Article

Injuries to Kickers in American Football: The National Football League Experience

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Abstract

Very little information is available regarding the incidence, causative mechanisms, and expected duration of time lost after injuries to kickers (placekickers and punters) in American football. Lower extremity musculotendinous injuries are the most common type of injury in American football kickers. The injuries related to punting differ from injuries related to placekicking. Descriptive epidemiologic study. A retrospective review of all documented injuries to kickers in the National Football League over a 20-year period (1988-2007) was performed using the League's injury surveillance database. The data were analyzed from multiple perspectives, with emphasis on the type of kick or activity at the time of injury and the factors that affect return to play after injury. There were 488 total injuries over the 20-year period: 72% involved the lower extremity, 9% involved the lumbosacral spine, and 7% involved the head. Muscle-tendon injuries (49%) were the most common, followed by ligamentous injuries (17%). There was a significantly higher risk of injury in games (17.7 per 1000) than during practice (1.91 per 1000). Most injuries (93%) did not require surgery, and the mean time to return to play was 15 days if no surgery was necessary. Kickers over 30 years of age took longer to return to play (mean, 21 days) than younger kickers (mean, 12 days) after nonsurgical injuries (P = .03). Mean return to play after injuries that required surgery was 121 days. Lumbosacral soft tissue injury, lateral ankle sprains, and shoulder injuries were more likely to occur in punters than placekickers. Kicking athletes face a low risk of injury in professional American football. Injuries most commonly involve the lower extremities. Training and injury prevention efforts should reflect that punting is associated with different injuries than placekicking, and that older kickers take longer to recuperate than younger kickers after certain injuries.

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... Punting and place kicking are a part of regular sport-specific activity within American football, rugby, and Australian rules football. Injuries to American kickers, and rugby and Australian rules football players predominantly affect the lower limb [1][2][3]. After any injury, the main goal is a safe return to sport activity and to ensure that an athlete's rehabilitation will reduce the risk for reinjury. ...
... In the National Football League (NFL), the population of professional kickers experiences injuries at a rate of 24 per year, while the total number of kickers in the position was only 45 in the 2020 team rosters [1,14]. This injury rate translates to over half of the NFL kickers experiencing injuries of varying detriment per season. ...
... These injuries can lead to significant medical costs for the teams, decreased overall team performance, and loss in playing time [15]. Over a 20-year surveillance period, it was shown that over 89% of both place kickers and punters in the NFL were right-footed, and the majority of injuries in the kickers were overrepresented for the dominant leg [1]. The vast majority of NFL kicker injuries are acute or traumatic, and nearly all of the most common diagnoses reported involve the lower extremities, barring concussion [1]. ...
Article
Interval programs have been developed for multiple sports, allowing athletes to return to sport-specific activity in a graded fashion, minimizing the risk of reinjury. However, there currently exists a gap in the literature surrounding the use of interval programs for the rehabilitation of punting and place-kicking athletes. We aim to perform a systematic review of the literature examining the use of interval kicking programs to aid punting and place-kicking athletes following a lower-extremity injury. Following PRISMA guidelines, a review was performed using PubMed and MEDLINE databases to evaluate the literature surrounding interval kicking programs for punting and place-kicking athletes. Search terms were combined using Boolean operators of "AND" and "OR". Articles included in this review met these criteria: 1) included patients with lower-extremity pain/injury, 2) reported a return to sport progressive program, and 3) analyzed the measure's ability to predict a successful return to sport. The initial search returned 115 articles. Seventy-nine of these articles were excluded after initial screening, leaving 36 full-text articles for final review. Of these final articles, there were no studies outlining the use of interval kicking programs by punting or place-kicking athletes. Of the articles reviewed, the most relevant was an interval kicking program developed by Arundale et al. specifically for the soccer athlete. Punting and place-kicking use biomechanically distinct patterns of movement, warranting a specific interval program. This review identified a gap in knowledge surrounding the use of interval programs in the rehabilitation of punting and place-kicking athletes. This review will now describe what is currently known regarding biomechanics of punting and place kicking, the injuries experienced by these athletes, and the benefit an individualized interval program could provide. There currently exists a gap in the literature surrounding the use of interval programs for the rehabilitation of punting and place-kicking athletes. The biomechanics and application of these skills are distinct, and an interval program designed specifically for these athletes is warranted. Future research should be dedicated to the development, implementation, and analysis of an interval kicking program designed for these athletes.
... Results Mean age of athletes was 22.5 ± 3.2 (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) years with an average Taekwondo experience of 12.1 ± 4.0 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) years. Hamstring muscles were most commonly injured (48.4 %), followed by quadriceps muscles (32.3 %) and calf muscles (9.6 %). ...
... Muskelverletzungen gehören zu den häufigsten Verletzungen bei Profiathleten überhaupt [6][7][8][9][10][11][12]. Für unterschiedliche Sportarten konnten jeweils spezifische Verletzungsmuster identifiziert werden [13]. ...
... Die Daten werden, falls nicht anderweitig festgelegt, als Mittelwert ± Standardabweichung und Spanne beschrieben. Zur statistischen Analyse wurden die Verletzungsgrade des BAMICS (0-4 Suffix a-c) in Zahlenwerte umgewandelt (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). Die Berechnung der Korrelation zwischen den Subgruppen der MRT-Klassifikation und den "Return-to-Training"-Zeiten erfolgte mithilfe des Kendall-Tau-b-Tests. Die Berechnung der klinischen Inzidenz pro Athlet und Jahr erfolgte nach der Formel: Verletzungen/Anzahl der Athleten pro Jahr. ...
Article
Background Muscle injuries frequently occur in sports involving explosive movement patterns, and they can cause considerable downtime. There is a lack of detailed data on muscle injuries in Olympic elite Taekwondo. Methods All injuries sustained by 76 elite Taekwondo athletes from a national Olympic training centre during training and competition were prospectively recorded over a period of five years. Data on muscle injuries, including location and time elapsed until return-to-training, were extracted from medical records. Injuries were diagnosed by means of MRI and were classified according to the British Athletes Muscle Injury System. The relationship between MRI classification subgroups and time elapsed until return-to-training was assessed. Results Mean age of athletes was 22.5 ± 3.2 (16–27) years with an average Taekwondo experience of 12.1 ± 4.0 (7–20) years. Hamstring muscles were most commonly injured (48.4 %), followed by quadriceps muscles (32.3 %) and calf muscles (9.6 %). The analysis of MRI injury subgroups showed grade 1 (32.2 %) and grade 2 (41.9 %) injuries in most cases. A positive correlation was found between injury groups and return-to-training (r = 0.56). The comparison between different injury groups and time elapsed until return-to-training also revealed significant differences (p < 0.0001). Conclusion Hamstring muscles are the most injured muscles in Taekwondo besides the quadriceps femoris muscle. Most injuries were mild to moderate (grade 1–2). The time needed for return-to-training increased significantly with the severity of injuries diagnosed by MRI.
... In case 1, an abdominal wall injury occurred after overuse of the torso by repetitive activities. In cases 2 and 3, the thigh muscles were ruptured, corresponding to the most common location of injuries in professional kickers [8]. ...
Article
Muscle injuries caused by indirect trauma during exercise are common. Most of these injuries can be managed conservatively; however, further treatment is required in extreme cases. Although transcatheter arterial embolization is a possible treatment modality, its role in traumatic muscle injuries remains unclear. In this case series, we present three cases of exercise-induced muscle hemorrhage treated by transcatheter arterial embolization with successful outcomes. The damaged muscles were the rectus abdominis, adductor longus, and iliopsoas, and the vascular injuries were accessed via the femoral artery during the procedures.
... Rectus femoris (RF) injuries are common in sports that require maximal acceleration and sprinting. [1][2][3][4][5][6] In a multisport American collegiate study, female track and field athletes had the 3rd highest overall quadriceps injury rates behind male and female soccer players. 7 In elite T&F, thigh muscle injury is consistently recorded as the principal injury type and quadriceps injuries account for up to 25% of those injuries. ...
Article
Full-text available
Rectus femoris (RF) injuries are common in sports requiring maximal acceleration and sprinting. The British Athletics Muscle Injury Classification (BAMIC) describes acute muscle injury based on the anatomical site of injury and has been associated with return to play in hamstring and calf muscle injury. The aim of this study was to describe and compare the time to return to full training (TRFT) and injury recurrence for BAMIC‐classified RF injuries sustained by elite track and field (T&F) athletes over a 9‐year period. All rectus femoris injuries sustained by elite T&F athletes on the British Athletics World Class Program between September 2010 and September 2019 that were investigated with an MRI within 7 days of acute onset anterior thigh pain were included. Injuries were graded from the MRI by a specialist musculoskeletal radiologist using the BAMIC, and TRFT and injury recurrence were determined by evaluation of the Electronic Medical Record. Athlete demographics and World Athletics event discipline were recorded. Specific injury details including mechanism, location of injury and whether surgical or rehabilitation management was undertaken were recorded. There were 38 RF injuries in 27 athletes (24.7±2.3 years; 10 male, 17 female). Average TRFT for rehabilitation managed cases was 20.4±14.8 days. Grade 1 injuries had significantly shorter TRFT compared to grades 2 (p=0.04) and 3 (p=0.01). Intratendinous (c) and surgically managed RF injuries each had significantly longer TRFT compared to other injury classes (p<0.001). Myofascial (a) injuries had reduced repeat injury rates compared to b or c classes (p=0.048). Grade 3 injuries had an increased repeat injury rate compared to other grades (p=0.02). There were 4 complete (4c) proximal free tendon injuries sustained during sprinting and all in female athletes. The average TRFT for RF injuries in elite T&F is similar to that previously identified in elite football and Australian Rules. Similar to previous research in hamstring and calf injury, RF injuries extending into the tendon (BAMIC class c) had delayed TRFT which may reflect the longer duration required for tendon healing and adaptation. Grade 3 injuries had in increased repeat injury rate compared to grades 1 and 2. The BAMIC diagnostic framework may provide useful information for clinicians managing rectus femoris injuries in T&F.
... Dentro de las lesiones musculares, las que implican la musculatura del cuádriceps ocurren con frecuencia en actividades deportivas que requieren esfuerzos repetidos de sprint 13---16 . Además, causan un tiempo medio de baja deportiva (16,9 días) más elevado que las lesiones de la musculatura isquiotibial (14,3 días), tríceps sural (14,7 días) y aductora (14,0 días) siendo sus tasas de recurrencia muy elevadas (17%) 14 . ...
Article
Resumen Introducción y objetivo La arquitectura muscular es la disposición de los elementos contráctiles del músculo definidos como longitud del fascículo (LF), ángulo de peneación (AP), grosor muscular (GM) y área de sección transversal (ASTA). Estas se ven alteradas por las lesiones siendo en el cuádriceps uno de los grupos musculares con mayor incidencia. Por tanto, la exploración de las variables que influyen en dicha circunstancia constituye una labor relevante. El objetivo fue el de evaluar cómo afectan los entrenamientos de fuerza y de fuerza resistencia en la arquitectura muscular del cuádriceps femoral. Métodos Se llevó a cabo una búsqueda sistemática sin limitación temporal, desde el 2007 hasta diciembre de 2019, en las bases de datos Medline, Sport discus, Cinahl y Scopus, obteniendo 13 ensayos clínicos después de aplicar los criterios de selección. Resultados Los resultados muestran una elevada heterogeneidad en los programas y metodologías de intervención, pero se observa que la arquitectura muscular se modifica tras un programa de fuerza, sobre todo en aquellos que utilizan métodos excéntricos (AP Recto femoral: [Pre] 12,44 ± 2,98 / [Post] 13,82 ± 3,8; GM Recto femoral [Pre] 2,1 ± 0,19 / [Post] 2,28 ± 0,31; LF Vasto Lateral [Pre] 7,82 ± 1,88 / [Post] 8,57 ± 1,14; ASTA Recto femoral [Pre] 9,21 ± 1,86 / [Post] 10,02 ± 1,98), que más frecuentemente obtienen cambios significativos y en todos los elementos arquitectónicos, e isométricos que han demostrado cambios en todos los vientres musculares del cuádriceps estudiados. Conclusión Los programas de fuerza afectan a la arquitectura muscular, sobre todo aquellos basados en ejercicios excéntricos e isométricos.
... (16)(17) Isso geralmente ocorre durante movimentos como chutar uma bola ou correr. (2,(18)(19)(20)(21) A causa mais comum de dor aguda na virilha em atletas é uma lesão musculoesquelética, como uma tensão muscular. (16) No entanto, o diagnóstico diferencial pode incluir uma variedade de causas. ...
Article
Full-text available
Introdução: o músculo reto femoral é o músculo mais frequentemente lesado do grupo quadríceps durante chutes e corridas repetitivas, apesar de suas avulsões serem raras. A dor localizada na coxa proximal e a incapacidade de flexionar o quadril e/ou estender o joelho associado à história do paciente de contração violenta ou alongamento forçado do grupo muscular do quadríceps femoral podem indicar uma avulsão do reto femoral. Objetivo: relatar um caso e revisar a literatura acerca desta lesão incomum. Materiais e Métodos: revisão do prontuário, registro fotográfico do método diagnóstico e revisão da literatura. Resultados: homem de 46 anos com dor localizada no quadril esquerdo com irradiação para a coxa por três meses após cair no chão com a região dolorida em um jogo de futebol. A dor começou subitamente uma semana após a queda. A ressonância magnética do quadril apresentava avulsão completa do reto femoral esquerdo, distando 2 cm da espinha ilíaca anterior inferior com efusão líquida adjacente. Conclusão: este relato demonstra a dificuldade de diagnosticar essa lesão, pois o seu exame físico é inespecífico, podendo simular patologias mais complexas, necessitando de exames complementares para seu correto diagnóstico.
