Video analysis of head impacts in top-level female football players: a cohort study

World Federation of Athletic Training and Therapy World Congress 2022 Peer-Reviewed Track Abstracts, May 5–7, 2022, Winnipeg, Manitoba, Canada

The objective was to examine the prevalence, incidence rate, and burden of health problems among top-level female football players in Finland. During the four-season follow-up, altogether 372 players (mean age 20.6 years) from 13 teams participated. Players reported all health problems (sudden-onset injuries, gradual-onset injuries and illnesses) weekly using a mobile application. Training exposure was collected at the team level from coaches and individual match exposure from the match statistics. Prevalence, incidence rate, and burden of injuries and illnesses were calculated. The average weekly response rate was 87%. The weekly prevalence of any health problem was 23.1% (95% CI 21.0–25.3%). Prevalence of health problems causing moderate or severe modifications in sports participation/performance (substantial health problems) was 15.8% (95% CI 14.2–17.7%). Altogether 783 injuries (5.5 injuries per 1000 hours) and 586 illnesses (1.7 cases per 365 player-days) were reported. Seventy percent of injuries were sudden-onset (3.7 per 1000 hours) and 30% gradual-onset injuries (1.6 per 1000 hours). The incidence rate of sudden-onset injuries per 1000 hours was 2.3 (1.9–2.7) in training and 15.3 (11.2–21.0) in match play. Sudden-onset injuries accounted for 54% of total time loss, gradual-onset injuries 17%, and illnesses 30%. Thigh (19%) and ankle (18%) injuries were most common. Knee injuries, particularly ACL injuries, were the most severe, with knee injuries causing 53% and ACL injuries 28% of all injury time loss. Sudden-onset injuries, occurring mainly in matches, posed the greatest health burden for female football players.

IntroductionRepetitive head impacts (RHI) in sports may represent a risk factor for long-term cognitive and neurological sequelae. Recent studies have identified an association between playing football at the top level...

BackgroundAntidepressant use has been associated with an increased risk of falling, but no studies have been conducted on whether antidepressant use is associated with an increased risk of head injuries which often result from falling among older persons. The objective of this study was to investigate the risk of head and brain injuries associated with antidepressant use among community-dwelling persons with Alzheimer’s disease.MethodsA matched cohort study was conducted by comparing new antidepressant users (n = 10,910) with two matched nonusers (n = 21,820) in the MEDALZ study cohort. The MEDALZ cohort includes all community-dwelling persons newly diagnosed with Alzheimer’s disease between 2005 and 2011 in Finland. Incident antidepressant users were identified based on register-based dispensing data from the Prescription register with a 1-year washout period for antidepressant use. Nonusers were matched with users based on age, gender, and time since Alzheimer’s disease diagnosis. The outcome events were defined as any head injuries and traumatic brain injuries based on diagnoses in Hospital Discharge and Causes of Death registers. Propensity score adjusted Cox proportional hazard models were utilized. Sensitivity analyses with case-crossover design were conducted. All registers are linkable with unique personal identification numbers assigned for each resident.ResultsAntidepressant use was associated with an increased risk of head injuries (age-adjusted event rate per 100 person-years 2.98 (95% confidence interval (CI) 2.49–3.06) during use and 2.43 (95% CI 2.06–2.35) during nonuse, adjusted hazard ratio (HR) 1.35, 95% CI 1.20–1.52) and traumatic brain injuries (age-adjusted event rate per 100 person-years 1.33 (95% CI 1.13–1.53) during use and 1.10 (95% CI 1.00–1.20) during nonuse, adjusted HR 1.26, 95% CI 1.06–1.50). The risk was highest during the first 30 days of use (HR 1.71, 95% CI 1.10–2.66 for head injuries; HR 2.06, 95% CI 1.12–3.82 for traumatic brain injuries) and remained at an elevated level for head injuries for over 2 years of use. In case-crossover analyses, antidepressant use was consistently associated with a higher risk of head injuries.ConclusionsAntidepressant use was associated with an increased risk of the most severe outcomes, head and brain injuries, in persons with Alzheimer’s disease. Antidepressant use should be carefully considered and the association confirmed in future studies.

