[show abstract][hide abstract] ABSTRACT: In an effort to minimize the risk of catastrophic eye injury, US Lacrosse initiated mandatory use of protective eyewear in women's lacrosse in the 2004-2005 season.
The authors compared eye injury rates in girls' scholastic lacrosse before and after implementation of protective eyewear. They also compared head/face injury rates, concussion rates, and overall injury rates before and after the rule change to assess possible unintended consequences of the change.
Cohort study; Level of evidence, 3.
The study group included female scholastic lacrosse players in the 25 public high schools in Fairfax County, Virginia, during the 2004-2009 spring seasons. Injury rates were compared with those from the same data source for the 2000-2003 seasons. Premandate versus postmandate injury rates were adjusted for athlete exposures, or total opportunities for injury throughout the season.
The rate of eye injuries was reduced from 0.10 injuries per 1000 athlete exposures (AEs) in 2000 through 2003 before the use of protective eyewear to 0.016 injuries per 1000 AEs in 2004 through 2009 (incident rate ratio [IRR], 0.16; 95% confidence interval [CI], 0.06-0.42). The rate ratio of head/face injuries excluding concussion also decreased (IRR, 0.44; 95% CI, 0.26-0.76). There was no change in the rate ratio of total injuries involving all body parts (IRR, 0.93; 95% CI, 0.82-1.1) after introduction of protective eyewear. However, the rate ratio of concussion increased (IRR, 1.6; 95% CI, 1.1-2.3).
The use of protective eyewear in women's lacrosse was associated with a reduction in the number of eye injuries. The number of head/face injuries decreased in this study group after introduction of protective eyewear, and there was no change in overall injury rates. The reason for the increase in concussion rate cannot be determined conclusively based on this study, but the authors speculate that this increase resulted largely from increased recognition and diagnosis because overall injury rates do not indicate rougher play with introduction of protective equipment.
The American journal of sports medicine 12/2011; 40(3):611-4. · 3.61 Impact Factor
[show abstract][hide abstract] ABSTRACT: Neuromuscular and proprioceptive training programs can decrease noncontact anterior cruciate ligament injuries; however, they may be difficult to implement within an entire team or the community at large.
A simple on-field alternative warm-up program can reduce noncontact ACL injuries.
Randomized controlled trial (clustered); Level of evidence, 1.
Participating National Collegiate Athletic Association Division I women's soccer teams were assigned randomly to intervention or control groups. Intervention teams were asked to perform the program 3 times per week during the fall 2002 season. All teams reported athletes' participation in games and practices and any knee injuries. Injury rates were calculated based on athlete exposures, expressed as rate per 1000 athlete exposures. A z statistic was used for rate ratio comparisons.
Sixty-one teams with 1435 athletes completed the study (852 control athletes; 583 intervention). The overall anterior cruciate ligament injury rate among intervention athletes was 1.7 times less than in control athletes (0.199 vs 0.340; P = .198; 41% decrease). Noncontact anterior cruciate ligament injury rate among intervention athletes was 3.3 times less than in control athletes (0.057 vs 0.189; P = .066; 70% decrease). No anterior cruciate ligament injuries occurred among intervention athletes during practice versus 6 among control athletes (P = .014). Game-related noncontact anterior cruciate ligament injury rates in intervention athletes were reduced by more than half (0.233 vs 0.564; P = .218). Intervention athletes with a history of anterior cruciate ligament injury were significantly less likely to suffer another anterior cruciate ligament injury compared with control athletes with a similar history (P = .046 for noncontact injuries).
This program, which focuses on neuromuscular control, appears to reduce the risk of anterior cruciate ligament injuries in collegiate female soccer players, especially those with a history of anterior cruciate ligament injury.
The American journal of sports medicine 08/2008; 36(8):1476-83. · 3.61 Impact Factor
[show abstract][hide abstract] ABSTRACT: To compare the incidence, nature, severity and cause of match injuries sustained on grass and new generation artificial turf by male and female footballers.
The National Collegiate Athletic Association Injury Surveillance System was used for a two-season (August to December) prospective study of American college and university football teams (2005 season: men 52 teams, women 64 teams; 2006 season: men 54 teams, women 72 teams). Injury definitions and recording procedures were compliant with the international consensus statement for epidemiological studies of injuries in football. Athletic trainers recorded details of the playing surface and the location, diagnosis, severity and cause of all match injuries. The number of days lost from training and match play was used to define the severity of an injury. Match exposures (player hours) were recorded on a team basis.