... 9,13 There is insufficient evidence to indicate whether an association exists between injury mechanism and MRI findings of acute rectus femoris injuries as injury mechanism has not been detailed in previous studies, including kicking sports. 3,14,15 The aim of our study was to describe the injury mechanism and its association with MRI injury findings in acute rectus femoris injuries. ...
Article
Full-text available
Objective: To describe the injury mechanism and its association with magnetic resonance imaging (MRI) injury findings in acute rectus femoris injuries. Design: Combined retrospective and prospective descriptive injury study. Retrospective cohort from January 2010 to October 2013 and prospective cohort from October 2013 to January 2019. Setting: Specialized sports medicine hospital. Participants: Male professional football players older than 18 years playing in a national football league, referred for injury assessment within 7 days after an acute rectus femoris injury, with a positive finding on MRI. Independent variables: Rectus femoris muscle injury MRI findings in relation to injury mechanism in male football players. Main outcome measures: Rectus femoris injury mechanism (kicking, sprinting, and others), MRI injury location, and grade. Results: There were 105 injuries in total, with 60 (57.1%) and 45 (42.8%) injuries from the retrospective and prospective cohorts, respectively. Kicking was the injury mechanism in 57 (54.3%) of all acute rectus femoris injuries, sprinting represented 32 (30.4%), and 16 (15.2%) were classified as others. There were 20 (19.05%) free tendon, 67 (63.8%) myotendinous junction and/or intramuscular tendon, and 18 (17.1%) peripheral myofascial located injuries. All free tendon injuries were related to kicking and graded as a complete tear of at least one of the tendons in 15/20 (75.0%) cases. Conclusions: Kicking seems to be an important mechanism related to complete ruptures and injuries occurring at the proximal free tendon. Sprinting was the other most common mechanism but was never associated with injury to the proximal free tendon.
... Rectus femoris injuries occur most frequently during eccentric muscle action in sporting activities that involve repetitive kicking or sprinting movements. 2,7,19,27 This is reflected in the sporting profiles of patients included within this study, where all participants were professional soccer or rugby players. In the present study, surgical repair of proximal rectus femoris avulsion injuries enabled return to preinjury level of sporting function at 15.8 6 2.2 weeks, which is more favorable than reports from existing studies using smaller sample sizes of patients with similar preinjury levels of activity. ...
Article
Background Surgical repair of proximal rectus femoris avulsion injuries is associated with prolonged periods of rehabilitation and highly variable risk of injury recurrence. Surgical tenodesis of these injuries is often reserved for recurrent injuries or revision surgery. To our knowledge, the outcomes of proximal rectus femoris avulsion injuries treated with surgical repair versus primary tenodesis have not been previously reported. Hypothesis Primary tenodesis of proximal rectus femoris avulsion injuries is associated with reduced risk of injury recurrence as compared with surgical repair. Study Design Cohort study; Level of evidence, 3. Methods This study included 25 patients (22 male and 3 female) who underwent surgical repair versus 30 patients (26 male and 4 female) who received primary tenodesis for proximal rectus femoris avulsion injuries. Predefined outcomes were recorded at regular intervals after surgery. Mean follow-up time was 27.9 months (range, 24.0-31.7 months) from date of surgery. Results All patients returned to their preinjury levels of sporting activity. Primary tenodesis was associated with earlier return to preinjury level of sporting function as compared with surgical repair (mean ± SD, 12.4 ± 1.6 vs 15.8 ± 2.2 weeks; P < .001) and reduced risk of recurrence (0% vs 16%; P < .001). At 1-year follow-up, there was no difference in surgical repair versus primary tenodesis relating to patient satisfaction scores (12 very satisfied and 13 satisfied vs 16 very satisfied and 14 satisfied; P = .70), isometric quadriceps strength (95.6% ± 2.8% vs 95.2% ± 6.3%; P = .31), Tegner scores (median [interquartile range], 9 [8-9] vs 9 [8-9]; P = .54), and lower extremity functional scores (73 [72-76] vs 74 [72-75]; P = .41). High patient satisfaction, quadriceps muscle strength, and functional outcome scores were maintained and remained comparable between treatment groups at 2-year follow-up. Conclusion Primary tenodesis was associated with reduced time for return to preinjury level of sporting function and decreased risk of injury recurrence when compared with surgical repair for proximal rectus femoris avulsion injuries. There were no differences in patient satisfaction, functional outcome scores, and quadriceps muscle strength between the treatment groups at 1- and 2-year follow-up.
... 6,15 As stated in our inclusion/exclusion criteria, players with any objective evidence of intra-articular hip pathology, such as femoral acetabular impingement, labral tear, or degenerative changes, were specifically excluded from this cohort to minimize bias of the results. In a study by Brophy et al, 2 NFL kickers were more likely to have injuries in the pelvis and hip than any other anatomic location, and muscle-tendon injuries were the most common type. Many patients can be treated effectively with an active training program. ...
Article
Full-text available
Background Chronic strain and/or tendinopathy of the adductor longus tendon can be a cause of long-standing groin pain in the elite athlete, resulting in significant time lost from competition. Accurate diagnosis and treatment can expedite return to play. Purpose/Hypothesis To evaluate return to sport and performance in National Collegiate Athletic Association (NCAA) Division I football players and National Football League (NFL) players following adductor longus release with or without sports hernia repair. We hypothesized that adductor release will be an effective method of treatment for recalcitrant groin/adductor pain in these athletes. Study Design Case series; Level of evidence, 4. Methods A cohort study was performed of all NFL players and NCAA Division I college athletes who had undergone an adductor longus tendon release with or without sports hernia repair by 1 of 2 fellowship-trained orthopaedic surgeons between May 1999 and January 2013. All patients reported groin pain below the inguinal ligament and localized to their adductor longus. Symptoms lasted longer than 10 weeks and limited their ability to effectively perform during sport, as assessed by their coach and self-assessment. Questionnaires were given to all 26 patients to assess long-term surgical outcomes. A subgroup analysis was performed for NFL players, in which “performance scores” were calculated according to individual player statistics while playing. Scores obtained before the diagnosis of chronic adductor longus tendinopathy or strain were compared with those after surgery. Patients with prior abdominal or pelvic surgery, radiographic evidence of degenerative joint disease of the hip, labral tears or femoral acetabular impingement, prostatic or urinary tract disease, or nerve entrapment of the ilioinguinal, genitofemoral, or lateral femoral cutaneous nerves were excluded from the study. Results A total of 32 athletes underwent an adductor longus tenotomy during the study period. Of these patients, 28 were college- or professional-level athletes who underwent an adductor longus tenotomy, with a mean ± SD follow-up time of 6.2 ± 4.2 years (range, 12-178 months). Of the 32 patients, 20 had a concomitant sports hernia repair in addition to an adductor longus tenotomy. Thirty-one patients (97%) were able to return to their previous sport, and 30 (94%) were able to return at their previous level of play. Thirty patients (94%) reported that they were satisfied with their decision to have surgery. No player complained of weakness or a decrease in running speed or power. Mean return to play was 12 weeks from date of surgery. In the subgroup analysis of 16 NFL players, there were no statistically significant differences for the pre- versus postoperative comparisons of the athlete performance scores ( P = .74) and the percentage of the games started versus played ( P = .46). After separation of players who had a concomitant hernia repair from players who did not, there was no statistically significant difference in performance scores or percentages of games started. Conclusion In this study of elite athletes, adductor longus tenotomy with or without a concomitant sports hernia repair provided overall acceptable and excellent results. Athletes were able to return to their previous level of athletic competition and performance with consistent relief of groin pain. Return to play in an NFL game averaged 12 weeks following surgery.
... By using categories based on the locations of pain, we do know that injuries of the upper leg, groin, and hip are among the most common injuries in sport. 2,3,4 A recent weekly survey of soccer players found the weekly prevalence of "groin problems" to be 29%. 5 We prefer the term core injury. ...
Article
Lower abdominal and groin injuries are among the most common causes of pain and lost playing time in sports. Treating these injuries requires understanding the anatomy of the core and how the various components interact. Every muscle of the core is subject to injury so therapeutic decision making depends on a precise diagnosis and an understanding of the natural history of that injury. In this review, we will describe the anatomy and pathophysiology of core muscle injuries in detail as well as the appropriate work-up and management.
... These included acromioclavicular (AC) joint separations in quarterbacks, forearm fractures in defensive backs, and lower extremity strains in kickers. 17,49,61,72 Corticosteroid injections for muscle strains as well as certain ligament sprains, such as the AC joint or ankle syndesmosis, have been shown to be safe as well as effective in allowing earlier return to play (RTP). 29,30,75,85 Finally, several studies documented increased arthritis and whole-person impairment in former NFL players, with the cervical and lumbar spine being highly affected. ...
Article
Full-text available
Background Orthopaedic injuries of National Football League (NFL) players can have a deleterious effect on their health, with minimal to no high-level evidence on the management of these injuries. Purpose To summarize all data published between January 1980 and March 2018 on orthopaedic injuries experienced by NFL candidates and professional players in the NFL. Study Design Systematic review; Level of evidence, 4. Methods A literature search of studies examining orthopaedic injuries in the NFL was performed through the PubMed, Embase, and CINAHL databases. The review included studies of orthopaedic injuries in college football recruits attending the NFL Combine as well as professional NFL players. Excluded were studies of nonorthopaedic injuries, such as concussions, traumatic brain injury, facial injuries, and vascular injuries, as well as case reports. Results A total of 147 articles met the inclusion criteria and were divided into 11 topics based on anatomic site: general (16%), spine (13%), shoulder (13%), elbow (3%), hand and wrist (3%), trunk (0.7%), hip and pelvis (7%), thigh (3%), knee (24%), ankle (5%), and foot (12%). Of these studies, 74% were of level 4 evidence. Most studies obtained data from the NFL Combine database (26%), by searching the internet (24%), and via the NFL Injury Surveillance System (22%). Studies using internet search methods to identify injuries consistently found fewer participants than studies using the NFL Injury Surveillance System. Conclusion This systematic review provides National Collegiate Athletic Association and NFL team physicians with a single source of the most current literature regarding orthopaedic injuries in NFL players. Most research was published on knee, spine, shoulder, and foot injuries and consisted of level 4 evidence. A substantial portion of the published literature was based on data obtained from internet searches and may not accurately represent the NFL population.
... Q uadriceps muscle injuries occur frequently in sports activities that require repeated sprint efforts. [1][2][3][4] in addition, they cause a longer period of time off than hamstring and adductor muscle injuries, 4 and their recurrence rates are very high (17%). In the extensor muscle of the knee, Rectus Femoris (RF) is the most commonly injured muscle. ...
Article
Background: Injuries and mechanical stimuli alter the muscle architecture and, therefore, its function. The changes in the architecture of the rectus femoris (RF) induced by an eccentric training protocol with reverse nordic hamstring exercises (RNHE) have never been studied. Therefore, the aim of the present study was to determine the architectural adaptations of the RF after an eccentric training with RNHE, followed by a subsequent detraining period. Methods: Twenty-six subjects performed a first week of control, 8 weeks of eccentric training, concluding with a 4-week period of detraining. The architectural characteristics of the RF were evaluated using 2D ultrasound at rest (pretest: week 1), after the training (post-test: week 9), and at the end of the detraining period (retest: week 13). Results: At the end of the training period, a significant increase in the muscle fascicle length (FL) (t=-8.96, d=2.22, P<0.001), muscle thickness (MT) (t=-8.76, d=2.219, P<0.001), pennation angle (PA) (t=-9.83, d=2.49, P<0.05) and cross-sectional area (CSA) (t=-13.06, d=3.06, P<0.001) was observed. After the detraining period FL, MT, PA and CSA showed a significant decrease. Conclusions: The eccentric training with RNHE may cause changes in the architectural conditions of RF, which, in addition, are also reversible after a 4-week detraining period. The adaptations produced by RNHE may have practical implications for injury prevention and rehabilitation programs, which include the changes in muscle architecture variables.
... Muscle injuries are very common in soccer [1], rugby [2], American Football [3][4][5], Australian Football [6,7], and track and field [8,9]. The incidence of muscle injury may be as high as 31% in soccer and 28.2% in track and field [1,9]. ...
Article
Full-text available
Muscle injuries are very common in sport.1–3 In soccer, the most popular sport in the world, the majority of muscle injuries are located in the lower extremity (92–97%); hamstrings (28–37%), quadriceps (19–32%), adductors (19–23%), and calf muscles (12–13%),1 all of them are biarticular muscles, with a complex architecture and containing a high proportion of fast-twitch fibers.1 Football teams have important budgets and spend great amounts of money to win titles; it has been proved that injuries had a significant influence on performance in male professional football,4 but muscle injuries seem to keep growing.5 The reason to this is multivariable: there is no consensus regarding hamstring muscle injuries (HMIs) return to play (RTP) criteria in the literature,6 the time for recovery is highly variable,7 the increased physical demands during games,8 or the influence of congested period of games on players health.9 During the last years several proposals for classification and grading muscle injuries have been published.10–12 The FC Barcelona medical department with the collaboration of two important institutions in sports medicine and several experts in the field, have developed the MLG-R proposal, with the hamstrings group as a model.13 A good classification system is necessary, which allows to have reliable epidemiological data, which are the base to improve our knowledge about muscle injuries; better knowledge leads to better therapeutic options, prognosis, RTP criteria or lower reinjury rates.