To compare the prevalence of pre-eclampsia in migrant women with Norwegian women, and to study the prevalence of pre-eclampsia by length of residence in Norway. Observational study. The Medical Birth Registry of Norway. All Norwegian, Pakistani, Vietnamese, Somali, Sri Lankan, Filipino, Iraqi, Thai and Afghan women who gave birth after 20 weeks of gestation during the period 1986-2005 in Norway. The prevalence of pre-eclampsia was calculated by country of birth. The association of country of birth and length of residence in Norway with pre-eclampsia was estimated as the odds ratio (OR) with 95% confidence interval (CI), using Norwegian women as a reference. We made adjustments for maternal age, parity, multifetal pregnancy, year of delivery and maternal diabetes in multivariable analysis. Pre-eclampsia. Migrant women had a lower prevalence of pre-eclampsia than Norwegian women (2.7% versus 3.7%, P < 0.001). Vietnamese (OR, 0.36; CI, 0.29-0.45), Afghan (OR, 0.52; CI, 0.30-0.90) and Thai (OR, 0.57; CI, 0.45-0.73) women had the lowest risk of pre-eclampsia relative to Norwegian women. Adjustment for the variables above or separate analyses for nulliparous women did not change the estimates notably. Using Norwegian women as the reference, the risk of pre-eclampsia increased by length of residence for migrant women: adjusted OR of 0.64 (0.59-0.70) at <5 years and 0.91 (0.84-0.99) at ≥5 years of residence. The risk of pre-eclampsia was lower in migrants relative to Norwegian women, but increased by length of residence in Norway.

BackgroundBicycle‐related head injuries are a common reason for paediatric emergency department visits. Helmets have been designed to reduce head injuries, and helmet use has been encouraged through mandatory helmet legislation and nonlegislation helmet promotion activities.ObjectivesTo synthesize the evidence published in the Cochrane Database of Systematic Reviews regarding bicycle helmet use among children, including helmet effectiveness and methods to promote helmet use.MethodsThe Cochrane Database of Systematic Reviews was searched for all systematic reviews where ‘bicycle*’ or ‘helmet’ appeared in title, abstract or keywords. Reviews were included if they examined paediatric data concerning head injuries among helmeted and nonhelmeted cyclists, helmet use or adverse consequences of helmets. Data pertaining to adults were excluded. Relevant data were extracted, entered into tables and synthesized using qualitative and quantitative methods.Main resultsThree systematic reviews were identified and included 21 observational studies and 14 experimental studies. The methodological quality was assessed in only two of the reviews: the quality was similar in studies examining legislative interventions and several weaknesses were identified in the nonlegislative interventions. Among children, helmet use resulted in a 63% reduction in medically reported head injuries [adjusted odds ratio (OR): 0.37; 95% confidence interval (CI): 0.20, 0.66] and an 86% reduction in the odds of brain injuries (OR: 0.14; 95% CI: 0.05, 0.38). Enactment of mandatory helmet legislation for child cyclists reduced the odds of head injury hospitalizations by 45%, while the odds of head injury hospitalizations reduced by 27% among children in jurisdictions without legislation. There was a significant reduction in traumatic brain injury among children cycling after the passage of helmet legislation (OR: 0.82; 95% CI: 0.76, 0.89); however, there was no significant decrease in other head and facial injuries post‐legislation (OR: 1.08; 95% CI: 0.90, 1.23). Legislation also resulted in a significant increase in the number of children observed wearing a helmet (prevalence ratio: 3.69; 95% CI: 2.65, 5.14). Compared with children who received no intervention, those who received nonlegislative helmet promotion activities had a significant increase in observed helmet wearing (OR: 2.08; 95% CI: 1.29, 3.34), self‐reported helmet wearing (OR: 3.27; 95% CI: 1.56, 6.87) and self‐reported helmet ownership (OR: 2.67; 95% CI: 0.89, 8.03). No adverse events were associated with helmet use among cyclists.Authors' conclusionsBicycle helmets appear to be an effective way to reduce head injuries among children. Interventions to increase helmet use may be effective, particularly community‐based, school‐based, and those that provide free helmets; however, no effect of the interventions on helmet use were reported in randomized controlled trials. Finally, helmet legislation appears to be effective in increasing helmet use and reducing head injuries. Copyright © 2011 The Cochrane Collaboration. Published by John Wiley &amp; Sons, Ltd. The Cochrane Collaboration

