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OBJECTIVE: Identifying which types of athletes have increased injury risk (ie, predictive risk factors) should help develop cost-effective selective injury prevention strategies. Our objective was to compare a theoretical injury risk classification system developed by coaches and rehabilitation therapists, with observed injury rates in human circus acts across dimensions of physical stressors, acrobatic complexity, qualifications, and residual risks. DESIGN: Descriptive epidemiological study. SETTING: professional circus company. PATIENTS OR OTHER PARTICIPANTS: Human circus artists performing in routine roles between 2007 and 2017. ASSESSMENT OF RISK FACTORS: Characteristics of circus acts categorized according to 4 different dimensions. MAIN OUTCOME MEASURES: Medical attention injury rates (injury requiring a visit to the therapist), time-loss injury rates (TL-1; injury resulting in at least one missed performance), and time-loss 15 injury rates (TL-15; injury resulting in at least 15 missed performances). RESULTS: Among 962 artists with 1 373 572 performances, 89.4% (860/962) incurred at least one medical attention injury, 74.2% (714/962) incurred at least one TL-1 injury, and 50.8% (489/962) incurred at least one TL-15 injury. There were important inconsistencies between theoretical and observed injury risk patterns in each of the 4 dimensions for all injury definitions (medical attention, TL-1, and TL-15). CONCLUSIONS: Although theoretical classifications are the only option when no data are available, observed risk patterns based on injury surveillance programs can help identify artists who have a high (or low) theoretical risk but are nonetheless actually at low (or high) risk of injury, given their current roles. This will help develop more cost-effective selective injury prevention programs.

Objectives: To describe and compare the incidence, prevalence, severity, and profile of injuries (acute and overuse) and illness between female and male youth elite judokas during 30 weeks of a sports season. Design: Prospective cohort study. Methods: A total of 154 elite youth judokas (83 males and 71 females) were assessed from January to August 2019 in a training period organized by the Brazilian Judo Confederation. We conducted a prospective 30-week follow-up study on acute and overuse injuries and illness among youth female and male judokas through the Oslo Sports Trauma Research Center questionnaire on health problems (OSTRC-H). Every week, the OSTRC-H was sent to all youth judokas electronically, starting in the first week of preseason. The incidence rate, prevalence, and severity of illnesses and acute and overuse injuries were compared between sexes using an independent t-test (variables with normal distribution) or Mann Whitney U test (variables with non-normal distribution) with α set a 0.05. Results: Female and male judokas showed 16.96 and 16.57 injuries per 1000 athletic exposures, respectively (p = 0.383). Female judokas showed a higher average weekly prevalence of health problems (38.8%) than male judokas (29.0%). In addition, females had a greater prevalence of substantial health problems (p < 0.001), injuries (p < 0.001), and overuse injuries (p < 0.001) than males. Conclusion: There were no differences in the incidence rate of injuries between sexes. Youth female judokas showed a higher prevalence of all health problems than youth male judokas. For both sexes, the knee and shoulder were the most affected joints for acute and overuse injuries, respectively.

Groin pain is common in athletes, but remains a challenge to diagnose. Self-reported pain quality distribution may facilitate differential diagnoses. We included 167 athletes with groin pain (≥ 4 weeks). All athletes received a standardized clinical examination. Athletes could choose multiple quality descriptors and intensity, and drew these on a digital body map. Overlay images were created to assess distribution and area visually. Intensity, duration, and qualities were compared between each clinical entity and multiple entities. Top three quality descriptors were electric (22%), pain (19%), and dull/aching (15%). There were no differences in the frequencies of quality descriptors (p = 0.893) between clinical entities. Areas of the mapped qualities were similar between the single clinical entities (χ2(3) = 0.143, p = 0.986 ) and independent of symptom duration (ρ = 0.004, p = 0.958). Despite a considerable overlap, the mapped pain qualities’ distributions appear to differ visually between single clinical entities and align with the defined clinical entities of adductor-related, inguinal-related, and pubic-related groin. In iliopsoas-related groin pain, pain extended more medially. The overlap between the drawn areas underscores a challenge in differentiating groin pain classifications based only on self-reported pain. The prevalence of pain quality descriptors varied and individually do not associate with one particular clinical entity of groin pain.

OBJECTIVE: To investigate the association between the acute:chronic workload ratio (ACWR) and running-related injuries (RRI).METHODS: This is a secondary analysis using a database composed of data from three studies conducted with the same RRI surveillance system. Longitudinal data comprising running exposure (workload) and RRI were collected biweekly during the respective cohorts' follow-up (18-65 weeks). ACWR was calculated as the most recent (i.e., acute) external workload (last 2 weeks) divided by the average external (i.e., chronic) workload of the last 4, 6, 8, 10 and 12 weeks. Three methods were used to calculate the ACWR: uncoupled, coupled and exponentially weighted moving averages (EWMA). Bayesian logistic mixed models were used to analyse the data.RESULTS: The sample was composed of 435 runners. Runners whose ACWR was under 0.70 had about 10% predicted probability of sustaining RRI (9.6%; 95% credible interval [CrI] 7.5-12.4), while those whose ACWR was higher than 1.38 had about 1% predicted probability of sustaining RRI (1.3%; 95% CrI 0.7-1.7). The association between the ACWR and RRI was significant, varying from a small to a moderate association (1-10%). The higher the ACWR, the lower the RRI risk.CONCLUSIONS: The ACWR showed an inversely proportional association with RRI risk that can be represented by a smooth L-shaped, second-order, polynomial decay curve. The ACWR using hours or kilometres yielded similar results. The coupled and uncoupled methods revealed similar associations with RRIs. The uncoupled method presented the best discrimination for ACWR strata. The EWMA method yielded sparse and non-significant results.