... 7,8 The most common cause of groin injury arises from the adductor, followed by the iliopsoas. 6,[9][10][11] The iliopsoas has been recently implicated in 25% of acute groin injuries. 5 Other studies similarly indicated that iliopsoas disorders were found in 25% to 30% of athletes with acute groin injury and 12% to 36% of athletes with chronic groin pain. ...
Article
Objectives Treatment for iliopsoas tendinopathy includes ultrasound (US)‐guided iliopsoas peritendinous corticosteroid injection. Evidence is lacking regarding US‐guided iliopsoas injection efficacy in patients with iliopsoas tendinopathy and intra‐articular (IA) hip abnormalities. The purpose of this study was to examine the efficacy of US‐guided iliopsoas corticosteroid injection for iliopsoas tendinopathy in patients with and without IA hip abnormalities. Methods This work was a prospective study evaluating patients aged 12 to 50 years with iliopsoas tendinopathy. Participants completed a Hip Disability and Osteoarthritis Outcome Score (HOOS) questionnaire before and 6 weeks after injection. The main outcome measure was the change in HOOS subcategory scores. Independent variables included time and hip status. Normal hips were compared to abnormal hips with IA abnormalities. A 2‐way repeated measures analysis of covariance with effect size (η²) was used to determine injection effects on HOOS scores before and 6 weeks after injection. Results A total of 178 patients (154 female and 24 male) were analyzed. Time effects were found for both normal and abnormal hips in all HOOS subcategories: symptoms (P = .041; η² = 0.050), pain (P = .001; η² = 0.184), activities of daily living (P = .011; η² = 0.076), function in sports and recreation (P = .001; η² = 0.151), and quality of life (QOL; P = .001; η² = 0.193). Significant differences between normal versus abnormal hips were found in the sports and recreation (P = .032; η² = 0.056) and QOL scores (P = .001; η² = 0.135). Conclusions In patients with iliopsoas tendinopathy, US‐guided iliopsoas corticosteroid injection improved outcomes regardless of coexisting IA hip abnormalities. Patients without IA hip abnormalities showed greater improvement in sports and recreation and QOL scores compared to patients with IA hip abnormalities. Ultrasound‐guided iliopsoas injection for iliopsoas tendinopathy may advance short‐term care and help continue with nonsurgical treatment regimens.
... Muscle injuries are very common in soccer [1], rugby [2], American Football [3][4][5], Australian Football [6,7], and track and field [8,9]. The incidence of muscle injury may be as high as 31% in soccer and 28.2% in track and field [1,9]. ...
... The inconsistent nomenclature and diversity of organ systems and processes that can give rise to groin pain in athletes makes tracking the incidence particularly difficult. By using categories based on the locations of pain, we do know that injuries of the upper leg, groin, and hip are among the most common injuries in sport (2,8,9). A recent weekly survey of soccer players found the weekly prevalence of ''groin problems'' to be 29% (10). ...
Article
Lower abdominal and groin injuries are among the most common causes of pain and lost playing time in sports. Perhaps the most important obstacle in understanding these injuries is the lack of consensus on nomenclature. There have been numerous advances in recent years in the understanding, prevention, diagnosis, and treatment of these injuries. The purpose of this review is to provide a general perspective on the current understanding of these injuries and a summary of recent advances.
... So far, full effort instep and side-kicks have been studied extensively (Brophy, Backus, Pansy, Lyman, & Williams, 2007;Brophy, Wright, Powell, & Matava, 2010;Charnock et al., 2009;Dörge et al., 1999;Dörge, Anderson, Sørensen, & Simonsen, 2002;Katis & Kellis, 2010;Levanon & Dapena, 1998;Nunome, Asai, Ikegami, & Sakurai, 2002). Comparisons between instep and sidekicks, with the latter being similar to a full effort inside pass, have shown similar kinematics. ...
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Groin injuries are common in soccer and often cause time-loss from training. While groin injuries have been linked to full effort kicking, the role of inside passing is unclear. Therefore, the purpose of this study was to investigate hip joint kinematics and muscle force, stress and contraction velocity for adductor longus and gracilis during inside passing. 3D kinematics of ten soccer players (23.4 yrs; 77.5 kg; 1.81 m) were captured with a motion capture system inside a Footbonaut. Muscle force and contraction velocity were determined with AnyBody Modelling System. Gracilis muscle forces were 9% lower compared to adductor longus (p = 0.005), but muscle stress was 183% higher in gracilis (p = 0.005). Contraction velocity reveals eccentric contraction of gracilis in the last quarter of the swing phase. Considering the combination of eccentric contraction, high muscle stress and the repetitive nature of inside passing, gracilis accumulates high loads in matches and training. These results indicate that the high incidence of groin injuries in soccer could be linked to isolated pass training. Practitioners need to be aware of the risk and refrain from sudden increases in the amount of pass training. This gives the musculoskeletal system time to adapt and might avoid career threatening injuries.
... In addition, whether players are able to return to preinjury levels of performance after RTP remains unknown, with information available only for running backs, wide receivers, quarterbacks, and kickers. 9,11,16 The purpose of this study was to evaluate RTP after primary ACL injuries, evaluate covariates that affect RTP, and assess preinjury and postinjury levels of performance for all positions. We hypothesized that RTP for skilled positions and that an early draft round would correlate to a higher probability and rate of RTP. ...
Article
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Background Anterior cruciate ligament (ACL) injuries pose a significant risk to the careers of players in the National Football League (NFL). The relationships between draft round and position on return to play (RTP) among NFL players are not well understood, and the ability to return to preinjury performance levels remains unknown for most positions. Purpose To test for differences in RTP rates and changes in performance after an ACL injury by position and draft round. We hypothesized that skilled positions would return at a lower rate compared to unskilled positions. We further hypothesized that early draft-round status would relate to a greater rate of RTP and that skilled positions and a lower draft round would correlate with decreased performance for players who return to sport. Study Design Case-control study; Level of evidence, 3. Methods Utilizing a previously established database of publicly available information regarding ACL tears among NFL players, athletes with ACL tears occurring between the 2010 and 2013 seasons were identified. Generalized linear models and Kaplan-Meier time-to-event models were used to test the study hypotheses. Results The overall RTP rate was 61.7%, with skilled players and unskilled players returning at rates of 64.1% and 60.4%, respectively (P = .74). Early draft-round players and unskilled late draft-round players had greater rates of RTP compared to skilled late draft-round players and both unskilled and skilled undrafted free agents (UDFAs). Skilled early draft-round players constituted the only cohort that played significantly fewer games after an injury. Unskilled UDFAs constituted the only cohort to show a significant increase in the number of games started and ratio of games started to games played, starting more games in which they played, after an injury. Conclusion Early draft-round and unskilled players were more likely to return compared to their later draft-round and skilled peers. Skilled early draft-round players, who displayed relatively high rates of RTP, constituted the only cohort to show a decline in performance. Unskilled UDFAs, who exhibited relatively low rates of RTP, constituted the only cohort to show an increase in performance. The significant effect of draft round and position type on RTP may be caused by a combination of differences in talent levels and in opportunities given to returning to play.
... Muscle injuries are very common in soccer [1], rugby [2], American Football [3][4][5], Australian Football [6,7], and track and field [8,9]. The incidence of muscle injury may be as high as 31% in soccer and 28.2% in track and field [1,9]. ...
Chapter
Muscle injuries are among the most common injuries in sport and continue to be a major concern due to training and competition time loss, challenging decision-making regarding treatment and return to sport, and relatively high recurrence rate. An adequate classification of muscle injury is essential for a full understanding of the injury and to optimize its management and return to play process. The ongoing failure to establish a classification system with broad acceptance has resulted from factors such as limited clinical applicability and the inclusion of subjective findings and ambiguous terminology. The purpose of this manuscript was to describe a classification system for muscle injuries with easy clinical application and adequate grouping of injuries with similar functional impairment and provide potential prognostic value. The goal of the classification is to enhance communication between health-care and sports-related professionals and facilitate the rehabilitation and return to play decision-making.
... We also found that in players with MRI, certain injury imaging characteristics, including the anteroposterior size of any fascial tear and the presence of fluid collection, were associated with longer return to play after injury. A single NFL team was chosen for this study as opposed to using data from the NFL Injury Surveillance System database as in many NFL studies 3,4,6,[10][11][12]15,16,20 because the imaging characteristics of the injuries were best reviewed with MRIs obtained at a single institution using identical sequences and protocols to allow valid comparison between athletes. In addition, if league-wide data had been used, we would not have had access to documented physical examinations or specific diagnoses for the studied injuries. ...
Article
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Background Lower extremity muscle injuries are common in professional football. Although less common than hamstring or quadriceps injuries in National Football League (NFL) athletes, calf injuries occur with relative frequency and have not previously been studied. Purpose To evaluate gastrocnemius-soleus complex muscle injuries over the past 13 years from a single NFL team to determine the incidence of such injuries, their imaging characteristics, and return to play after such injuries and any correlation between imaging findings and prolonged return to play. Study Design Case series; Level of evidence, 4. Methods A retrospective review of all acute calf muscle injuries on a single NFL team from 2003 to 2015 was performed. Player demographics and return-to-play data were obtained from the medical records. All available magnetic resonance images (MRIs) were reviewed by a musculoskeletal radiologist for specific imaging findings that correlated with return to play. Results A total of 27 calf injuries in 24 NFL players were reviewed, yielding an incidence of 2.3 acute calf injuries per year on a single NFL team. Of these 27 injuries, 20 (74%) were isolated injuries to the gastrocnemius muscle, 4 (15%) were isolated injuries to the soleus muscle, and the remaining 3 injuries (11%) involved both. Defensive players were more likely to sustain injuries (P = .043). The mean time to return to play for all 27 players was 17.4 ± 14.6 days (range, 3-62 days). MRIs were available in 14 of the 27 injuries. The average size of the fascial defect (P = .032) and the presence of a fluid collection (P = .031) both correlated with return to play of longer than 2 weeks. Conclusion Although less common than hamstring or quadriceps muscle injuries, calf muscle injuries occur with relative frequency in the NFL, and more so in defensive players. The majority of these injuries occur in the gastrocnemius and result in significant disability, with at least 2 weeks of missed playing time on average. MRI may have an important role in the evaluation of calf injuries in NFL players, as certain injury imaging characteristics, including the anteroposterior size of any fascial tear and the presence of a fluid collection, are associated with longer return-to-play times after injury.
... Quadriceps muscle strains frequently occur in sports that require repetitive kicking and sprinting efforts. 4,5,7,14,17,18,24,27,34 Thigh strains, including hamstring and quadriceps muscles, have been reported as the most common injuries among professional soccer players. 18,19,34 Most muscle strains occur in response to eccentric loading, with the resultant injury occurring near the musculotendinous junction. ...
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Background: Rectus femoris injuries are common among athletes, especially in kicking sports such as soccer; however, proximal rectus femoris avulsions in athletes are a relatively rare entity. Purpose/Hypothesis: The purpose of this study was to describe and report the results an original technique of surgical excision of the proximal tendon remnant followed by a muscular suture repair. Our hypothesis was that this technique limits the risk of recurrence in high-level athletes and allows for rapid recovery without loss of quadriceps strength. Study Design: Case series; Level of evidence, 4. Methods: Our retrospective series included 5 players aged 31.8 ± 3.9 years with acute proximal rectus femoris avulsion injuries, who underwent a surgical resection of the proximal tendon between March 2012 and June 2014. Four of these players had recurrent rectus femoris injuries in the 9 months before surgery, while 1 player had surgery after a first injury. Mean follow-up was 18.2 ± 12.6 months, and minimum follow-up was 9 months. We analyzed the age, sex distribution, physical examination outcomes, type and mechanism of injury, diagnosis, treatment and complications during surgery, postoperative follow-up, and time to return to play. The Lower Extremity Functional Scale (LEFS) and Marx scores were obtained at 3-month follow-up, and isokinetic tests were performed before return to sports. A telephone interview was completed to determine the presence of recurrence at an average follow-up of 18.2 months. Results: At 3-month follow-up, all patients had Marx activity scores of 16 and LEFS scores of 80. Return to the previous level of play occurred at an average of 15.8 ± 2.6 weeks after surgery, and none of the athletes suffered a recurrence. Isokinetic test results were comparable between both sides. Conclusion: The surgical treatment of proximal rectus femoris avulsions, consisting of resection of the tendinous part of the muscle, is a reliable and safe technique allowing a fast recovery in professional athletes.
... Muscle injuries are very common in soccer [1], rugby [2], American Football [3][4][5], Australian Football [6,7], and track and field [8,9]. The incidence of muscle injury may be as high as 31% in soccer and 28.2% in track and field [1,9]. ...
Article
Full-text available
Muscle injuries are among the most common injuries in sport and continue to be a major concern because of training and competition time loss, challenging decision making regarding treatment and return to sport, and a relatively high recurrence rate. An adequate classification of muscle injury is essential for a full understanding of the injury and to optimize its management and return-to-play process. The ongoing failure to establish a classification system with broad acceptance has resulted from factors such as limited clinical applicability, and the inclusion of subjective findings and ambiguous terminology. The purpose of this article was to describe a classification system for muscle injuries with easy clinical application, adequate grouping of injuries with similar functional impairment, and potential prognostic value. This evidence-informed and expert consensus-based classification system for muscle injuries is based on a four-letter initialism system: MLG-R, respectively referring to the mechanism of injury (M), location of injury (L), grading of severity (G), and number of muscle re-injuries (R). The goal of the classification is to enhance communication between healthcare and sports-related professionals and facilitate rehabilitation and return-to-play decision making.
