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Groin pain is a widely recognized medical issue among athletes. Groin pain can affect both player and team performance and sometimes can be a career-ending injury. The aim of this study was to assess seasonal groin pain prevalence and the average seasonal time loss from sport for each injury in different team sport athletes. The hip and groin functionality at the beginning of the following season was also investigated.A cross-sectional study was undertaken on 600 team sport athletes (soccer, futsal, basketball, volleyball, and water polo players). The seasonal prevalence of groin pain, level of competition (professional and non-professional), time loss, and concomitant injuries in addition to groin pain were reported and analyzed. The Copenhagen Hip and Groin Outcome Score (HAGOS) was used to assess hip and groin pain and function related to sport and activity.Among the 506 (84%) players included, 123 players (24.3%) reported groin pain. Overall, soccer players reported the highest groin pain prevalence (32.5%) followed by futsal (25.5%), basketball (25.2%), water polo (17.6%) and volleyball players (13.6%). Professional soccer, futsal and basketball athletes showed higher groin pain prevalence in comparison with non-professional athletes (p = 0.02, p = 0.005 and p = 0.004, respectively). The mean time loss from sport due to groin pain was 60.3 ± 66 days in soccer, 41.1 ± 16.6 days in futsal, 31.5 ± 18 days in water polo, 37.2 ± 14.2 days in basketball and 50.8 ± 24.6 days in volleyball. Significantly lower HAGOS values were found in athletes with groin pain for all sports evaluated compared to athletes with no groin pain history (p = 0.0001). Longer time loss from sport was correlated with lower HAGOS values in soccer (p = 0.002) and futsal (p = 0.002) players with groin pain. Concomitant injuries were correlated with lower HAGOS values in water polo players (p = 0.03).Seasonal groin pain occurs in as many as one in four team sport athletes. Soccer players show the highest groin pain prevalence and the longest time loss from sport. Professional athletes report higher prevalence of groin pain in comparison with non-professional athletes. HAGOS appears to be a valid outcome instrument to measure groin pain, correlating with both time loss from sport and concomitant injuries in athletes.Level IV.

Background and Objectives. The debonding procedures of brackets in orthodontics cause a different amount of time loss and enamel damage. The current research assesses and equates the time consumption for bracket debonding using four different techniques. Materials and Methods. A total of 80 human premolars were included in this study. The samples were first arranged following a standard protocol for bracketing and then debonded using the ultrasonic scaler (US), debonding plier (DP), ligature cutter (LC), and thermal method (TM). Depending on the technique applied for debonding, the specimens were randomly divided into four groups with 20 samples, each keeping a 1 : 1 ratio. During the debonding process, the time taken for each bracket removal was recorded using a stopwatch. To assess the difference in mean time required for debonding among the four techniques, one-way ANOVA test was applied along with Tukey’s HSD to compare the two methods. Results. The time range and the mean time required for the four techniques analyzed show that the DP method has the highest range of time needed for debonding with 0.97–2.56 seconds, while LC methods have the least time range taking 0.46 to 1.79 seconds. TM’s mean time to debond is the highest at 1.5880 seconds. LC method has the lowest mean debonding time of 0.9880 seconds. The one-way ANOVA test has shown the mean debonding time required by the four techniques to be significantly different ( p < 0.001 ). Tukey’s HSD multiple comparisons also show that the mean time to debond using the LC method is substantially less than the other three methods ( p < 0.001 ). Conclusion. The mean debonding time for the TM was substantially the highest, followed by the US and DP. Debonding with the LC technique required the least time. This study shows some limelight towards the effectiveness of the LC method as it is the least time-consuming technique.

There is a trend toward increased surgical treatment of displaced clavicle fractures in the adolescent population presumably because of extrapolation of adult-derived best practice guidelines. The purpose of this study was to compare return to sport between nonoperative and operative treatment of clavicle fractures in high school athletes.A retrospective review of clavicle fractures sustained in scholastic athletes participating in school-sponsored athletics in the upstate South Carolina was performed from 2015 to 2019. Injury circumstances, demographics, radiographs, treatment, and return to sport data were documented for all patients. Radiographs were evaluated for fracture location, comminution, displacement, shortening, and angulation. Patients were followed until complete return to sport, and results were compared based on sport participation, injury mechanism, fracture morphology, treatment type, and time to return to sport.Forty-seven patients (44 were male; average age 15.6 years) were included who all returned to sport within the original or subsequent season. Thirty-six patients (73%) were managed conservatively (30 middle third fractures, 4 medial third fractures, 2 distal third fractures), whereas 11 were managed surgically (11 middle third fractures). Eighty-one percent of fractures occured in collision athletes (55% in football). There was no difference in time loss based on participating in collision vs. noncontact sports (P = .4). Conservatively managed fractures returned to sport faster (61 ± 38 days vs. 100 ± 49 days; P = .008) compared with surgically managed patients. Fracture displacement ≥100% (100 ± 51 days vs. 54 ± 27 days; P = .001), greater comminution (128 ± 50 days vs. 59 ± 31 days; P = .001), and angulation (86 ± 52 days vs. 54 ± 22 days; P = .001) all were statistically significant for slower return to sport. Athletes presenting with clavicular shortening2 cm returned to sport within a similar time frame as athletes with ≥2 cm (P = 0.1).Our results show that adolescent athletes with clavicular fractures predictably return to athletics, including collision sports. Athletes conservatively managed returned 40% faster than those with surgery. However, this appears to be associated with the severity and complexity of fractures treated surgically. This study provides evidence to counsel adolescent athletes following clavicular fractures on return to sport expectations.

Objective To examine the individual experiences of injury burden in amateur Rugby players across the onset of injury, rehabilitation, and return to play. Design Qualitative. Setting Irish amateur Rugby clubs. Participants Three male and two female Rugby players who sustained a severe injury that resulted in a time loss of at least 28 days. Main outcome measures Semi-structured interviews were used to explore the injury burden experienced during the three phases of injury. Results Hierarchical content analysis revealed 36 codes representing individual injury burden, which were clustered into seven themes across personal (emotional reaction; impact on performance or involvement; lack of knowledge; severity of injury and incapacitation) and situational (exposure to others playing; negative experiences with treatment or rehabilitation; societal burden) dimensions. Conclusions The findings indicate that individual injury experiences can affect a player’s recovery and rehabilitation outcome, potentially extending the injury process and affecting player availability for the team. As such, injury management should focus on alleviating any injury-related burden experienced by players, as well as burden placed on the team, to maximise rehabilitation outcomes.

BACKGROUND: Despite growing participation in circus arts, little is known about associated injuries. Understanding injury patterns is critical for developing interventions to decrease injury risk and guiding rehabilitation. OBJECTIVE: The purpose of this pilot prospective cohort study was to describe injury frequency and characteristics in adolescent and adult circus artists using a surveillance method derived from dance. METHODS: Participants included 14 adolescent [mean age 14.7 yrs (1.3); 100% female] and 10 adult circus artists [mean age 30.7 yrs (3.1); 60% female]. Circus training exposure (single session of one circus discipline) and injuries were tracked for 1 year using a dance-derived injury surveillance guideline. A regression analysis was run using total session exposures, age (in years), and years of circus experience as predictor variables for injury rate. RESULTS: Twenty-one of 24 participants completed the study. Forty-seven injuries were reported (53.2% time loss; 46.8% non-time loss). Joint injuries were most common for both groups. The injury rate per 1,000 exposures was 3 (95%CI 0.6–8.7) for adolescents and 13 (95%CI 6.9–22.01) for adults. The overall regression was significant (F(3,13)=6.66, p=0.006). The only significant predictor was age (beta=0.82, p=0.003). Total session exposures and years of circus experience had betas close to 0 (–0.11 and –0.04, respectively). CONCLUSION: This pilot study comparing injuries in adolescent and adult circus artists found age but not exposure was predictive of injury risk. Use of a standardized injury surveillance guideline in circus, similar to the one used in this study, will provide greater insight into injury patterns by allowing between-study comparison.

