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Adolescent cricket pace bowlers are prone to non-contact shoulder, low back and lower-limb injuries. Exercise-based injury prevention programmes (IPPs) are effective for reducing non-contact injuries in athletes; however, a specific programme for adolescent pace bowlers has not been published. This paper therefore seeks to provide a rationale for the development of an exercise-based IPP specific for adolescent pace bowlers. It also outlines design principles and provides an example exercise programme that can be implemented at the community level. In addition, the paper addresses other injury prevention techniques concerned with the prescription of appropriate bowling loads and the modification of poor bowling biomechanics. Performing an exercise-based IPP before cricket training could reduce injury rates in adolescent pace bowlers. Eccentric strengthening exercises can be employed to target injuries to the posterior shoulder muscles, hip adductors and hamstring muscles. The risk of low back, knee and ankle injury could also be reduced with the inclusion of dynamic neuromuscular control exercises and trunk extensor endurance exercises. Other prevention strategies that need to be considered include the modification of poor bowling biomechanics, such as shoulder counter-rotation and lateral trunk flexion. Coaches and players should also aim to quantify bowling load accurately and coaches should use this information to prescribe appropriate individualised bowling loads. Specifically, players would benefit from avoiding both long periods of low load and acute periods when load is excessively high. Future evidence is needed to determine the effectiveness of the example programme outlined in this paper. It would also be beneficial to investigate whether the modification of bowling biomechanics is achievable at the non-elite level and if bowling load can be accurately measured and manipulated within a community-level population. [ABSTRACT FROM AUTHOR]

Football codes (rugby union, soccer, American football) train and play matches on natural and artificial turfs. A review of injuries on different turfs was needed to inform practitioners and sporting bodies on turf-related injury mechanisms and risk factors. Therefore, the aim of this review was to compare the incidence, nature and mechanisms of injuries sustained on newer generation artificial turfs and natural turfs. Electronic databases were searched using the keywords 'artificial turf', 'natural turf', 'grass' and 'inj*'. Delimitation of 120 articles sourced to those addressing injuries in football codes and those using third and fourth generation artificial turfs or natural turfs resulted in 11 experimental papers. These 11 papers provided 20 cohorts that could be assessed using magnitude-based inferences for injury incidence rate ratio calculations pertaining to differences between surfaces. Analysis showed that 16 of the 20 cohorts showed trivial effects for overall incidence rate ratios between surfaces. There was increased risk of ankle injury playing on artificial turf in eight cohorts, with incidence rate ratios from 0.7 to 5.2. Evidence concerning risk of knee injuries on the two surfaces was inconsistent, with incidence rate ratios from 0.4 to 2.8. Two cohorts showed beneficial inferences over the 90% likelihood value for effects of artificial surface on muscle injuries for soccer players; however, there were also two harmful, four unclear and five trivial inferences across the three football codes. Inferences relating to injury severity were inconsistent, with the exception that artificial turf was very likely to have harmful effects for minor injuries in rugby union training and severe injuries in young female soccer players. No clear differences between surfaces were evident in relation to training versus match injuries. Potential mechanisms for differing injury patterns on artificial turf compared with natural turf include increased peak torque and rotational stiffness properties of shoe-surface interfaces, decreased impact attenuation properties of surfaces, differing foot loading patterns and detrimental physiological responses. Changing between surfaces may be a precursor for injury in soccer. In conclusion, studies have provided strong evidence for comparable rates of injury between new generation artificial turfs and natural turfs. An exception is the likely increased risk of ankle injury on third and fourth generation artificial turfs. Therefore, ankle injury prevention strategies must be a priority for athletes who play on artificial turf regularly. Clarification of effects of artificial surfaces on muscle and knee injuries are required given inconsistencies in incidence rate ratios depending on the football code, athlete, gender or match versus training. [ABSTRACT FROM AUTHOR]

