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Objectives Ski and snowboard-related injuries are common among Canadian youth. Analyzing the role of risky behaviours that contribute to injury risk is essential for gaining an understanding of injury prevention opportunities. The objective was to determine if rates of risky behaviour seen at the ski hill were lower for children and adolescents exposed to an educational injury prevention video. Methods This single-blinded cluster randomized controlled trial included students (ages 7–16) from 18 Calgary schools who were enrolled in novice levelled school-sanctioned ski and snowboard programs. Consenting schools were randomly assigned to the intervention or control. The control group followed standard preparation including watching a general ski hill orientation video that was created by the ski hill. The intervention group viewed the intervention video focussed on injury prevention. The Risky Behaviour and Actions Assessment Tool was used by blinded research assistants to observe and record students’ risky behaviours at an Alberta ski hill. Results In total, 407 observations estimated the rate of risky behaviour. The overall rate of risky behaviour was 23.31/100 person runs in the control group and 22.95/100 person runs in the intervention group. The most commonly observed risky behaviours in both groups were skiing too close to other skiers/snowboarders and near collision with an object/person. Conclusions Both groups showed similar rates of risky behaviour and demonstrated the same most common type of behaviour. Practical applications: future work should focus on mitigating common risky behaviours.

The goal of the OPTIKNEE consensus is to improve knee and overall health, to prevent osteoarthritis (OA) after a traumatic knee injury. The consensus followed a seven-step hybrid process. Expert groups conducted 7 systematic reviews to synthesise the current evidence and inform recommendations on the burden of knee injuries; risk factors for post-traumatic knee OA; rehabilitation to prevent post-traumatic knee OA; and patient-reported outcomes, muscle function and functional performance tests to monitor people at risk of post-traumatic knee OA. Draft consensus definitions, and clinical and research recommendations were generated, iteratively refined, and discussed at 6, tri-weekly, 2-hour videoconferencing meetings. After each meeting, items were finalised before the expert group (n=36) rated the level of appropriateness for each using a 9-point Likert scale, and recorded dissenting viewpoints through an anonymous online survey. Seven definitions, and 8 clinical recommendations (who to target, what to target and when, rehabilitation approach and interventions, what outcomes to monitor and how) and 6 research recommendations (research priorities, study design considerations, what outcomes to monitor and how) were voted on. All definitions and recommendations were rated appropriate (median appropriateness scores of 7–9) except for two subcomponents of one clinical recommendation, which were rated uncertain (median appropriateness score of 4.5–5.5). Varying levels of evidence supported each recommendation. Clinicians, patients, researchers and other stakeholders may use the definitions and recommendations to advocate for, guide, develop, test and implement person-centred evidence-based rehabilitation programmes following traumatic knee injury, and facilitate data synthesis to reduce the burden of knee post-traumatic knee OA.

Objectives(1) To determine the prevalence of spine and upper limb osteoarthritis (OA) and pain in retired Olympians; (2) identify risk factors associated with their occurrence and (3) compare with a sample of the general population.Methods3357 retired Olympians (44.7 years) and 1735 general population controls (40.5 years) completed a cross-sectional survey. The survey captured demographics, general health, self-reported physician-diagnosed OA, current joint/region pain and significant injury (lasting ≥1 month). Adjusted ORs (aORs) compared retired Olympians and the general population.ResultsOverall, 40% of retired Olympians reported experiencing current joint pain. The prevalence of lumbar spine pain was 19.3% and shoulder pain 7.4%, with lumbar spine and shoulder OA 5.7% and 2.4%, respectively. Injury was associated with increased odds (aOR, 95% CI) of OA and pain at the lumbar spine (OA=5.59, 4.01 to 7.78; pain=4.90, 3.97 to 6.05), cervical spine (OA=17.83, 1.02 to 31.14; pain=9.41, 6.32 to 14.01) and shoulder (OA=4.91, 3.03 to 7.96; pain=6.04, 4.55 to 8.03) in retired Olympians. While the odds of OA did not differ between Olympians and the general population, the odds of lumbar spine pain (1.44, 1.20 to 1.73), the odds of shoulder OA after prior shoulder injury (2.64, 1.01 to 6.90) and the odds of cervical spine OA in female Olympians (2.02, 1.06 to 3.87) were all higher for Olympians compared with controls.ConclusionsOne in five retired Olympians reported experiencing current lumbar spine pain. Injury was associated with lumbar spine, cervical spine and shoulder OA and pain for Olympians. Although overall OA odds did not differ, after adjustment for recognised risk factors, Olympians were more likely to have lumbar spine pain and shoulder OA after shoulder injury, than the general population.