The overall incidence of match injuries for men was 25.43 injuries/1000 player hours on artificial turf and 23.92 on grass (incidence ratio 1.06; p = 0.46) and for women was 19.15 injuries/1000 player hours on artificial turf and 21.79 on grass (incidence ratio = 0.88; p = 0.16). For men, the mean severity of non-season ending injuries was 7.1 days (median 5) on artificial turf and 8.4 days (median 5) on grass and, for women, 11.2 days (median 5) on artificial turf and 8.9 days (median 5) on grass. Joint (non-bone)/ligament/cartilage and contusion injuries to the lower limbs were the most common general categories of match injury on artificial turf and grass for both male and female players. Most injuries were acute (men: artificial turf 24.60, grass 22.91; p = 0.40; women: artificial turf 18.29, grass 20.64; p = 0.21) and resulted from player-to-player contact (men: artificial turf 14.73, grass 13.34; p = 0.37; women: artificial turf 10.72; grass 11.68; p = 0.50).
There were no major differences in the incidence, severity, nature or cause of match injuries sustained on new generation artificial turf and grass by either male or female players.
British journal of sports medicine 09/2007; 41 Suppl 1:i20-6. · 3.67 Impact Factor
[show abstract][hide abstract] ABSTRACT: To compare the incidence, nature, severity and cause of training injuries sustained on new generation artificial turf and grass by male and female footballers.
The National Collegiate Athletic Association Injury Surveillance System was used for a two-season (August to December) prospective study involving American college and university football teams (2005 season: men 52 teams, women 64 teams; 2006 season: men 54 teams, women 72 teams). Injury definitions and recording procedures were compliant with the international consensus statement for epidemiological studies of injuries in football. Athletic trainers recorded details of the playing surface and the location, diagnosis, severity and cause of all training injuries. The number of days lost from training and match play was used to define the severity of an injury. Training exposures (player hours) were recorded on a team basis.
The overall incidence of training injuries for men was 3.34 injuries/1000 player hours on artificial turf and 3.01 on grass (incidence ratio 1.11; p = 0.21) and for women it was 2.60 injuries/1000 player hours on artificial turf and 2.79 on grass (incidence ratio 0.93; p = 0.46). For men, the mean severity of injuries that were not season ending injuries was 9.4 days (median 5) on artificial turf and 7.8 days (median 4) on grass and, for women, 10.5 days (median 4) on artificial turf and 10.0 days (median 5) on grass. Joint (non-bone)/ligament/cartilage and muscle/tendon injuries to the lower limbs were the most common general categories of injury on artificial turf and grass for both male and female players. Most training injuries were acute (men: artificial turf 2.92, grass 2.63, p = 0.24; women: artificial turf 1.94, grass 2.23, p = 0.21) and resulted from player-to-player contact (men: artificial turf 1.08, grass 0.85, p = 0.10; women: artificial turf 0.47, grass 0.56; p = 0.45).
There were no major differences between the incidence, severity, nature or cause of training injuries sustained on new generation artificial turf and on grass by either men or women.
British journal of sports medicine 09/2007; 41 Suppl 1:i27-32. · 3.67 Impact Factor
[show abstract][hide abstract] ABSTRACT: A previous injury can increase the risk of sustaining a similar injury by up to an order of magnitude. To understand the role of previous injury as a risk factor, it is necessary to consider, among other issues, the clinical status of the first (index) injury at the time of the subsequent (recurrent) injury: currently, the inconsistent use of descriptive terms for recurrent injuries makes this extremely difficult. Although recent consensus statements on injury definitions based on return-to-play criteria have provided a consistent methodology for recording and reporting index and recurrent injuries, these statements do not differentiate between the types of recurrent injuries that can occur. This paper presents a recording and reporting framework that subcategorizes recurrent injuries into reinjuries and exacerbations on the basis of whether a player was fully recovered from the preceding index injury, with the state of fully recovered determined by medical opinion. A reinjury is a repeat episode of a fully recovered index injury and an exacerbation is a worsening in the state of a nonrecovered index injury. With this more detailed framework, researchers will be able to investigate risk factors for reinjuries and exacerbations separately, and they will be able to investigate how well players have been rehabilitated before returning to full training and match play.
Clinical Journal of Sport Medicine 06/2007; 17(3):197-200. · 1.60 Impact Factor
[show abstract][hide abstract] ABSTRACT: Risks and mechanisms of head, face, and eye injuries in high school and college lacrosse are not well documented.
To identify (1) primary mechanisms of head, face, and eye injuries in lacrosse and (2) differences in injury risk between the men's and women's game and between high school and collegiate levels.
Descriptive epidemiological study.
The authors gathered data on 507,000 girls' and boys' high school and 649,573 women's and men's college lacrosse athletic exposures using sport-specific injury surveillance systems over 4 seasons. They identified the most common scenarios for head, face, and eye injuries.
