Injury Prevention - Science topic

Dear Dr Ali Emadzadeh

Hello

Thank you very much

Best regards

HN

Performing a Generalized Estimating Equations (GEE) analysis in SPSS involves several steps. Here's a simplified guide:

1. Open Data and Select Variables:

- Open your dataset in SPSS.

- Select the variables you need for the GEE analysis, including the dependent variable (injuries) and any relevant independent variables.

2. Navigate to the GEE Procedure:

- Go to "Analyze" in the top menu.

- Choose "Generalized Estimating Equations."

3. Specify the Model:

- Move the dependent variable (injuries) to the "Dependent" box.

- Add the independent variables to the "Covariates" box.

4. Specify the Repeated Statement:

- Click on the "Repeated" button.

- Select the grouping variable (e.g., subjects, time) and the working correlation matrix (e.g., exchangeable, unstructured).

5. Specify Link Function and Distribution:

- Choose the link function (e.g., identity, logit) based on your data's characteristics.

- Select the distribution appropriate for your dependent variable (e.g., normal, binomial).

6. Specify Additional Options:

- Depending on your needs, you may want to adjust settings under the "Options" tab. This could include choosing estimation methods or specifying convergence criteria.

7. Run the Analysis:

- Click "OK" to run the GEE analysis.

8. Interpret Results:

- Examine output tables, including parameter estimates, standard errors, and significance levels.

- Pay attention to the coefficients and their confidence intervals.

Other point, your specific analysis might require adjustments based on your research questions and data characteristics. for further informations or collaboration contact me miloud.chakit@uit.ac.ma

Bijan Rajaeian

In general, high intensity of internal and external loads during training increases the risk of injury for athletes of all levels, ages, and sports. Internal loads refer to heart rates and hematological measures in the body while external load refers to loads experienced by an athlete's body during performances such as weight lifting and sprinting.

Having said that, this is true for an isolated training session. But during training, an athlete can gradually increase his/her load-bearing capacities and it has been proven to improve their injury prevention capabilities. Studies have found that an appropriately graded prescription of high training loads can actually improve a player's fitness and protect him/her against injury. I think this is because our musculoskeletal system adapts itself to the gradual load applied and achieves the ability to sustain higher loads during a sport.

If you are asking about the relationship between internal and external load for athletes, I found an article about that -

This relates heart rate-derived measures with accelerations and distance traveled in American football athletes. Hope this helps!

No, I am not. Sorry,

Dear Pegah Jamali , According to force-velocity curve muscle contraction, Muscles are capable of generating greater forces under eccentric conditions than under either isometric or concentric contractions. (1)

To understand how eccentric exercise produces more force and how it can help to prevent injuries, you should know the mechanism of that, which I have explained in my article

1- https://www.sciencedirect.com/topics/medicine-and-dentistry/eccentric-muscle-contraction

Dear Abdallah Rejeb, thank you for your interesting and Good question. Please meet my apologies for the late response. It was a crazy year... The most important element to answer your interest is that bio-banding is a tool to pay attention to connect knowledge about biological maturation and keeping training’s rules. Most coaches look only on this second part and as soon as possible want to gain results, do not carry about risks and Future of kids/youth competitors. Unfortunately, ignoring long term athlete development in so many different areas (psychological, social, performance, etc.) there is a wrong way and could destroy real talent (-s). And to create an athlete on a higher and higher level body, motor performance (fitness) and psyche, social relations, ..., need time. Step by step especially around growth spurt period keeping controlling, identifying and diversifying players according to the individual tempo of growth and maturation trainer should improve skills, techniques and also slowly increase loads. Such work should be prepared during training, as well as continue during special competition to observe reaction on training and grouping kids for more advanced in biological maturation (early maturing) and less advanced (late maturing). Biology supports motor development and thanks to it reduces risk of injuries. From our more than 4 years observation it works. More about it you will be able to find in Malina et al. (2004) Growth, maturation and Physical activity and other publications of our Team. Some other proofs are during preparation to publication and will be presented soon.

