered LBP during the previous year. 73 (15.7 %) had received medical attention for LBP. 51 players (11.0 %) had suffered over 4 weeks9 total duration of pain symptoms during the previous year. 80 (17.2 %) reported missing training because of LBP. Male players had more time-loss from training due to LBP than females. Family history of LBP and higher age were associated with LBP in players. Conclusions Low back pain is a relatively common complaint in young team sport players. Preventive measures are needed to reduce low back pain in youth sports.

Background Number of sports injuries has increased in Finland during the past decades. Today sports injuries are the most common injury type. Especially children and youth are at high risk. Objective The purpose of the LiVE program is to increase safety of sports and exercise in a nationwide setting. Methods Sports specific injury incidence, risk factors and mechanisms were studied. Two prevention RCT9s have been carried out, one among female athletes (Pasanen et al. BMJ 2008) and another among army recruits (Parkkari et al. BMC Medicine 2011), and finally a systematic review and meta-analysis was conducted in September 2013 on all randomised controlled intervention trials aiming at the prevention of sports injuries (Leppanen et al. submitted). The effectiveness of following interventions was studied: insoles, external joint supports, training programmes, stretching, protective head equipment, modified shoes, and injury prevention videos. Results Implementation of the findings of the above noted studies is now conducted in two nationwide projects; Healthy Athlete (2006-) and Safety in Schools (2010-). The primary target groups are young athletes, their coaches and parents, elementary school pupils and their teachers. Programs main communication channels are websites: www.terveurheilija.fi and www.tervekoululainen.fi. So far, the prevention program has educated over 80 tutors who work in different organisations (e.g. Finnish Ice Hockey Association and Finnish Gymnastic Federation), built up sport safety networks, introduced itself to projects target groups in numerous events, and organized several seminars to improve safety in sports. LiVE websites have attracted 6000-9000 visitors per month each. RE-AIM analyses will be presented during the conference. Conclusions Successful development and implementation of preventive strategies against sports injuries are likely to result in reduction in the absolute number of health problems in sports, decrease in training, work and school absenteeism, and reduction in medical costs.

Background The popularity of organized sports, especially team sports is growing among youth. High training volume and intensity at early age may predispose young athletes to overuse injuries. Objective To examine the occurrence, nature and severity of overuse injuries in youth basketball and floorball. Design A descriptive retrospective study. Setting Finnish youth basketball and floorball. Participants: 406 athletes (mean age 15.9, SD 2.0) from six basketball and floorball clubs (210 basketball and 196 floorball players). Main outcome measurements Self-reported history of overuse injuries over the preceding 12-month period. Data was obtained from a questionnaire. The severity of injuries was defined according to time-loss from full-time game or training. Results 172 overuse injuries (sustained by 139 players) were reported. Basketball players sustained 97 and floorball players 75 overuse injuries. Injury incidence in basketball was 1.1 and in floorball 0.8 injuries/1000h of exposure. Most of the overuse injuries involved the lower extremities (72% of all injuries). Most commonly injured site was the knee (45%). Another common site of the injury was the area of lower back/pelvis (26%), followed by the calf/shin (11%). No differences between the genders or the two sports were observed. Most of the injuries were slight (time-loss 1–3 days) injuries (33%). 23% of injuries were mild (time-loss 4–7 days), 20% were moderate (time-loss 8–28 days) and 25% of injuries were severe (time-loss ≥29 days) injuries. Overuse injuries caused an average time-loss of 24 days (SD 52). Conclusions Over a one third of the players participating in the study reported having sustained an overuse injury in the preceding 12 months. Remarkable proportion of overuse injuries were severe injuries. Overuse injuries often cause long absence from full-time game and training. Prospective studies to assess the risk factors and mechanisms of overuse injuries among youth team sports are needed.

Backround It is expected that every second runner has a running-related overuse injury each year. The knee joint and Achilles tendon are the most commonly injured sites covering both about one fifth of all running related injuries. 1 Runners can be categorized into rearfoot strikers, mid-foot strikers or forefoot strikers based on the landing strategy at the instant of initial ground contact. Forefoot or mid-foot striking has been shown to reduce impact peak and loading rate of the ground reaction force during early stance phase. 2 Furthermore, the finding of the recent study suggest that forefoot striking may potentially decrease the risk of running-related injuries. 3 However, the effect of runner9s foot striking pattern on the ankle and especially on the knee loading is poorly understood. Therefore, the purpose of this study was to examine whether runners with forefoot striking exhibit different lower limb loading profile than runners who use rearfoot strike pattern. Methods Nineteen female athletes with natural forefoot strike pattern and pair-matched females with rearfoot strike pattern (n=19) performed running analysis at 4 m/s. Kinematic (300Hz) and kinetic (1500Hz) data was recorded using Vicon motion analysis system. Inverse dynamics was used to calculate knee and ankle moments during stance phase of running and biomechanical model was then utilized to estimate patellofemoral stress and Achilles tendon force. Results Forefoot strikers demonstrated lower patellofemoral stress compared to heel strikers (11.1±2.9 vs. 13.0±2.8 Mpa; P=0.04). In addition, the knee frontal plane moment was lower in the forefoot strikers compared heel strikers (1.49±0.51 vs. 1.97±0.66 Nm/kg; P=0.015). At the ankle level, forefoot strikers exhibited higher Achilles tendon force (6.3±0.8 vs. 5.1±1.3 BW; P=0.002) compared to rearfoot strikers. Discussion Forefoot strikers demonstrate lower patellofemoral stress and frontal plane moment compared to runners with rearfoot strike pattern. This suggests that runners with forefoot strike pattern may have reduced risk of running-related knee injuries. However, parallel increase in Achilles tendon loading may alter forefoot striker into higher risk of ankle and foot injuries.