Some of the highest rates of head injuries and concussion among all contact/collision sports are observed in soccer; yet, the multifactorial determinants of head injuries among players remain relatively undefined. PURPOSE: To examine sex-differences in the rate and the severity (lost days of participation, resultant concussions) of head injuries among collegiate soccer players between 2004 and 2009, while controlling for several covariables previously linked to injury occurrence. METHODS: Data from the National Collegiate Athletic Association Injury Surveillance System (NCAA-ISS) were used to calculate injury incidence density (ID) per 1000 athletic exposures (AE). The rate ratio (RR), along with the 95% Wald confidence interval (CI), compared ID among female, relative to male soccer players. Multivariable logistic regression and multivariable negative binomial regression modeling then tested the relation between sex and head injury incidence and severity while controlling for contact, setting, and competition level. RESULTS: Between 2004 and 2009, the sex-specific rate of soccer-related head injuries was 0.87 per 1000 AEs in women and 0.71 per 1000 AEs in men (RR = 1.23, 95% CI = [1.08, 1.41]). The rate of head injuries due to player-to-player contact was comparable between women and men (RR=0.95, 95% CI=[0.81, 1.11]); however, the rate of injury due to contact with apparatus was nearly 2 ½ -fold higher (RR=2.46, 95% CI = [1.76, 3.44]) and the rate due to contact with a playing surface was over two-fold higher (RR=2.29, 95% CI = [1.34, 3.91]) in women than in men. We also observed a significant joint effect between sex and contact in our regression models, with a particularly notable antagonistic interaction observed while modeling head injuries. CONCLUSION: Among female players, head contact with a ball, a goal post, or the playing surface may be especially deleterious compared with head contact with another player.

Studies focusing on minor head injury in intoxicated patients report disparate prevalences of intracranial injury. It is unclear if the typical factors associated with intracranial injury in published clinical decision rules for computerized tomography (CT) acquisition are helpful in differentiating patients with and without intracranial injuries, as intoxication may obscure particular features of intracranial injury such as headache and mimic other signs of head injury such as altered mental status. This study aimed to estimate the prevalence of intracranial injury following minor head injury (Glasgow Coma Scale [GCS] score ≥14) in intoxicated patients and to assess the performance of established clinical decision rules in this population. This was a prospective cohort study of consecutive intoxicated adults presenting to the emergency department (ED) following minor head injury. Historical and physical examination features included those from the Canadian CT Head Rule, National Emergency X-Radiography Utilization Study (NEXUS), and New Orleans Criteria. All patients underwent head CT. A total of 283 patients were enrolled, with a median age of 40 years (interquartile range [IQR] = 28 to 48 years) and median alcohol concentration of 195 mmol/L (IQR = 154 to 256 mmol/L). A total of 238 of 283 (84%) were male, and 225 (80%) had GCS scores of 15. Clinically important injuries (injuries requiring admission to the hospital or neurosurgical follow-up) were identified in 23 patients (8%; 95% confidence interval [CI] = 5% to 12%); one required neurosurgical intervention (0.4%, 95% CI = 0% to 2%). Loss of consciousness and headache were associated with clinically important intracranial injury on CT. The Canadian CT Head Rule had a sensitivity of 70% (95% CI = 47% to 87%) and NEXUS criteria had a sensitivity of 83% (95% CI = 61% to 95%) for clinically important injury in intoxicated patients. In this study, the prevalence of clinically important injury in intoxicated patients with minor head injury was significant. While the presence of the common features associated with intracranial injury in nonintoxicated patients should raise clinical suspicion for intracranial injury in intoxicated patients, the Canadian CT Head Rule and NEXUS criteria do not have adequate sensitivity to be applied in intoxicated patients with minor head injury.