All Good and Good Luck!

:-)

Jan

Hello, yes, you have hit upon an interesting nuance as its knowledge being presented not simply as education but taking advantage, so it seems, of the efficacy building properties of a placebo and getting people (Maids) to re-evaluate their behaivor in a new and more favorable light. In your last line about your study I think it would be valuable to assess the things you think are responsible for a decrease in injury.

Hi Daniel!

Thank you for answering! unfortunately I don't have any publicated article in English yet, althought I have one in second revision in a journal, let's hope well! is there a possibility of getting in contact through e-mail?

Best regards

Silvia

You may find this article interesting:

Schuermans J, Van Tiggelen D, Witrouw E. Prone Hip Extension Muscle Recruitment is Associated with Hamstring Injury Risk in Amateur Soccer. Int J Sports Med. 2017 Sep;38(9):696-706

As you stated, my concern would also be the lack of carryover due to the differences in the motions and demands of the sports. In fact, it is perceivable that the resulting strength in a limited range of motion could increase the risk of injury when performing the larger-ROM tasks of soccer play, especially if there is adaptive shortening of the muscle-tendon unit.

An important clinical question and one that many people are starting to explore in quality of movement screenings. Below are several studies that have explored the topic of dorsiflexion's influence on lower extremity movement broadly during a variety of tasks. Hope these help.

We know about orthesis, but can you add link to example of this special compressive clothes? Yes, his brother is asparger like with EDS and mother is under diagnosis. Thank you, I do not know about influence of head trauma, this is very helpful information.

Hi,

There are much data supporting the use of the FIFA 11+ warm up program for the prevention of knee injuries in football (soccer). The overall reduction in injuries by 30--55% in males, females and children players is notable. Please see reference below:

Does the FIFA 11+ Injury Prevention Program Reduce the Incidence of ACL Injury in Male Soccer Players?

Silvers-Granelli HJ, Bizzini M, Arundale A, Mandelbaum BR, Snyder-Mackler L.

Clin Orthop Relat Res. 2017 Apr 7.

Yu could also do a FIFA 11 + search on Pubmed

The level of learning and motor skills develops at early age in rugby union as individual rugby athletes as young as U12 years .Expected variability occurs when players are coached on the Laws of the Game as written, namely Law 15 on the tackle and Law 20 on the scrum as already alluded to.. Unexpected variability occurs when chaotic moments evolve hence the potential for injury.

The Scandinavians have excellent population registers, so I would expect them to contain comprehensive accident data.   Also Taiwan insurance registers.

Saul,

I worked with a physical therapist and an osteopathic physician to investigate the change in stiffness following a muscle energy treatment (i.e. an osteopathic manual medicine treatment used for tissues and joints that are restricted in their motions).  We investigated the straight leg raising test before and after treatment and found a significant reduction in the "passive stiffness" in this motion.  The results are in "Quantification of the Passive Resistance to Motion in the Straight Leg Raising Test on Asymptomatic Subjects" (J. A. O. A., September 22, 1992).

From a personal perspective, I do not understand how increasing muscle tissue stiffness would contribute to injury -resistance.  Passive muscle stiffness reflects primarily health of the connective tissue surrounding muscle and possibly the neurological response of muscle.  In my view of passive motions, neither the connective tissue or neurological response should affect the passive response until reaching the end of the range of motion. Am I missing something in the logic of your research?

Agree with the view that going from injury severity to impact speed would be too reliable. Having done a lot of research review in this field in the past four years, I am not aware of any published work on this.

Determining delta-v from vehicle crush depth, skid marks and other crash dynamics evidence is a pretty standard crash reconstruction practice. There are publicly available US data sets of reconstructed crashes (+200,000 cases) held by National Highway Traffic Safety Administration (NHTSA). The data sets are called NASS/CDS and CIREN databases. Injury data is available there as well. Cases are weighted according to distribution of crash severities in the USA.

Delta-v can be used to theorise vehicle impact speeds, and the relationship to injury severity, although many limitations exist. We did this in a couple of recent papers among my uploaded publications.

