sport injury prevention final

why is sport injury prevention important?

injuries have a wide variety of short and long-term consequences to both the individual and the community

what is the burden of sport injuries in youth?

s&r is one of the leading causes of injuries in youth, 1/3 youth seek medical attention every year for s&r injuries

what are the most common injuries in youth sports?

lower extremity (60%) and concussions (20%)

knee and ankle are the most common LE injuries

what sports contribute the highest burden of injuries in youth?

soccer, basketball, and hockey (all 10%)

what are the highest risk sports for injuries?

in general: team and contact sports (can’t control other people, involve cutting and direction changes, high contact)

for head injuries: high speed (skiing/snowboarding) and team contact sports (soccer, hockey, rugby, football)

what are the highest risk sports for knee injuries?

pivoting sports (soccer, handball, basketball, football, skiing)

what are the consequences of sport injuries?

Time loss from sport, increased risk for future injury, reduced physical activity, increased risk of obesity, post-traumatic osteoarthritis, post-concussion syndrome, chronic pain, disability, mental health effects

what are the levels of prevention?

primary = prevent the first injury → interventions applied beforee there is any evidence of an injury

secondary = prevent sequelae, early detection of injury and early treatment to slow progression

tertiary = prevent long-term consequences → interventions designed to arrest progress of an established injury and prevent long-term effects

what is the Van Mechelen 1992 model?

Four-step sequence of sport injury prevention research model:


1. surveillance: establishing the incidence and severity of the injury problem
2. establishing the aetiology and mechanisms of the injury
3. introducing a preventative measure
4. assessing its effectiveness (via RCT) and repeat cycle

what is the Meeuwisse 1994 model?

multifactorial model of athletic injury etiology

involves timeline of intrinsic risk factors creating a pre-disposed athlete, which interacts with extrinsic risk factors to create a susceptible athlete. if a susceptible athlete meets an inciting event than an injury occurs.

the primary goal of this model is to understand causation of injury prior to an inciting event

what is the bahr & krosshaug 2005 model?

comprehensive model for injury causation

updated version of the meeuwisse 1994 model that expands on the internal and external risk factors as well as highlights specfic components of the inciting event

what are the components of an inciting event according to the bahr & krosshaug 2005 model?

playing situation, player/opponent behaviour, gross (whole body) biomechanics, and detailed (joint-specific) biomechanics

what is the meeuwisse 2007 model?

dynamic model of etiology in sport injury.

expands on 1994 model to reflect dynamic risk factors that are continually changing. specifically mentions the susceptible athlete engaging in several events with no injury which leads to adaptations and changes to internal risk factors. also adds that recovery from an injury also changes risk factors or that there can be non-recovery

what is the haddon matrix?

a logical framework originally designed for prevention of MVa injuries. Incorporates human, vehicle, physical environment, and social environment factors on pre-crash, crash, and post-crash event

what is the modified haddon matrix?

matrix adapted by meeuwisse and bahr in 2009 for sport. incorporates athlete, environment, equipment facotrs in pre-event, event, and post-event. used as a tool for developing prevention strategies

what is the finch 2006 framework?

Translating research into injury prevention practice (TRIPP) framework

extends after van mechelen 1992 model for implementation research.


5. describe inervention context to inform implementation strategies
6. evaluate effectiveness of preventative measures in implementation context

what types of study designs are used in descriptive studies?

qualitative studies, case study, cross-sectional studies (for answering who, what, where)

what types of study designs are used in analytic studies?

exploratory studies use qualitative, cross-sectional, case-control, and cohort designs. experimental studies use RCTs or quasi-experimental designs

why would a qualitative study design be used?

* provide deeper insight into real-world problems
* create a complete and detailed description of the research topic
* understand individuals’ attitudes, beliefs, behaviour, motivation, values, and perceptions
* help develop ideas or hypotheses for quantitative research

what are the disadvantages of qualitative studies?

can incorporate researchers personal opinions, lack the ability to be replicated, and can involve selection bias

where in the van mechelen model can qualitative studies be used?