... As mentioned above, the vast majority of muscle injuries can be resolved with non-operative management, only a small number of cases will require surgical intervention (Brophy, Wright, Powell, & Matava, 2010; Complete tendinous avulsion/rupture with significant retraction of the muscle (in biomechanical terms a total tear in the origin or insertion of the muscle) is unlikely to heal spontaneously at the original anatomical localisation (Ueblacker, Müller-Wohlfahrt, Hinterwimmer, Imhoff, & Feucht, 2015). Thus, surgical reattachment using suture anchors is usually indicated in these cases, especially on the proximal rectus femoris (Garcia, Duhrkop, Seijas, Ares, & Cugat, 2012;Ueblacker, Müller-Wohlfahrt, Hinterwimmer, et al., 2015) and the proximal hamstrings (Cohen & Bradley, 2007;Harris, Griesser, Best, & Ellis, 2011). ...
Article
Muscle injuries are frequent and represent one of the most substantial medical problems in professional football. They can have both traumatic and overuse causes with direct practical consequence due to differences in terms of the post-primary care regimen and prognosis. An accurate diagnosis is the first step towards a specific treatment and usually allows to predict return to play (RTP). Current treatment principles have no firm scientific basis; they are practiced largely as empirical medicine due to a lack of prospective randomised studies. Immediate treatment usually follows the PRICE-principle (protection, rest, ice, compression, elevation). Depending on the type of the muscle injury, specific physical and physiotherapeutical procedures as well as rehabilitative exercises and gradual training therapy are used to recondition the injured structure, to restore coordination and proprioception, and to normalise movement patterns. Injection therapy with various substances is frequently used, with positive results empirically, but evidence in form of prospective randomised studies is lacking. A precise rehabilitation plan should be developed for every muscle injury, including recommendations for sport-specific training with increasing intensity. Since there are no guidelines regarding safe RTP, regular follow-up examinations on the current muscle status are crucial to evaluate the progress made in terms of healing and to determine when the injured muscle can be exposed to the next step of load. This narrative review describes the various factors that a medical team should consider during assessment, treatment and rehabilitation of a muscle injury with particular focus on professional football.
... Muscle injuries are very common in soccer [1], rugby [2], American Football [3][4][5], Australian Football [6,7], and track and field [8,9]. The incidence of muscle injury may be as high as 31% in soccer and 28.2% in track and field [1,9]. ...
Presentation
A new proposal to classify muscle injuries.
... Collateral ligament injuries were confirmed by review of both documented physical examination findings and magnetic resonance imaging (MRI) for all included players. A single NFL team was chosen for this study as opposed to data from the NFL Injury Surveillance System database as in many NFL studies, [2][3][4]8,9,12,16,17,21 as simultaneous UCL and RCL injuries are not commonly described and may not be documented in league-wide injury databases. ...
Article
Full-text available
Background: Thumb collateral ligament injuries occur frequently in the National Football League (NFL). In the general population or in recreational athletes, pure metacarpophalangeal (MCP) abduction or adduction mechanisms yield isolated ulnar collateral ligament (UCL) and radial collateral ligament (RCL) tears, respectively, while NFL athletes may sustain combined mechanism injury patterns. Purpose: To evaluate the incidence of simultaneous combined thumb UCL and RCL tears among all thumb MCP collateral ligament injuries in NFL athletes on a single team. Study design: Case series; Level of evidence, 4. Methods: A retrospective review of all thumb injuries on a single NFL team from 1991 to 2014 was performed. All players with a thumb MCP collateral ligament injury were included. Collateral ligament injuries were confirmed by review of both physical examination findings and magnetic resonance imaging. Player demographics, surgical details, and return-to-play data were obtained from the team electronic medical record and surgeons' records. Results: A total of 36 thumbs in 32 NFL players were included in the study, yielding an incidence of 1.6 thumb MCP collateral ligament injuries per year on a single NFL team. Of these, 9 thumbs (25%) had a simultaneous combined UCL and RCL tear injury pattern confirmed on both physical examination and MRI. The remaining 27 thumbs (75%) were isolated UCL injuries. All combined UCL/RCL injuries required surgery due to dysfunction from instability; 63.0% of isolated UCL injuries required surgical repair ( P = .032) due to continued pain and dysfunction from instability. Repair, when required, was delayed until the end of the season. All players with combined UCL/RCL injuries and isolated UCL injuries returned to play professional football the following season. Conclusion: Simultaneous combined thumb UCL and RCL tear is a previously undescribed injury pattern that occurred in 25% of thumb MCP collateral ligament injuries on a single NFL team over a 23-year period. All players with combined thumb UCL/RCL injuries required surgical repair, which was significantly higher compared with players with isolated UCL injuries. Team physicians and hand surgeons treating elite football players with suspected thumb collateral ligament injuries should examine for RCL and UCL instability and consider MRI if any concern exists for a combined ligament injury pattern, as this injury is likely frequently missed.
... Injuries of the RF mainly occur among soccer players [7]. Indeed, quadriceps strains are the fourth most common injury experienced by National Football League kickers [13]. In elite players, quadriceps injuries cause more missed games than hamstring or adductor group strains [3]. ...
Article
The rectus femoris is the most commonly injured muscle of the anterior thigh among athletes, especially soccer players. Although the injury pattern of the muscle belly is well documented, less is known about the anatomy and specific lesions of the proximal tendons. For each head, three distinctive patterns may be encountered according to the location of the injury, which can be at the enthesis, within the tendon, or at the musculotendinous junction. In children, injuries correspond most commonly to avulsion of the anteroinferior iliac spine from the direct head and can lead to subspine impingement. Calcific tendinitis and traumatic tears may be encountered in adults. Recent studies have shown that traumatic injuries of the indirect head may be underdiagnosed and that injuries of both heads may have a surgical issue. Finally, in the case of tears, functional outcome and treatment may vary if the rupture involves one or both tendons and if the tear is partial or complete. Thus, it is mandatory for the radiologist to know the different ultrasound and magnetic resonance imaging (MRI) patterns of these lesions in order to provide accurate diagnosis and treatment. The purpose of this article is to recall the anatomy of the two heads of rectus femoris, describe a reliable method of assessment with ultrasound and MRI and know the main injury patterns, through our own experience and literature review.
... Muscle Strength: During the first evaluation, four patients had grade IV muscle strength on the affected limb, three patients had muscle strength grade V, and one patient had muscle strength grade III. At the end of six weeks of treatment, all patients showed muscle strength grade V. Pain: The average points achieved before the start of treatment for VAS pain was 5.75 points (range, [3][4][5][6][7][8]. After six weeks of treatment, this average decreased to 0.5 points (range, 0-2 points). ...
Article
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Objective: To evaluate the low energy extracorporeal shock waves therapy (ESWT) associated with physical therapy in the treatment of chronic muscle injuries classified as grades 2 and 3 in the lower limbs of amateur athletes. Methods: Eight athletes presenting with lower limb muscle injury for more than three weeks were treated with physiotherapy and ESWT. We evaluated the following parameters during treatment: palpable gap, muscle strength, pain, and Tegner score, as well as ultrasound image features and the ability to return to sports practice. Results: The average time of the first evaluation of the injury was 8.75 weeks. All patients presented muscle strength grade V after eight weeks. The pain score evolved from 5.75 to 0.5 points of the visual analogue scale (VAS), at the end of the treatment. The Tegner score after treatment was six points on average. Patients returned to sports practice after 8.14 weeks. Conclusion: ESWT associated with physical therapy proved to be effective to treat long-term muscle injury, with good performance and the ability to return to sport practice for all patients. Level of Evidence IV, Case Series, Prospective Study.
... Quadriceps injuries are frequent in sports that involve repetitive kicking and sprinting such as football in its different forms [1][2][3]. Within the quadriceps muscle group, the rectus femoris is the most commonly injured muscle [8,13]. ...
Article
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Purpose To report the results of suture anchor repair of proximal rectus femoris avulsions in elite football players. Methods Four professional football players (first-team regulars of European first division football clubs) underwent suture anchor repair of complete proximal rectus femoris avulsions with significant tendon retraction. The following parameters were analysed: demographic data, mechanism of injury, type of injury, classification according to the Munich consensus statement, time between injury and surgery, time between surgery and full participation in training and availability for match and/or competition selection (return to play/RTP), and time between surgery and the comeback to the first official league match (return to competition/RTC). Radiographic evaluation was performed by magnetic resonance imaging (MRI) obtained pre-operatively and at 6 and 12 weeks post-operatively. All players were followed for at least 24 months after return to play to exclude recurrence. Results Mean age at surgery was 30 ± 2 years. All injuries occurred while kicking a ball, with the dominant leg affected in all patients. The injury was considered acute in three cases and chronic in one case. According to the Munich classification, all injures were type 4. Mean time to surgery was 60 ± 88 days (range, 8–191), mean time to RTP was 111 ± 15 days (range, 100–134), and mean time to RTC was 140 ± 23 days (range, 114–166). Follow-up MRIs demonstrated anatomically reinserted tendons with decreasing signal intensity over time in all cases. After a mean follow-up of 35 ± 6 months, all players were still competing at the same level as before the injury without re-injury. Conclusion Suture anchor repair of proximal rectus femoris avulsions allows unrestricted return to play in professional elite football players. Return to play can be expected at approximately 16 weeks post-operatively. Level of evidence Case series, IV.
... 9,31,68 Muscletendon injuries of the lower extremity are common in National Football League (NFL) kickers. 9 Eleven proximal rectus femoris avulsions were reported in a study of the NFL Injury Surveillance System. 25 Frequently, rectus femoris avulsions in adults or apophyseal avulsions in skeletally immature patients are associated with clinical findings suspicious for underlying FAI. ...
Article
In active individuals with femoroacetabular impingement (FAI), the resultant reduction in functional range of motion leads to high impaction loads at terminal ranges. These increased forces result in compensatory effects on bony and soft tissue structures within the hip joint and hemipelvis. An algorithm is useful in evaluating athletes with pre-arthritic, mechanical hip pain and associated compensatory disorders. A literature search was performed by a review of PubMed articles published from 1976 to 2013. Level 4. Increased stresses across the bony hemipelvis result when athletes with FAI attempt to achieve supraphysiologic, terminal ranges of motion (ROM) through the hip joint required for athletic competition. This can manifest as pain within the pubic joint (osteitis pubis), sacroiliac joint, and lumbosacral spine. Subclinical posterior hip instability may result when attempts to increase hip flexion and internal rotation are not compensated for by increased motion through the hemipelvis. Prominence of the anterior inferior iliac spine (AIIS) at the level of the acetabular rim can result in impingement of the anterior hip joint capsule or iliocapsularis muscle origin against the femoral head-neck junction, resulting in a distinct form of mechanical hip impingement (AIIS subspine impingement). Iliopsoas impingement (IPI) has also been described as an etiology for anterior hip pain. IPI results in a typical 3-o'clock labral tear as well as an inflamed capsule in close proximity to the overlying iliopsoas tendon. Injury in athletic pubalgia occurs during high-energy twisting activities in which abnormal hip ROM and resultant pelvic motion lead to shearing across the pubic symphysis. Failure to recognize and address concomitant compensatory injury patterns associated with intra-articular hip pathology can result in significant disability and persistent symptoms in athletes with pre-arthritic, mechanical hip pain. B.
Article
Purpose: American football is considered one of the more injury-prone sports given its high-speed and high-impact nature. While much attention has been focused on chronic traumatic encephalopathy, spinal injuries represent the most common catastrophic injury incurred in football. The goal of this investigation is to describe the most common football-associated spinal lesions in a multi-center health system. Methods: This is a retrospective analysis of patients with imaging evidence of spinal injuries related to American football during a 10-year period. Injuries were classified based on the anatomic level, type injury, spinal cord compromise, and therapeutic management. Chi-squared and Fisher's exact test were used for statistical analysis of categorial variables, and simple logistic regression was used to determine individual odds ratios. Results: A total of 71 patients were included, with a median age of 17 (IQR, 15-22) years. The cervical spine was the most frequently affected segment (46%), followed by lumbar spine injuries (45%), and thoracic spine injuries (10%). Discogenic injuries were identified in 45 patients (63%). Spinal cord injury was documented in 7 subjects (10%), while cauda equina compression was reported in 1 patient (1%). Conclusions: Acute spinal injuries continue to represent a significant cause of morbidity among American football players. Compared to national statistics, we found a similar distribution of spinal injuries in terms of anatomic location and an alarmingly high proportion of SCI. This investigation represents the largest single-center study addressing spinal injuries among football players.
Article
Introduction: Rectus femoris injuries are common in sports requiring sprinting and kicking, especially in football. In addition to sports injuries, rectus femoris injuries can occur during physically active daily living and physical work. Most muscle injuries heal well by conservative treatment, but more severe ruptures often require surgical treatment, especially in athletes. Some ruptures can cause so severe functional loss of the muscle that it causes problems also in everyday life. Complete rectus femoris mid-substance rupture is a rare injury type, which tends to recover poorly and cause significant functional deficit. Descriptions of this injury type are mainly lacking in the literature and there is no consensus on the management of these injuries. To the best of our knowledge, this is the first report of this kind in the literature including strength measurements pre- and post-operatively. Case report: We report a case of a 48-year-old Caucasian man who suffered a complete rectus femoris mid-substance rupture at physically active work. The injury mechanism was slipping on an asphalt ramp, leading to rapid eccentric contraction of rectus femoris involving knee flexion and hip extension. The rupture was treated surgically and the muscle strength of quadriceps femoris was measured pre- and postoperatively. Conclusion: This case report showed that muscle strength in knee extension recovers well after an operative treatment of complete rectus femoris mid-substance rupture. Therefore, it can be concluded that operative treatment is beneficial for this specific injury type. This case report brings important and objective evidence on the relevance of surgical treatment in these injuries that are mainly lacking the consensus about the best treatment methods. To the best of our knowledge, this case report is also the first one which indirectly shows the value of isolated rectus femoris muscle in the whole quadriceps muscle group.