ObjectivesThis study aims (1) to determine the prevalence of lower limb osteoarthritis (OA) and pain in retired Olympians; (2) to identify factors associated with their occurrence and (3) to compare with a sample of the general population.Methods3357 retired Olympians (median 44.7 years) and 1735 general population controls (40.5 years) completed a cross-sectional survey. The survey captured demographics, general health, self-reported physician-diagnosed OA, current joint/region pain and injury history (lasting >1 month). Adjusted OR (aOR) compared retired Olympians with the general population.ResultsThe prevalence of (any joint) OA in retired Olympians was 23.2% with the knee most affected (7.4%). Injury was associated with increased odds (aOR, 95% CI) of OA and pain in retired Olympians at the knee (OA=9.40, 6.90 to 12.79; pain=7.32, 5.77 to 9.28), hip (OA=14.30, 8.25 to 24.79; pain=9.76, 6.39 to 14.93) and ankle (OA=9.90, 5.05 to 19.41; pain=5.99, 3.84 to 9.34). Increasing age and obesity were also associated with knee OA and pain. While the odds of OA did not differ between Olympians and the general population, Olympians with prior knee and prior hip injury were more likely than controls with prior injury to experience knee (1.51, 1.03 to 2.21 (Olympians 22.0% vs controls 14.5%)) and hip OA (4.03, 1.10 to 14.85 (Olympians 19.1% vs Controls 11.5%)), respectively.ConclusionsOne in four retired Olympians reported physician-diagnosed OA, with injury associated with knee, hip and ankle OA and pain. Although overall OA odds did not differ, after adjustment for recognised risk factors Olympians were more likely to have knee and hip OA after injury than the general population, suggesting injury is an occupational risk factor for retired Olympians.

Increasing rates of sport-related concussion (SRC) in youth impose a significant burden on public health systems and the lives of young athletes. Accurate prediction for those likely to develop persistent post-concussion symptomology (PPCS) using a fluid biomarker, reflecting both acute injury and recovery processes, would provide the opportunity for early intervention. Cortisol, a stress hormone released through the hypothalamic-pituitary-adrenal (HPA) axis following injury, may provide a missing physiological link to clinical recovery. This cohort study investigated the change in saliva cortisol following SRC and the association between cortisol and symptom burden in pediatric ice hockey players. Further, the association between cortisol levels and medical clearance to return to play was explored. In total, cortisol samples from 233 players were included; 165 athletes (23.6% female) provided pre-injury saliva and 68 athletes (19.1% female) provided post-SRC saliva samples for cortisol analysis. Quantile (median) regressions were used to compare cortisol between pre-injury and post-SRC groups, and the association between total symptoms (/22) and symptom severity scores (/132) reported on the Sport Concussion Assessment Tool (SCAT)3/SCAT5 and post-SRC cortisol (adjusting for age, sex, history of concussion, and time from injury to sample collection). Results demonstrated significantly lower saliva cortisol in post-SRC athletes compared with the pre-injury group (β = -0.62, 95% confidence interval [CI; -1.08, -0.16]

ObjectivesTo compare rates of injury and concussion among U-15 (ages 13–14 years) ice hockey players playing in leagues allowing body checking, but who have a varying number of years of body checking experience.MethodsThis 5-year longitudinal cohort included U-15 ice hockey players playing in leagues where policy allowed body checking. Years of body checking experience were classified based on national/local body checking policy. All ice hockey game-related injuries were identified using a validated injury surveillance methodology. Players with a suspected concussion were referred to a study sport medicine physician. Multiple multilevel Poisson regression analysis was performed, adjusting for important covariates and a random effect at a team level (offset by game exposure hours), to estimate injury and concussion incidence rate ratios (IRRs).ResultsIn total, 1647 players participated, contributing 1842 player-seasons (195 players participating in two seasons). Relative to no body checking experience, no significant differences were found in the adjusted IRRs for game-related injury for players with 1 year (IRR=1.06; 95% CI: 0.77 to 1.45) or 2+ years (IRR=1.16; 95% CI: 0.74 to 1.84) body checking experience. Similarly, no differences were found in the rates of concussion for players with 1 year (IRR=0.92; 95% CI: 0.59 to 1.42) or 2+ years (IRR=0.69; 95% CI: 0.38 to 1.25) body checking experience.ConclusionsAmong ice hockey players aged 13–14 years participating in leagues permitting body checking, the adjusted rates of all injury and concussion were not significantly different between those that had body checking experience and those that did not. Based on these findings, no association was found between body checking experience and rates of injury or concussion specifically in adolescent ice hockey.

