Athlete Exposures Research Articles

Concussion Rates Differ by Practice Type and Equipment Worn in an Autonomy Five Collegiate Football Conference.

Evaluate the rate of concussions across Big 12 Conference football programs based on (1) equipment worn, (2) contact level, (3) preseason practice versus in-season practice versus games, and (4) mechanism of injury for concussion. Descriptive epidemiology study. Big 12 Conference football practices and competitions. Big 12 Conference football teams. All Big 12 Conference institutions collected data on practice types, equipment worn, practice and game participation, and concussions during the fall, preseasons and regular seasons, from 2013 to 2016. Injury rates and injury rate ratios were reported with 95% confidence intervals (CIs). From 2013 to 2016, there were 375 concussions reported [0.98/1000 athlete exposures (AEs) (95% CI, 0.88-1.08)], an average of approximately 9 concussions per team per year. Concussion rates were highest in games (5.73/1000 AE), but among practices, concussion rates were highest in full-pad (1.18/1000 AEs) and live-contact (1.28/1000 AEs) practices. Concussion rates increased with increasing contact and equipment worn. Concussion rates were higher in the preseason than in the regular season, even when stratifying by contact level and equipment worn. Practice concussion rates are highest during fully padded and live-contact practices, supporting limitations on practice contact and equipment worn to reduce the risk associated with head-impact exposure. Higher concussion rates in the preseason and during games indicate an effect of play intensity on concussion risk, and further research is needed to evaluate the direct effect of practice contact level and equipment guidelines and restrictions on concussion incidence.

Injuries in Korean Elite Taekwondo Athletes: A Prospective Study.

This prospective cohort study aimed to identify the incidence and characteristics of Taekwondo-related injuries according to age, sex, and event type (i.e., practice or competition) based on a web-based injury surveillance system (ISS) with a follow-up period of 12 months. A total of 285 members of the Korea Taekwondo Association who competed in the 2016 season participated. Injury incidence rates (IRs) were calculated per 1000 athlete-exposures (AEs). Injury rate ratios (RRs) with 95% confidence intervals were calculated and compared regarding age, sex, and event type. During the season, 336 injuries were reported, resulting in a rate of 6.31/1000 AEs. The most common location, type, and mechanism of injury in Taekwondo athletes were the foot/ankle, ligament sprain, and contact with another player, respectively. The overall injury IRs associated with Taekwondo practicing and competition were 4.79/1000 AEs and 24.86/1000 AEs, respectively. The overall injury RR related to both practice and competition was higher in youth athletes than in adult athletes. However, adult athletes were more likely to sustain more severe injuries. Korean elite Taekwondo athletes were commonly exposed to injury, especially youth and female athletes. Therefore, continuation of the ISS suggests the development of interventions for preventing injuries sustained by Taekwondo athletes.

Injury Trends In Special Olympics Athletes From The 2018 USA Games

PURPOSE: We analyzed injury data from the Seattle Special Olympics USA Games 2018. Our findings and analysis may inform ways by which medical coverage at future similar events can be reinforced, prepared, and improved. METHODS: Deidentified injury data, collected by the RaceSafe app, was categorized by injury type: Musculoskeletal (MSK), Non-musculoskeletal (Non-MSK) and Minor Injury (including ice, bandaging, and massage). Individual event data was analyzed by percent of athletes injured and by injuries per 1000 athlete exposures. For each team sport, injury data was analyzed by injuries per game. RESULTS: The individual events with the highest percent of athletes injured were gymnastics (38.5%, 95% CI 22.4-62.0), tennis (31.5, 95% CI 21.5-44.7) and stand-up paddleboard (28.6%, 95% CI 11.6-59.4). The individual event with the lowest percent of athletes injured was golf (12.9%, 7.9-19.9). Among the gymnastics and tennis injuries, 53.3% and 58.6% were MSK, respectively. For stand-up paddleboard there were no MSK injuries with the majority being non-MSK (66.7%). Per 1000 athlete exposures, gymnastics had the highest rate of MSK injuries at 25.6 (95% CI 11.9-48.7), while stand-up paddleboard had the highest rate of both non-MSK injuries at 95.2 (95% CI 30.3-23.0) and minor injuries at 47.6 (95% CI 8.0-157.3). The team sports with the highest rate of injuries per game were softball at 1.9 (95% CI 1.6-2.4), followed by soccer at 1.7 (95% CI 1.4-2.0), and flag football at 1.6 (95% CI 1.3-1.9). CONCLUSION: The Special Olympics 2018 USA Games required a well-staffed and organized medical team to meet the injury needs of its athletes. Based on our analysis, future events should provide a team with many medical personnel divided amongst the competition venues. A unique feature of the Special Olympics is the high rates of non-MSK injuries requiring medical attention, and appropriate measures should be taken to address these conditions.