Article
»: Injuries to the proximal rectus femoris remain rare, occurring primarily in soccer and American football athletes during kicking and sprinting because of its unique biarthrodial nature. »: The appropriate diagnosis is dependent on careful physical examination and imaging interpretation. »: While no universal treatment algorithm has been adopted for high-level athletes, recent investigations support operative repair using suture anchors to restore strength and function in order to allow an effective return to competition while minimizing the risk of injury recurrence. »: Complications following surgical management include injury to the lateral femoral cutaneous nerve and hematoma formation, and there are reports of residual pain and weakness with chronic injuries that fail the initial nonoperative treatment. »: Current investigations examining outcomes following treatment remain limited, warranting additional studies that examine patient-reported results, return-to-play rates, and the role of orthobiologics and accelerated rehabilitation protocols following injury to further improve athlete health and safety.
Article
Objectives: We aimed to determine the prevalence of low back pain (LBP) in sport, and what risk factors were associated with LBP in athletes. Design: Systematic review with meta-analysis. Data sources: Literature searches from database inception to June 2019 in Medline, Embase, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Web of Science and Scopus, supplemented by grey literature searching. Eligibility criteria: Studies evaluating prevalence of LBP in adult athletes across all sports. Results: Eighty-six studies were included (30 732, range 20-5958, participants), of which 45 were of 'high' quality. Definitions of LBP varied widely, and in 17 studies, no definition was provided. High-quality studies were pooled and the mean point prevalence across six studies was 42%; range 18%-80% (95% CI 27% to 58%, I2=97%). Lifetime prevalence across 13 studies was 63%; range 36%-88% (95% CI 51% to 74%, I2=99%). Twelve-month LBP prevalence from 22 studies was 51%; range 12%-94% (95% CI 41% to 61%, I2=98%). Comparison across sports was limited by participant numbers, study quality and methodologies, and varying LBP definitions. Risk factors for LBP included history of a previous episode with a pooled OR of 3.5; range 1.6-4.0 (95% CI 1.9 to 6.4). Statistically significant associations were reported for high training volume, periods of load increase and years of exposure to the sport. Conclusion: LBP in sport is common but estimates vary. Current evidence is insufficient to identify which sports are at highest risk. A previous episode of LBP, high training volume, periods of load increase and years of exposure are common risk factors.
Article
Objective To determine the muscle architecture adaptations in the vastus lateralis (VL) and vastus medialis (VM) after an eccentric training programme based on the Reverse Nordic Hamstring Exercise (RNHE) and after a subsequent detraining period. Subjects and methods The participants (N = 28) underwent a 12-week intervention, consisting of one week of assessment and familiarisation, followed by seven weeks of eccentric training and four weeks of detraining. The VL and VM muscle architecture features were assessed in resting conditions by means of 2D ultrasonography before (week 1) and after (week 8) the training period, as well as after the detraining period (week 12). Results Significant increases in the VL and VM muscle fascicle length (FL) (t = − 5.06, d = 1.43, P < 0.05 and t = − 11.14, d = 3.09, P < 0.001, respectively), muscle thickness (MT) (t = − 5.0, d = 1.39, P < 0.05 and t = − 6.17, d = 1.71, P < 0.05) and pennation angle (PA) (t = − 6.77, d = 1.88, P < 0.05 and t = − 4.48, d = 1.25, P < 0.05) were observed after the training period. Conclusion The FL, MT and PA showed a significant decrease after the detraining period. The results provide evidence that an eccentric training programme based on the RNHE may lead to changes in the VL and VM muscle architecture features, which are reversible after a four-week detraining period.
Article
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This statement summarises and appraises the evidence on diagnosis, prevention and treatment of the most common lower extremity muscle injuries in sport. We systematically searched electronic databases, and included studies based on the highest available evidence. Subsequently, we evaluated the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework, grading the quality of evidence from high to very low. Most clinical tests showed very low to low diagnostic effectiveness. For hamstring injury prevention, programmes that included the Nordic hamstring exercise resulted in a hamstring injury risk reduction when compared with usual care (medium to large effect size; moderate to high quality of evidence). For prevention of groin injuries, both the FIFA 11+programme and the Copenhagen adductor strengthening programme resulted in a groin injury risk reduction compared with usual care (medium effect size; low to moderate quality of evidence). For the treatment of hamstring injuries, lengthening hamstring exercises showed the fastest return to play with a lower reinjury rate compared with conventional hamstring exercises (large effect size; very low to low quality of evidence). Platelet-rich plasma had no effect on time to return-to-play and reinjury risk (trivial effect size; moderate quality of evidence) after a hamstring injury compared with placebo or rehabilitation. At this point, most outcomes for diagnosis, prevention and treatment were graded as very low to moderate quality of evidence, indicating that further high-quality research is likely to have an important impact on the confidence in the effect estimates.
Article
Introduction Severe sports-related injuries are a common affliction treated in Level I trauma departments. Detailed knowledge on injury characteristics from different medical settings is essential to improve the development of injury prevention strategies in different team sports. Methods Team sport injuries were retrospectively analysed in a Level I trauma department registry over 15 years. Injury and treatment data were compared with regard to competition and training exposure. Injury data such as “time of visitation”, “type of injury”, “multiple injured body regions” and “immediate hospitalisation” helped to define the severity level of each team sports injury. Results At the Level I trauma department, 11.361 sports-related injuries were seen over 15 years, of which 34.0 % were sustained during team sports. Soccer injuries were the most common injuries of all team sports (71.4 %). The lower extremity was the most affected body region overall, followed by the upper extremity. Head injuries were mainly seen in Ice hockey and American football and concussion additionally frequently in team handball. Slight injuries like sprains or contusions occurred most frequently in all team sports. In soccer and team handball, injuries sustained in competition were significantly more severe (p < 0.001) than those sustained in practice. Volleyball and basketball had a trend to higher rate of severe injuries sustained during practice sessions. Conclusion Depending on the specific injury profile of each team sports, injury prevention strategies should address competitive as well as training situations, which may need different strategies.
Chapter
Muscle injuries are very frequent in football. The primary goal of every rehabilitation is a safe RTP with a minimal risk of reinjury. The biology of tissue healing as a gradual process has to be respected during rehabilitation. Thus, different absence times are needed depending on injury type and the size of the tissue defect to restore the function and load-bearing capacity of the muscle. Exercises for neuromuscular function, core-strengthening and proprioception should be included into a rehabilitation programme.
Article
Kicking is a fundamental skill and a primary non-contact mechanism of injury in soccer, with injury incidence increasing during the latter stages of match-play. Ten male professional soccer players completed a 90min treadmill protocol based on the velocity profile of soccer match-play. Pre-exercise, and at 15 min intervals, players completed a maximal velocity kick subjected to kinematic analysis at 200 Hz. Pre-exercise, and at the end of each half, players also completed isokinetic concentric knee extensor repetitions at 180, 300 and 60 °·s-1. Kicking foot speed was maintained at ~19 m·s-1, with no main effect for exercise duration. In relation to proximal-distal sequencing during the kicking action, there was a significant increase in the duration (but not magnitude) of thigh rotation, with a compensatory decrease in the duration (but not magnitude) of shank rotation during the latter stages of the exercise protocol. In relation to long-axis rotation, pelvic orientation at ball contact was maintained at ~6˚, representing a total pelvic rotation in the order of ~15 ˚ during the kicking action. Peak knee extensor torque at all speeds was also maintained throughout the protocol, such that kinematic modifications are not attributable to a decline in knee extensor strength.
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Résumé Objectifs L’incidence des lésions musculaires est élevée dans les sports où la vitesse de mouvement, l’explosivité ou les changements brusques de direction sont déterminants. Cet article a pour objectifs d’analyser : (1) les facteurs de risque des principales lésions musculaires des membres inférieurs (ischiojambiers, quadriceps, adducteurs et triceps sural) ; (2) l’efficacité des principales stratégies préventives de ce type de blessures. Actualités Ces dernières années, un nombre significatif d’études prospectives a permis d’identifier plusieurs facteurs de risque de lésions musculaires. Parmi ceux-ci, un premier épisode lésionnel représente le seul facteur de risque intrinsèque retrouvé pour l’ensemble des quatre grands groupes musculaires. L’âge et la présence d’un déséquilibre musculaire interviennent plus spécifiquement dans la lésion des ischiojambiers ; la dominance dans la lésion du quadriceps ; un déséquilibre musculaire et un manque de souplesse dans la lésion des adducteurs, et enfin l’âge ainsi qu’un manque de souplesse dans la lésion du triceps sural. Les facteurs de risque extrinsèques apparaissent plus difficiles à associer à une localisation précise et sont principalement le type de sport pratiqué (sports collectifs et athlétisme notamment), un échauffement inadapté, une charge de travail mal répartie, ainsi que la pratique de l’activité en compétition. D’un point de vue préventif, il apparaît essentiel de favoriser la pratique régulière d’exercices de renforcement à haute intensité en mode excentrique et de corriger les éventuels déséquilibres musculaires. Perspectives et projets L’influence de certains facteurs de risque comme le manque de souplesse dans les lésions des ischiojambiers et du quadriceps, la fatigue ou encore le moment de la saison mériterait d’être approfondie. La réalisation d’étirements, largement répandue sur les terrains de sport, ne devrait pas être remise en cause mais l’évidence scientifique de l’efficacité préventive de toute lésion musculaire reste à démontrer, et des précisions concernant les modalités pratiques des étirements (durée, type d’étirement…) sont souhaitables. Des études ultérieures sont également nécessaires pour confirmer l’intérêt préventif, dans les lésions des ischiojambiers et du quadriceps, de la thérapie manuelle ou d’exercices de gainage. Conclusion Un premier épisode de blessure musculaire représente le principal facteur de risque de lésions musculaires aux membres inférieurs, et chaque groupe musculaire semble présenter des facteurs de risque spécifiques à leur localisation. Pour les quadriceps et surtout pour les ischiojambiers, l’incidence lésionnelle peut être réduite de manière conséquente grâce à l’implémentation de certaines mesures comme la réalisation régulière d’exercices à haute intensité en mode excentrique.
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The painful groin is a challenging entity. It is a common problem in sports with incidence 5–18 % and is most prevalent in sports which involve kicking and sprinting with rapid changes of direction. The adductor longus is the most common pathology causing long-standing problems. The complexity of groin anatomy, the similarity of symptoms for different pathologies that may or may not co-exist and the lack of consensus in terminology for the different groin entities may lead to a diagnostic dilemma with difficulty to recognise the precipitating disease, delays in diagnosis and treatment and potential career-ending for the athlete.
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American football has become one of the most popular sports in the United States. Despite the millions of players at all levels of competition who gain the physical, social, and psychological rewards that football provides, many interested stakeholders continue to ask, "Is football safe?" Although there are only approximately 1,700 players on National Football League (NFL) rosters, the injuries they sustain have garnered the most attention-and criticism-from the national media. Increased public awareness of the injury potential football possesses has led to an open debate and a major shift in public sentiment over the past 5 years. Although no sport is perfectly safe, the question is whether it can be made relatively safe and if the long-term consequences are worth the risk. This article reviews the methods by which one sports league-the NFL-has used advances in medical technology and injury surveillance to improve the health and safety of its players. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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Case: A sixteen-year-old professional soccer player presented with persistent pain in the right thigh of two years’ duration and the inability to return to play. Evaluation revealed a chronic rupture of the rectus femoris muscle. Because physiotherapy and rehabilitation failed to help, a surgical repair was performed. He returned to his previous activity level within nine months after surgery. Conclusion: Rupture of the proximal part of the rectus femoris should be acknowledged in the differential diagnosis, especially when presenting with persistent pain in the anterior aspect of the thigh lasting more than one year. Delayed repair might be recognized as a reasonable option for chronic rupture of the proximal part of the rectus femoris.
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Evaluating the painful hip in the absence of osteoarthritis requires a comprehensive and detailed understanding of the potential underlying abnormal joint mechanics that predispose the hip joint and the associated hemipelvis to asymmetric loads. These asymmetric loads and abnormal joint kinematics secondary to underlying abnormal bony morphology can result in labral and cartilage injury, musculotendinous injury, as well as resultant injury to the neural structures about the hemipelvis. Without having a clear understanding of how mechanical factors can result in such a wide range of compensatory injury patterns about the hip, appropriate diagnosis and treatment recommendations cannot be made. © 2013 Springer Science+Business Media New York. All rights are reserved.
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Background: Injury incidence rates are commonly reported using either a time-based denominator, such as injuries per 1000 player hours, or an event-based denominator, such as injuries per 1000 athletic exposures. Unless researchers give very detailed baseline information on their study population, it is not possible to convert between these units. We previously observed an apparent geographic split in reporting injury incidence rates between American and non-American researchers. Methods: We manually searched all issues of The American Journal of Sports Medicine and British Journal of Sports Medicine published between January 1, 2009 and December 31, 2013 for studies reporting injury risk or incidence during organized sporting events. For each article, the following information was recorded: journal, geographic location of the senior author, method of injury reporting (risk or incidence), incidence rate reporting method (time-based vs. event-based), sports studied, event types included (practice, game/match, or both), injury types reported. Results: A total of 109 articles that reported injury risk or rate were identified. Seventy-four articles reported injury incidence. Twenty-five of the 74 articles reporting injury incidence were written by American researchers, and 92% of these utilized an event-based denominator. Forty-five of the 49 (92%) articles reporting injury incidence written by non-American authors utilized a time-based denominator. Conclusions: Over the last five years, American researchers have chosen to report rates in terms of injuries per athletic exposure, while non-American researchers have preferred time-based rate reporting. Standardization of reporting measures would facilitate cross-sport comparisons of injury rates and metaanalyses of existing studies.