The high school girls' head, face, and eye injury rate (0.54 per 1000 athletic exposures) was significantly higher (incident rate ratio, 1.42; 95% confidence interval, 1.09-1.86) than that for boys (0.38 per 1000 athletic exposures); college women (0.77 per 1000 athletic exposures) sustained a higher rate of injuries (incident rate ratio, 1.76; 95% confidence interval, 1.42-2.19) than did men (0.44 per 1000 athletic exposures). Concussions constituted a higher percentage of injuries among boys (73%) and men (85%) than among girls (40%) and women (41%). Men sustained few facial injuries, whereas a substantial proportion of women's injuries involved the face and orbital area.
Although permitting only incidental contact, women's lacrosse had higher rates of head, face, and eye injuries at both the high school and collegiate levels. Concussion was the most common injury. For men, the primary injury mechanism was player-to-player contact; women's injuries primarily resulted from stick or ball contact. High school injury rates were lower than were college rates, but the nature of injuries, body parts affected, and mechanisms were similar.
The American Journal of Sports Medicine 03/2007; 35(2):207-15. · 4.44 Impact Factor
[show abstract][hide abstract] ABSTRACT: To describe the history and methods of the National Collegiate Athletic Association (NCAA) Injury Surveillance System (ISS) as a complement to the sport-specific chapters that follow.
The NCAA has maintained the ISS for intercollegiate athletics since 1982. The primary goal of the ISS is to collect injury and exposure data from a representative sample of NCAA institutions in a variety of sports. Relevant data are then shared with the appropriate NCAA sport and policy committees to provide a foundation for evidence-based decision making with regard to health and safety issues.
The ISS monitors formal team activities, numbers of participants, and associated time-loss athletic injuries from the first day of formal preseason practice to the final postseason contest for 16 collegiate sports. In this special issue of the Journal of Athletic Training, injury information in 15 collegiate sports from the period covering 1988–1989 to 2003–2004 is evaluated.
Athletic trainers and the NCAA have collaborated for 25 years through the NCAA ISS to create the largest ongoing collegiate sports injury database in the world. Data collection through the ISS, followed by annual review via the NCAA sport rules and sports medicine committee structure, isa unique mechanism that has led to significant advances in health and safety policy within and beyond college athletics.The publication of this special issue and the evolution of an expanded Web-based ISS enhance the opportunity to apply the health and safety decision-making process at the level of the individual athletic trainer and institution.
Journal of athletic training 01/2007; 44(2):173-82. · 1.68 Impact Factor
[show abstract][hide abstract] ABSTRACT: The incidence of noncontact anterior cruciate ligament injuries in young to middle-aged athletes remains high. Despite early diagnosis and appropriate operative and nonoperative treatments, posttraumatic degenerative arthritis may develop. In a meeting in Atlanta, Georgia (January 2005), sponsored by the American Orthopaedic Society for Sports Medicine, a group of physicians, physical therapists, athletic trainers, biomechanists, epidemiologists, and other scientists interested in this area of research met to review current knowledge on risk factors associated with noncontact anterior cruciate ligament injuries, anterior cruciate ligament injury biomechanics, and existing anterior cruciate ligament prevention programs. This article reports on the presentations, discussions, and recommendations of this group.
The American Journal of Sports Medicine 10/2006; 34(9):1512-32. · 4.44 Impact Factor
[show abstract][hide abstract] ABSTRACT: The present investigation was initiated to examine the weight management practices among wrestlers participating in the NCAA Division I, II, and III wrestling tournaments. Part 1 examined the efficacy of body composition assessment between preseason (PRE) and postseason (POST). Part 2 examined rapid weight loss (RWL) during the 20 h preceding the weigh-in and the rapid weight gained (RWG) during the first day's competition.
Subjects include 811 competitors from Divisions I, II, and III participating in the NCAA national championship tournaments between 1999 and 2004. Measurements included relative body fatness (% BF) and weight (WT) on the day preceding the tournament and the evening of the first day. Minimal weight (MW) was computed with 5% BF. Retrospectively, MW, % BF, and WT from the previous fall were obtained for comparisons from NCAA records.
Part 1: WT and % BF decreased significantly PRE (WT 74.0 +/- 11.1 kg; % BF 12.3 +/- 3.4%) to POST (WT 71.5 +/- 10.4 kg; % BF 9.5 +/- 1.8%), but MW (PRE MW 68.0 +/- 9.2 kg, POST MW 67.9 +/- 9.1 kg) remained unchanged. Heavier wrestlers and Division I and II wrestlers showed the greatest changes in WT and % BF. Part 2: RWL averaged (+/- SD) 1.2 +/- 0.9 kg and relative to weight 1.7 +/- 1.2%. Division I and lighter wrestlers showed the greatest change. RWG averaged 0.9 +/- 0.8 kg, or 1.3 +/- 1.2%. RWG was greater among lighter and Division I and II wrestlers.