This study aimed to investigate the impact of COVID-19 enforced prolonged training disruption and shortened competitive season, on in-season injury and illness rates. Injury incidence and percent proportion was calculated for the 2020 elite men’s senior domestic cricket season and compared to a historical average from five previous regular seasons (2015 to 2019 inclusive). The injury profile for the shortened 2020 season was generally equivalent to what would be expected in a regular season, except for a significant increase in medical illness as a proportion of time loss (17% compared to historic average of 6%) and in-season days lost (9% compared to historic average of 3%) due to COVID-19 related instances (most notably precautionary isolation due to contact with a confirmed or suspected COVID-19 case). There was a significant increase in the proportion of in-season days lost to thigh injuries (24% compared to 9%) and a significant decrease in the proportion of days lost to hand (4% compared to 12%) and lumbar spine (7% compared to 21%) injuries. These findings enhance understanding of the impact prolonged period of training disruption and shortened season can have on cricket injuries and the challenges faced by practitioners under such circumstances.

Athletic injuries to the hip flexors and iliopsoas have been described in populations across all levels of competitive sports. Overall estimates of hip flexor pathology have ranged from 5% to 28% of injuries among high-risk sport specific groups. Although most of these injuries are successfully treated with conservative management, and high rates of return to play are observed, significant rehabilitation time can be involved. As the understanding of hip pathology with imaging modalities such as MRI has advanced, greater importance has been placed on accurately diagnosing hip flexor injuries and initiating rehabilitation protocols early to minimize time loss from sport.

ObjectiveWe assessed past-season, pre-season and in-season risk factors to investigate their association with an in-season groin problem in male amateur football players.MethodsPast-season groin-pain information and pre-season short-lever and long-lever adductor squeeze strength were obtained at baseline, together with anthropometrics (weight, lower limb lever length) and player age. In-season hip-related and groin-related sporting function was monitored every 4 weeks using the Sports and Recreation (Sport) subscale from the Hip And Groin Outcome Score questionnaire (HAGOS (Sport)). Groin problems, including time-loss groin injuries and groin pain irrespective of time loss, were collected over a 39-week competitive in-season. We estimated relative risk (RR), and 95% credibility interval (ICr) from logistic regressions fitted in a Bayesian framework.ResultsPlayers (n=245) suffering from groin pain during the past-season had 2.4 times higher risk of experiencing a groin problem in the new season (2.40 RR; 95% ICr 1.5 to 3.7). This risk was reduced by 35% (0.65 RR; 95% ICr 0.42 to 0.99) per unit (N·m/kg) increase in the long-lever adductor squeeze test. Player age, short-lever squeeze test and the HAGOS (Sport) scores were not associated with the risk of a groin problem.ConclusionsPast-season groin pain increased the risk of a groin problem in the new in-season. This risk was reduced by higher pre-season long-lever adductor squeeze strength. Past-season groin-pain information and long-lever adductor squeeze strength can be quickly obtained during pre-season to identify players with an elevated risk of in-season groin problems. This may be key to reduce these problems in the new season.

To prevent the occurrence of injury in a sport, exact knowledge of injury patterns is needed. To synthesize sport-specific injuries in track and field comparing elite and recreational level athletes, as well as gender. Furthermore, analyze the time loss due to injury and reduction in athletic performance.Injury type-specific frequencies were recorded according to discipline, gender and performance level. Injury severity was assessed by time loss duration and performance reduction.64% of athletes suffered at least one injury. In the top 10 ranking, 83% (n = 524) were located in the lower extremities. A muscle strain of the thigh had the highest prevalence in sprint (34%, n = 41), jump (15%, n = 15) and middle-distance running (16%, n = 6). More injuries occurred during training (75%, n = 165) as compared to competition (25%, n = 56). The longest time loss was documented in throwing with a downtime of 36 weeks after a ligament injury of the elbow and 39 weeks after a muscle injury of the elbow. The injury with the highest number of athletes with a reduced level of performance was the foot ligament injury in sprint athletes at 100%.Assessing time loss and performance reduction in athletics, there are discipline-specific injury patterns. This study points out the high prevalence of training injuries, highlighting the need for future investigations to adapt training management, improve medical care and rehabilitation with respect to every discipline.

Background: High-speed running is commonly implicated in the genesis of hamstring injury. The success of hamstring injury management is typically quantified by the duration of time loss or reinjury rate. These metrics do not consider any loss in performance after returning to play from hamstring injury. It is not known to what extent high-speed running is altered on return to play after such injury. Hypothesis: Match high-speed running distance will change after returning from hamstring injury. Study Design: Non-randomized cohort. Level of Evidence: Level 3. Methods: Match high-speed running distance in highest level professional football (soccer, Rugby League, Rugby Union, and Australian Rules) were examined for a minimum of 5 games prior and subsequent to hamstring strain injury for individual differences using a linear regression models approach. A total of 22 injuries in 15 players were available for analysis. Results: Preinjury cumulative high-speed running distances were strongly correlated for each individual ( r2 = 0.92-1.0; P < 0.0001). Pre- and postinjury high-speed running data were available for a median of 15 matches (range, 6-15). Variance from the preinjury high-speed running distance was significantly less ( P = 0.0005) than the post injury values suggesting a suppression of high-speed running distance after returning from injury. On return to play, 7 of the 15 players showed a sustained absolute reduction in preinjury high-speed running distance, 7 showed no change, and 1 player (only) showed an increase. Analysis of subsequent (second and third injury) return to play showed no differences to return from the index injury. Conclusion: Return to play was not associated with return to high-speed running performance for nearly half of the players examined, although the same number showed no difference. Persisting deficits in match high-speed running may exist for many players after hamstring strain injury. Clinical Relevance: Returning to play does not mean returning to (high-speed running) performance for nearly half of the high-level professional football players examined in this study. This suggests that successful return to play metrics should be expanded from simple time taken and recurrence to include performance.

Purpose The prevalence of hip and groin problems in professional male ice hockey is unknown and suspected to differ between playing positions. The purpose of this study was to explore potential differences in the seasonal prevalence of hip and groin problems between playing positions in male elite ice hockey players and to explore the relationship between symptom duration and hip and groin function at the beginning of the new season. Methods Male ice hockey players [n = 329 (92 goalkeepers, 93 defensemen, 144 forwards), Mean age (SD): 24 (5)] from the professional leagues in Sweden responded to an online survey. The survey assessed presence of hip and groin problems (time loss and non-time loss) and symptom duration (categorized into 0, 1–6, or > 6 weeks) in the previous season, and current self-reported hip and groin function (Copenhagen Hip and Groin Outcome Score). Results During the previous season, 175 players (53.2%) had experienced hip and groin problems. Non time loss problems were experienced by 158 (48%) and time loss problems were experienced by 97 (29.5%) players. No significant differences between playing positions were found. Self-reported function differed significantly between players with different symptom duration and more disability was reported among players with longer symptom duration (p ≤ 0.002). Conclusion Regardless of playing position, hip and groin problems were prevalent in male ice hockey players. Players with hip and groin problems during the previous season had significantly worse hip and groin function in the beginning of the new season, and longer symptom duration was associated with more disability. Level of evidence III

Data with respect to collegiate fencing injuries are very limited. We performed a prospective cohort study of a college fencing team to analyze the rates and types of injuries that occurred to this team over the course of a year. We noted that the injury rate was low, with 2.43 injuries per 1000 athlete exposures. We also noted that 75% of those injured had a time loss of less than 2 wk. A large percentage of our injuries (88%) were musculoskeletal in nature. There were equal numbers of acute and chronic injuries. Men and women had a similar rate of injury. In our study population, we noted that most of the injuries occurred in practice over competition (87.5% vs 12.5%, respectively). We compared the data from a small subset population with the current evidence published with respect to fencing injuries. We noted some similarities and also some differences when comparing certain populations.