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MRI is the “gold standard” for the assessment of muscle injuries. This chapter includes a discussion of the structure of muscle and the muscle–tendon junction, the use of MRI and ultrasound for the assessment of muscle injury and the current grading systems for both modalities. Muscle injuries include: muscle strain/tear, muscle contusion, delayed onset muscle soreness, compartment syndrome and muscle hernias. Complications of muscle injuries include: myositis ossificans and calcific myonecrosis. Sports specific injuries to rectus abdominis, the flexor-pronator muscle group, hamstrings (acute and recurrent injuries) and rectus femoris and side strain have also been addressed.
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Groin injuries are a major challenge in sports medicine. Groin injuries occur in various anatomical structures. The typical groin injury involves one or more muscle-tendinous structures in the groin region, usually involving the adductors, the iliopsoas, or the abdominals. Differences in injury patterns between sports and in clinical definitions and examination techniques may explain some of the variance seen across studies. Some consistency, however, does seem to emerge especially in soccer where groin injuries have been prospectively and systematically registered and investigated during the last three decades. Diagnostic imaging seems to provide some information concerning specific injuries of the musculoskeletal structures around the pubic symphysis; however, the significance of these findings is still unknown with a large proportion of these findings also being present in asymptomatic athletes. Future epidemiological studies of sports other than men’s football and ice hockey are needed to understand how big the problem is outside these sports including important subgroups such as female and adolescent athletes.
Article
Chronic adductor enthesopathy is a well-known cause of groin pain in athletes. Currently, percutaneous nonselective adductor tenotomies give mixed results and not always predictable outcomes. A selective partial adductor longus release as treatment for recalcitrant chronic adductor longus enthesopathy provides excellent pain relief with a prompt and consistent return to preinjury levels of sport. Case series; Level of evidence, 4. All athletes were assessed in a standard way for adductor dysfunction. They received radiographs and a specifically designed magnetic resonance imaging groin study protocol. Only professional athletes who received a selective partial adductor release were included. Pain and functional improvement were assessed with the visual analog scale (VAS) pain score and time to return to sport. Forty-three professional athletes (39 soccer and 4 rugby) with chronic adductor-related groin pain were treated with a selective partial adductor release. The average follow-up time was 40.2 months (range, 25-72 months). Forty-two of 43 athletes returned to their preinjury level of sport after an average of 9.21 weeks (range, 4-24 weeks; SD, 4.68 weeks). The preoperative VAS score improved significantly (Wilcoxon signed-rank test, P < .001) from 5.76 ± 1.08 (range, 3-8) to 0.23 ± 0.61 (range, 0-3) postoperatively. A selective partial adductor longus release provides excellent pain relief for chronic adductor enthesopathy in professional athletes with a consistent high rate of return to the preinjury level of sport.
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Objective To provide a clear terminology and classification of muscle injuries in order to facilitate effective communication among medical practitioners and development of systematic treatment strategies. Methods Thirty native English-speaking scientists and team doctors of national and first division professional sports teams were asked to complete a questionnaire on muscle injuries to evaluate the currently used terminology of athletic muscle injury. In addition, a consensus meeting of international sports medicine experts was established to develop practical and scientific definitions of muscle injuries as well as a new and comprehensive classification system. Results The response rate of the survey was 63%. The responses confirmed the marked variability in the use of the terminology relating to muscle injury, with the most obvious inconsistencies for the term strain. In the consensus meeting, practical and systematic terms were defined and established. In addition, a new comprehensive classification system was developed, which differentiates between four types: functional muscle disorders (type 1: overexertion-related and type 2: neuromuscular muscle disorders) describing disorders without macroscopic evidence of fibre tear and structural muscle injuries (type 3: partial tears and type 4: (sub)total tears/tendinous avulsions) with macroscopic evidence of fibre tear, that is, structural damage. Subclassifications are presented for each type. Conclusions A consistent English terminology as well as a comprehensive classification system for athletic muscle injuries which is proven in the daily practice are presented. This will help to improve clarity of communication for diagnostic and therapeutic purposes and can serve as the basis for future comparative studies to address the continued lack of systematic information on muscle injuries in the literature. What are the new things Consensus definitions of the terminology which is used in the field of muscle injuries as well as a new comprehensive classification system which clearly defines types of athletic muscle injuries. Level of evidence Expert opinion, Level V.
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Quadriceps muscle strains frequently occur in sports that require repetitive kicking and sprinting, and are common in football in its different forms around the world. This paper is a review of aetiology, mechanism of injury and the natural history of rectus femoris injury. Investigating the mechanism and risk factors for rectus femoris muscle injury aims to allow the development of a framework for future initiatives to prevent quadriceps injury in football players.
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Adductor strains are among the most common injuries in ice hockey. Hip adductor weakness has been identified as a strong risk factor. An intervention program including muscle strengthening can reduce the incidence of adductor strains in professional ice hockey players. Prospective risk factor prevention study. Thirty-three of 58 players from the same National Hockey League team were identified as "at risk" on the basis of preseason hip adductor strength and participated in an intervention program. The program consisted of 6 weeks of exercises aimed at functional strengthening of the adductor muscles. Injury and individual exposure data were recorded for all players. There were 3 adductor strains in the 2 seasons subsequent to the intervention, compared with 11 in the previous 2 seasons (0.71 versus 3.2 per 1000 player-game exposures). All adductor strains were first-degree strains and occurred during games. A therapeutic intervention of strengthening the adductor muscle group appears to be an effective method for preventing adductor strains in professional ice hockey players.
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Muscular tightness is frequently postulated as an intrinsic risk factor for the development of a muscle injury. However, very little prospective data exist to prove this. Increased muscle tightness identifies a soccer player at risk for a subsequent musculoskeletal lesion. Prospective cohort study. We examined 146 male professional soccer players before the 1999-2000 Belgian soccer competition. None of the players had a history of muscle injury in the lower extremities in the previous 2 years. The flexibility of the hamstring, quadriceps, adductor, and calf muscles of these players was measured goniometrically before the start of the season. All of the examined players were monitored throughout the season to register subsequent injuries. Players with a hamstring (N = 31) or quadriceps (N = 13) muscle injury were found to have significantly lower flexibility in these muscles before their injury compared with the uninjured group. No significant differences in muscle flexibility were found between players who sustained an adductor muscle injury (N = 13) or a calf muscle injury (N = 10) and the uninjured group. These results indicate that soccer players with an increased tightness of the hamstring or quadriceps muscles have a statistically higher risk for a subsequent musculoskeletal lesion. Preseason hamstring and quadriceps muscle flexibility testing can identify male soccer players at risk of developing hamstring and quadriceps muscle injuries.
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A 6-year study was performed to determine the circumstances, causes, and outcomes of concussions in the National Football League. Between 1996 and 2001, the epidemiological features of concussions were recorded by National Football League teams with a standardized reporting form. Symptoms were reported and grouped as general symptoms, cranial nerve symptoms, memory or cognitive problems, somatic complaints, and loss of consciousness. The medical actions taken were recorded. In total, 787 game-related cases were reported, with information on the players involved, type of helmet impact, symptoms, medical actions, and days lost. Concussion risks were calculated according to player game positions. There were 0.41 concussions per National Football League game. The relative risk was highest for quarterbacks (1.62 concussions/100 game-positions), followed by wide receivers (1.23 concussions/100 game-positions), tight ends (0.94 concussion/100 game-positions), and defensive secondaries (0.93 concussion/100 game-positions). The majority of concussions (67.7%) involved impact by another player's helmet. The remainder involved impact by other body regions of the striking player (20.9%) or ground contact (11.4%). The three most common symptoms of mild traumatic brain injury were headaches (55.0%), dizziness (41.8%), and blurred vision (16.3%). The most common signs noted in physical examinations were problems with immediate recall (25.5%), retrograde amnesia (18.0%), and information-processing problems (17.5%). In 58 of the reported cases (9.3%), the players lost consciousness; 19 players (2.4%) were hospitalized. A total of 92% of concussed players returned to practice in less than 7 days, but that value decreased to 69% with unconsciousness. The professional football players most vulnerable to concussions are quarterbacks, wide receivers, and defensive secondaries. Concussions involved 2.74 symptoms/injury, and players were generally removed from the game. More than one-half of the players returned to play within 1 day, and symptoms resolved in a short time in the vast majority of cases.
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To assess in a single team of Australian Rules football players the effect of a specific intervention program on the incidence and consequence of hamstring muscle strain injuries. A prospective study was performed with a single team being followed for four playing seasons for hamstring injury. Magnetic resonance imaging was used to confirm the diagnosis of hamstring muscle injury. After two playing seasons an intervention program was implemented with the number of athletes with hamstring injury, competition days missed, and incidence of hamstring match injuries per 1000 h of playing time being compared pre- and post-intervention. The intervention program involved stretching whilst fatigued, sport specific training drills, and an emphasis on increasing the amount of high intensity anaerobic interval training. In the seasons prior to the intervention, nine and 11 athletes sustained hamstring injury compared to two and four following intervention. Competition days missed reduced from 31 and 38 to 5 and 16 following intervention and match incidence decreased from 4.7 to 1.3 per 1000 h of playing time. A beneficial effect was demonstrated with a smaller number of players having hamstring injuries (p = 0.05), a lower number of competition games missed being recorded (p < 0.001), and a decrease in hamstring strain incidence per 1000 h of playing time (p = 0.01) following the intervention program. Increasing the amount of anaerobic interval training, stretching whilst the muscle is fatigued, and implementing sport specific training drills resulted in a significant reduction in the number and consequences of hamstring muscle strain injuries.
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No previous study on adult football involving several different countries has investigated the incidence and pattern of injuries at the highest club competitive level. To investigate the risk exposure, risk of injury, and injury pattern of footballers involved in UEFA Champions League and international matches during a full football season. Eleven top clubs (266 players) in five European countries were followed prospectively throughout the season of 2001-2002. Time-lost injuries and individual exposure times were recorded during all club and national team training sessions and matches. A total of 658 injuries were recorded. The mean (SD) injury incidence was 9.4 (3.2) injuries per 1000 hours (30.5 (11.0) injuries per 1000 match hours and 5.8 (2.1) injuries per 1000 training hours). The risk of match injury was significantly higher in the English and Dutch teams than in the teams from France, Italy, and Spain (41.8 (3.3) v 24.0 (7.9) injuries per 1000 hours; p = 0.008). Major injuries (absence > 4 weeks) constituted 15% of all injuries, and the risk of major injury was also significantly higher among the English and Dutch teams (p = 0.04). National team players had a higher match exposure, with a tendency towards a lower training injury incidence than the rest of the players (p = 0.051). Thigh strain was the most common injury (16%), with posterior strains being significantly more common than anterior ones (67 v 36; p < 0.0001). The risk of injury in European professional football is high. The most common injury is the thigh strain typically involving the hamstrings. The results suggest that regional differences may influence injury epidemiology and traumatology, but the factors involved are unclear. National team players have a higher match exposure, but no higher risk of injury than other top level players.
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Very little information is available regarding the incidence, causative mechanisms, and expected duration of time lost following upper extremity injuries in professional American football players. (1) Upper extremity injuries in professional American football players are a common cause of missed time from practice and game participation. (2) The effect of upper extremity injuries differs as a function of the site involved and the athlete's position. Descriptive epidemiologic study. A retrospective review of all documented injuries to the elbow, forearm, and wrist sustained by all players in the National Football League over a 10-year period (1996-2005) was performed using the League's injury surveillance database. An injury was considered significant if it resulted in premature cessation of (or absence from) at least 1 practice, game, or training event. The data were analyzed from multiple perspectives, with emphasis on the type of injury, athlete position, and activity at the time of injury. There were 859 total injuries over the 10-year period: 58% involved the elbow, 30% involved the wrist, and 12% involved the forearm. Ligamentous injuries were the most common diagnosis in the elbow and wrist, with wrist sprains the most common of all diagnoses. Fractures were the most common injury occurring in the forearm. For all 3 anatomic locations, game injuries were much more common than practice injuries by a factor of 2.8 to 1. Forearm injuries led to a mean of 42 days lost, wrist injuries led to a mean of 27 days lost, and elbow injuries led to an average of 22 days lost. Fractures and dislocations led to the greatest amount of time lost (47 days and 53 days, respectively). Tackling was the activity most often (24%) implicated as causing injuries to the elbow, forearm, and wrist. Offensive and defensive linemen were most commonly injured. Elbow injuries were the most common at these positions, constituting approximately 75% of all injuries. Defensive backs sustained the greatest number of forearm injuries, approximately double the total number at any other position. Upper extremity trauma is a significant issue for professional football players. In particular, the high incidence rates of elbow injuries in linemen and forearm injuries in defensive backs warrant further scrutiny.
Article
Background The injury risk in football is high, but little is known about causes of injury. Purpose To identify risk factors for football injuries using a multivariate model. Study Design Prospective cohort study. Methods Participants were 306 male football players from the two highest divisions in Iceland. Before the 1999 football season started, the following factors were examined: height, weight, body composition, flexibility, leg extension power, jump height, peak O2 uptake, joint stability, and history of previous injury. Injuries and player exposure were recorded throughout the competitive season. Results Older players were at higher risk of injury in general (odds ratio [OR] = 1.1 per year, P = 0.05). For hamstring strains, the significant risk factors were age (OR = 1.4 [1 year], P < 0.001) and previous hamstring strains (OR = 11.6, P < 0.001). For groin strains, the predictor risk factors were previous groin strains (OR = 7.3, P = 0.001) and decreased range of motion in hip abduction (OR = 0.9 [1°], P = 0.05). Previous injury was also identified as a risk factor for knee (OR = 4.6) and ankle sprains (OR = 5.3). Conclusions Age and previous injury were identified as the main risk factors for injury among elite football players from Iceland.