To investigate whether adolescent elite female and male handball players with shoulder muscle weakness, deficits in shoulder rotation range of motion (ROM) or in joint position sense (JPS), or scapular dyskinesis in the preseason had a higher rate of new shoulder injuries compared to players without these characteristics. Prospective cohort study. We studied 344 uninjured players (452 player-seasons, 50% female). We measured their shoulder strength in isometric external rotation (IER), isometric internal rotation (IIR), isometric abduction, and eccentric external rotation, as well as their shoulder ROM, JPS, and scapular dyskinesis, during the preseason. Players were monitored weekly regarding match and training hours and shoulder injuries during 1 or 2 seasons. We used multivariable Cox proportional hazard models to calculate hazard rate ratios related to the first injury and 95% confidence intervals (CIs). During 2 seasons, the participants reported 48 new shoulder injuries. In female players, the hazard rate ratio was 2.37 (95% CI: 1.03, 5.44) for IER weakness and 2.44 (95% CI: 1.06, 5.61) for IIR weakness. The hazard rate ratio was 0.85 (95% CI: 0.39, 1.83) for an IER/IIR ratio of less than 0.75 and 1.53 (95% CI: 0.36, 6.52) for scapular dyskinesis. In male players, the hazard rate ratio was 1.02 (95% CI: 0.44, 2.36) for IER weakness, 0.74 (95% CI: 0.31, 1.75) for IIR weakness, 2.0 (95% CI: 0.68, 5.92) for an IER/IIR ratio of less than 0.75, and 3.43 (95% CI: 1.49, 7.92) for scapular dyskinesis. There were no associations between new shoulder injuries and deficits in ROM or JPS. In adolescent elite handball, male players with preseason scapular dyskinesis and female players with preseason IIR or IER shoulder weakness had an increased shoulder injury rate. J Orthop Sports Phys Ther 2020;50(2):67-74. Epub 27 Nov 2019. doi:10.2519/jospt.2020.9044.

The prevention of head injuries in alpine activities has focused on helmets. However, no systematic review has examined the effect of helmets on head and neck injuries among skiers and snowboarders. We searched electronic databases, conference proceedings and reference lists using a combination of the key words "head injury or head trauma," "helmet" and "skiing or snowboarding." We included studies that used a control group; compared skiers or snowboarders with and without helmets; and measured at least one objectively quantified outcome (e.g., head injury, and neck or cervical injury). We included 10 case-control, 1 case-control/case-crossover and 1 cohort study in our analysis. The pooled odds ratio (OR) indicated that skiers and snowboarders with a helmet were significantly less likely than those without a helmet to have a head injury (OR 0.65, 95% confidence interval [CI] 0.55-0.79). The result was similar for studies that used controls without an injury (OR 0.61, 95% CI 0.36-0.92), those that used controls with an injury other than a head or neck injury (OR 0.63, 95% CI 0.52-0.80) and studies that included children under the age of 13 years (OR 0.41, 95% CI 0.27-0.59). Helmets were not associated with an increased risk of neck injury (OR 0.89, 95% CI 0.72-1.09). Our findings show that helmets reduce the risk of head injury among skiers and snowboarders with no evidence of an increased risk of neck injury.