Hi,

1) This was published in September last year and is based on a study assessing quality of life indicators before and after operating Wind turbines.

2) This is a recent publication wherein the distractive potential of noise is studied.

Hope this helps. I would be happy to check more studies since I am working on Childhood injuries.

All the best

Very interesting topic, and there are many angles to it. One is safety, of course. and I think the figure is in the range of 93% to 99% of accidents, attributed to human error.

I think it is likely that there will be a long period of manual assisted driving. But new options will begin to emerge. One example might be special highway lanes dedicated to autonomous driving, in which traffic will move much faster and more efficiently that manually driven traffic. People may opt for those lanes, for example, in long trips.

It turns out that because of human reaction times, the highest throughput of high speed roads is when cars travel at speeds around 65 km/h (40 mph). Sounds ridiculous, right? This is because at higher speeds, more distance has to be maintained between vehicles. So how much traffic a road can support peaks when traffic moves at around this speed. Autonomous driving would reduce that problem, as cars can tailgate each other at much higher speeds.

Another aspect is public transportation, without drivers, a more generalized version of something that exists today in many airports (autonomous shuttle trains between terminals). This can include door to door services like Uber, available on demand 24 hours a day, which make very efficient use of cars. Otherwise, cars sit idle well over 90% of the time.

I think the biggest hurdles are not technical at all, but instead, legal. Who is liable in case of accidents? That aside, the case for autonomous driving for safety reasons seems relatively easy, considering the fatalities and serious injuries involved in manual driving. In the US, annual fatalities of around 35,000!! That's incredibly bad. And never mind accidents without fatalities. That is one key motivation for autonomous driving.

BRSI link to weather and road safety research appears to have been fixed:

Now that was a tricky question. All my research into this indicates that self-reports of driver behaviour and accidents usually are very unreliable and biased in various ways. So, what can we actually use them for? Well, such data can tell us things about how the human mind works, and possibly also something about why drivers behave as they do in traffic.

For example, studies on forgetting of crashes indicate how poor our memories are. This is similar to memory studies in the lab, but in a real setting, and can therefore tell us things about how we remember important/aversive happenings in real life.

.But we could also possibly understand why drivers do not correct their own dangerous behaviour in traffic. The responses given in questionnaires, if compared to actual behaviour, may tell us something important about this. For example, if drivers selectively remember certain aspects of their driving, this may be what is important to them. This could be a way to educate drivers, showing them the discrepancy between their self-image and reality.

Now, this is all very much from the top of my head right now, but I must say that if we are to learn from self-reported driving behaviour and crashes, I think we need a new take on how to use this kind of data.

As for your specific question about predicting crashes from self-reported driving behaviour, I think there is very little we can learn there, apart from the need to be very cautious with this kind of data.

As for references on which I base these statements, they can be found on my Rg page.

Hi Marcelo,

I'm not sure of any college specific injury prevention techniques, but most clubs screen players for potential risk factors and try to prevent these from becoming an injury by targeted training. However, the usefulness of screening to prevent injuries is limited (read for example these papers: Why screening tests to predict injury do not work—and probably never will… a critical review, and Screening and likelihood ratio infographic). 

Therefore, a better way to prevent injuries is perhaps to monitor the training load and to make sure there are no spikes in the training load. For example, recent research has investigated the acute to chronic workload ratio for this purpose and found this ratio could best stay within 0.8-1.3 to reduce the likelihood of injuries (see: Has the athlete trained enough to return to play safely  The acute chronic workload ratio permits clinicians to …).

 Hope this helps!

Dear Kamarudin & Dear Syed Muhammad,

Thanking you for your recommendations. According to the rules of TPB questionnaire construction, we have to define the behavior of interest in terms of its target, action, context, and time elements. Defining the behavior in terms of time element is problematic. Because when you set the time e.g. for the past two weeks, the behavior of interest would be indeed, the reflection of past behavior, and when you want to measure the past behavior you will come up with the same question you set for the behavior.