Context The combination of excessive increases in running pace and volume is essential to consider when investigating associations between running and running-related injury. Objectives To complete a secondary analysis, using a dataset from a randomized trial, to evaluate the interactions between relative or absolute weekly changes in running volume and running pace on the occurrence of running injuries among a cohort of injury-free recreational runners in Denmark. Design Prospective cohort study. Setting Running volume and pace were collected during a 24-week follow-up using global positioning systems data. Training data were used to calculate relative and absolute weekly changes in running volume and pace. Patients or Other Participants A total of 586 recreational runners were included in the analysis. All participants were injury free at baseline. Main Outcome Measure(s) Running-related injury was the outcome. Injury data were collected weekly using a modified version of the Oslo Sports Trauma Research Centre questionnaire. Risk difference (RD) was the measure of injury risk. Results A total of 133 runners sustained running-related injuries. A relative weekly change of progression >10% in running volume and progression in running pace (RD = 8.1%, 95% CI = −9.3%, 25.6%) and an absolute weekly change of progression >5 km in running volume and progression in running pace (RD = 5.2%, 95% CI = −12.0%, 22.5%) were not associated with a statistically significant positive interaction. Conclusions Given that coaches, clinicians, and athletes may agree that excessive increases in running pace and running volume are important contributors to injury development, we analyzed the interaction between them. Although we did not identify a statistically significant positive interaction on an additive scale in runners who progressed both running pace and running volume, readers should be aware that an interaction is an important analytical approach that could be applied to other datasets in future publications.

ObjectiveTo review and frequently update the available evidence on injury risk factors and epidemiology of injury in trail running.DesignLiving systematic review. Updated searches will be done every 6 months for a minimum period of 5 years.Data sourcesEight electronic databases were searched from inception to 18 March 2021.Eligibility criteriaStudies that investigated injury risk factors and/or reported the epidemiology of injury in trail running.ResultsNineteen eligible studies were included, of which 10 studies investigated injury risk factors among 2 785 participants. Significant intrinsic factors associated with injury are: more running experience, level A runner and higher total propensity to sports accident questionnaire (PAD-22) score. Previous history of cramping and postrace biomarkers of muscle damage is associated with cramping. Younger age and low skin phototypes are associated with sunburn. Significant extrinsic factors associated with injury are neglecting warm-up, no specialised running plan, training on asphalt, double training sessions per day and physical labour occupations. A slower race finishing time is associated with cramping, while more than 3 hours of training per day, shade as the primary mode of sun protection and being single are associated with sunburn. An injury incidence range 0.7–61.2 injuries/1000 hours of running and prevalence range 1.3% to 90% were reported. The lower limb was the most reported region of injury, specifically involving blisters of the foot/toe.ConclusionLimited studies investigated injury risk factors in trail running. Our review found eight intrinsic and nine extrinsic injury risk factors. This review highlighted areas for future research that may aid in designing injury risk management strategies for safer trail running participation.PROSPERO registration numberCRD42021240832.

ObjectivesTo identify individual characteristics associated with the adoption of injury risk reduction programmes (IRRP) and to investigate the variations in sociocognitive determinants (ie, attitudes, subjective norms, perceived behavioural control and intentions) of IRRP adoption in athletics (track and field) athletes.MethodsWe conducted a cross-sectional study using an online survey sent to athletes licensed with the French Federation of Athletics to investigate their habits and sociocognitive determinants of IRRP adoption. Sociodemographic characteristics, sports practice and history of previous injuries were also recorded. Logistic regression analyses and group comparisons were performed.ResultsThe final sample was composed of 7715 athletes. From the multivariable analysis, competing at the highest level was positively associated with IRRP adoption (adjusted OR (AOR)=1.66; 99.9% CI 1.39 to 1.99 and AOR=1.48; 99.9% CI 1.22 to 1.80) and presenting a low number of past injuries was negatively associated with IRRP adoption (AOR=0.48; 99.9% CI 0.35 to 0.65 and AOR=0.61; 99.9% CI 0.44 to 0.84), both during their lifetime and the current season, respectively. These results were supported by higher scores of sociocognitive determinants among athletes who reported IRRP adoption compared with other athletes.ConclusionSome characteristics of athletes seem to be associated with IRRP adoption either positively (competing at the highest level) or negatively (presenting a lower number of past injuries), whereas all the sociocognitive determinants tested appear to be linked to IRRP adoption. Since many athlete characteristics are difficult or impossible to change, IRRP promotion may be enhanced by targeting athletes’ beliefs and intentions to adopt an IRRP.