Minimal weight estimates PRE appear valid compared with POST. RWL and RWG are reduced significantly over previous investigations with only mat-side weigh-ins. The NCAA weight management program appears effective in reducing unhealthy weight cutting behaviors and promoting competitive equity. Efforts to institute similar programs among younger wrestlers seem warranted.
Medicine & Science in Sports & Exercise 06/2006; 38(5):963-70. · 4.48 Impact Factor
[show abstract][hide abstract] ABSTRACT: Contact sports have high rates of injury. Protective equipment regulations are widely used as an intervention to reduce injury risk. The purpose of this study was to investigate the injury prevention effect of regulations governing protective equipment in two full-body contact sports.
Injury rates in US collegiate football were compared to New Zealand club Rugby Union. Both sports involve significant body contact and have a high incidence of injury. Extensive body padding and hard-shell helmets are mandated in collegiate football but prohibited in Rugby Union.
The injury rate in football was approximately one-third the rugby rate (rate ratio [RR] = 0.35; 95% CI: 0.31-0.40). The head was the body site with the greatest differential in injury incidence (RR = 0.11; 95% CI: 0.08-0.16). Rugby players suffered numerous lacerations, abrasions, and contusions to the head region, but the incidence of these injuries in football was almost zero (RR = 0.01; 95% CI: 0.01-0.03). Injury rates were more similar for the knee (RR = 0.61; 95% CI: 0.43-0.87) and ankle (RR = 0.72; 95% CI: 0.46-1.13), two joints largely unprotected in both sports.
The observed differences are consistent with the hypothesis that regulations mandating protective equipment reduce the incidence of injury, although important potential biases in exposure assessment cannot be excluded. Further research is needed into head protection for rugby players.
International Journal of Epidemiology 07/2002; 31(3):587-92. · 6.98 Impact Factor
[show abstract][hide abstract] ABSTRACT: An estimated 80,000 anterior cruciate ligament (ACL) tears occur annually in the United States. The highest incidence is in individuals 15 to 25 years old who participate in pivoting sports. With an estimated cost for these injuries of almost a billion dollars per year, the ability to identify risk factors and develop prevention strategies has widespread health and fiscal importance. Seventy percent of ACL injuries occur in noncontact situations. The risk factors for non-contact ACL injuries fall into four distinct categories: environmental, anatomic, hormonal, and biomechanical. Early data on existing neuromuscular training programs suggest that enhancing body control may decrease ACL injuries in women. Further investigation is needed prior to instituting prevention programs related to the other risk factors.
The Journal of the American Academy of Orthopaedic Surgeons 01/2000; 8(3):141-50. · 2.46 Impact Factor
[show abstract][hide abstract] ABSTRACT: To determine potential patterns that cause males and females to tear the anterior cruciate ligament (ACL) while playing basketball or soccer.
We reviewed data submitted to the National Collegiate Athletic Association Injury Surveillance System over the last 10 years, as well as profile data collected from collegiate certified athletic trainers.
College athletes involved in basketball or soccer.
Historical information was collected on those athletes involved in the National Collegiate Athletic Association Injury Surveillance System. Athletes involved in the profiling study underwent physical measurements related to flexibility, as well as a more detailed history relating to the ACL tear.
College-age women involved in basketball or soccer tear their ACLs at significantly higher rates than college-age men involved in the same sports. No distinct physical or historical measurements could be attributed to this different rate of injury.
Although the higher rate at which women compared with men tear their ACLs has persisted over the last 10 years, this increased incidence is not clearly attributable to any physical or historical measurements that were monitored.
Journal of athletic training 02/1999; 34(2):86-92. · 1.68 Impact Factor
[show abstract][hide abstract] ABSTRACT: To review 15 years of National Collegiate Athletic Association (NCAA) injury surveillance data for women's field hockey and identify potential areas for injury prevention initiatives.
Field hockey is one of the most popular sports worldwide and is growing in participation in the United States, particularly among women. From 1988-1989 to 2002-2003, participation in NCAA women's field hockey increased 12%, with the largest growth among Division III programs. In 2002- 2003, 253 colleges offered women's field hockey and 5385 women participated.