Hi, Christian. In addition to what has been mentioned above, the following articles may be of assistance. Of particular interest is a recent systematic review which demonstrated that keeping it simple is best in terms of monitoring athletes' subjective reports in regards to loading/training response. 

I've also attached a link to a recent systematic review detailing the changes in different heart rate measures in response to training/loading. Hopefully these are of help!  

To add to this: in this report

the scientist involved have found that in the age group 20 - 60 years old, male drivers had 1.5 higher risk (accidents/km) of a fatal accident than female drivers. However, for the non-fatal accidents, the risk of the women is 26% higher to get injured and 16% higher to get involved in an accident than men. So, one may in fact assign males a more risky driving-style, but only after proper normalization. However, this analysis was performed for the US in 1990; different areas and different times may provide different numbers.

Dear Rojer,

I also have interest in this subject of study. In any case, it's a complex response, but I will try to show some points of view about this. There is a principle in the movement control namely "variability", which can to explain it. Specifically to athltletes, they have a efficient capacity to adaptation and they use also a greater set possibilities to perform a same movements. There is a standard (movement pattern) however they have a different capacity to perform a movement comparing for example to no-athlete.

The human movement concepts come from a set of processes and events occurring neuronal level, physiological and structural body of individuals, may also be a reflection of immeasurable influences arising from the physical environment, cultural and social environment in which the individual is inserted. These processes result from the interactions between the current state of each of these environments and the acquisition of new skills, resulting in relatively permanent changes in performance through practice or experience. These changes can be characterized as motor learning (MAGILL, 2000; Schmidt et al., 2001; Wulf et al., 2010).

One of the most important characteristics of human movement is the variability. This is important because it allows movement patterns are actually adapted to the environment, in order to perform the required tasks or endogenous variables (such as motivation, and fatigue), while the task goal remains unchanged (Bernstein, 1967; Davids et al., 2006). Several attempts to the same task allow lead to some movement patterns. Thus, some researchers consider motor variability not as a disturbance, but as a kind of central organization window for motor organization system that makes voluntary movements; however, when the subject reaches the autonomous stage of learning, which is able to perform the movements required in an automated manner and without giving much attention, may have therefore a pattern of movement with less variability.

I recommend the Massion's papers, Stapley or Bernstein. These authors work a lot with this subject and I'm sure that you will can clarify your ideas.

I hope this helps.

 Thanks Deborah. Looks really useful. I'll read the paper. Is the ontology open access?

Mark, Appreciate the offer. I'll keep it in mind. Thanks.

As you have said, "Is the goal to reduce the rate to zero?" In our "nanny state" mentality we have come to believe that we can control all risks and reduce the incidence of injury or death to zero. Unfortunately for those who believe this is possible the world they seek will never exist. Risk and Reward are just opposite sides of the same coin. There are vast quantities of incidence information for most sports, indeed the NCAA has been cataloguing this information for years, most of it can be accessed through the ACSM, NSCA, and NATA; the primary sources of peer-reviewed literature on these topics. With most of the research a statistic giving incidence of specifically defined injuries per number of exposures (practice or game) usually measured in 100 to 1000 hours of participation is determined.

It is possible to analyze contributory factors and their correlation to specifically defined injuries and attempt to provide interventions to reduce the risk of that factor contributing to a future injury. For example, in the 1980's and 1990's it was discovered that when males make a cut while running their knee stays largely in the sagittal plane, where females have a strong tendency for their knees to move first in the frontal plane (varus/valgus strain/stress) before moving in the sagittal plane. This "wobble" was proposed as an important factor in the higher percentage of "noncontact" ACL injuries in women athletes. It was also discovered that high school female athletes were both significantly weaker than their male counterparts in the quadriceps and hamstrings, and that the ratio of the quadriceps to the hamstrings was also significantly different among males and females. This information is irrefutable and provides specific interventions to help reduce the incidence of "noncontact" ACL injuries in women, but it is seldom mentioned in discussions of the topic because it suggests that their are underlying gender differences between males and females and that is not allowed in the Politically Correct Nanny State.