ObjectiveTo investigate prevalence, incidence and profile of musculoskeletal injuries in para athletes.DesignSystematic review.Data sourcesSearches were conducted in MEDLINE, EMBASE, AMED, SPORTSDiscus, CINAHL and hand searching.Eligibility criteriaStudies were considered if they reported prevalence or incidence of musculoskeletal injuries in para athletes. Study selection, data extraction and analysis followed the protocol. Meta-analyses were conducted to estimate the prevalence and incidence rate among studies and subgroup analyses investigated whether methodological quality and sample size of the studies influenced on the estimated injury prevalence and incidence. The Grading of Recommendations Assessment, Development and Evaluation system determined the strength of evidence.ResultsForty-two studies were included. The prevalence of musculoskeletal injuries was 40.8% (95% CI 32.5% to 49.8%). Because of imprecision, indirectness and inconsistency, the strength of evidence was very low quality. The incidence of musculoskeletal injuries was 14.3 injuries per 1000 athlete-days (95% CI 11.9 to 16.8). The strength of evidence was low quality because of imprecision and indirectness. The subgroup analyses revealed that the sample size influenced on estimated injury prevalence and methodological quality influenced on estimated incidence. Injuries were more prevalent in the shoulder, for non-ambulant para athletes, and in the lower limbs, for ambulant para athletes.Summary/conclusionPara athletes show high prevalence and incidence of musculoskeletal injuries. Current very low-quality and low-quality evidence suggests that future high-quality studies with systematic data collection, larger sample size and specificities of para athletes are likely to change estimates of injury prevalence and incidence in para athletes.PROSPERO registration numberCRD42020147982.

The purpose of this study was to gather information from scientific literature related to all steps of Van Mechelen’s “sequence of prevention” for injuries applied to youth and adult recreational field hockey players. A systematic review was conducted in Medline via Pubmed and in SPORTDiscus via EBSCOhost. Twenty-six original studies were included. Regarding injury incidence (step 1) results showed several overall injury incidence rates (youth: 1.47 per 1,000 Athlete Exposure (AE) time-loss (TL) injury up to 11.32 per 1,000 AE TL ánd non-time loss (NTL) injury, adults: 2.2 NTL injury per 1,000 AE, 15.2 injury per 1,000 hours of sports participation). Considering games and practices, most injuries were sustained in games (youth: 4.9, adults: 7.87 per 1,000 AE). Considering body parts, highest injury incidence rates were found in body parts in the lower extremities (youth: knee injuries in games (0.33 per 1,000 AE), adults: hamstring injuries in pre-season (0.75 per 1,000 AE)) and injuries in the head/face/eye (youth: 0.66 and adults: 0.94 head/face/eye, 0.71 head/face and 0.63 concussion per 1,000 AE). Regarding aetiology (step 2), no studies were found. Regarding the efficacy of available interventions (step 3 and 4), one study was found among youth players, describing a warm-up programme.

Purpose To identify modifiable biomechanical and neuromuscular anterior cruciate ligament (ACL) injury risk factors for first-time ACL injury in adolescent female elite football and team handball players. Methods Adolescent female elite football and handball players with no previous ACL injury participated in the present study. At baseline, players were tested during side-cutting manoeuvres performed in a 3-dimensional motion analysis laboratory with concomitant electromyography (EMG) measurements. Maximal isometric lower limb muscle strength was assessed by handheld dynamometry. Players were prospectively followed for 2 years after baseline testing, and all magnetic resonance imaging (MRI) verified ACL injuries were registered. The effect of 16 risk factor candidates on the relative risk (RR) of ACL injury was estimated using Poisson regression analysis. Results Ninety players (age 16.9 ± 1.2 years) were included in the analyses. Nine first-time ACL injuries (injury incidence 10.0% (95% confidence interval (CI) 5.4–18.6%)) were registered during the 2-year follow-up period. Four risk factor candidates were significantly associated with the risk of ACL injury: (1) hip flexion angle at initial contact (IC) [RR 0.56, 95% confidence interval (CI) 0.34–0.92], (2) internal knee rotation angle at IC [RR 1.13, 95% CI 1.08–1.19], (3) semitendinosus EMG activity 50 ms prior to IC [RR: 0.62, 95% CI 0.43–0.89], and (4) external hip rotator strength [RR: 0.77, 95% CI 0.66–0.89]. Conclusion Four distinct ACL injury risk factors related to the side-cutting manoeuvre were identified in a population of adolescent female elite football and team handball players with no previous ACL injury. As ACL injury typically occur during side-cutting, intervention programmes to modify these risk factors pose a promising strategy for ACL injury prevention in adolescent female elite football and team handball. Level of evidence II.

Trail running involves running on varying natural terrains, often including large elevation gains/losses. Trail running has a high risk of injury, and runners often participate in remote regions where medical support is challenging. The aim of this study was to determine the epidemiology, clinical characteristic, and associated injury risk factors among trail runners. A modified Oslo Sports Trauma Research Center Questionnaire for Health Problems (OSTRC-H) was used biweekly to collect running-related injury (RRI) and training history data prospectively, among 152 participants (males n = 120, females n = 32) over 30 weeks. We report an overall injury rate of 19.6 RRIs per 1000 h and an RRI mean prevalence of 12.3%. The leading anatomical site of RRIs was the lower limb (82.9%), affecting the knee (29.8%), shin/lower leg (18.0%), and the foot/toes (13.7%). A history of previous RRI in the past 12 months (p = 0.0032) and having a chronic disease (p = 0.0188) are independent risk factors for RRIs among trail runners. Two in three trail runners sustain an RRI mainly affecting the knee, shin/lower leg, and foot/toes. A history of previous RRI in the past 12 months and a having chronic disease is independently associated with RRI among trail runners. These results could be used to develop future RRI prevention strategies, combined with clinical knowledge and experience.