Background: Anterior cruciate ligament (ACL) injury is one of the most frequent orthopaedic injuries and reasons for time loss in sports and carries significant implications, including posttraumatic osteoarthritis (OA). Instability associated with ACL injury has been linked to the development of secondary meniscal tears (defined as tears that develop after the initial ACL injury). To date, no study has examined secondary meniscal tears after ACL injury and their effect on OA and arthroplasty risk. Purpose: To describe the rates and natural history of secondary meniscal tears after ACL injury and to determine the effect of meniscal tear treatment on the development of OA and conversion to total knee arthroplasty (TKA). Study Design: Cohort study; Level of evidence, 3. Methods: A geographic database of >500,000 patients was reviewed to identify patients with primary ACL injuries between January 1, 1990, and December 31, 2005. Information was collected with regard to ACL injury treatment, rates/characteristics of the secondary meniscal tears, and outcomes, including development of OA and conversion to TKA. Kaplan-Meier and adjusted multivariate survival analyses were performed to test for the effect of meniscal treatment on survivorship free of OA and TKA. Results: Of 1398 primary ACL injuries, the overall rate of secondary meniscal tears was 16%. Significantly lower rates of secondary meniscal tears were noted among patients undergoing acute ACL reconstruction within 6 months (7%) as compared with patients with delayed ACL reconstruction (33%, P < .01) and nonoperative ACL management (19%, P < .01). Of the 235 secondary meniscal tears identified (196 patients), 11.5% underwent repair, 73% partial meniscectomy, and 16% were treated nonoperatively. Tears were most often medial in location (77%) and complex in morphology (56% of medial tears, 54% of lateral tears). At the time of final follow-up, no patient undergoing repair of a secondary meniscal tear (0%) underwent TKA, as opposed to 10.9% undergoing meniscectomy and 6.1% receiving nonoperative treatment ( P = .28). Conclusion: Secondary meniscal tears after ACL injury are most common among patients undergoing delayed surgical or nonoperative treatment of their primary ACL injuries. Secondary tears often present as complex tears of the medial meniscus and result in high rates of partial meniscectomy.

Overuse injuries in dance are extremely common and often difficult to treat. High training load and dancing with pain are frequently regarded as risk factors for musculoskeletal injuries in professional dancers. The aims of this study were to assess for: 1. any association between training load (TL) and symptoms of overuse injury in professional dancers, and 2. any difference between the number of "time-loss" injuries and injuries causing significant symptoms not leading to decreased performance time. Twenty-one dancers from a professional contemporary dance company were followed for 7 weeks. They completed the dance-specific Self-Estimated Functional Inability because of Pain (SEFIP) questionnaire on a weekly basis to quantify musculoskeletal pain. Their TL was calculated by multiplying the Ratings of Perceived Exertion scale (RPE Borg CR10) by the daily training time. Associations between TL and SEFIP scores, recorded on a weekly basis, were evaluated using a mixed linear model with repeated measurements. No significant association was found between TL and severity of musculoskeletal pain. However, the TL of the dancers with no symptoms of overuse-injury, SEFIP = 0, was significantly lower compared to the dancers with symptoms, SEFIP > 0; p = 0.02. No time loss because of injury was reported during the study period. There were 251 symptoms of overuse injury reported, and 67% of the recorded time was danced with pain. It is concluded that dancers without musculoskeletal pain had lower TLs. While no time-loss injuries were found, two-third of the participants danced with pain during this 7-week period.

Sports-related injuries increase healthcare cost burden, and in some instances have harmful long term physical and psychological implications. There is currently a lack of comprehensive data on temporal injury trends across professional North American sports. The purpose of this study was to compare temporal trends, according to incidence and time-loss injuries, by body part in professional baseball, basketball, football, and ice hockey. Public injury data from Major League Baseball, National Basketball Association, National Football League, and National Hockey League from 2007 to December 2019 were extracted and used. A mean of 62.49 injuries per 100 players per season was recorded for all professional sports. The groin/hip/thigh reported the greatest season proportional injury incidence for baseball, football, and ice hockey, with the groin/hip/thigh as the third highest injury incidence in basketball. When stratifying by more specific body part groupings, the knee demonstrated the greatest injury proportional incidence for basketball, football, and ice hockey, with the knee as the third highest proportional injury incidence for baseball. There was an increased in basketball ankle injuries following 2011–2012 season. Football and ice hockey reported the greatest concussion proportion incidence, with football demonstrating an increase in concussions over time, and a substantial increase in concussions from the 2014 to 2015 season. These publicly extracted data and findings can be used as a shared resource for professional baseball, basketball, football, and ice hockey for future individual and across sport collaborations concerning resource allocation and decision making in order to improve player health.

A better insight into injuries in elite-youth football may inform prevention strategies. The purpose of this prospective cohort study was to investigate the frequency, incidence, and pattern of time-loss injuries in an elite male football academy, exploring injuries in relation to age and maturation status. Across four consecutive playing seasons, playing exposure and injuries to all academy players (U’9 to U’21) were recorded by club medical staff. Maturation status at the time of injury was also calculated for players competing in U’13 to U’16 aged squads. Time-loss injury occurrence and maturation status at time of injury were the main outcome measures. A total of 603 time-loss injuries were recorded, from 190 different players. Playing exposure was 229 317 hours resulting in an overall injury rate of 2.4 p/1000 h, ranging from 0.7 p/1000 h (U’11) to 4.8 p/1000 h (U’21). Most injuries were traumatic in mechanism (73%). The most common injury location was the thigh (23%), and the most common injury type was muscle injury (29%) combining to provide the most common injury diagnosis; thigh muscle injury (17%). In U’13-U’16 players, a higher number of injuries to early-maturing players were observed in U’13-U’14 players, while more injuries to U’15-U’16 players occurred when classed as “on-time” in maturity status. Maturation status did not statistically relate to injury pattern; however, knee bone (not-fracture) injuries peaked in U’13 players while hip/groin muscle injuries peaked in U’15 players.

To describe all health problems (injuries and illnesses) in relation to type, location, incidence, prevalence, time loss, severity, and burden, in competitive adolescent distance runners in England. Prospective observational study: 136 competitive adolescent distance runners (73 female athletes) self-reported all health problems for 24-weeks between May and October 2019. Athletes self-reported health problems using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems. The incidence of running-related injury per 1,000 hours of exposure was markedly higher, compared to previous research. At any time, 24% [95% Confidence Intervals (CI): 21–26%] of athletes reported a health problem, with 11% [95% CI: 9–12%] having experienced a health problem that had substantial negative impact on training and performance. Female athletes reported noticeably more illnesses, compared to male athletes, including higher prevalence, incidence, time loss, and severity. The most burdensome health problems, irrespective of sex, included lower leg, knee, and foot/toes injuries, alongside upper respiratory illnesses. The mean weekly prevalence of time loss was relatively low, regardless of health problem type or sex. Competitive adolescent distance runners are likely to be training and competing whilst concurrently experiencing health problems. These findings will support the development of injury and illness prevention measures.

Background Video analysis is one of the most commonly applied methods for analysing football injuries. Purpose The objective of this study was to assess the accuracy of video analysis for recording head injuries in professional football from official matches in the four highest men’s professional football leagues in Germany. Methods In this cohort study, head injuries detected by means of video analysis of all official matches over one season (2017–18) were compared to head injuries registered with the German statutory accident insurance. Results Our video analysis yielded 359 head injuries of 287 players. The comparison of head injuries found in our video analysis to those registered with the accident insurance only yielded a match in 23.1% (n = 83), which presents a rather low verification rate. The verification rates varied between the leagues (7.0–30.8%). All injuries documented in the accident insurance registry were found in the video analysis (100%). The types of head injury most often verified by the accident insurance registry (n = 83) were contusion (43.4%), bone fractures (19.3%) and skin lacerations (18.1%). Only 66 of the 359 head injuries (18.4%) resulted in absence from at least one training session and involved a mean time loss of 18.5 days (1–87 days). Conclusion The mismatch between the number of head injuries found in the video analysis and head injuries registered with the accident insurance is an important methodological issue in scientific research. The low verification rate seems to be due to the unclear correlation between injury severity and clinical consequences of head injuries detected by means of video analysis and the failure of football clubs to register minor head injuries with the accident insurance.