Purpose: To compare the movement patterns and underlying energetics of individuals with chronic ankle instability (CAI) to ankle sprain 'copers' during a landing task.Methods: Twenty-eight (age 23.2 ± 4.9 years; body mass 75.5 ± 13.9 kg; height 1.7 ± 0.1 m) participants with CAI and 42 (age 22.7 ± 1.7 years; body mass 73.4 ± 11.3 kg; height 1.7 ± 0.1 m) ankle sprain 'copers' were evaluated 1 year after incurring a first-time lateral ankle sprain injury. Kinematics and kinetics of the hip, knee and ankle joints from 200 ms pre-initial contact (IC) to 200 ms post-IC, in addition to the vertical component of the landing ground reaction force, were acquired during performance of a drop land task.Results: The CAI group adopted a position of increased hip flexion during the landing descent on their involved limb. This coincided with a reduced post-IC flexor pattern at the hip and increased overall hip joint stiffness compared to copers (-0.01 ± 0.05 vs. 0.02 ± 0.05°/Nm kg(-1), p = 0.03).Conclusions: Individuals with CAI display alterations in hip joint kinematics and energetics during a unipodal landing task compared to LAS 'copers'. These alterations may be responsible for the increased risk of injury experienced by individuals with CAI during landing manoeuvres. Thus, clinicians must recognise the potential for joints proximal to the affected ankle to contribute to impaired function following an acute lateral ankle sprain injury and to develop rehabilitation protocols accordingly.Level Of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Chronic ankle instability (CAI) is a frequent sport orthopaedic entity. Although many risk factors have been studied extensively, little is known how it is influenced by the osseous joint configuration. Based on lateral X-rays, the radius of the talar surface and the tibial coverage of the talus (sector α) were measured on a DICOM/PACS system in 52 patients with CAI and an age- and sex-matched control group. The talar radius was found to be larger in patients with CAI (21.2 ± 2.4 mm) than in the control group (17.7 ± 1.9 mm; P < 0.0001). The tibio-talar sector was smaller in patients with CAI (80° ± 5.1°) than in the control group (88.4° ± 7.2°; P < 0.0001). The aim of this study is to analyse the biomechanical influence of the clinical data on stability of the ankle joint. A two-dimensional model of the tibio-talar joint in the sagittal plane was developed. The joint configuration was described by the tibio-talar sector (α) and the radius ( r) of the talus. The force ( F = F BW tan α/2) and energy ( E = F BW r [1 − cos α/2]) to dislocate the talus out of the tibial plafond were deduced. Ankle stability is a function of the tibio-talar sector: the force necessary to dislocate the joint is decreasing with a smaller sector. The clinical data show that the force needed to dislocate the ankle of CAI patients was 14% weaker than the one needed in the case of healthy subjects ( P < 0.0001). The energy to dislocate the ankle depends both on the sector and the radius. The clinical data do not show a significant difference between the energy needed to dislocate the joint of CAI patients and the one of healthy subjects. This is because there is a correlation of a small sector and a large radius for CAI ankles. CAI is associated with an unstable osseous joint configuration, which is characterized by a larger radius of the talus and a smaller tibio-talar sector. The findings of the biomechanical model explain the clinical observations and demonstrate how stability of the ankle joint is influenced by the osseous configuration. Surgical ankle ligament stabilization might be more recommended in patients with an unstable osseous configuration as such patients have a disposition for recurrent sprains. Removing anterior osteophytes for anterior impingement should be done carefully in CAI patients because this would decrease the tibial coverage of the talus and thus dispose the talus to dislocate anteriorly. People who have an unstable ankle configuration and who nevertheless engage in activities with high risk of ankle sprains could be asked to wear ankle protecting sports equipment. [ABSTRACT FROM AUTHOR]

Zusammenfassung Persistierende Bandinstabilitäten am oberen Sprunggelenk führen zu chronischen Synovitiden, Knorpelläsionen und osteophytären Anbauten im Sinne einer präarthrotischen Deformität. Verletzungen der distalen tibiofibularen Syndesmose werden bei einer Ruptur des Lig. tibiofibulare interosseum relevant. Die exakte Reposition der Fibula in die Tibiainzisur und temporäre Stellschraubenfixation sind Voraussetzung für eine anatomische Ausheilung. Zur Therapie der chronischen Syndesmoseninsuffizienz wird eine anatomische Bandplastik bevorzugt. In der Behandlung frischer fibularer Bandrupturen hat sich in den letzten 20 Jahren das Konzept der konservativ-funktionellen Therapie etabliert. Auch in neueren Metaanalysen konnten keine klaren Vorteile der zudem mit Komplikationen behafteten operativen Therapie herausgearbeitet werden. Chronische Bandinstabilitäten können mit guter Prognose sekundär operativ versorgt werden, wobei den anatomischen Rekonstruktionen eindeutig der Vorzug gegenüber extraanatomischen Tenodesen zu geben ist, da Letztere mit unphysiologischen Restriktionen behaftet sind. Die eher seltenen isolierten Verletzungen des Lig. deltoideum heilen bei korrekter Diagnosestellung unter konservativ-funktioneller Behandlung problemlos aus. Abstract Ligamentous instability in the ankle frequently leads to chronic synovitis, cartilage lesions and osteophyte formation, which may degenerate into posttraumatic arthritis. Lesions of the distal tibiofibular syndesmosis are significant for the biomechanics of the ankle when the interosseous tibiofibular ligament is ruptured. Accurate reduction of the fibula to reposition it in the tibial incision and temporary fixation with a syndesmosis screw are essential if healing in the anatomical position is to be achieved. For treatment of a chronic instability of the distal tibiofibular syndesmosis anatomical ligamentoplasty is preferred. In the case of acute lateral ankle ligament ruptures conservative-functional treatment has become established over the last 20 years. Recent meta-analyses have failed to demonstrate any clear superiority of operative treatment, which has the potential for considerable complications. Chronic lateral ankle instability has a favorable prognosis with secondary interventions. Anatomical reconstruction should be given priority over extra-anatomical tenodesis procedures, since the latter are associated with considerable functional restrictions. Isolated ruptures of the deltoid ligaments are rare injuries that heal well with conservative-functional treatment after correct diagnosis. [ABSTRACT FROM AUTHOR]