Zusammenfassung Hintergrund Zweikämpfe an der Bande oder Kontakt mit dem Puck, Eishockeyschläger oder Schlittschuhen können Verletzungen bei Eishockeyspielern verursachen. Für eine adäquate Prävention von Verletzungen und Planung des Verletzungsmanagements ist eine gute epidemiologische Datenlage notwendig. In der Schweiz fehlen bis dato solche epidemiologischen Daten im Amateur-Eishockey. Diese Arbeit hatte das Ziel, die Verletzungshäufigkeit, Verletzungslokalisationen, Verletzungsart, Schweregrad, Verletzungsmechanismen, Präventionsmaßnahmen sowie Zugang zu Erstversorgung nach einer Verletzung in Zweitliga-Amateur-Eishockeymannschaften des Kantons Bern aufzuzeigen. Probanden/Methodik Diese deskriptive Studie wurde mittels einer retrospektiven, selbstrapportierten Fragebogenerhebung am Ende der Saison 2017/18 durchgeführt. Erhoben wurden anthropometrische Merkmale, Angaben zum Trainings- und Wettkampfvolumen, zur Verletzungshäufigkeit, Verletzungslokalisationen, Verletzungsart, Schweregrad, Verletzungsmechanismen und Präventionsmaßnahmen sowie zur klinischen Versorgung im Fall einer Verletzung. Ergebnisse 86 von 96 Fragebögen konnten ausgewertet werden. Während der letzten 12 Monate verletzten sich 44 Spieler 1-mal und 5 Spieler 2-mal. Die Verletzungshäufigkeit betrug im Training 0,7 Verletzungen pro 1000 Stunden und im Wettkampf 4,7 pro 1000 Stunden. Die meist genannten Verletzungslokalisationen waren Knie (17,9 %), Fuß (14,3 %), Kopf (12,5 %) und Schulter (10,7 %). Verletzungen wurden vorwiegend durch externe Faktoren produziert. Distorsionen, Frakturen und Kontusionen waren die häufigsten Verletzungsarten. 19 Verletzungen hatten eine Auszeit von mehr als 4 Wochen zur Folge („schwer“). Schlussfolgerung Die Verletzungshäufigkeit war im Wettkampf 6,35-mal höher im Vergleich zum Training. Die Hälfte aller Verletzungen wurde in der unteren Extremität lokalisiert, davon 18 % am Knie. 19 Verletzungen wurden als „schwer“ eingestuft. Verletzungen wurden vorwiegend durch externe Faktoren produziert. Mögliche Präventionsmaßnahmen sind Fördern von Fairplay, das Anpassen von Spielregeln, Förderung zum Tragen von Schutzausrüstung, das Üben des peripheren Sehens und Krafttraining für die Rumpf- und Beinmuskulatur. Um die Vergleichbarkeit solcher Studien zu erhöhen, ist das Handhaben von standardisierten Definitionen bzgl. „Verletzung“ und „Verletzungsschweregrad“ notwendig.

In 2020, the IOC released a consensus statement that provides overall guidelines for the recording and reporting of epidemiological data on injury and illness in sport. Some aspects of this statement need to be further specified on a sport-by-sport basis. To extend the IOC consensus statement on methods for recording and reporting of epidemiological data on injury and illness in sports and to meet the sport-specific requirements of all cycling disciplines regulated by the Union Cycliste Internationale (UCI). A panel of 20 experts, all with experience in cycling or cycling medicine, participated in the drafting of this cycling-specific extension of the IOC consensus statement. In preparation, panel members were sent the IOC consensus statement, the first draft of this manuscript and a list of topics to be discussed. The expert panel met in July 2020 for a 1-day video conference to discuss the manuscript and specific topics. The final manuscript was developed in an iterative process involving all panel members. This paper extends the IOC consensus statement to provide cycling-specific recommendations on health problem definitions, mode of onset, injury mechanisms and circumstances, diagnosis classifications, exposure, study population characteristics and data collection methods. Recommendations apply to all UCI cycling disciplines, for both able-bodied cyclists and para-cyclists. The recommendations presented in this consensus statement will improve the consistency and accuracy of future epidemiological studies of injury and illness in cycling.