Background: Juvenile Idiopathic Arthritis (JIA) is the most common childhood rheumatic disease. Given the heterogeneity of JIA and advances in treatment approaches, there is a persistent lack of consensus regarding the secondary consequences of JIA. This study assessed body structure and function and physical activity outcomes in youth with JIA compared to their healthy peers. Methods: Youth with JIA (n=25; 10-20 years old) and age and sex matched healthy peers (n=25) participated in two data collections (one week apart) (Ethics ID# REB15-3125). Day 1 testing included a triple single leg hop test (TSLH) and an incremental bike test. Participants then recorded their physical activity for one week using the waist worn ActiGraph. Day 2 testing consisted of a dual-energy x-ray absorptiometry scan. Outcomes included: moderate to vigorous physical activity (MVPA), peak oxygen uptake (VO2peak), maximal TSLH distance (% leg length), and fat mass index (FMI). Data were assessed for normality and outliers. Pair differences were analyzed in R (R Core Team, Austria) using t-confidence intervals (CI) or the Hodges-Lehmann method with Bonferroni correction. A significant difference was accepted if CIs excluded zero. The effect of sex on outcomes was examined using pair difference medians and first and third quartiles. Results: CIs for all study outcomes contained zero and did not meet criteria for significant differences between pairs. However, based on the large lower limit and small upper limit of the CIs for MVPA (median -18.6min 97.5%CI [-44.3,2.0]), a larger sample might have concluded that youth with JIA perform substantially less MVPA than their healthy peers. Further, based on pair difference point estimates and interquartile ranges, sex may be a confounder with regards to physical activity participation and may be an effect modifier of the TSLH. Conclusions: The results of this study provide further evidence on the consequences of JIA on physical activity participation in youth. These findings highlight the importance of considering the effects of sex, particularly with regards to physical activity and TSLH outcomes. Further research across JIA subtypes is needed to inform the targeted exercise therapy programs to restore healthy patterns of physical activity participation.

Background Children and youth who sustain a sport and recreational (S&R) injury may be at greater risk of attributing long-term unhealthy body composition and low physical fitness. Objective To assess the potential influence of previous S&R injury on body composition, cardiorespiratory fitness, musculoskeletal strength, and dynamic balance in junior high school students. Design Cross-sectional. Setting Junior high schools in Calgary, Alberta, Canada. Participants Students aged 11–16 years (n=1,039; 584 males and 455 females) from six junior high schools. Assessment of Risk Factors Participants reported information on demographics, sport participation over the previous year, and S&R injuries sustained in the previous 12 months via a questionnaire. Main Outcome Measurements Physical fitness measures included predicted VO2max from a 20-m shuttle run to assess cardiorespiratory fitness, vertical jump to assess lower body musculoskeletal fitness, and the Y-balance and unipedal eyes closed balance tests to assess dynamic balance. Health outcome measures to assess body composition included waist circumference, and body mass index (BMI) calculated from height and weight measures. Statistical analyses (adjusting for age, sex, and mean weekly hours of sport participation) to assess the association between previous S&R injury (yes/no) and each outcome included multivariable logistic regression for body composition measures and multivariable linear regression for physical fitness measures. Results One hundred eighty-eight (18.1%) students reported sustaining a S&R injury in the previous year. Previously injured participants had significantly higher BMI (OR=1.82, 99% CI 1.07–3.11) compared to uninjured participants. Exploratory analysis results suggest a more in-depth look at the association between number of previous injuries and body composition. Conclusions Participants with a history of injury demonstrated unhealthier body composition compared to uninjured participants. Body composition should be considered in future injury prevention research in youth.

Background Hockey Canada developed the Hockey Canada Skills Test (HCST), which measures skill acquisition and development. Objective To investigate the effect of previous concussion on sport-specific skill performance in youth ice hockey players. Design Cross-sectional. Setting Ice hockey arenas in Calgary, Alberta, Canada. Participants 596 participants [525 males and 71 females, ages 11–17, representing elite (upper 30% by division of play) and non-elite (lower 70%) levels] recruited from minor ice hockey teams over three seasons of play (2012–2015). Assessment of Risk Factors Players completed a baseline questionnaire including the number, date of occurrence, and length of recovery for any previous concussions. Main Outcome Measurements On-ice skill performance was based on the HCST battery (forward agility weave, forward/backward speed skate, forward-to-backward transition agility, 6-repeat endurance skate). Multiple linear regression (adjusted for relative age, level of play, position, elite/non-elite, and musculoskeletal injury in the previous year), accounting for clustering by team, was conducted to explore the effect of history of concussion, number of previous concussions, time since most recent concussion, and severity of most recent concussion on HCST performance. Results A history of concussion and time since most recent concussion were not associated with any HCST component. Players reporting two or more concussions were 7.32 seconds faster (95% CI:3.59–11.05) than those with no history performing forward agility weave with puck. For every additional day to return to play post-concussion, player times were faster by: 0.11 seconds (95% CI:0.05–0.16) on forward agility weave with puck and 0.08 seconds (95% CI:0.04–0.13) without puck, 0.01 seconds (95% CI:0.01–0.02) on transition agility without puck, and 0.06 seconds (95% CI:0.03–0.1) on backward speed with puck and 0.05 seconds (95% CI:0.03–0.07) without puck. Conclusions Players with and without a history of concussion have similar HCST scores. Greater time loss following concussion was associated with better performance. The mechanism for this finding requires further exploration.