Injury Incidence In Competitive Wheelchair Tennis Athletes

There is great interest in tennis sports science and in the wheelchair tennis community on the overall injury incidence in competitive wheelchair tennis players. There are biomechanical differences between the wheelchair tennis and the able-bodied tennis serve that have been published. In addition, wheelchair tennis players are required to propel their wheelchair around the court during match play, which exposes the upper extremities and trunk to additional movements during tennis play. Currently, there is a paucity of data published on the injury incidence in competitive wheelchair tennis athletes. PURPOSE: To provide a prospective evaluation of the injury incidence in wheelchair tennis players during their competitive schedule. METHODS: The study is a prospective cohort study of competitive wheelchair tennis players during their seasons. 81 subjects were enrolled at 5 different tennis tournaments over a two year period. Subjects completed an injury history and a training log at the beginning of the study. 39 subjects volunteered for a physical exam at the start of the study. Once enrolled in the study, the subjects were monitored for injuries through weekly email communication. RESULTS: The injury incidence is calculated to be 1.88 injuries per 100 athletic exposures. Of the reported injuries, 2 occurred during match play, 3 occurred during training, and 8 were reported while not playing tennis. There were no statistically significant findings associating physical exam findings and future injury. CONCLUSIONS: An injury incidence in competitive wheelchair tennis athletes obtained while competing and training prospectively contributes to the body of evidence to guide further research to evaluate the mechanism of injuries and develop injury risk reduction strategies in a unique population of high performance athletes. Future injury risk reduction strategies should include a focus on potential causes of non-tennis related injuries in competitive wheelchair tennis players.

Frequency of overtime and consecutive games and their impact on injury rate in the National Hockey League (NHL)

ABSTRACT Objectives Ice hockey is a high-intensity contact sport that places athletes at an elevated risk for injury relative to other sports. The purpose of the current study was to analyze factors contributing to fatigue and decreased recovery time and their associations with injury incidence among professional athletes in the National Hockey League (NHL). Methods A retrospective review of all injuries suffered by NHL athletes during six consecutive seasons from 2013 to 2019 was performed. Team schedules were analyzed to assess (1) the number of instances with games on consecutive calendar days, (2) the number of overtime games, and (3) the number of overtime games within three calendar days of a previous overtime game. A Spearman’s rank correlation coefficient was calculated from this data to assess the association between these factors and injury rates. Results In total, 4886 injuries were suffered by NHL players during the period of study, with the 2013–2014 regular season highest injury rate per 1000 athletic exposures (15.8). The lower body was the most frequently injured body area (25.0% of all injuries), followed by injuries to the upper body (23.7%). In an analysis of the number of overtime games and games on consecutive days and their relationships to injury rate, only overtime games within three calendar days and total injuries were found to have a significant association (ρ = 0.19, p = 0.01). Conclusion The weak positive correlation between the number of overtime games within threedays of a previous overtime game and total injuries in professional ice hockey players suggests that overtime games played within a short period of time place athletes at increased risk for injury. Further studies are necessary to address this on an athlete-by-athlete level.

Heat Policy Revision for Georgia High School Football Practices Based on Data-Driven Research.

Interscholastic heat policies for football have not been evidence based. Therefore, their effectiveness in mitigating exertional heat illness has not been assessed. To discuss the development of the Georgia High School Association heat policy and assess the effectiveness of revised guidelines. Descriptive epidemiology study. Georgia high schools. Interscholastic football players in grades 9 through 12. Heat syncope and heat exhaustion (HS/HE) illness rates (IRs) were calculated per 1000 athlete-exposures (AEs), and relative risk (RR) was calculated as a ratio of postpolicy (POST) IR divided by prepolicy (PRE) IR. A total of 214 HS/HE cases (172 PRE, 42 POST) and 341 348 AEs (178 230 PRE, 163 118 POST) were identified. During the first 5 days of the PRE period, approximately 50% of HS/HE illnesses occurred; HS/HE IRs doubled when practice sessions increased from 2 to 2.5 hours and tripled for practices ≥3 hours. The HS/HE IRs in the PRE period increased from 0.44/1000 AEs for wet-bulb globe temperatures (WBGTs) of <82°F (<27.8°C) to >2.0/1000 AEs for WBGTs from 87°F (30.6°C) to 89.9°F (32.2°C). The RRs comparing PRE and POST policy periods were 0.29 for WBGTs of <82.0°F (<27.80°C), 0.65 for WBGTs from 82.0°F (27.8°C) to 86.9°F (30.5°C), and 0.23 for WBGTs from 87.0°F (30.6°C) to 89.9°F (32.2°C). No HS/HE illnesses occurred in the POST period for WBGTs at >90°F (>32.3°C). Results from the PRE period guided the Georgia High School Association to revise its heat and humidity policy to include a mandated 5-day acclimatization period when no practices may exceed 2 hours and the use of WBGT-based activity-modification categories. The new policy reduced HS/HE IRs by 35% to 100%, depending on the WBGT category. Our results may be generalizable to other states with hot and humid climates similar to that of Georgia.