Game injury rates showed a significant average annual 2.5% decline over 15 years, most likely fueled by drops in ankle ligament sprain, knee internal derangement, and finger fracture injuries. Despite this, ankle ligament sprains were common (13.7% of game and 15.0% of practice injuries) and a frequent cause of severe injuries (resulting in 10+ days of time-loss activity). Concussion and head laceration injuries increased over this same time, and the risk of sustaining a concussion in a game was 6 times higher than the risk of sustaining one during practice. Overall, injury rates were twice as high in games as in practices (7.87 versus 3.70 injuries per 1000 athlete-exposures, rate ratio = 2.1, 95% confidence interval = 2.0, 2.3). Most head/neck/face (71%) and hand/finger/thumb (68%) injuries occurred when the player was near the goal or within the 25-yd line and were caused by contact with the stick or ball (greater than 77% for both body sites); for 34% of head/neck/ face injuries, a penalty was called on the play.
Equipment (requiring helmets and padded gloves) and rule changes (to decrease field congestion near the goal) as well as evidence-based injury prevention interventions (eg, prophylactic ankle taping/bracing, neuromuscular balance exercise programs) may be viable prevention initiatives for reducing injury rates in women's collegiate field hockey players.
Journal of athletic training 42(2):211-20. · 1.68 Impact Factor
[show abstract][hide abstract] ABSTRACT: To review 16 years of National Collegiate Athletic Association (NCAA) injury surveillance data for women's softball and to identify potential areas for injury prevention initiatives.
The NCAA Injury Surveillance System has tracked injuries in all divisions of NCAA softball from the 1988-1989 to the 2003-2004 seasons. This report describes what was found and why the findings are important for the safety, enhancement, and continued growth of the sport.
Across all divisions, preseason practice injury rates were more than double the regular-season practice injury rates (3.65 versus 1.68 injuries per 1000 athlete-exposures, rate ratio = 2.2, 95% confidence interval [CI] = 2.0, 2.4, P < .01). The rate of injury in a game was 1.6 times that in a practice (4.30 versus 2.67 injuries per 1000 athlete-exposures, rate ratio = 1.6, 95% CI = 1.5, 1.7). A total of 51.2% of game injuries resulted from "other-contact" mechanisms, whereas 55% of practice injuries resulted from noncontact mechanisms. In games, ankle ligament sprains and knee internal derangements accounted for 19% of injuries. Twenty-three percent of all game injuries were due to sliding, most of which were ankle sprains. In practices, ankle ligament sprains, quadriceps and hamstring strains, shoulder strains and tendinitis, knee internal derangements, and lower back strains (combined) accounted for 38% of injuries.
Ankle ligament sprains, knee internal derangements, sliding injuries, and overuse shoulder and low back injuries were among the most common conditions in NCAA women's softball. Preventive efforts should focus on sliding technique regardless of skill level, potential equipment changes, neuromuscular training programs, position-specific throwing programs, and mechanisms of low back injury. Further research is needed on the development and effects of these preventive efforts, as well as in the area of windmill-pitching biomechanics.
Journal of athletic training 42(2):286-94. · 1.68 Impact Factor
[show abstract][hide abstract] ABSTRACT: To review 16 years of National Collegiate Athletic Association (NCAA) injury surveillance data for men's ice hockey and to identify potential areas for injury prevention initiatives.
The NCAA began injury surveillance of men's ice hockey during the 1988-1989 academic year. These data represent all 3 NCAA divisions; the last Division II championship, however, was held during the 1998-1999 academic year.
The rate of injury was more than 8 times higher in games than in practices (16.27 versus 1.96 injuries per 1000 athlete-exposures [A-Es], rate ratio = 8.3, 95% confidence interval [CI] = 7.9, 8.8). A significant average annual increase of 1.3% in game injury rates occurred over the sample period (P = .05), but practice rates stayed static (P = .77). Preseason practice injury rates were more than twice as high as regular-season practice rates (5.05 versus 1.94 injuries per 1000 A-Es, rate ratio = 2.6, 95% CI = 2.4, 2.9, P < .01). The majority of game and practice injuries occurred to the lower extremity. Knee internal derangement (13.5%) was the most common lower extremity injury reported for games, whereas pelvis and hip muscle strains (13.1%) were the most common injury reported during practices. Player-to-player contact was the most frequent game mechanism of injury (50.0%). The majority of injuries occurred between the blue line and face-off circles (28.0%), in the corner (23.5%), and in the neutral zone (21.4%).
Preventive efforts should focus on strategies that limit player-to-player contact in the neutral zone and at the top of the offensive and defensive zones. In addition, clinicians and researchers should identify risk factors and interventions for muscle strains at the pelvis and hip region.
Journal of athletic training 42(2):241-8. · 1.68 Impact Factor