Steps can be taken to reduce the risk of injury. Individual athletes should be screened for musculoskeletal factors, not just cardiovascular factors. Previous injuries are one of the strongest predictors of future injuries, so a good injury history and adequate rehabilitation of previous injuries are primary factors that must be addressed. We have done research and intervention studies on this topic and have demonstrated a significant decrease in the incidence and severity of injuries through the use of a thorough musculoskeletal screening of high school athletes involved in American Football. Muscular strength, muscular endurance, and flexibility have all been shown to reduce certain types of injuries, but as you already know, the only way to reduce the risk and incidence to Zero is "DON'T PLAY."

In the 1990’s a vast quantity of research was done to determine ways to prevent ACL injuries and predictive measures that could be used to identify those in need of such interventions (primarily female athletes). ACL rehabilitation protocols, some evidence based, some developed through trial and error, were developed that included neuromuscular training with aspects being touted as preventative. It is interesting to note that much of the information discovered between 1990 and 2005 has been ignored as individuals within the medical and rehabilitation profession continue to seek new remedies because they didn’t learn from the past.

In ACL rehabilitation, it has been demonstrated that functional deficits that can be linked to “neuromuscular” dysfunction persist for years after those undergoing ACL reconstruction have been discharged. One of the most striking, and seemingly completely ignored because it doesn’t fit the current orthodoxy, is the persistence of quadriceps weakness in the involved limb. Currently the focus of many researchers who advocate “closed kinetic chain” rehabilitation over “open kinetic chain” rehabilitation interventions, is on the hip abductors because those athletes who experience “non-contact” ACL injuries have what these people see as weakness and lack of endurance of the hip abductors which causes the knee to be predisposed to knee to valgus stress when cutting, landing from a leap, etc.

Once again, in the 1990’s researchers investigating the cause for a greater incidence of “noncontact” ACL injuries in female athletes discovered that females tend to cut differently than males. As any coach can tell you, girls and boys run differently. These researchers discovered that girls tended to allow their knees to collapse into a position of high valgus deviation as they decelerated an the knee flexed in preparation for the cut, this then became a strong varus deviation as the knee extended and they accelerated in the new direction. The male subjects had very little varus or valgus deviations as they cut, it was decelerate as the knee flexed, accelerate as the knee extended; keeping all of the forces in the sagittal plane. Additionally, other researchers discovered that not only were female athletes significantly weaker than male athletes, even when the loads were normalized, the relationship was especially more pronounced in the hamstrings and quadriceps, and the quadriceps:hamstring ratio.

In 2003, Salem, Salinas, & Harding published a paper in the Archives of Physical Medicine and Rehabilitation, in addition to other presentations at scientific meetings that demonstrated that the body had different motor programs for extending the lower extremity in a “closed kinetic chain” situation. If limb dominance was ascertained by “which leg do you kick a ball with?” The body used a hip dominant strategy on the non-dominant, support limb; and a knee (quadriceps) dominant strategy on the dominant, kicking leg. ACL injuries and reconstruction resulted in the injured leg adopting a “hip dominant” strategy. This finding has been validated in countless studies over the past 12 years.

Also of significance, the strong bias toward “closed kinetic chain” exercise for ACL rehabilitation has probably compounded the problem. Research has failed to discover the “best” way to perform the squat exercise. The reason is because the “best” way to squat is completely dependent on the skeletal arrangement of the individual’s hips. In physical therapy it is understood that some people’s hips are in an anatomically determined position of anteversion, retroversion, or neutral. This causes the knees and feet to have positions that are congruent with the position of the hip or incongruent with the hip position. Persons who squat in their “anatomically correct” position perform better, with proper neuromuscular input to activate the various muscles through what amounts to primitive reflex motor programs, while those who squat in a manner that is not “anatomically correct” produce alterations in neuromuscular coordination resulting in the adoption of faulty motor programs for squatting. These faulty programs affect how the body performs all activities. Therefore, as one uses proprioceptive (balance training) in the rehabilitation process after the ACL injury, similar activities and progression models would be used preventatively.