1st stage - establishing extent of injury problem. can be used as substudy in other stages

what is a case study?

an in-depth examination of a particular case within a real-world context

used to give descriptive characteristics of a specific injury and its associated variables

what are the pros and cons of case studies?

pros: detailed, generates ideas for future studies, inexpensive, relatively easily accomplished

cons: no ability to establish causation or temporality, lack of generalizability

where in the van mechelen model can case studies be used?

2. establishing the etiology/mechanisms of injury
3. introducing a preventative measure

what is a cross-sectional study?

a snapshot of a specfic point in time, evaluates variables of interest in certain populations at one specific point in time

commonly used to establish the point prevalence of an injury and trends over time with serial cross-sectional studies

what are the pros and cons of cross-sectional studies?

pros: description of outcomes, characteristics and exposures in the population at a specific time point, ideas for future prospective studies, inexpensive, easy data acquisition

cons: no follow-up, difficult to determine causation/what came first? exposure vs outcome, recall bias

where in the van mechelen model can cross-sectional studies be used/

1. establishing the incidence and severity of the injury problem

what are case-control studies?

usually retrospective studies that split participants based on an outcome (i.e. injury group v control group) to establish a relationship between exposures and specific outcomes

what are the pros and cons of case-control studies?

pros: can establish relationship between exposures and specific outcomes, are efficient for studying rare outcomes, relatively inexpensive, usually quick to complete

cons: recall bias, inefficient for rare exposures, prone to selection bias

where in the van mechelen model are case-control studies used?

stage 2 → establishing injury etiology and mechanism

what are cohort studies?

usually prospective, compares occurence of an outcome among groups that have different exposures over time, examines risk factors

cohort involves well-defined groups of people that share a characteristic/experience

what are the pros and cons of cohort studies

pros: can compare injury occurence in groups that have different exposures over time, demonstrates temporal relationship between exposures and outcome, provides good descriptive information about exposures, efficient for studying rare exposures, common outcomes and multiple outcomes

cons: expensive, requires large numbers, takes a long time

where in the van mechelen model can we use cohort studies?

stage 2→ establishing injury etiology and mechanism

(potentially stage 4→ assessing effectiveness but not as good as RCT)

what are RCTs?

participants are assigned randomly into exposure vs control groups and are followed prospectively to investiagte the effect of the intervention on a specific outcome

what are the pros and cons for RCTs?

pros: most reliable form of scientific evidence, controls confounding and allows generalization of results, high internal validity

cons: expensive and time-consuming, rare outcomes necessitate large numbers, difficulties with participant compliance, low external validity

where in the van mechelen model should RCTs be used?

stage 4→ establishing the effectiveness of an intervention

what is the difference between systematic reviews and meta-analyses?

systematic reviews = synthesis of findings from a wide range of research

meta-analysis = analysis of analyses, (pulls data from studies to lump together and analyze)

what are the pros and cons of systematic reviews and meta-analyses?

pros: best available research evidence, makes evidence more accessible

cons: time-consuming, challenges with discrepancies between studies (i.e. in definitions, data collection, etc.)

what are the types of acute injuries?

direct contact, indirect contact, or non-contact injuries

what are the types of overuse injuries?

repetitive (gradual onset) or repetitive (sudden onset)

what are the categories of injury mechanism descriptions?

sport situation (team action, court position, player position, skill performed), athletes behaviour, whole body biomechanics, joint tissue biomechanics

how is data collected on injury mechanism?

interviews, clinical studies (imaging and surgery), analysis of video recordings of actual injuries, lab motion analysis, injuries during biomechanical experiments, cadaver and dummy studies, mathematical modeling and simulation of injury situation

what is the most common ACL injury situation in soccer?

non-contact or indirect contact situations: pressing in defensive play, regaining balance during landings after heading and kicking

what is the most common ACL mechanism in soccer?

dynamic valgus movement of the knee, full body weight on 1 leg, relatively straight knee

what are the recommendations for preventing ACL injuries?