Background Policy disallowing body checking in youth ice hockey significantly reduces the risk of injury and concussion. Based on video analysis, frequency and intensity of player to player physical contacts (PCs) are higher in Pee Wee players (ages 11–12) in leagues allowing body checking, however this has not been examined in Bantam leagues (ages 13–14). Objective To determine the association between body checking policy and the frequency and intensity of physical contacts in Bantam ice hockey players (ages 13–14). Design Cohort study. Setting Ice hockey arenas. Participants Thirteen non-elite (lowest 60% by division of play) Bantam ice hockey games in Calgary, Alberta, Canada (2014–15 season) and 13 non-elite games in Vancouver, British Columbia, Canada (2014–15 season) were videotaped. Intervention Policy allowed body checking in Calgary and not Vancouver in the non-elite levels (2014–15). Main Outcome Measurements Incidence rate ratios [IRRs] (adjusted for player position) were estimated using multiple Poisson regression to examine the effect of body checking policy on player-to-player PCs [levels 1–5 with increasing intensity (levels correspond to 4–5 body checking)] and hooking/slashing behaviours. Results Lower rates of higher intensity contacts (levels 4–5 body checking) were observed in Bantam ice hockey players in a league where body checking was disallowed [IRR=0.09; 95% CI: 0.05–0.15]. Players in a league where body checking was disallowed, however, had significantly higher rates of hooking and slashing behaviours [IRR=1.81; 95% CI: 1.33–2.47]. Conclusions Bantam ice hockey players in a league where policy disallowed body checking are at a lower risk of high intensity physical contacts, but commit higher rates of hooking and slashing behaviours. This research informs the mechanisms explaining injury risk reduction related to body checking policy change and have important national public health implications for policy decisions related to rule enforcement in youth sport.

Preparticipation examinations are often performed based on the assumption that the exam contributes to the identification of risk factors for injury and, therefore, lead to the implementation of appropriate injury prevention strategies for athletes. Research evidence supporting the components, benefits, and limitations of the preparticipation examination performed by a physiotherapist is the focus of this paper. Evidence exists that some specific preparticipation examination components will identify known risk factors which may be addressed in the context of injury prevention strategies for that athlete. Examinations should use existing evidence-based practice to identify valid and appropriate tests examining known risk factors. Physiotherapists are encouraged to continue development, implementation, and evaluation of appropriate training techniques for the athletes to minimize their risk of injury. Physiotherapists need to be aware of athlete confidentiality issues as well as the importance of cost effectiveness of preparticipation examinations. The future of physiotherapist delivered preparticipation examinations may lie in the utilization of an evidence-based approach to risk factor identification, development and evaluation of prevention strategies, and development and evaluation of performance enhancement strategies for the athlete.

Background Studies examining risk factors for sport injury in elementary school children are few. The risk of sport injury in special populations including Developmental Coordination Disorder (DCD) and Attention Deficit Hyperactivity Disorder (ADHD) has not been previously examined. Objective To examine risk factors for sport injury in elementary school students (ages 9–12), including special populations (DCD and ADHD). Design Cross-sectional study. Setting A survey was sent home with students in 26 randomly selected Calgary (Canada) elementary schools. Participants Children ages 9–12 years (n=540). Risk factor assessment The primary risk factors of interest were probable DCD (pDCD) and ADHD. Other risk factors considered included age, sex, ethnicity, highest level of parent education, stressful life events (previous year), receiving coaching in at least 1 sport, and body mass index. Main outcome measurements Injury definitions included any sport injury in the previous year and sport injury in the previous year requiring medical attention. Results Based on univariate Poisson regression (adjusted for exposure hours and cluster) the risk of all sport injury in the previous year in typically developing children did not differ from children with either pDCD (n=150, Incidence Rate Ratio (IRR=1.02 [95% CI 0.7–1.5]) or ADHD (n=87, IRR=0.94 [95% CI 0.58–1.55]). Children with ADHD were at a greater risk of sport injury requiring medical attention compared to those without ADHD (IRR: 1.82 [95% CI 1.23–2.68]). No other risk factors were identified based on univariate analysis. Conclusions Children (9–12 years) with pDCD and ADHD were at a similar risk of sport injury in the previous year as typically developing children. Children with ADHD were at an 82% greater risk of sport injury requiring medical attention than children without the disorder. This study will inform the development of injury prevention strategies for future studies in elementary school targeting children with ADHD.