Article
A 24-year-old NCAA Division I collegiate football placekicker presented in the clinic 4 months postseason complaining he had begun to experience pain and stiffness in his knee with subsequent loss of power and distance with his kicks toward the latter part of the previous season. He was placed on a rehabilitation program which included utilizing end-range isotonics for the quadriceps, short-arc isokinetics at intermediate speeds, and full range isokinetics at high contractile speeds for knee extension and flexion, lower extremity stretching, electrical stimulation to the quadricep musculature, and underwater kicking workouts along with placekicking and kickoff workouts. The patient was treated in the clinic 3 times per week for 8 weeks and upon discharge subjectively reported having regained distance and power with his kicks. Pre- and post-Cybex testing revealed an increase in peak torque at 60 and 180 degrees /sec of 14 and 15%, respectively, of the quadriceps in the affected kicking leg. This study details one form of intervention in patellofemoral syndrome associated with the specialized sport skill of placekicking.J Orthop Sports Phys Ther 1988:10(6):224-227.
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Aside from questions raised relating to safety, synthetic turfs offer certain advantages over natural turf. However, the results of the second year of a prospective study conducted at the high school level indicate that the type of playing surface influences the rate of injuries sustained. Of the three major field types studied, the astroturf fields had significantly higher injury rates than did grass or tartan turf. Grass had an intermediate number of injuries per game, and tartan turf had the lowest injury rate. Thus, the alteration of a single environmental variable (in this case the playing surface) had a significant impact on the frequency with which injuries were sustained.
Article
To investigate high school football injuries, we analyzed 1,877 injuries (661 game, 1,216 practice) treated from 1976 through 1979 at the Sports Medicine Clinic at the University of Alabama in Birmingham. The common injury types were sprain (32.2%), contusion (24.8%), strain (12.4%), fracture (11.0%), tear (3.8%), dislocation (2.1%), myositis ossificans (1.4%), tendinitis (1.3%), and concussion (1.0%). Position of the player injured was quarterback (8.7%), running back (19.6%), receiver (12.4%), offensive lineman (23.7%), defensive lineman (10.2%), defensive back (9.2%), and linebacker (9.0%). Body areas affected included head/neck (7.6%), shoulder (13.3%), upper arm (1.4%), elbow (3.4%), lower arm (2.0%), wrist (2.9%), hand/fingers (11.9%), chest/ribs (3.4%), back (4.9%), abdomen (0.7%), groin (0.7%), hip (2.4%), upper leg (4.6%), knee (22.2%), lower leg (4.0%), ankle (10.9%), and foot/toes (4.2%). These data are similar to those in previous reports, although subtle differences suggest variations in injury patterns due to rule changes and equipment modification.
Article
To define the causes of injuries to players in English professional football during competition and training. Lost time injuries to professional and youth players were prospectively recorded by physiotherapists at four English League clubs over the period 1994 to 1997. Data recorded included information related to the injury, date and place of occurrence, type of activity, and extrinsic Playing factors. In all, 67% of all injuries occurred during competition. The overall injury frequency rate (IFR) was 8.5 injuries/1000 hours, with the IFR during competitions (27.7) being significantly (p < 0.01) higher than that during training (3.5). The IFRs for youth players were found to increase over the second half of the season, whereas they decreased for professional players. There were no significant differences in IFRs for professional and youth players during training. There were significantly (p < 0.01) injuries in competition in the 15 minute periods at the end of each half. Strains (41%), sprains (20%), and contusions (20%) represented the major types of injury. The thigh (23%), the ankle (17%), knee (14%), and lower leg (13%) represented the major locations of injury, with significantly (p < 0.01) more injuries to the dominant body side. Reinjury counted for 22% of all injuries. Only 12% of all injuries were caused by a breach of the rules of football, although player to player contact was involved in 41% of all injuries. The overall level of injury to professional footballers has been showed to be around 1000 times higher times higher than for industrial occupations generally regarded as high risk. The high level of muscle strains, in particular, indicates possible weakness in fitness training programmes and use of warming up and cooling down procedures by clubs and the need for benchmarking players' levels of fitness and performance. Increasing levels of injury to youth players as a season progresses emphasizes the importance of controlling the exposure of young players to high levels of competition.
Article
We performed a retrospective review to evaluate acute medial collateral ligament injuries of the elbow in professional football players from 1991 to 1996 (5 seasons). There were 5 acute medial collateral ligament injuries in 4 players (1 player with bilateral involvement). All injuries occurred with the hand planted on the playing surface while a valgus or hyperextension force was applied to the elbow. There were 2 centers, both involved with long-snapping situations, 1 running back, and 1 quarterback. All elbows had valgus instability on physical examination. Despite this instability, all players were able to function without operative reconstruction of the medial collateral ligament. No evidence of valgus instability was seen at the time of follow-up (average, 3.4 years). Next, we reviewed all acute elbow injuries in the National Football League from the same 5-season period. Ninety-one acute elbow injuries were reviewed. Overall, there were 70 (76.9%) elbow sprains, 16 (17.6%) dislocation/subluxation patterns, 4 (4.4%) fractures, and 1 (1.1%) miscellaneous injury. Review of the acute elbow sprains revealed 39 (55.7%) hyperextension injuries, 14 (20%) medial collateral ligament injuries, 2 (2.9%) lateral collateral ligament sprains, and 15 (21.4%) nonspecific sprains. The epidemiology of the 14 medial collateral ligament injuries was studied in more detail. The 2 most common mechanisms of injury were blocking at the line of scrimmage (50%) and the application of a valgus force with the hand planted on the playing surface (29%). There were 8 linemen, 4 receivers, 1 running back, and 1 quarterback. All injuries were managed with nonoperative treatment. The average time lost was 0.64 games (range, 0 to 4). We report 19 acute medial collateral ligament injuries of the elbow in elite football players, 2 of whom are considered overhead throwing athletes, who were able to function at a competitive level without surgical repair or reconstruction, in contrast to baseball players, in whom the mechanics and demands may differ.
Article
To undertake a prospective epidemiological study of the injuries sustained in English professional football over two competitive seasons. Player injuries were annotated by club medical staff at 91 professional football clubs. A specific injury audit questionnaire was used together with a weekly form that documented each club's current injury status. A total of 6,030 injuries were reported over the two seasons with an average of 1.3 injuries per player per season. The mean (SD) number of days absent for each injury was 24.2 (40.2), with 78% of the injuries leading to a minimum of one competitive match being missed. The injury incidence varied throughout the season, with training injuries peaking during July (p<0.05) and match injuries peaking during August (p<0.05). Competition injuries represented 63% of those reported, significantly (p<0.01) more of these injuries occurring towards the end of both halves. Strains (37%) and sprains (19%) were the major injury types, the lower extremity being the site of 87% of the injuries reported. Most injury mechanisms were classified as being non-contact (58%). Re-injuries accounted for 7% of all injuries, 66% of these being classified as either a strain or a sprain. The severity of re-injuries was greater than the initial injury (p<0.01). Professional football players are exposed to a high risk of injury and there is a need to investigate ways of reducing this risk. Areas that warrant attention include the training programmes implemented by clubs during various stages of the season, the factors contributing to the pattern of injuries during matches with respect to time, and the rehabilitation protocols employed by clubs.
Article
A retrospective case series analysis of 80 patients (44 males and 36 females) who presented with acute, unilateral, noncontact anterior cruciate ligament (ACL) tears was performed. The role of limb dominance as a possible etiologic factor in noncontact ACL tears was investigated and the gender-specific relationship was determined. Patients were questioned about the nature of their injury and asked to list their preferred upper and lower extremities for writing, throwing, and kicking-activities previously used to define upper and lower extremity dominance. The relationships between limb dominance, side of injury, and gender were assessed. Mean patient age was 27.8 years. The left knee was involved in 54% of patients and the right knee in 46%. Eighty-nine percent of the study group identified themselves as right-hand dominant for writing, 91% were right-hand dominant for throwing, and 89% were right-leg dominant for kicking. Overall, there was no significant correlation between the side of injury and dominant limb for writing (P=.84), throwing (P=.68), or kicking (P=.99). There also was no significant gender effect on the relationship between limb dominance and side of injury (P=.65). Limited numbers precluded an analysis of specific limb-dominant sports activities as potential risk factors. The results of this pilot study suggest limb dominance is not a significant etiologic factor for noncontact ACL tears.
Article
To review the epidemiology of anterior cruciate ligament (ACL) injuries in the National Football League (NFL) and current treatment trends within this population. Descriptive. Part 1 of this study reviews the data collected in the NFL Injury Surveillance System from 1986 to 1995 with respect to these injuries. Included in this review are the specifics surrounding these injuries such as exposure type (game versus practice), position, mechanism, and playing surface on which the injury occurred. Part 2 of this analysis focuses on present treatment performed on these high-level athletes through a survey that was sent to and completed by all 31 NFL team orthopaedic surgeons. The total number of ACL injuries in this select population has remained constant over the period analyzed. Current preferred treatment technique favors endoscopic patellar tendon autograft reconstruction.
Article
A paucity of literature exists on the subject of youth football with the majority of research concentrating on athletes of high-school age or older. Youth football participants include those athletes who compete in organised football prior to high school. Injury rate and severity for youth players is surprisingly low when compared with those competitors who have passed through puberty. As children mature they become bigger, faster and stronger, which is accompanied by an increased injury risk. Quarterbacks and running backs are injured almost five times more often than offensive linemen and linebackers. The knee is the most common site of injury followed by the ankle, wrist and hand. Fortunately, traumatic brain and cervical spine injuries are exceedingly rare. In this article, we review the youth football literature, identify the most common injuries by anatomical location, discuss the differential diagnoses and outline treatment options.
Article
In 1998, the National Collegiate Athletic Association legislated a decrease in the number of scrimmages and full-contact practices allowed during the spring season. A significantly increased risk of injury faced by the same player during the spring versus fall practice sessions does exist, but the National Collegiate Athletic Association regulations will not have the intended effect of reducing injury rates to equal or below those of the fall practice sessions. Retrospectively analyzed, descriptive study of prospectively collected injury surveillance data followed by a prospective, controlled, repeated-measures study after the rule change. Phase 1: the Big Ten Conference Sports Injury Surveillance System database was reviewed from spring 1992 through fall 1997 for all reportable injuries. Phase 2: a prospective investigation was instituted from spring 1998 through fall 2000. This protocol was modified to also document updated individual player position descriptions and string as well as exposures for the old fall and spring practice categories (scrimmages, full contact, and limited contact) and the new spring practice designations (full pads with and without tackling, helmets only, spring game, and other scrimmages). Phase 1: There were 3950 fall injuries and 1007 spring injuries, with 469 of the 1007 attributable to the "spring risk factor." There was a statistically significant increase in injury rate in the spring (19.8) versus fall (10.6). Scrimmages (incidence density ratio = 2.4) and limited-contact practices (incidence density ratio = 2.5) showed more than twice the fall injury rate. Phase 2: There were 1502 fall injuries and 648 spring injuries, with 192 attributable to the spring risk factor. There was a 3-fold increase in injury rate in the spring (incidence density ratio = 3.2). Although the noncontact, helmets-only practices produced the lowest injury rates, the nonspring game scrimmages and the limited-contact practices defined as "practice with pads but without tackling" displayed the highest injury rates. In both spring and fall, nonplayers exhibited the highest injury rates for all string groups. There was and still is a statistically significant increase in spring practice injury risk. The 1998 rule change resulted in an even greater increase in spring practice injury risk. If the goal is to minimize the number of spring practice injuries, it will be best accomplished by limiting the number of scrimmages and limited-contact sessions.
Article
The Danish and Swedish male top football divisions were studied prospectively from January to June 2001. Exposure to football and injury incidence, severity and distribution were compared between the countries. Swedish players had greater exposure to training (171 vs. 123 h per season, P<0.001), whereas exposure to matches did not differ between the countries. There was a higher risk for injury during training in Denmark than in Sweden (11.8 vs. 6.0 per 1000 h, P<0.01), whereas for match play there was no difference (28.2 vs. 26.2 per 1000 h). The risk for incurring a major injury (absence from football more than 4 weeks) was greater in Denmark (1.8 vs. 0.7 per 1000 h, P=0.002). The distribution of injuries according to type and location was similar in both countries. Of all injuries in Denmark and Sweden, overuse injury accounted for 39% and 38% (NS), and re-injury for 30% and 24% (P=0.032), respectively. The greater training exposure and the long pre-season period in Sweden may explain some of the reported differences.
Article
The purpose of this study was to study the risk for injury and injury pattern in Swedish male elite football and to compare two different injury definitions. A prospective cohort study was conducted during 2001 on all 14 teams (310 players) in the Swedish top division. Injuries and individual exposure were recorded. Injury was defined as time-lost injury (715 injuries) and for comparison as tissue injury (765 injuries). No significant difference in the risk for injury between tissue injuries and time-lost injuries was found during matches (27.2 vs. 25.9 injuries per 1000 match hours, P=0.66) or training sessions (5.7 vs. 5.2 injuries per 1000 training hours, P=0.65). The risk for injury during training was significantly higher during the pre-season compared with the competitive season (P=0.01). Thigh strain was the single most common injury (14%). Knee sprain was the most common major injury (absence >4 weeks). Overuse injuries and re-injuries were frequent and constituted 37% and 22% of all injuries. Re-injuries caused significantly longer absence than their corresponding initial injuries (P=0.02). The risk for re-injury (P=0.02) and overuse injury (P<0.01) was significantly higher during the pre-season compared with the competitive season.