teach proper single leg landing techniques, change of direction technique, proper limb alignment, movement control of core and lower extremities before ground contact, no tackling from behind

what is the most common head injury situation in skiing and snowboarding?

when landing or turning from a jump, pitching backwards or sideways falls, impacts to the back or side of the head

what is the common head injury mechanism in downhill sports?

common landing sequence: skis/board → upper or lower extremity → butt/pelvis → back → head

what is the mechanism for ankle injuries?

sudden inversion and internal rotation, slightly inverted ankle orientation, centre of pressure shifts laterally

what is a risk factor?

a condition, behaviour, or other factor that increases the risk of injury, can be either intrinsic or extrinsic

what is the complex system approach for sport injuries?

model that describes risk factors as an interconnected web that are all interacting and constantly changing

what are the two types of hamstring strains?

sprint-related: occurs during late swing or early stance phase with huge eccentric biecps femoris contraction stretch-related: occurs during extensive hip flexion with exttended knee, rapid overstretching of semimembranosus

what are the risk factors for hamstring strains?

previous hamstring strain, older age, reduced hip ROM, poor hamstring strength, superior running speed, low back pain, muscle fatigue, insufficient warm-up, level of play, changes in training program

what are the risk factors for ankle sprain?

previous ankle sprain, limited dorsiflexion, reduced proprioception, deficiencies in balance, female, lower BMI, decreased peroneal reaction time, pivoting sport

what are the risk factors for knee ligament injuries?

previous knee joint injury, female, high knee adbduction moments during landing and cutting, stiff landings, landing with a heel strike, weak hip abductor strength, poor core stability, high friction surfaces

what is the relationship between training load and injury risk?

some studies shown that spikes in training load increase injury risk, and high absolute loads increase injury risk

What elements are necessary in a risk management system for a team?

injury surveillance, season analysis, preseason screening, athlete monitoring, return to sport, education, equipment and facilities, emergency action plan

what are the primary targets for prevention of sport injuries?

training strategies, rule modifications, equipment recommendations

what are the most common strategies used in sport injury prevention studies?

training programs to improve fitness/movement quality, new/modifiedsport equipment new/modified rules coach or referee education policy change training programms to improve psychological or cognitive skills

what areas do we need more intervention studies in?

specific injury types (hamstring strains, shoulder, low back, and overuse injuries) individual sports female athletes rehabilitation

what effective interventions exist for reducing injury risk?

NMT programs, Insoles, external joint supports

how can we prevent hamstring injuries?

eccentric strength training → nordic hamstring curls

how can we prevent ankle sprains?

NMT and proprioceptive training, bracing

how can we prevent knee injuries?

NMT programs to increase core and lower limb strength and stability, awareness of knee position, and quality of movement

what is the neuromuscular system?

the nervous system and muscles working together to control, direct, and allow movement of the body

what is neuromuscular control?

the ability to produce controlled movement through coordinated muscle activity and dynamic joint stability and postural control

what are the aims of neuromuscular training?

-to improve the nervous system’s ability to generate a fast and optimal muscle firing pattern -to increase dynamic joint stability -to decrease joint forces -to learn movement patterns and skills

what is training load?

a function of the intensity, duration, and frequency of exercise, is specific to the exercise type

what is the difference between internal and external training load?

external = work performed, distance travelled, index workouts etc. = the quantifiable, absolute work done

internal = the physiological and/or psychological load or response to training (heart rate response, blood lactate response, perception of effort)

what is sessional load?