Our aims were to evaluate the feasibility of a framework based on micro-sensor technology for in-field analyses of performance and sub-technique selection in Para cross-country (XC) skiing by using it to compare these parameters between elite standing Para (two men, one woman) and able-bodied (AB) (three men, four women) XC skiers during a classical skiing race. The data from a global navigation satellite system and inertial measurement unit were integrated to compare time loss and selected sub-techniques as a function of speed. Compared to male/female AB skiers, male/female Para skiers displayed 19/14% slower average speed with the largest time loss (65 ± 36/35 ± 6 s/lap) found in uphill terrain. Female Para/AB skiers utilized DP, DK, and DIA, 61/43%, 15/10%, and 25/47% of the distance at low speeds, respectively, while the corresponding numbers for male Para/AB skiers were 58/18%, 1/13%, and 40/69%. At higher speeds, female Para/AB skiers utilized DP and OTHER, 26/52% and 74/48% of the distance, respectively, while corresponding numbers for male Para/AB skiers were 29/66% and 71/34%. This indicates different speed thresholds of the classical sub-techniques for Para than AB skiers. The framework provides a point of departure for large-scale international investigations of performance and related factors in Para XC skiing.

This study investigated the weekly prevalence of groin problems over a 3-week football pre-season, compared to a 39-week competitive in-season. We registered time-loss groin injuries, and self-reported weekly groin-pain in 17 amateur male football teams (386 players). The average weekly prevalence of groin problems (prevalence ratio (PR)) was 1.8 times higher (95% CI 1.6 to 2.0) during pre-season (21%) compared to in-season (12%). We found a higher weekly prevalence (PR 1.8; 95% CI 1.6 to 2.1) of groin problems without time loss, during the pre-season (19%) compared to the in-season (10%), but no significant difference in the weekly prevalence of groin problems with time loss (PR 1.5; 95% CI 1.0 to 2.4). Attention should be given to optimal load progression, and early implementation of preventive measures during the football pre-season to reduce the prevalence of groin problems in both pre- and in-season.

ObjectivesTo describe age group patterns for injury incidence, severity and burden in elite male youth football.MethodsProspective cohort study capturing data on individual exposure and time-loss injuries from training and matches over four seasons (2016/2017 through 2019/2020) at a national football academy (U13–U18; age range: 11–18 years). Injury incidence was calculated as the number of injuries per 1000 hours, injury severity as the median number of days lost and injury burden as the number of days lost per 1000 hours.ResultsWe included 301 players (591 player-seasons) and recorded 1111 time-loss injuries. Overall incidence was 12.0 per 1000 hours (95% CI 11.3 to 12.7) and burden was 255 days lost per 1000 hours (252 to 259). The mean incidence for overall injuries was higher in the older age groups (7.8 to 18.6 injuries per 1000 hours), while the greatest burden was observed in the U16 age group (425 days; 415 to 435). In older age groups, incidence and burden were higher for muscle injuries and lower for physis injuries. Incidence of joint sprains and bone stress injuries was greatest for players in the U16, U17 and U18 age groups, with the largest burden observed for U16 players. No clear age group trend was observed for fractures.ConclusionInjury patterns differed with age; tailoring prevention programmes may be possible.

BACKGROUND: Bharatanatyam is an Indian classical dance form that is practiced globally. There is limited information about the prevalence of injuries in Bharatanatyam dancers. OBJECTIVES: To investigate the prevalence of musculoskeletal injuries and specifics of dance training in female Bharatanatyam dancers in the Udupi district of India. METHODS: We developed and tested a survey for Bharatanatyam dancers regarding injury history in the prior year, including location, time loss, cause, and need for medical help. We also obtained demographic and training information. RESULTS: 101 dancers completed the survey. 10.8% of dancers reported musculoskeletal injuries because of participation in dance. They sustained 0.65 injuries/1,000 hours of dancing. The most frequently injured areas were ankle (27.2%) and knee (27.2%) followed by lower back (13.6%) and hip (9%). Despite being injured, 36.4% of the dancers continued to dance. 54.5% of the injured dancers sought the help of a medical professional for their dance-related injuries. The most common surface for dance was concrete followed by other hard surfaces such as marble and tile. CONCLUSION: Female Bharatanatyam dancers are prone to injuries of the lower extremity and back. Most dancers in our study practice the Pandanalluru style on hard surfaces. There is a need to investigate the impact of training factors on the injury occurrence.

Spine sports stress injuries account for a significant amount of time loss at play in athletes, particularly if left unrecognized and allowed to progress. Spondylolysis makes up most of these stress injuries. This article focuses on spondylolysis, bringing together discussion from the literature on its pathomechanics and the different imaging modalities used in its diagnosis. Radiologists should be aware of the limitations and more importantly the roles of different imaging modalities in guiding and dictating the management of spondylolysis. Other stress-related injuries in the spine are also discussed including but not limited to pedicle fracture and apophyseal ring injury.

Hand and wrist injuries have been described as the second most common severe injuries in handball. However, no evidence exists regarding the specific characteristics of these injuries. The aim of this study was to determine the injury pattern of hand and wrist injuries in youth handball.Two-hundred and ninety-six adolescent elite handball players (mean age: 14.0 ± 0.8 years) completed a retrospective survey regarding their hand and wrist injuries during the previous season. The injury questionnaire was adapted from sports-specific questionnaires to the demands of hand and wrist injuries in handball and included injury location, type of injury and injury severity.One-hundred and twenty-three (42 %) players reported 156 injuries (0.53 injuries per season per player) to their hands or wrists in the past season. Injuries to the proximal interphalangeal joints were most frequently described (n = 74, 47 %). The thumb was involved in 46 (29 %) cases. Sprains (n = 113, 72 %) were the most common type of injury. Thirty-six percent of moderate and severe injuries ( 7 days time loss) had not been treated by a physician.The rates of hand and wrist injuries are high in youth elite handball. Injury prevention strategies and return to competition criteria should focus on the thumb and the interphalangeal joints. Further research into these injuries is essential to identify risk factors and to develop adequate injury prevention measures.Verletzungen der Hand und des Handgelenks sind als zweithäufigste, schwere Verletzung im Handball beschrieben. Allerdings existiert bisher keine Evidenz bezüglich der spezifischen Charakteristiken dieser Verletzung. Das Ziel dieser Studie war es, das Verletzungsmuster von Hand- und Handgelenksverletzungen im Handball zu bestimmen.296 jugendliche Landeskaderspieler (Durchschnittsalter 14,0 ± 0,8 Jahre) haben einen retrospektiven Fragebogen über erlittene Verletzungen der Hand und des Handgelenks in der vorherigen Saison ausgefüllt. Der Verletzungsfragebogen wurde von sportspezifischen Fragebögen auf die Anforderungen von Hand- und Handgelenksverletzungen im Handball adaptiert, einschließlich Verletzungslokalisation, Verletzungstyp und Verletzungsschwere.123 (42 %) Spieler meldeten 156 Verletzungen (0,53 Verletzungen pro Saison pro Spieler) ihrer Hände und Handgelenke in der vergangenen Spielsaison. Verletzungen der proximalen Interphalangealgelenke wurden am häufigsten beschrieben (n = 74; 47 %). Der Daumen war 46-mal (29 %) beteiligt. Kapsel-Band-Verletzungen (n = 113; 72 %) waren der häufigste Verletzungstyp. 36 % der moderaten und schweren Verletzungen ( 7 Tage Ausfallzeit vom Sport) wurden nicht von einem Arzt behandelt.Die Verletzungsraten von Hand- und Handgelenksverletzungen im jugendlichen Kaderhandball sind hoch. Verletzungsprävention und Return-to-Competition-Kriterien sollten sich auf den Daumen und die Interphalangealgelenke fokussieren. Weitere Untersuchungen sind notwendig, um Risikofaktoren zu identifizieren und adäquate Maßnahmen zur Verletzungsprävention zu entwickeln.