BackgroundLateral ankle sprains are common in indoor sports. High shoe–surface friction is considered a risk factor for non-contact lateral ankle sprains. Spraino is a novel low-friction patch that can be attached to the outside of sports shoes to minimise friction at the lateral edge, which could mitigate the risk of such injury. We aimed to determine preliminary effectiveness (incidence rate and severity) and safety (harms) of Spraino to prevent lateral ankle sprains among indoor sport athletes.MethodsIn this exploratory, parallel-group, two-arm pilot randomised controlled trial, 510 subelite indoor sport athletes with a previous lateral ankle sprain were randomly allocated (1:1) to Spraino or ‘do-as-usual’. Allocation was concealed and the trial was outcome assessor blinded. Match and training exposure, number of injuries and associated time loss were captured weekly via text messages. Information on harms, fear-of-injury and ankle pain was also documented.Results480 participants completed the trial. They reported a total of 151 lateral ankle sprains, of which 96 were categorised as non-contact, and 50 as severe. All outcomes favoured Spraino with incidence rate ratios of 0.87 (95% CI 0.62 to 1.23) for all lateral ankle sprains; 0.64 (95% CI 0.42 to 0.98) for non-contact lateral ankle sprains; and 0.47 (95% CI 0.25 to 0.88) for severe lateral ankle sprains. Time loss per injury was also lower in the Spraino group (1.8 vs 2.8 weeks, p=0.014). Six participants reported minor harms because of Spraino.ConclusionCompared with usual care, athletes allocated to Spraino had a lower risk of lateral ankle sprains and less time loss, with only few reported minor harms.Trial registration numberNCT03311490.

Para football is currently played in impairment-specific formats by thousands of people worldwide. To date, there have been no prospective longitudinal injury surveillance studies. This study aimed to implement a prospective injury surveillance study within elite English Para football and analyse the injury risk within the England Blind and Cerebral Palsy (CP) squads. Match and training injury data based on a 'time loss' definition were collected and analysed for each squad including incidence per 1,000 player hours, severity, injury location and associated event of injury. Injury incidence were lower in training than matches (CP 67.6/1000 player match hours (CI 33.8-135.2) and 5.7/1000 training hours (CI 3.8-8.7) and Blind 44.0/1000 player match hours (CI 26.1-74.3) and 5.5/1000 training hours (CI 3.5-8.6). Training injuries were more severe than match injuries across both squads (CP median 12 days lost in matches and 16 training and Blind median days 5 matches and 12 training). 73% Blind and 74% CP footballer injuries were to the lower limb and 17% head and neck equally across both Para football squads. 'Muscle and tendon injuries' (51%) represented the greatest proportion of injuries for CP footballers, and 'joint (non-bone)/ligament injuries' (43%) for Blind footballers. Collaboration and implementation of higher quality surveillance methodology and data collection in Para sport with greater athlete numbers are needed to inform injury prevention strategies.

Background/aimBokSmart is a nationwide injury prevention programme that aims to reduce players’ injury risk mainly through education of coaches and referees in mandatory biennial education courses. These courses are held throughout each rugby season. The objective of this cross-sectional study was to assess whether these courses were associated with improvements in attendees’ behavioural determinants.MethodsCoaches and referees completed a questionnaire based on the theory of planned behaviour, immediately before and after their 2012 BokSmart courses. Twelve behavioural determinants were assessed on a five-point Likert scale and open-ended questions. A meaningful change was defined as an improvement of ≥1 unit score supported by null hypothesis testing. Odds of improving by ≥1 unit score (compared with not improving) were assessed in attendees using multivariate logistic regression.ResultsIn total, 390 coaches and 74 referees completed both questionnaires. ‘Before’ scores were high for most outcomes, except for knowledge. Although there was a significant (pConclusionAlthough the only meaningful improvement in 2012 BokSmart course attendees was in one outcome, it should be noted that before-course scores were already high, reducing the questionnaire’s ability to assess change because of a ceiling effect. Nonetheless, the knowledge acquisition of these courses was low and not related to previous course attendance or more years of rugby experience. These results justify the biennial nature of this safety course but also indicate that knowledge acquisition is generally low.

Context Field hockey is popular worldwide; however, it entails a risk of injury. Injuries hamper players' participation in the sport and impose a burden on public health. Objective To investigate the effectiveness of a structured exercise program among youth field hockey players on the injury rate, severity, and burden. Design Quasi-experimental study. Setting On field during 1 season of field hockey (October 2016 through June 2017). Patients or Other Participants A convenience sample of 22 teams (291 players): 10 teams (135 players, mean age = 11.5 years [95% confidence interval (CI) = 11.2, 11.7 years]) in the intervention group and 12 teams (156 players, mean age = 12.9 years [95% CI = 12.6, 13.2 years]) in the control group. Intervention(s) The Warming-up Hockey program, a sex- and age-specific, structured, evidence-informed warm-up program consisting of a preparation phase (ie, agility and cardiovascular warm-up exercises), movement skills (ie, stability and flexibility exercises), and sport-specific skills (ie, speed and strength exercises in field hockey situations). Participants in the control group performed their usual warm-up routines. Main Outcome Measure(s) Injury rate (ie, the number of injuries per 1000 player-hours of field hockey exposure), severity (ie, days of player time-loss), and burden on athletes' availability to play (ie, days of time loss due to injury per 1000 player-hours of field hockey exposure). Results The injury rate was lower in the intervention group (hazard ratio of 0.64 [95% CI = 0.38, 1.07]); however, this result was not statistically significant. The severity of injuries was similar in both groups (t statistic P = .73). The burden of injuries on players' field hockey participation was lower in the intervention group (difference of 8.42 [95% CI = 4.37, 12.47] days lost per 1000 player-hours of field hockey). Conclusions Exposure to the Warming-up Hockey program was not significantly associated with a lower injury rate. No reduction was observed in the severity of injuries alone; however, the burden of injuries on players' field hockey participation was lower in the intervention group.