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

Head Injury, Lead and the Risk of Parkinson’s DiseaseAbstract Number:2656 Kathryn Taylor*, David Sparrow, Howard Hu, and Marc Weisskopf Kathryn Taylor* Harvard School of Public Health , United States, E-mail Address: [email protected] Search for more papers by this author , David Sparrow Boston University, United States, E-mail Address: [email protected] Search for more papers by this author , Howard Hu Dalla Lana School of Public Health, Canada, E-mail Address: [email protected] Search for more papers by this author , and Marc Weisskopf Harvard School of Public Health, United States, E-mail Address: [email protected] Search for more papers by this author AbstractBackground: Head injuries have been associated with the risk of Parkinson’s disease (PD). However, this could result from reverse causation whereby pre-clinical motor symptoms result in head injury. On the other hand, paraquat has been found to have a stronger association with PD among people with head injury, which would suggest that head injury does increase the risk of PD. Aims: To evaluate the association between head injury and PD risk, and whether having a head injury modifies the association between lead exposure and PD.Methods: We obtained head injury history by questionnaire from 225 PD patients from 4 movement disorder clinics in the Boston, MA area, and 260 controls recruited via referrals from cases and 2 research studies in the Boston area. Tibia bone lead—a marker of cumulative lead exposure—was measured using K-shell x-ray fluorescence. We used logistic regression analyses adjusting for age, sex, smoking, education and race to estimate odds ratios (OR) and 95% confidence intervals (CI).Results: Ever having a head injury was associated with an increased risk of PD occurrence (OR=1.60; 95%CI: 1.00-2.55). Although the confidence intervals got wider, this association was stronger when excluding head injuries in the 5, 10, or 15 years before the questionnaire. The OR for PD also increased with earlier age at first head injury: the OR among those <12, 13-19 and 46-75 years at 1st head injury were 2.89 (95%CI: 1.15-7.25), 1.61 (95%CI: 0.69-3.78) and 0.79 (95%CI: 0.28-2.23), respectively. The association between lead and PD was stronger among those with a head injury before age 19, but it was not statistically significant (p-value: 0.46).Conclusion: Our results are consistent with an increased risk of PD with head injury, rather than reverse causation. Furthermore, the association appears driven by head injuries earlier in life. The lead-head injury interaction findings were suggestive, but inconclusive. Larger studies could better address this question.

PurposeThe aim of this study was to define the relationship between gender identity, the perception of the body, depressiveness, and aggression in female football players who represent different levels of competence (playing in the premier league vs. second league) and seniority in sport.MethodsResearch was carried out on female football players (aged 16-31 years) playing in the premier league (N = 49) and second league (N = 45). Data were obtained with the use of: the Body Image Evaluation Questionnaire by Mandal, developed on the basis of Franzoi's concepts; Kuczyńska's Gender Assessment Inventory (IPP) adapted from the Bem Sex Role Inventory (BSRI), which diversifies individuals in terms of their gender identity in accordance to the Gender Schema Theory by Bem; the Beck Depression Inventory, translated by Lewicka and Czapiński; and the Buss-Durkee Inventory, adapted by Kosewski with comments from Stanik. To find a relationship between the mentioned variables, statistical analysis was carried out by use of ANOVA, the t test, the χ2 test and correlation coefficients.ResultsThe obtained research results indicate that, among female football players, the following occurs: a predominance of androgynous gender identities and a deficiency of its other types, a higher level of masculinity than among non-training women, a more favorable perception of body-as-process, a higher evaluation of body-as-object, along with an increase of masculinity and a decrease in indirect aggression at higher competition levels.ConclusionsThe application of the masculinity dimension by female football players with androgynous gender identity is probably an effective strategy for survival in conditions that are unsuitable and gender-inappropriate in typical masculine sports.

ACL tears in female and male professional soccer players.

In this study, three-dimensional kinematics and performance were analyzed for male and female top level and junior elite volleyball players in a spike, which is an essential offensive volleyball action. Top level players had higher impact speeds and jumping height than junior elite players for both genders and the male players had higher impact speeds and jumping height than the female players for both levels of expertise. For the analysis of the three-dimensional kinematics of the pelvis, trunk, shoulder and elbow angles and angular velocities, Statistical Parametric Mapping was used. No differences were observed for the orientation angles of pelvis and trunk, indicating a set of invariant kinematics. The pelvis and trunk angular velocities on the other hand did show many interesting differences throughout the approach, cocking and acceleration phase of the spike. The shoulder and elbow angles and angular velocities also illustrated the different strategies used for generating high impact speeds. An important conclusion was that interaction effects between gender and level of expertise were mostly observed in variables from the shoulder and elbow, whereas pelvis and trunk velocities only presented significant main effects. These differences suggest how the motion pattern of the young elite athletes will change over the following years when they gradually make the change towards the highest competitive levels.