Rink Hockey is a high-speed low-contact sport with a widely recognized injury potential. Played with a hard ball by players wearing little or no protective gear, the rates of concussions and head injuries are of high interest. In this study, we reviewed and investigated injuries sustained by 108 German National League rink hockey players. We conducted an epidemiological cross-sectional study to determine sport-specific injuries and injury patterns in female and male rink hockey players. Data were collected by a standardized questionnaire. A total of 108 players participated in the study. The combined rate of injuries were 9.4/1000 athlete exposures. There was no significant difference between injury rates during games and practice. A sex-specific difference was not detected. Head injuries were the most frequent type (20.8% of all injuries). Concussions made up 7% of all head injuries with a rate of 0.76/1000 athlete exposure. Ball contact was the cause for 31% of injuries, while player contact generated 26.2% of all injuries. High rates of ball-contact-related injuries resulted in time loss and medical consultations. Head injuries were frequent, however did not result in significant time loss as compared to other injuries. The use of protective gear should be recommended.

The time-loss definition of injury is commonly adopted in epidemiological groin-injury studies in football, with a significant risk of underestimating the impact of these injuries. This study investigated the extent of groin problems, beyond the time-loss approach, over a full Spanish football season. Players from 17 amateur male teams were followed over 39 consecutive weeks. Groin-injury time loss and self-reported groin pain, irrespective of time loss, were combined to calculate the average weekly prevalence of all groin problems with or without time loss. A subscale measuring hip- and groin-related sporting function from the Copenhagen Hip and Groin Outcome Score questionnaire (HAGOS, Sport/Rec) was registered every 4 weeks. In total, 407 players participated in the study. The average (range) weekly prevalence of all groin problems was 11.7% (7.2%-20.8%); 1.3% with time loss (0.0%-3.2%) and 10.4% without time loss (6.3%-17.6%). Players with groin problems reported lower scores (mean difference) on the HAGOS, Sport/Rec subscale compared with players without (−19.5 [95% CI: −20.7 to −18.4]), while there was no difference between players reporting groin problems with and without time loss (4.0 [95% CI: −1.1 to 9.1]). The traditional time-loss measure only captured 10% of all groin problems. Hip- and groin-related sporting function was not different between players reporting groin problems with or without time loss, suggesting the reason for continuing to play is not only related to the severity of symptoms. These findings question the judicious use of the time-loss approach in overuse conditions, such as groin pain in footballers.

ContextMost studies of injury trends associated with softball focus on injuries requiring at least 24 hours of missed participation time (time-loss [TL] injuries), with little focus on those that do not (non–time-loss [NTL] injuries). A better understanding of injury trends associated with softball will improve athlete care.ObjectiveTo describe NTL and TL injuries experienced by secondary school girls' softball players.DesignDescriptive epidemiology study.SettingSecondary school athletic training clinics.Patients or Other ParticipantsSecondary school girls' softball players.Main Outcome Measure(s)Aggregate data were collected from schools participating in the National Athletic Treatment, Injury, and Outcomes Network surveillance program during the 2011–2012 through 2013–2014 academic years. Frequencies and rates of injuries (NTL and TL) according to time of season, event type, body part injured, and diagnosis were analyzed.ResultsIn total, 1059 injuries were reported during 140 073 athlete-exposures (AEs): overall injury rate = 7.56/1000 AEs. Of these injuries, 885 (83.6%) were NTL (NTL rate = 6.32/1000 AEs) and 174 (16.4%) were TL (TL rate = 1.24/1000 AEs). Of the NTL and TL injuries, the largest numbers occurred during the regular season (NTL: n = 443 [50.1%]; TL: n = 131 [75.3%]). Injuries sustained during practices accounted for the majority of NTL and TL injuries (NTL: n = 631 [71.3%]; TL: n = 104 [59.8%]). The NTL injuries occurred most often at the shoulder (n = 134 [15.1%]) and hand/fingers (n = 109 [12.3%]) and were diagnosed as contusions (n = 316 [35.7%]), strains (n = 157 [17.7%]), and abrasions (n = 151 [17.1%]). The largest numbers of TL injuries were to the head/face (n = 71 [40.8%]) and diagnosed as concussions (n = 50 [28.7%]) and strains (n = 28 [16.1%]).ConclusionsSecondary school softball players sustained a larger proportion of NTL injuries than TL injuries. Although NTL injuries may be less severe, they are numerous. Efforts are needed to ensure that injury-prevention programs are incorporated into the care of softball athletes to promote health and reduce injury occurrence.

Objectives To establish patterns of subsequent injury in U18 rugby, to quantify the burden of within season injury recurrence. Design Secondary analysis of prospective data. Setting 28 Schools in Ireland. Participants 825 male rugby players (aged 15–18 years). Main outcome measures Subsequent injuries were classified as: new, local or recurrent (same site and type as index injury). All recurrent injuries were sub-grouped by body part and diagnosis. Burden was based on frequency, days lost and injury proportion ratios. Results A total of 426 injuries were eligible for analysis, of which, 121 were subsequent injuries. The majority of subsequent injuries involved a different body part than their index injury. There were n = 23 cases of within season recurrence. 78% of recurrences occurred within 2 months of return to play. Recurrent injuries comprised 5% of all injuries and their cumulative time loss was 1073 days. Recurrent injury to the ankle ligaments, lumbar muscles and concussions carried the greatest burden. Conclusion The burden of recurrent injury in U18 rugby is lower than in the professional game. However, this population could benefit from targeted secondary prevention efforts including reconsideration of return-to-play protocols for ankle sprain, lumbar muscles and potentially concussion.

Context: Rugby union is the most widely played team collision sport globally. As with other contact sports, there is substantial risk of injury. To date, the majority of studies on injury epidemiology have focused on elite male cohorts, which inherently prevents extrapolation of research findings to other groups within the player continuum. This review aims to describe emerging injury trends across the spectrum of various rugby union subpopulations and to highlight gaps that may influence future injury prevention tactics. Evidence Acquisition: Relevant articles published from 2007 to 2017 were obtained by searching MEDLINE, PubMed, and SPORT Discus. Studies on 15-a-side rugby union, implemented according to the 2007 consensus statement on injury definitions and data collection procedures for injuries in rugby union, were used. Study Design: Clinical review. Level of Evidence: Level 3. Results: Match injuries occur more frequently than training injuries. Injury rates increase consistently according to age and level of play. Severity of injury often is greater among lower levels of the game, and sex-specific differences relating to injury patterns and incidence rates exist. Conclusion: To date, a paucity of injury surveillance data exists for women and players of both sexes at all levels of community rugby union. Furthermore, the incidence of injuries and illnesses are poorly reported in epidemiological studies. Despite methodological differences, injury trends remain consistent throughout all levels of play.

To examine how injury definition inclusiveness affects the rank order of injury rates in 27 high school (HS) sports.The National Athletic Treatment, Injury and Outcomes Network (NATION) used certified athletic trainers (ATs) to collect injury and athlete-exposure (AE) data in practices and competitions for 27 HS sports during the 2011/2012 to 2013/2014 academic years. Time loss (TL) injuries resulted in ≥24 hours of participation restriction. Nontime loss (NTL) injuries resulted in24 hours of participation restriction.Aggregate injury and exposure data collected from 27 HS sports.High school student-athletes.Sports injury data from the National Athletic Treatment, Injury and Outcomes Network.Time loss and TL + NTL injury rates were calculated. Sport-specific rates were placed in rank order, stratified by gender.Most of the 47 014 injuries reported were NTL (82.8%). Among boys' sports, TL injury rates were greatest in football (3.27/1000AE) and wrestling (2.43/1000AE); TL + NTL injury rates were greatest also in football (15.29/1000AE) and wrestling (11.62/1000AE). Among girls' sports, TL injury rates were greatest in soccer (1.97/1000AE) and basketball (1.76/1000AE); TL + NTL injury rates were greatest in field hockey and lacrosse (both 11.32/1000AE).The rank order of injury rates and the resulting injury prevention priorities may depend on injury definition inclusiveness, particularly in female HS sports.

Acute traumatic glenohumeral joint instability is common within the general population and endemic in young athletes and physically active populations. Individuals who experience acute traumatic glenohumeral joint instability events are at high risk of recurrent injury. In addition, glenohumeral joint instability results in substantial short-term and long-term consequences, including significant time loss from activity, degenerative joint changes, and reduced quality of life. This review provides an overview of the epidemiology of glenohumeral joint instability, reviews the modifiable and nonmodifiable risk factors for glenohumeral joint instability identified in the literature, and discusses the need for developing and implementing effective multilevel strategies for the primary, secondary, and tertiary prevention of glenohumeral joint instability and the long-term consequences associated with injury.