The British Journal of Sports Medicine has introduced a series of editorials and infographics that explain the value of using appropriate methodology in sports injury research.1–6 Indeed, proper methodology is necessary for understanding why sports injuries develop, how best to prevent them and which therapeutic interventions will be most effective. Without correctly applying and interpreting statistics, subjective intuitions could lead to incorrect conclusions. In this editorial, we present seven common ‘statistical sins’ made in research and discuss how to present research findings in such a way as to help athletes, coaches and clinicians avoid drawing flawed conclusions when attempting to interpret causality in sports injury research. The sins have been adapted from an article originally published in The Conversation .7 Did you know that NFL teams with an animal team logo (eg, Denver Broncos and Carolina Panthers) have a dramatic 15% reduced risk of concussions compared with NFL teams without animal logos (eg, Tennessee Titans and Pittsburgh Steelers)?8 If one looks hard enough, apparently interesting associations and spurious correlations between phenomena can be found almost everywhere. However, simply because two things happen to change in parallel, or follow a similar pattern, does not mean they are causally related. To avoid this sin, one must thoughtfully consider whether the association is likely to be causal or non-causal. Most sports injury studies simply examine non-causal associations, which are sometimes wrongly interpreted as being causal. Think of concussions and animal logos next time you read a sports injury article: are the reported relationships likely to be causally …

INTRODUCTION: Knee injuries are frequent in children, with most studies reporting traumatic knee injuries. Evidence of risk factors for knee injuries in children is sparse. The purpose of this study was to report the extent of traumatic and overuse knee injuries in children and to evaluate intrinsic and extrinsic factors for risk of these injuries.METHODS: Weekly musculoskeletal pain, sport participation and sports type were reported by 1326 school children (8-15 years). Knee injuries were classified as traumatic or overuse. Multinomial logistic regression was used for analyses.RESULTS: During the study period, 952 (15% traumatic, 85% overuse) knee injuries were diagnosed. Period prevalence for traumatic and overuse knee injuries were 0.8/1000 and 5.4/1000 sport participations, respectively. Participation in tumbling gymnastics was a risk factor for traumatic knee injuries (OR 2.14). For overuse knee injuries, intrinsic risk factors were sex (girls OR 1.38), and previous knee injury (OR 1.78), while participation in soccer (OR 1.64), handball (OR 1.95), basket (OR 2.07), rhythmic (OR 1.98), and tumbling gymnastics (OR 1.74) were additional risk factors. For both injury types, sport participation above two times/week increased odds (OR 1.46-2.40).CONCLUSION: Overuse knee injuries were the most frequent injury type. For traumatic knee injuries, participation in tumbling gymnastics was a risk factor. Risk factors for overuse knee injuries were being a girl, previous knee injury and participation in soccer, handball, basket, rhythmic and tumbling gymnastics. Further risk factors for both types of injury were participation in sports above two times/week. Although growth-related overuse knee injuries are a self-limiting condition, a major part of children are affected by these injuries with unknown short and long-term consequences.

The objectives of this prospective school cohort study were to describe the epidemiology of diagnosed musculoskeletal extremity injuries and to estimate the injury incidence rates in relation to different settings, different body regions and injury types. In all, 1259 schoolchildren, aged 6-12, were surveyed weekly during 2.5 years using a new method of automated mobile phone text messaging asking questions on the presence of any musculoskeletal problems. All injuries were clinically diagnosed. Physical activity was measured from text messaging and accelerometers. A total number of 1229 injuries were diagnosed; 180 injuries in the upper extremity and 1049 in the lower extremity, with an overall rate of 1.59 injuries per 1000 physical activity units [95% confidence interval (CI) 1.50-1.68]. Upper extremities accounted for a rate of 0.23 (95% CI 0.20-0.27) and lower extremities accounted for 1.36 (95% CI 1.27-1.44). This study has added a wide overall perspective to the area concerning incidence and incidence rates of musculoskeletal extremity injuries in schoolchildren aged 6-12 years, including severe and less severe, traumatic, and overuse injuries. The understanding of injury epidemiology in children is fundamental to the acknowledgement and insurance of the appropriate prevention and treatment.