Background In Finnish elementary schools injuries happen mostly in physical education (PE) classes, recesses and on the way to school. Most injuries are mild, but treatment can be time consuming and expensive. Especially knee, low back and head injuries may cause long-term pain and disabilities. A remarkable part of these injuries can be prevented by enhancing pupils9 motor skills and awareness of injury risks by improving quality and contents of PE and health education classes, and taking care of safety equipment and environment. Methods The Sports and Exercise Safety in Finland programme (LiVE) and its second nationwide implementation project TEKO (2010−), is delivering research findings and producing educational material to the internet to promote physical activity and safety of sports and leisure time (http://www.tervekoululainen.fi). The main target group for TEKO is secondary school teachers and pupils. Results In TEKO project the safety promotion is focused on 10 segments; physical activity, sports skills, maturation, nutrition, rest and sleep, environment and equipment, health care, atmosphere and rules, injuries and support network. Teachers can use free of charge information packages and practical toolkits per segment to enhance the sports and leisure time safety. Contribution to the Field The implementation set up developed in TEKO project has received a positive feedback. Experiences indicate that this kind of set up might be a spreadable and affordable way to do safety promotion in schools.

Background Sports injuries are the most common injury type in Finland. The Sports and Exercise Safety in Finland (LiVE) program started in 2006, and is financially supported by the Ministry of Education and Culture and the Ministry of Social Affairs and Health. Objectives The aim of the program is to increase safety of sports and exercise in a nationwide setting. Methods LiVE research projects are carried out in Tampere Research Centre of Sports Medicine. Epidemiology and prevention of sports injuries are in focus on the studies. Results are spread to the field by two campaigns, Healthy Athlete (TU) and Safety in School Sports (TEKO). The target group of the TU is young athletes, their coaches and parents. The target group of the TEKO is secondary school students, their teachers and parents. LiVE program educates annually LiVE-instructors who work in different operational environments. The 1-year education is directed for coaches, physical therapists, PE teachers and PE instructors. Educated LiVE-instructors uses a four-step-approach to prevent injuries: 1) Survey in a target group, 2) Analyses and planning, 3) Implementation, and 4) Evaluation. Results Two large randomised controlled trials have been carried through. Also, numerous original studies of sports injury epidemiology have been published. Results have been spread to the field by education and communication. Today, overall 55 LiVE-instructors work in different organisations (eg, sports federations, sports clubs, schools). In addition, the program has appeared annually in about 30 different sports and school events. LiVE website has attracted 4000–6000 visitors and 40,000–60,000 hits per month. Conclusion Implementation of preventive strategies against sports injuries will result in a reduction of the number of health problems and work or school absenteeism, as well as a clear decrease in the medical costs. Essential results of the LiVE program will be expressed within five to 10 years.

Objective To investigate whether a neuromuscular training programme and educational counselling are effective in preventing acute lower limb injuries in young men during military service. Design Cluster randomised controlled study. Setting Two successive cohorts of male conscripts in four companies of one brigade (Pori Brigade, Sakyla) in the Finnish Defence Forces were first followed prospectively for one 6-month term (pre-study period). After this, two new successive cohorts in the same four companies were randomised into two groups and followed prospectively for one term (6 months) comprising data during the intervention (study period). Participants 944 conscripts participated in the study during the pre-study period. The randomised controlled trial included 968 conscripts (mean age 19 years): 501 conscripts in the intervention group and 467 conscripts in the control group. Intervention A neuromuscular training programme was used to enhance conscripts9 motor skills and body control, and an educational counselling programme was used to increase knowledge and awareness of acute injuries during compulsory military service. Main outcome measures Acute injuries of the lower limbs. Results In the intervention companies, the risk for acute ankle injuries decreased significantly compared to control companies (adjusted Hazard ratio (HR)=0.34; 95% CI 0.15 to 0.78, p=0.011). This risk decline was observed in conscripts with low, as well as medium-to-high, baseline fitness. In addition, the intervention companies tended to have fewer severe injuries (adjusted HR=0.42; 95% CI 0.17 to 1.06). On the other hand, among men with low baseline fitness, intervention-induced additional training was associated with an increased risk for overuse injuries (adjusted HR=1.81; 95% CI 1.16 to 2.84, p=0.009). Conclusion A neuromuscular training programme was effective in preventing acute ankle injuries in young Finnish men during compulsory military service. Among conscripts with low baseline fitness, the amount and intensity of neuromuscular training requires careful planning and execution to avoid overuse injuries.

The most common forms of osteoporotic fractures occur at the distal forearm, spine, and hip. Treating less common fractures (such as those of the proximal humerus, pelvis, knee, and ankle1) is also demanding and expensive. Yet epidemiological information on these is scarce; no nationwide study of the incidence of the osteoporotic fractures of the proximal humerus has been reported. We defined an osteoporotic fracture of the proximal humerus as a fracture occurring in people aged >/=60 that resulted from minimal trauma only—that is, a fall from standing height or less. We selected all such patients admitted to Finnish hospitals in 1970–2, 1974–5, 1978–80, 1983–5, 1988–9, and 1991–3 for primary treatment of first fracture of the proximal …