Background and purposeIt is increasingly recognized that time is one of the key determinants in acute stroke outcome when interventional stroke therapy is applied. With increasing device efficacy and understanding of imaging triage options, reducing pre-treatment time loss may be a critical component of improving interventional stroke outcomes for the population at large. Time sensitive procedures such as organ harvest have transported physicians to the patient site to improve time to procedure. Applying this same principle to interventional stroke management may be a valid paradigm.MethodsPrevious logistical deliberation with hospital and Medevac companies was carried out to provide the rationale and funding for helicopter transfer of a neurointerventionalist to an in-network hospital with an on-site angiographic suite. An appropriate patient with large vessel occlusion and an NIH Stroke Scale score >8 was identified. MRI was performed, then the Medevac transport system was activated and the intervention was carried out. Times were collected during the case and assessed for time efficiency.ResultsThe proof of concept case was identified and Medevac was consulted at 12:13 after verifying that no in-house emergencies would prevent physician departure. Weather clearance was obtained and stroke intervention confirmed as a go at 12:24. Groin puncture occurred at 13:07 and the intervention was completed at 13:41. The total time from decision-to-treat to groin puncture was 43 min and groin closure was completed at 77 min from decision-to-treat.ConclusionsThis proof of concept case is presented for logistical, financial and use-case analysis. As it is a first case, times can likely be improved. We assert that this model may be another option in the spoke-and-hub design of stroke systems of care.

Objectives To investigate the prevalence, nature and factors associated with injury among adult amateur rowers. Design Retrospective cross-sectional study. Setting UK-based amateur rowing clubs. Participants 160 amateur rowers. Main outcome measures Frequency, type, location, severity and rowing-related factors associated with injury. Results Injury rate was 5.7 per 1000 sessions, with no effect of sex (χ2 = 0.195, P = 0.659) or weight class (χ2 = 0.800, P = 0.371). The lower-back demonstrated an epidemiological incidence proportion (IP) of 0.39 (95%CI = 0.33 to 0.46). The IP for water- and land-based training was 0.39 (95%CI = 0.31 to 0.47) and 0.57 (95%CI = 0.49 to 0.65), respectively. IP was highest between January and March (0.13–0.15), whilst time loss was 0.49 (95%CI = 0.42–0.57). The IP for ‘overuse’ and ‘traumatic’ injuries was 0.71 (95%CI = 0.65 to 0.78) and 0.22 (95%CI = 0.16 to 0.27), respectively. Training volume was positively associated with injury rate (r = 0.418, P Conclusions Injury rates appear higher among amateur rowers with the most common injury site being the lower-back. Our results suggest several contextual factors influence injury risk including seasonal phase, training type and training volume.

Objectives The aim was to assess the 1-year retrospective prevalence of athletes reporting a sports-related injury among Paralympic judokas with visual impairment (VI), and to identify any associations between injury, vision class, gender and weight category. Design Cross-sectional retrospective study. Methods The data were collected through an adapted questionnaire given to athletes with VI during an international training camp. Forty-five Paralympic judokas answered the questionnaire. Descriptive statistics and chi-square statistics (p

Talented athletes use metacognitive skills to improve their performance. Also, it is known that these skills are important for managing one's health. The goal of this study was to identify the relationship between metacognitive skills and overuse injuries in talented tennis players. Metacognitive skills were measured in 73 talented tennis players (45 boys and 28 girls, age 11-14) at the start of the season, using the Self-Regulation of Learning Self-Report Scale. Overuse injuries were monitored for one season using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems. Ordinal regression indicated that moderate or low selfmonitoring skills (compared to high selfmonitoring) (OR 4.555, CI 1.096-18.927, P = 0.037) and exposure time (OR 1.380, CI 1.106-1.721, P = 0.004) were associated with more time loss overuse injuries. A second analysis showed that this was the case in girls (OR 10.757, CI 1.845-62.714, P = 0.008), but not in boys. Linear regression revealed that higher reflection scores and exposure time predicted overuse severity (F(5,58) = 2.921, P = 0.020, R-2 = 0.201). Possibly, selfmonitoring can help players to prevent themselves from time loss overuse injuries. Coaches should be aware that players can differ in selfmonitoring ability and thus in the ability to prevent overuse injuries. The role of reflection needs more research.

ObjectiveTo describe the incidence of injuries and illnesses sustained during the XXIII Olympic Winter Games, hosted by PyeongChang on 9–25 February 2018.MethodsWe recorded the daily number of athlete injuries and illnesses (1) through the reporting of all National Olympic Committee (NOC) medical teams and (2) in the polyclinic and medical venues by the PyeongChang 2018 medical staff.ResultsIn total, 2914 athletes (1210 women, 42%; 1704 men, 58%) from 92 NOCs were observed for occurrence of injury and illness. NOC and PyeongChang 2018 medical staff reported 376 injuries and 279 illnesses, equalling 12.6 injuries and 9.4 illnesses per 100 athletes over the 17-day period. Altogether, 12% of the athletes incurred at least one injury and 9% at least one illness. The injury incidence was highest in ski halfpipe (28%), snowboard cross (26%), ski cross (25%), snowboard slopestyle (21%) and aerials (20%), and lowest in Nordic combined, biathlon, snowboard slalom, moguls and cross-country skiing (2%–6%). Of the 376 injuries recorded, 33% and 13% were estimated to lead to ≥1 day and >7 days of absence from sport, respectively. The highest incidences of illness were recorded in biathlon (15%), curling (14%), bobsleigh (14%) and snowboard slalom (13%). Thirty per cent of the illnesses were expected to result in time loss, and 70% affected the respiratory system. Women suffered 61% more illnesses than men.ConclusionOverall, 12% of the athletes incurred at least one injury during the Games and 9% an illness, incidences that are similar to the Olympic Winter Games of 2010 and 2014.

Objectives Australian football is associated with a risk of concussion. However, despite the extensive and varied nature of literature devoted to this issue, concussion incidence has not been systematically evaluated. To address this, we aimed to conduct a meta-analysis of concussion incidence in Australian football. Design Systematic review. Prospero registration number: CRD42017064290. Methods A systematic search of 14 databases using the terms ‘concussion’, and ‘Australian football’ (and variations) was used to obtain records that reported concussion incidence per 1000 players hours across age, sex, and level-of-play. Data were grouped based on how time-loss was applied to the concussion definition. Results Forty-two studies met inclusion criteria. Incidence rates based on a possible time-loss definition per 1000 player hours, ranged from 2.24 to 17.63 at the elite level, and 0.35 to 14.77 at the community/amateur level. Return-to-play details were reported by six studies and only two studies measured head-impacts in real-time. Several limitations were identified with this literature. First, insufficient return-to-play details precluded a meta-analysis of incidence rates. Second, no longitudinal studies across levels-of-play were found. Third, concussion incidence data for junior and female players were notably scarce. Conclusions There was limited scope to determine concussion burden (i.e., incidence and severity) and only preliminary data for player exposure to head-impacts. To address these limitations, injury surveillance should capture sufficient information to permit comparisons within and across levels-of-play. This will also help determine the influence of interventions aimed at reducing the frequency and severity of concussive-injuries.

Although the 11+ program has been shown to reduce injuries in sub-elite football, program compliance is typically poor, suggesting that strategies to optimize delivery are necessary. This study investigated the effect of rescheduling Part 2 of the three-part 11+ program on program effectiveness. Twenty-five semi-professional football clubs were randomly allocated to either a Standard-11+ (n = 398 players) or P2post group (n = 408 players). Both groups performed the 11+ program at least twice a week throughout the 2017 football season. The Standard-11+ group performed the entire 11+ program before training activities commenced, whereas the P2post group performed Parts 1 and 3 of the 11+ program before and Part 2 after training. Injuries, exposure, and individual player 11+ dose were monitored throughout the season. No significant between group difference in injury incidence rate (P2pos t vs Standard-11+ = 11.8 vs 12.3 injuries/1000 h) was observed. Severe time loss injuries > 28 days (33 vs 58 injuries; P < .002) and total days lost to injury (4303 vs 5815 days; P < .001) were lower in the P2post group. A higher 11+ program dose was observed in the P2post (29.1 doses; 95% CI 27.9-30.1) versus Standard-11+ group (18.9 doses; 95% CI 17.6-20.2; P < .001). In semi-professional football, rescheduling Part 2 of the 11+ program to the end of training maintained the effectiveness of the original 11+ program to reduce injury incidence. Importantly, rescheduling Part 2 improved player compliance and reduced the number of severe injuries and total injury burden, thereby enhancing effectiveness of the 11+ program.