O objetivo deste estudo foi descrever a população, as características do treinamento e o histórico de lesões musculoesqueléticas em atletas de handebol do gênero feminino e investigar possíveis associações entre as características de treinamento com lesões musculoesqueléticas relacionadas ao handebol. Participaram deste estudo transversal 220 atletas, que responderam a um questionário autorreportado que abordava dados pessoais, características do treinamento e lesões prévias relacionadas ao handebol nos últimos 12 meses. Os dados foram analisados por estatística descritiva e modelos de regressão logística. Os resultados demonstram que a maioria era constituída de atletas com idade aproximada de 15 anos, com índice de massa corpórea classificado como normal, que realizavam 3 treinos por semana, com carga horária semanal de aproximadamente 8 horas e 30 minutos. As principais lesões encontradas foram as entorses e as tendinopatias, sendo o tornozelo e o joelho as regiões mais acometidas. Somente a experiência no esporte acima de 6 anos mostrou relação estatística com lesões prévias (p=0,032). A prevalência de lesões nos últimos 12 meses nesta população foi de 53,60%. Este estudio tuvo los propósitos de describir la población, las características de entrenamiento y el historial de lesiones musculo esqueléticas en atletas de balonmano del género femenino y de investigar posibles asociaciones entre las características del entrenamiento a este tipo de lesiones relacionadas con la práctica del balonmano. Han participado de este estudio transversal 220 atletas, que contestaron a un cuestionario auto reportado que contenían datos personales, características del entrenamiento y lesiones previas relacionadas con la práctica del balonmano en los últimos 12 meses. Se han evaluados los datos por estadística descriptiva y modelos de regresión logística. Los resultados muestran que la mayoría se constituía por atletas de edad cercana a los 15 años, con índice de masa corporal clasificado como normal, que hacían entrenamiento 3 veces por semana, con carga horaria semanal de cerca de 8 horas y 30 minutos. Se han encontrado las principales lesiones: esguinces y tendinopatías, en que el tobillo y la rodilla eran los más afectados. Se ha mostrado relación estadística con lesiones previas (p=0,032) solamente la experiencia de más de 6 años en la práctica del deporte. El 53,60% fue la prevalencia de lesiones en los últimos 12 meses en la población investigada. This study aimed to describe the population, training features and history of musculoskeletal injuries in young female handball players and to investigate possible associations between these features and previous musculoskeletal injuries related to handball. The subjects of this cross-sectional study were 220 athletes who completed a self-reported questionnaire about personal data, training features and previous injuries related to handball in the last 12 months. Data were analyzed using descriptive statistics and logistic regression models. The results showed that most of the athletes were approximately 15 years old, had a body mass index was classified as normal, worked out at an average of 3 times a week and their weekly workload was approximately 8 hours and 30 minutes. The main injuries found were sprains and tendinopathies, with the ankle and knee being the most affected regions. Only the sport practice of over 6 years showed statistical relationship with previous injuries (p=0.032). The prevalence of injuries in the last 12 months in this population was 53.60%.

OBJECTIVES:It is not known which sports are most likely to cause overuse injuries of the extremities in children. In this study, we report on the incidence of overuse injuries of the upper and lower extremities in children who participate in various leisure-time sports and relate this to the frequency of sport sessions.DESIGN:Natural experiment including a prospective cohort study.SETTING:10 state schools in 1 Danish municipality: Svendborg.PARTICIPANTS:1270 children aged 6-13 years participating in the Childhood Health, Activity, and Motor Performance School Study Denmark.OUTCOMES MEASURES:Over 2.5 years, parents answered weekly SMS-track messages (a) on type and frequency of leisure-time sports undertaken by their child, and (b) reporting if their child had experienced any musculoskeletal pain. Children with reported pain were examined by a clinician and diagnosed as having an overuse injury of an extremity or not. The incidence of diagnosed overuse injury was calculated for each of the 9 most common sports in relation to 5-week periods. Incidence by frequency of sessions was calculated, and multivariable analysis was performed taking into account age, sex and frequency of physical education classes at school.RESULTS:Incidence of overuse injuries of the lower extremity ranged from 0.2 to 3.3 for the 9 sports, but was near 0 for overuse injuries of the upper extremities. There was no obvious dose-response. The multivariate analysis showed soccer and handball to be the sports most likely to result in an overuse injury.CONCLUSIONS:Among a general population of schoolchildren, overuse injuries of the lower extremities were not common and overuse injuries of the upper extremities were rare. Organised leisure-time sport, as practised in Denmark, can be considered a safe activity for children.

Growing participation of children in sports has resulted in an increased incidence of sports injuries. Although methodological differences in epidemiologic studies largely prevent precise comparisons, it appears that young athletes participating in combat and contact sports seem to be more prone to injuries. Knee and ankle injuries are the most commonly encountered problems and chronic events are more prevalent than acute ones. The occurrence of athletic injuries is multifactorial and may present differences with respect to sex and the sports branch involved. An analytical approach of all relevant groups (parents, coaches, physical education teachers, health personnel) is necessary to understand, treat, and prevent athletic injuries in children., Çocuklarda spora katılımın artmasıyla birlikte yaralanma sıklıklarında da artış görülmektedir. Çeşitli ülkelerde yapılan istatistiksel çalışmalar yöntem açısından farklılıklar gösterdiğinden sağlıklı bir karşılaştırma yapılamamasına karşın, genellikle temas ve mücadele sporlarında yaralanma riski daha fazladır. Diz ve ayak bileği en sık zedelenen bölgelerdir. Akut sorunlara oranla kronik sorunlarla daha sık karşılaşılmaktadır. Yaralanma nedenleri birçok etkene bağlıdır ve her spor dalı ve cinsiyet için farklılıklar gösterebilir. Bu nedenle, çocuklarda sportif yaralanmaların bilinmesi, tedavisi ve önlenmesine yönelik olarak sporcuyla ilgili her kesimin (eğitimci, anne-baba, sağlık personeli) analitik yaklaşımı gerekmektedir.