The athlete must be examined to insure that they are properly aligned when performing squats, proprioceptive training must become part of the training program, open chain, isolation exercises for the quadriceps and hamstrings must be performed (this is the topic of another paper, if you are interested), and specific high level plyometric and agility drills must be used when the strength and motor control issues have been adequately accomplished. Attached to this answer you will find some other materials related to this answer.      

Hi!! ...here is another option:

SafetyLit: Injury Research and Prevention Literature Update

Regards,

Ruben.

Javier,

As some others have mentioned, the importance of balance training in younger adults may be primarily for those susceptible to falls and the subsequent injuries. I have not seen anything saying otherwise healthy people cannot also improve with training, but I have been involved with a study showing effectiveness of a balance training in amputees.

Gait & Posture. 11/2013; 38:S102. DOI: 10.1016/j.gaitpost.2013.07.208

Regards,

Jordan

I hope that you can find someone who can share this kind of specific information, because as you probably already know, most qualitative researchers do not include the content of their interview questions in their publications. I suspect, however, that you will have to do what almost everyone else in qualitative research has done: write your own questions and hope for the best.

As general resources on qualitative interviewing (including writing questions), I would recommend:

Spradley, The Ethnographic Interview.

Rubin & Rubin, Qualitative Interviewing: The Art of Hearing Data.

It will be hard to find what you want whithout soccer involved as well. Here are two studies who worked with basketball injuries. The first is about warm-up, as you wanted, and the second found that warm up is a important factor in ankle injurie in basketball player. Sorry for not been any more helpfull. 

Hi Dario, please see if this scaling method (script available for download) can be of any use when fitting data to Vasavada's model.

Regards,

Ricardo

I am not sure about research evidence, however the physiological mechanisms associated with a warm up should rationalise the use of a warm up prior to any exercise session or match event. 

I think it would be difficult to manage variables and find a direct causal relationship for a study on injury incidence.

When the shoulder labrum tears, what movement causes (and therefore aggravates) the tear? It seems that, with this knowledge, we can limit that movement and then strengthen the muscles that promote the opposite movement. Does this seem reasonable?

Yes-or maybe email her directly for the info.

The Football Matrix is a football specific movement screen. It is a battery of tests, which identifies movement impairment which are related to risk of injury, recurrence of injury and influence performance - for more detail see link

I go out every year at least once, or more.

I will still prefer to fly, despite these aircraft incidents. I think flying is less unsafe than driving on highways, more so in my country where the driving habits of most people are not acceptable. Some risk is involved in almost activities that we do.

Admittedly, humans are rational human beings. They sub-consciously take decisions on the basis of cost-benefit analysis. I will vote for flying than driving anywhere.

why do some nations have bigger risk of fatal occupational injuries?

1. Legislation/lack of enforcement: some countries do not have OHS law/regulations. If the legislation is not in place, there cannot be any enforcement. This means that people keep working in unsafe manner. Employers keep exposing their employees to hazards. Some countries do have the legislation but enforcement is weak. This is all about the government's commitment. You find this in most developing countries

2. Awareness on the part of the populace where majority of the general public know little or nothing health and safety at work. Knowledge is power.. People perish for lack of knowledge (Bible says that) . knowledge of cause and prevention. The government and various educational institutions have a role to play in this...

3. Exploitative employers: whereby employers cut corners or compromise safety standards (safety culture, just like the first commentator mentioned)

Ur question is asking for who is 'mostly responsible' . This implies that all the stakeholders on OHS are responsible. In my own opinion, it's really difficult to say who is mostly responsible for accidents in the workplace. As we know that there are various factors that cause accidents in the workplace. One can't really give a general answer. It depends on a case-by-case situation, the safety culture and OHS management system in place, and also the government of the country. As to this, I will say all the stakeholders (government, employers and employees) share responsibilities. It's left for each stakeholder to play his part proactively..