BackgroundHip and groin injuries are common in men’s professional football, but the time-trend of these injuries is not known.AimTo investigate hip and groin injury rates, especially time-trends, in men’s professional football over 15 consecutive seasons.Study designProspective cohort study.SettingMen’s professional football.Methods47 European teams were followed prospectively for a varying number of seasons between 2001/2002 and 2015/2016, totalling 268 team seasons. Time-loss injuries and individual player exposure during training and matches were recorded. Injury rate was defined as the number ofinjuries/1000 hours and injury burden as the number oflay-off days/1000 hours. Time-trends for total hip and groin injuries and adductor-related injury rates were analysed using Poisson regression, and injury burden was analysed using a negative binomial regression model.ResultsHip and groin injuries contributed 1812 out of 12 736 injuries (14%), with adductor-related injury as the most common of hip and groin injuries (n=1139, 63%). The rates of hip and groin injury and adductor-related injury were 1.0/1000 hours and 0.6/1000 hours, and these rates decreased significantly with on average 2% (Exp(b)=0.98, 95% CI 0.97 to 0.99, P=0.003) and 3% (Exp(b)=0.97, 95% CI 0.95 to 0.99, PConclusionsHip and groin injuries constitute a considerable part of all time-loss injuries in men’s professional football. Although there was a promising slight decreasing trend in the rates of hip and groin injury (as a category) and adductor-related injury (as a specific diagnosis), the injury burden remained at a consistent level over the study period.

This study describes the epidemiology of "stinger" injuries in National Collegiate Athletic Association (NCAA) Men's Football. About 57 NCAA Men's Football programmes provided 153 team-seasons of injury data to the NCAA Injury Surveillance Programme (NCAA-ISP) during the 2009/2010-2014/2015 academic years. In the study period, 229 "stingers" were reported for an injury rate of 2.04/10,000 athlete-exposures (AE). Most "stingers" were reported during competitions (55.5%) and the preseason (80.3%) and resulted in time loss less than 24 hours (63.8%). One in five (18.8%) were recurrent. Most "stingers" were due to player contact (93.0%), particularly while tackling (36.7%) and blocking (25.8%) and occurred to defensive ends/linebackers (25.8%) and offensive linemen (23.6%). Although previous research reports a large prevalence of "stingers" among football players, the NCAA-ISP reported a relatively low injury rate. The transient nature of pain associated with "stingers" may have contributed to under-reporting, highlighting the need to deduce manners to increase reporting.

Pain is the most common complaint that is debilitating, and affects the individual person, their families, and time loss at work. Over 100 million Americans suffer from chronic pain and 63% of the patient seeks help initially from their primary care Physician. According to 2010 survey, 19% adults in USA report constant or frequent pain persisting for at least 3 months. Persistent pain often causes functional impairment and disability, psychological distress, anxiety, depression, and sleep deprivation. Pain disrupts activities of daily living and personal relationships. Pain is the most common cause of long-term disability, with lost work days.

The goal of abbreviated laparotomy is to treat severely injured patients whose condition requires an immediate surgical operation but for whom a prolonged procedure would worsen physiological impairment and metabolic failure. Indeed, in severely injured patients, blood loss and tissue injuries enhance the onset of the "bloody vicious circle", triggered by the triad of acidosis-hypothermia-coagulopathy. Abbreviated laparotomy is a surgical strategy that forgoes the completeness of operation in favor of a physiological approach, the overriding preference going to rapidity and limiting the procedure to control the injuries. Management is based on sequential association of the shortest possible preoperative resuscitation with surgery limited to essential steps to control injury (stop the bleeding and contamination), without definitive repair. The latter will be ensured during a scheduled re-operation after a period of resuscitation aiming to correct physiological abnormalities induced by the trauma and its treatment. This strategy necessitates a pre-defined plan and involvement of the entire medical and nursing staff to reduce time loss to a strict minimum.

Background There are limited data on the nature, type and incidence of illness in football. Previous studies indicate that gastrointestinal and respiratory tract illnesses are most common. Aim To describe the incidence and burden of illness in male professional football. Methods Over the 4-year study period, 2011–2014, 73 professional football teams in Europe participated, with a total of 1 261 367 player-days recorded. All time-loss illnesses were recorded by the medical staff of each club. A recordable illness episode was any physical or psychological symptom (not related to injury) that resulted in the player being unable to participate fully in training or match play. Results A total of 1914 illness episodes were recorded. The illness incidence was 1.5 per 1000 player-days, meaning that, on average, a player experienced an illness episode every second season, with a median of 3 days absence per illness episode. Severe illness (absence >4 weeks) constituted 2% of all illnesses. Respiratory tract illness was the most common (58%), followed by gastrointestinal illness (38%). Respiratory tract illness, gastrointestinal illness and cardiovascular illness caused the highest illness burden. Conclusions The illness incidence among male professional football players is low compared with the injury incidence. We found that the highest illness burden was caused by illness to the respiratory tract, gastrointestinal tract and cardiovascular system.

Objective This study examined the epidemiology of concussions in high school boys' ice hockey during the 2008/09 to 2016/17 school years. Design Prospective cohort study. Athletic trainers from an average 33 high schools annually reported boys' ice hockey concussion and athlete-exposure (AE) data for the High School Reporting Information Online system. Setting Convenience sample of high school boys' ice hockey programs during the 2008/09 to 2016/17 school years. Patients or other participants High school boys' ice hockey players (aged ∼14-18 years). Independent variables Concussion data on event type, injury mechanism, symptom resolution time, and time loss were obtained. Main outcome measures Concussion rates with 95% confidence intervals (CIs) and distributions were calculated. Results Overall, 348 concussions were reported in boys' ice hockey during the 2008/09 to 2016/17 academic years, leading to a concussion rate of 0.68/1000 AEs (95% CI, 0.61-0.75). Most occurred in competitions (85.6%), particularly after the first period (72.1% of all competition concussions). Among practice concussions, most occurred after the first hour of practice (60.0%). Most concussions were due to player contact (47.7%) and boards/glass contact (31.9%). Although 69.0% of concussed athletes had symptoms resolve in less than 7 days, only 14.1% returned to activity within a week. Conclusions Most concussions occurred within the second and third periods. Preventive strategies that counter an increased risk of concussion due to a greater intensity of gameplay coupled with increased fatigue may be warranted. Moreover, athletes may further benefit from prevention efforts that focus on anticipating impacts during gameplay.

Objective: To examine rates of concussion and more severe concussion (time loss of greater than 10 days) in elite 13- to 17-year-old ice hockey players. Methods: This is a prospective cohort study (Alberta, Canada). Bantam (13-14 years) and Midget (15-17 years) male and female elite (top 20% by division of play) youth ice hockey players participated in this study. Players completed a demographic and medical history questionnaire and clinical test battery at the beginning of the season. A previously validated injury surveillance system was used to document exposure hours and injury during one season of play (8 months). Players with a suspected ice hockey–related concussion were referred to the study sport medicine physicians for assessment. Time loss from hockey participation was documented on an injury report form.Results: Overall, 778 elite youth ice hockey players (659 males and 119 females; aged 13-17 years) participated in this study. In total, 143 concussions were reported. The concussion incidence rate (IR) was 17.60 concussions/100 players (95% CI, 15.09-20.44). The concussion IR was 1.31 concussions/1000 player-hours (95% CI, 1.09-1.57). Time loss of greater than 10 days was reported in 74% of cases (106/143), and 20% (n = 28) had time loss of greater than 30 days.Conclusions: Concussion is a common injury in elite youth ice hockey players. In this study population, a large proportion of concussions (74%) resulted in a time loss of greater than 10 days, possibly reflecting more conservative management or longer recovery in youth athletes.