Article
We present the first report of proximal rectus femoris avulsion injury in kickers and the outcome after nonoperative treatment. Since it is a rarely reported injury, more cases would be helpful to confirm our findings. However, based on our experience with 2 NFL kickers, we believe rapid recovery is possible without surgical intervention.
Article
The incidence of hamstring muscle injuries in professional rugby union is high, but evidence-based information on risk factors and injury-prevention strategies in this sport is limited. To define the incidence, severity, and risk factors associated with hamstring muscle injuries in professional rugby union and to determine whether the use of hamstring strengthening and stretching exercises reduces the incidence and severity of these injuries. Cohort study (prevention); Level of evidence, 3. Team clinicians reported all hamstring muscle injuries on a weekly basis and provided details of the location, diagnosis, severity, and mechanism of each injury; loss of time from training and match play was used as the definition of an injury. Players' match and training exposures were recorded on a weekly basis. The incidence of hamstring muscle injuries was 0.27 per 1000 player training hours and 5.6 per 1000 player match hours. Injuries, on average, resulted in 17 days of lost time, with recurrent injuries (23%) significantly more severe (25 days lost) than new injuries (14 days lost). Second-row forwards sustained the fewest (2.4 injuries/1000 player hours) and the least severe (7 days lost) match injuries. Running activities accounted for 68% of hamstring muscle injuries, but injuries resulting from kicking were the most severe (36 days lost). Players undertaking Nordic hamstring exercises in addition to conventional stretching and strengthening exercises had lower incidences and severities of injury during training and competition. The Nordic hamstring strengthening exercise may reduce the incidence and severity of hamstring muscle injuries sustained during training and competition.
Article
The primary purpose of this study was to evaluate whether a preseason strength training programme for the hamstring muscle group - emphasising eccentric overloading - could affect the occurrence and severity of hamstring injuries during the subsequent competition season in elite male soccer players. Thirty players from two of the best premier-league division teams in Sweden were divided into two groups; one group received additional specific hamstring training, whereas the other did not. The extra training was performed 1-2 times a week for 10 weeks by using a special device aiming at specific eccentric overloading of the hamstrings. Isokinetic hamstring strength and maximal running speed were measured in both groups before and after the training period and all hamstring injuries were registered during the total observational period of 10 months. The results showed that the occurrence of hamstring strain injuries was clearly lower in the training group (3/15) than in the control group (10/15). In addition, there were significant increases in strength and speed in the training group. However, there were no obvious coupling between performance parameters and injury occurrence. These results indicate that addition of specific preseason strength training for the hamstrings - including eccentric overloading - would be beneficial for elite soccer players, both from an injury prevention and from performance enhancement point of view.
Article
The National Football League holds an annual combine where individual teams evaluate college football players likely to be drafted. As part of the combine, the players are evaluated with a medical history, physical exam, and review of imaging studies, and then they are rated medically as to their ability to participate in the NFL. The purpose of this study was to review the prevalence of musculoskeletal disorders in this population and to test the hypothesis that fewer players were medically disqualified over calendar time from 1987 to 2000. The available summary data for all players reviewed at the annual combine by the medical staff of one NFL team from 1987 to 2000 was analyzed, including each player's position, collegiate division, medical rating, and their diagnoses and surgical procedures. A total of 5047 complete records were available for analysis. The average number of diagnoses per player was 2.45, and the average number of procedures was 0.53. The most common diagnoses were ankle sprain, burner, hand/wrist soft-tissue injury, knee MCL injury, and AC-joint injury. The most common procedures were meniscectomy, knee arthroscopy, ACL reconstruction, shoulder stabilization, and ORIF ankle fracture. Overall, 5.63% of the players were rejected for medical reasons. The risk of failure dropped during the study period (P < 0.0002). Over time, fewer players with a history of ACL reconstruction received a failing grade (P = 0.0005). The percentage of athletes with a failing grade, particularly those with a history of ACL reconstruction, decreased over the study period. Knowing the trends in prevalence of injury and treatment for these athletes may help optimize their care and aid the development of injury-prevention and treatment strategies.
Article
The purpose of this study was to determine if lower-limb dominance is a potential etiologic factor in noncontact anterior cruciate ligament (ACL) tears. A multicenter retrospective case analysis was performed. In each of the participating centers, patients were questioned to confirm a noncontact ACL injury and to determine lower-limb dominance. Three hundred and two subjects (149 males and 153 females) who presented with unilateral noncontact ACL tears participated in the study. The relationships between limb dominance, side of injury, and gender were analyzed. There was no significant correlation between the side of injury and the dominant limb for kicking (p = 0.30). There was no significant gender effect of the relationship between side of injury and dominant limb (p = 0.36). When assessing gender types and side of ACL tears, females showed a strong trend toward tearing the left ACL more frequently than the right (p = 0.06). No such trend existed for males. The results of this study indicate that there is no significant relationship between lower-limb dominance and the likelihood of sustaining a noncontact ACL tear. However, the strong trend toward females tearing their left ACLs more often than their right ACLs warrants further investigation to determine what neuromuscular asymmetries may exist between the right and left lower limbs.
Article
Football, one of the most popular sports among male high school students in the United States, is a leading cause of sports-related injuries, with an injury rate almost twice that of basketball, the second most popular sport. Injury patterns will vary between competition and practice exposures and between levels of play (ie, high school vs. National Collegiate Athletic Association [NCAA]). Descriptive epidemiology study. Football-related injury data were collected over the 2005-2006 school year from 100 nationally representative high schools via High School RIO (Reporting Information Online) and from 55 Division I, II, and III colleges via the NCAA Injury Surveillance System. Nationally, an estimated 517,726 high school football-related injuries (1881 unweighted injuries) occurred during the 2005-2006 season. The rate of injury per 1000 athlete-exposures was greater during high school competitions (12.04) than during practices (2.56). The rate of injury per 1000 athlete-exposures was also greater during collegiate competitions (40.23) than during practices (5.77). While the overall rate of injury per 1000 athlete-exposures was greater in the NCAA (8.61) than in high school (4.36), high school football players sustained a greater proportion of fractures and concussions. Running plays were the leading cause of injury, with running backs and linebackers being the positions most commonly injured. Patterns of football injuries vary, especially by type of exposure and level of play. Future studies should continue to compare differences in injury patterns in high school and collegiate football, with particular emphasis placed on high-risk plays (running plays) and positions (running backs and linebackers).
Article
Football is one of the leading causes of athletic-related injuries. Injury rates and patterns of the training camp period of the National Football League are unknown. Injury rates will vary with time, and injury patterns will differ between training camp practices and preseason games. Descriptive epidemiology study. From 1998 to 2007, injury data were collected from 1 National Football League team during its training camp period. Injuries were recorded as a strain, sprain, concussion, contusion, fracture/dislocation, or other injury. The injury was further categorized by location on the body. Injury rates were determined based on the exposure of an athlete to a game or practice event. An athlete exposure was defined as 1 athlete participating in 1 practice or game. The injury rate was calculated as the ratio of injuries per 1000 athlete exposures. There were 72.8 (range, 58-109) injuries per year during training camp. Injuries were more common during weeks 1 and 2 than during weeks 3 to 5. The rate of injury was significantly higher during games (64.7/1000 athlete exposures) than practices (12.7/1000 athlete exposures, P < .01). The rate of season-ending injuries was also much higher in games (5.4/1000 athlete exposures) than practices (0.4/1000 athlete exposures). The most common injury during the training camp period was a knee sprain, followed by hamstring strains and contusions. Muscle strains are the most common injury type in practices. Contact type injuries are most common during pre-season games, and the number of significant injuries that occur during preseason games is high.
Article
The relationship between muscle injury and strength disorders remains a matter of controversy. Professional soccer players performed a preseason isokinetic testing aimed at determining whether (1) strength variables could be predictors of subsequent hamstring strain and (2) normalization of strength imbalances could reduce the incidence of hamstring injury. Cohort study (prognosis); Level of evidence, 1. A standardized concentric and eccentric isokinetic assessment was used to identify soccer players with strength imbalances. Subjects were classified among 4 subsets according to the imbalance management content. Recording subsequent hamstring injuries allowed us to define injury frequencies and relative risks between groups. Of 687 players isokinetically tested in preseason, a complete follow-up was obtained in 462 players, for whom 35 hamstring injuries were recorded. The rate of muscle injury was significantly increased in subjects with untreated strength imbalances in comparison with players showing no imbalance in preseason (relative risk = 4.66; 95% confidence interval: 2.01-10.8). The risk of injury remained significantly higher in players with strength imbalances who had subsequent compensating training but no final isokinetic control test than in players without imbalances (relative risk = 2.89; 95% confidence interval: 1.00-8.32). Conversely, normalizing the isokinetic parameters reduced the risk factor for injury to that observed in players without imbalances (relative risk = 1.43; 95% confidence interval: 0.44-4.71). The outcomes showed that isokinetic intervention gives rise to the preseason detection of strength imbalances, a factor that increases the risk of hamstring injury. Restoring a normal strength profile decreases the muscle injury incidence.
Article
Very little has been published regarding the incidence of and duration of time lost after hand injuries in professional American football players. (1) Hand, first ray, and finger injuries in professional American football players represent a common cause of missed time from practice and game participation. (2) The effect of upper extremity injuries differs as a function of the anatomic site involved, injury type, and athlete's position. Descriptive epidemiologic study. A retrospective review of all documented injuries to the hand, first ray, and fingers sustained by American football players in the National Football League over a 10-year period (1996-2005) was performed using the League's injury surveillance database. The data were analyzed from multiple perspectives, with emphasis on the type of injury, athlete position, and activity at the time of injury. A total of 1385 injuries occurred to the hand, first ray, and fingers over the 10 seasons studied. Of these injuries, 48% involved the fingers, 30% involved the first ray, and 22% involved the hand, with game injuries more common than practice injuries at each location. Metacarpal fractures and proximal interphalangeal joint dislocations were the 2 most common injuries. Offensive and defensive linemen were the most likely to sustain a hand injury; 80% of hand injuries were metacarpal fractures. The most common injuries to the first ray were fractures (48%) and sprains (36%), which occurred most often in athletes playing a defensive secondary position. Finger injuries were most commonly dislocations at the level of the proximal interphalangeal joint, typically involving the ulnar 2 digits. Finger injuries were most common in wide receivers and defensive secondary players. The act of tackling produced the most injuries (28%). Upper extremity trauma, especially injury to the hand, first ray, and fingers, is a significant source of morbidity for professional football players. The results of this study may be used to implement preventive measures to help minimize these injuries.
Article
The National Football League (NFL) holds an annual combine to evaluate college football athletes likely to be drafted for physical skills, to review their medical history, and to perform a physical examination. The athletes receive an orthopedic grade on their ability to participate in the NFL. The purpose of this study was to test the hypothesis that this orthopedic rating at the combine predicts the percent of athletes who play in the NFL and the length of their careers. A database for all athletes reviewed at the combine by the medical staff of one team from 1987 to 2000 was created and linked to a data set containing the number of seasons and the games played in the NFL for each athlete. Players were grouped by orthopedic grade: high, low, and orthopedic failure. The percent of players who played in the NFL and the mean length of their careers was calculated and compared for these groups. The orthopedic grade assigned at the NFL combine correlated with the probability of playing in the league. Whereas 58% of athletes with a high grade and 55% of athletes with a low grade played at least one game, only 36% of athletes given a failing grade did so (P < 0.001). Players with a high grade had a mean career of 41.5 games compared with 34.2 games for players with a low grade and 19.0 games for orthopedic failures. This is the first study to report on the predictive value of a grading system for college athletes before participation in professional sports. Other professional sports may benefit from using a similar grading system for the evaluation of potential players.
Article
The aims of this study were to determine Lipoprotein (a) [Lp(a)] concentrations in a sample of subjects from Maracaibo, Venezuela, and to determine the relationship of family risk factors for cardiovascular disease and their Lp(a) levels. Two hundred twenty-seven healthy individuals between 5 and 19 years of age of both genders and multiethnic origins were selected. A complete background clinical chart and laboratory test was conducted for each patient to discard cardiovascular diseases and confirm their healthy state. The Lp(a) concentration was determined using the double antibody enzyme-linked immunosorbent assay method. For inferential statistical analysis, one-factor analysis of variance tests and Student t test for independent observations were used according to each case, considered significant when P value was <0.05. No significant differences were observed when evaluating Lp(a) levels according to gender in all ages. Males showed no significant difference in Lp(a) levels between groups, but, in females, a significantly lower level (P < 0.03) in the group 5 to 9 years of age was found. When considering only age, significantly lower levels were observed (P < 0.03) in the 5- to 9-year-old group. When studying family risk factors of cardiovascular diseases, it was found that the group with family risk factors had a significantly higher Lp(a) concentration (P < 0.01) than those without family risk factors, observing that those who had four or more factors exhibited a significantly higher concentration than those with two to three risk factors (30.6 ± 4.5 mg/dL versus 18.5 ± 12.2 mg/dL, P < 0.009) and than those with one risk factor (30.6 ± 4.5 mg/dL versus 21.6 ± 1.4 mg/dL, P < 0.03). These results emphasize the clusters of family risk factors of cardiovascular disease with higher Lp(a) levels and also indicate that the evaluation of its concentration should be taken as an independent risk factor of atherosclerosis for the population in developmental ages.