The incidence of stress fractures in young athletes has increased with the popularization of sports among children and adolescents. Stress fractures are less common in children and adolescents than in adults. A combination of intrinsic or anatomical factors and extrinsic factors such as training pitfalls and environmental insufficiencies predispose athletes to stress fractures. This review aims to outline current knowledge about clinical manifestations, diagnostic imaging, and treatment of stress fractures in children and adolescents., Çocuklar arasında sporun yaygınlaşması ile yorgunluk kırıklarının sıklığı da artmaktadır. Yorgunluk kırıkları çocuklarda yetişkinlere oranla daha az görülür. Hastaya ait anatomik özellikler, antrenman hataları, uygun olmayan spor alanları gibi dış etmenler bu kırıklara zemin hazırlayan en önemli unsurlardır. Bu yazıda, çocukluk ve ergenlik döneminde görülen yorgunluk kırıklarının klinik bulguları, tanı yöntemleri ve tedavisindeki güncel yaklaşımlar gözden geçirildi.

Purpose: (1) Examine the influence of extra physical education (EPE) on the number of musculoskeletal injuries in public schools accounting for organized sports participation (OSP) outside school. (2) Examine the major injury subgroup: growth-related overuse (GRO) through the overuse-related injury group. Methods: A longitudinal controlled school-based study among Danish public schools. At baseline, 1216 children participated age 6.2-12.4 yr. Six schools (701 children) with EPE and four control schools (515 children) were followed up with weekly automated mobile phone text messages for information on musculoskeletal problems and OSP. Health care personnel diagnosed the children according to the World Health Organization's International Classification of Diseases, Tenth Revision. Data were analyzed using a two-part zero-inflated negative binomial (ZINB) regression model. Results: School type had no influence on the odds of sustaining an injury but increased the probability of sustaining a higher injury count for children with injuries, with total injuries by a factor of 1.29 (95% confidence interval [CI] = 1.07-1.56), overuse by a factor of 1.29 (95% CI = 1.06-1.55), and GRO by a factor of 1.38 (95% CI = 1.02-1.80). Weekly mean OSP decreased the odds of belonging to the group of children with no injuries, by a factor of 0.29 (95% CI = 0.14-0.58), 0.26 (95% CI = 0.14-0.48), and 0.17 (95% CI = 0.06-0.52) for total, overuse, and GRO, respectively. OSP also increased the probability of sustaining a higher injury count for children with injuries by a factor of 1.11 (95% CI = 1.02-1.22), 1.10 (95% CI = 1.00-1.22), and 1.14 (95% CI = 1.00-1.30), respectively. Conclusions: Children enrolled in EPE schools with high OSP have the highest odds of injury and a high probability of sustaining a higher injury count compared to their peers at schools with normal PE. Special attention should be assigned to these children during compulsory PE.

A total of 570 injuries in handball players were pro spectively registered in a well-defined geographic area of 124,321 inhabitants. The incidence of handball inju ries was 46 per 10,000 inhabitants per year. The inci dence in women (61 per 10,000 per year) was double that of men (31 per 10,000 per year). Sixty-two percent of the injuries were ligament sprains and tears and 12% were fractures. A total of 7% of the patients were hospitalized and the total loss of income because of sick leave was $3870. Sixty-eight percent of the injured handball players were absent from handball more than 1 week. Surprisingly, 8% of the minor injuries resulted in a sick leave of more than 6 days.

Purpose Physical activity-related injuries in children constitute a costly public health matter. The influence of motor performance on injury risk is unclear. The purpose of this study was to examine if motor performance was a risk factor of traumatic and overuse lower extremity injuries in a normal population of children. Methods This study included 1244 participants from 8 to 14 yr old at baseline, all participating in the "Childhood Health, Activity and Motor Performance School Study Denmark." The follow-up period was up to 15 months. The motor performance tests were static balance, single leg hop for distance, core stability tests, vertical jump, shuttle run, and cardiorespiratory fitness test. Lower extremity injuries were registered by clinicians using weekly questionnaires and classified according to the International Classification of Diseases, 10th Revision, system. Results Poor balance increased the risk for traumatic injury in the foot region (incidence rate ratio [IRR] = 1.09-1.15), and good performance in single leg hop for distance protected against traumatic knee injuries (IRR = 0.66-0.68). Good performance in core stability tests and vertical jump increased the risk for traumatic injuries in the foot region (IRR = 1.12-1.16). Poor balance increased the risk for overuse injuries in the foot region (IRR = 1.65), as did good performance in core stability tests and shuttle run, especially for knee injuries (IRR = 1.07-1.18). Conclusions Poor balance (sway) performance was a consistent predictor of traumatic injuries, in particular, for traumatic ankle injuries. Good motor performance (core stability, vertical jump, and shuttle run) was positively associated with traumatic and overuse injuries and negatively (single leg hop) associated with traumatic injuries, indicating different influences on injury risk. Previous injury was a confounder affecting the effect size and the significance. More studies are needed to consolidate the findings, to clarify the influence of different performance tests on different types of injuries, and to examine the influence of behavior in relation to injury risk.