Objectives Understanding the nature of injuries in cricket is key to mitigate injury risks and prioritise preventive measures. This study aimed to identify the incidence and nature of match injuries among Sri Lankan junior cricketers. Design Longitudinal follow-up study with prospective in-season data collection. Methods A national survey of schoolboy, division-1 cricket teams in under-15 and under-17 age groups. Using a paper-based questionnaire, distributed to school-teams at the start of the 2016 cricket season, respondents recorded any injuries, including the site, type and mechanism. Match injury incidence rates (match-IIR) (injuries/100 match-player-days) were calculated overall, by position and for match time loss (MTL) and non-MTL injuries. Results From 59 school-teams, 573 players responded, with 404 players reporting 744 injuries in 648 matches. The match-IIR was 28.0 injuries/100 match-player-days (95% CI = 26.0–30.2). The highest match-IIR was reported among fielders (46.0% of all injuries sustained; match-IIR = 12.9) compared with batters (25.4%; match-IIR = 7.1) and bowlers (20.3%; match-IIR = 5.7). Abrasions and bruises to the knee or elbow were the most common injuries among fielders, with the majority being non-MTL injuries. Conclusions Almost half (46.0%) of all injuries were to fielders, and more research into their severity and mechanisms is needed to identify the need for, and design of, preventive measures. Batters sustained a relatively large number of facial-organ injuries from being struck by the ball, presenting a need to evaluate the use and appropriateness of helmets by Sri Lankan junior cricketers. Similar to other junior cricket studies, the most common injuries among bowlers were strains and sprains, mainly affecting the lower limbs and lower back.

Background: Sports-related concussion (SRC) injury rates are well established in collegiate athletics through epidemiological studies using the National Collegiate Athletic Association Injury Surveillance System. However, few studies have examined sex differences, time loss, and missed school days in high school athletes, especially at the state level. Purpose: To identify sex differences in the clinical incidence of SRCs, missed school days, and time loss in high school student-athletes. Study Design: Descriptive epidemiological study. Methods: A total of 193,757 (116,434 male and 77,323 female) student-athletes (10th grade ± 1.1) participating in Michigan High School Athletic Association (MHSAA)–sponsored athletic activities were recorded in the Head Injury Reporting System. Certified athletic trainers, school athletic administrators, and coaches from MHSAA high schools reported SRC data and overall participation for the 2015-2016 academic year. Total concussive injuries, as well as missed school days and time loss for each concussive injury, were reported. The clinical incidence was calculated by dividing the number of SRCs in a particular category by the number of participants in that category and presented with 95% CIs. Relative risk ratios (RRs) were determined for sex-comparable sports. Results: The overall clinical incidence for all sports was 1.7 per 100 player-seasons (95% CI, 1.6-1.8) and 1.9 (95% CI, 1.8-2.0) for male sports and 1.5 (95% CI, 1.4-1.6) for female sports. Female athletes were at a 1.9 (95% CI, 1.8-2.2) times greater risk for enduring SRCs than male athletes in sex-comparable sports, with a greater risk in baseball/softball (RR, 2.7 [95% CI, 1.9-3.8]), basketball (RR, 2.5 [95% CI, 2.1-2.9]), and soccer (RR, 1.6 [95% CI, 1.4-1.9]). Female student-athletes had significantly longer time loss than male student-athletes ( P < .001). The mean number of missed school days did not differ between sexes ( P = .70). Conclusion: High school female student-athletes have a higher risk for an SRC in all sex-comparable sports except lacrosse. This may be because of biomechanical differences of the head-neck segment, hormonal differences, and the fact that female athletes are more likely to report symptoms after a suspected SRC. Clinical Relevance: Despite sex differences in the clinical incidence of SRCs and time loss from participation in high school sports, the numbers of missed school days are relatively similar between sexes.

Objective To develop and implement a prospective varsity athlete surveillance system to identify injury and illness trends in a multisport varsity-level university setting. Design Longitudinal prospective surveillance study. Setting Varsity-level sport program at the University of Guelph, Guelph, ON, Canada. Participants Athletic therapists (ATs) (n = 35) from 17 varsity sports provided injury and illness information on 624 varsity-level athletes (381 men and 243 women) during the 2016/2017 competitive season. Interventions Team ATs reported athlete health complaints weekly. Athletes reported additional details on the injury or illness that was reported. Main outcome measures The outcome measurements included when the injury or illness occurred, anatomical location, diagnosis, cause, perceived severity, treatment, estimated athlete exposure (AE) to training and competition, and time loss from sport. Measures were recorded from the teams' first competition through to the end the season and/or playoffs. Results Twenty-nine of 30 varsity sports teams participated in this injury and illness surveillance protocol. The compliance of team ATs and varsity athletes was 89% (men: 94%, women: 82%). The overall injury and illness rates were 5.5 injuries and 1.7 illnesses per 1000 AEs, respectively. Men's injury rates were greater than women's, and injury rates of contact sports were greater than noncontact sports. Conclusions The utilization of a prospective injury and illness surveillance protocol in the Canadian University sport system is feasible with good athlete, AT, and coach acceptance. The surveillance data should inform future injury and illness prevention strategies.

Youth rugby is a popular sport in South Africa (SA) with a high injury incidence. The annual SA Rugby Youth Week tournaments attract the top age-group players in the country providing a sample of players for reliable injury surveillance. The aim of the study was to analyze the changes in time-loss injury rates at the SA Rugby Youth Week tournaments between 2011 and 2016, differences between age-groups, and to investigate associated injury risk factors. All confirmed time-loss injuries at the 4 age-group tournaments (under-13, under-16, and 2 under-18) from 2011 to 2016 were recorded. Injury incidence densities (IID) for years, tournaments, and injury risk factors were calculated and Poisson regression analyses were performed to determine differences. Time-loss injuries (n = 494) were reported over 24 240 exposure hours, with an overall IID of 20.4 (18.6-22.2) injuries per 1000 player hours. The year 2013 had a significantly lower IID compared to 2011. Injury risk decreased with increasing age; under-13 and under-16 had significantly higher IID compared to under-18 Craven Week. Tackling was the phase of play at highest risk, with an IID of 7.4 (6.3-8.5) injuries per 1000 player hours. Central/peripheral nervous system (CNS/PNS) and, therefore, the head/neck were the most commonly occurring injuries/location injured. In conclusion, within the SA Rugby tournament structure, the older players had a decreased rate of injury. The tackle event was still the phase of play with the highest injury incidence regardless of age. This increase in incidence is largely due to an increase in CNS/PNS injuries.

Little is known about the prevalence and associated of morbidity of tendon problems. With only severe cases of tendon problems missing games, players that have their training and performance impacted are not captured by traditional injury surveillance. The aim of this study was to report the prevalence of Achilles and patellar tendon problems in elite male Australian football players using the Oslo Sports Trauma Research Centre (OSTRC) overuse questionnaire, compared to a time-loss definition. Male athletes from 12 professional Australian football teams were invited to complete a monthly questionnaire over a 9-month period in the 2016 pre- and competitive season. The OSTRC overuse injury questionnaire was used to measure the prevalence and severity of Achilles and patellar tendon symptoms and was compared to traditional match-loss statistics. A total of 441 participants were included. Of all participants, 21.5% (95% CI: 17.9-25.6) and 25.2% (95% CI 21.3-29.4) reported Achilles or patellar tendon problems during the season, respectively. Based on the traditional match-loss definition, a combined 4.1% of participants missed games due to either Achilles or patellar tendon injury. A greater average monthly prevalence was observed during the pre-season compared to the competitive season. Achilles and patellar tendon problems are prevalent in elite male Australian football players. These injuries are not adequately captured using a traditional match-loss definition. Prevention of these injuries may be best targeted during the off- and pre-season due to higher prevalence of symptoms during the pre-season compared to during the competitive season.