= session duration x rating of perceived exertion

what are the advantages of using sessional RPE?

low cost and practical,

can be used to estimate training load in continuous, intermittent and team sports

RPE can be used as standalone measures or in combination with other metrics

Why is physical and mental rest important in training cycles?

to avoid injury and promote structural tolerance

what is structural tolerance?

the concept of the body needing time to adapt to a training load, means that body structures (ligaments, bones, tendons, etc.) need to build capacity to cope with physical stress and the ability to withstand years of progressive training without injury or fatigue

what are the classifications of training load?

non-stimulating → potentiating → recovery → maintaining → optimal training → excessive training (way abaove capacity)

what is the fitness fatigue model?

incorporates the competing factors of fitness and fatigue and how they respond after a training session.

why is session timing important in training?

if training frequency too soon, fatigue accumulates and there is no chance to recovery

if training is too infrequent, the fitness gains are lost and improvement is not made

improperly timed workouts impair performance, not just load

what are common training load prescription errors?

spike = doing too much too soon

undertraining = not enough training to support the physical demands of training or competition

introducing a new/unaccustomed form of exercise suddenly

too little variation = maladaption

insufficient practice vs competition hours

what kind of training load has a protective effect on injury risk?

high chronic training load

what is the acute:chronic ratio?

= current week training load/ mean of training load of the previous 4 weeks

it is a way to normalize current training in the context of the past training.

sweet spot = 10-15%, over-reaching = 20-30%

what is the relationship between acute:chronic ratio and injury risk?

high acute:chronic ratio is associated with increased injury risk

low acute:chronic ratio is associated with increased injury risk in the presence of low chronic workload (maybe athlete is unprepared?)

athletes with better fitness can better tolerate higher acute:chronic ratios

what are the problems with using acute:chronic ratio?

because coupled measure, can hide problems

does not point to a specific window of vulnerability so cannot definiteivly point to causation

what is future training load and injury risk research focused on?

connection between training load and tissue damage as mediated by cellular processes,

trying to estimate training load effects on tissue-level maladaption

why is training load planning and monitoring important?

reduces injuries, illness, overtraining, non-functional over-reaching, and poor performance

what is the public health burden of concussion?

1 in 5 lifetime risk

1 in 10 youth sustain an SRC annually

30% are recurrent

30% have persistent symptoms

what sports have the greatest concussion risk?

rugby, hockey, american football

what are the three targets for concussion prevention?

rule changes (head contact, tackle, headers, no contact practices)

equipment (mouth guard use, wearable tech, helmet fit)

training strategies (neuromuscular and sensorimotor training strategies, contact and tackle training)

how does delayed body checking in youth hockey prevent concussion?

estimated reduction of around 4800 concussions annually in Canadian U13 leagues

much lower risk of concussion in younger age groups

policy change also reduced non concussion injury incidence

saved over $2.3 million in public health care costs annually

no protective effect of body checking experience seen either

what is the zero tolerance for head contact policy? what were the implications of it?

penalizes all intentional and unintentional player head contact

however head contact incidence and enforcement did not change so issue with implementation

who are the SHRed participants

6000 high school athletes

60 highschools in 5 provinces

3 year long study

what are the ultimate goals of SHRed

move upstream towards primary and secondary prevention to have the greatest impact

scale up validated injury and concussion surveillance measures

what is the difference between an acute and overuse injury?

acute = sudden onset, from identifiable situation

overuse injury = repetitive mechanism, can be either sudden onset or gradual, can be hard to differentiate

why do overuse injuries occur?

result from a period of inappropriate tissue loading such as excessive magnitude of volume of load or insufficient recovery between bouts of loading

what are the common types of overuse bone injuries?

bone stress reaction, stress fracture, apophysitis

what is the most common tendon over use injury?

tendinopathy

what are the common types of joint/ligament overuse injuries?

synovitis, chondropathy, labrum injury, ligament degeneration

what are the common types of muscle/fascia overuse injuries?

chronic compartment syndrome, fasciitis, DOMSwhat

what is the most common type of bursa overuse injury?

bursitis

what is the most common type of nerve overuse injury?

altered neuromechanical sensitivity

what are the symptoms of overuse injuries?

pain, aching, tenderness, burning, weakness, numbness, tingling, cramping, swelling, tightness, stiffness, and limited motionw

what type of injury definition would be best when investigating overuse injuries?

all complaint (athletes push through pain, don’t always take time off with overuse injuries)

what tool is used to collect information on overuse injuries in research?

OSTRC questionnaire (Oslo Sport Trauma Research Centre)