Head impact exposures in women’s collegiate rugby

ABSTRACT Objectives: To describe the incidence, magnitude, and distribution of head impacts and track concussions sustained in a collegiate level women’s rugby season. Methods: Data on head impact incidence and magnitude were collected via Smart Impact Monitors (SIM) (Triax Technologies, Inc., Norwalk, CT) within fitted headbands during practices and games of one competitive season. Magnitude data included peak linear acceleration (PLA) and peak rotational velocity (PRV) measurements and were reported as median [IQR]. Results: Players sustained 120 head impacts ≥15 g (18.1 g – 78.9 g) with 1199 total athlete exposures. In eight games, 67 head impacts were recorded with a mean rate of 0.40 ± 0.22 hits per-player per-match, median PLA of 32.2 g, and PRV of 13.5 rad.sec−1. There were 53 head impacts in 47 practices with a mean rate of 0.05 ± 0.04 hits per-player per-practice, median PLA of 29.8 g and PRV of 15.7 rad.sec−1. Four concussions were reported and monitored. Conclusion: The incidence and magnitude of head impacts in collegiate level women’s rugby over one season of practices and games were fewer than those reported in other comparable studies. These findings give insight into the impact burden that female collegiate rugby athletes withstand throughout a competitive season.

Are high school girls\u2019 lacrosse players at increased risk of concussion because they are not allowed to wear the same helmet boys\u2019 lacrosse players are required to wear?

BackgroundBoys’ lacrosse (LAX), a full contact sport allowing body and stick checking, mandates hard shell helmets with full face masks. Girls’ LAX, which prohibits body checking and whose sphere rule is supposed to prevent stick checking to the head, allows optional flexible headgear with/without integrated eye protection. Whether the required boys’ LAX helmets should also be mandated in girls’ LAX has been debated.MethodsIn this retrospective cohort study we used LAX concussion data from a national high school sports-related injury surveillance study to determine if girls’ LAX players were at increased risk of concussion from stick or ball contact due to differences in helmet regulations by calculating the attributable risk and attributable risk percent (AR%) for concussion resulting from ball or stick impacts.ResultsFrom 2008-09 through 2018–19, boys’ LAX players sustained 614 concussions during 1,318,278 athletic exposures (AEs) (4.66 per 10,000 AEs) and girls’ LAX players sustained 384 concussions during 983,291 AEs (3.91 per 10,000 AEs). For boys, athlete-athlete contact was the most common mechanism of concussion accounting for 66.4% of all concussions, while stick or ball contact accounted for 23.5%. For girls, stick or ball contact accounted for 72.7% of all concussions, while athlete-athlete contact accounted for 19.8%. Concussion rates from stick or ball contact were significantly higher in girls vs. boys (RR = 2.60, 95% CI 2.12–3.18). The attributable risk associated with playing girls’ vs. boys’ LAX for concussion resulting from stick or ball contact was 1.75 concussions per 10,000 AEs (95% CI 1.37–2.12) and the AR% was 61.5% (95% CI 52.9–68.5). An estimated 44.7% of all girls’ LAX concussions could have been prevented if girls’ LAX players wore the helmet mandated in boys’ LAX.ConclusionsGirls’ LAX players who are allowed, but not required, to wear a flexible headgear are at increased risk of concussions from stick or ball impacts compared to boys’ LAX players, who are required to wear a hard shell helmet with full face mask. Additional research is needed to determine if there are any defendable arguments to continue justifying restricting girls’ LAX players access to this effective piece of protective equipment.

Sex-Based Differences in Anterior Cruciate Ligament Injuries Among United States High School Soccer Players: An Epidemiological Study.

Background:Anterior cruciate ligament (ACL) tears are common among high school athletes, with sex-based differences accounting for higher injury rates in girls. Previous epidemiological studies on ACL injuries focusing on adolescent athletes have looked at injuries across multiple sports, but few have analyzed ACL tears in solely high school soccer athletes.Purpose:To examine sex-based differences in the epidemiology of ACL injuries among high school soccer players in the United States (US).Study Design:Descriptive epidemiological study.Methods:ACL injury data for US high school soccer players were obtained from the internet-based National High School Sports-Related Injury Surveillance Study’s High School RIO (Reporting Information Online) system. Athletic trainers from a random sample of 100 high schools from 8 strata based on US Census geographic region reported data for athlete-exposures (AEs) (practice or competition) and ACL injuries from 2007 through 2017. Injury rates were calculated as the number of ACL injuries per 100,000 AEs. Subgroup differences were evaluated with rate ratios (RRs) or injury proportion ratios (IPRs) and 95% CIs. Statistical differences in demographics between groups were examined using independent t tests. Comparisons of categorical data (ie, level of play) were performed using the Wald chi-square test.Results:The reported number of ACL injuries corresponded to weighted national estimates of 41,025 (95% CI, 33,321-48,730) ACL injuries in boys’ soccer and 110,028 (95% CI, 95,349-124,709) in girls’ soccer during the study period. The rate of injuries was higher in girls’ soccer (13.23/100,000 AEs) than boys’ soccer (4.35/100,000 AEs) (RR, 3.04 [95% CI, 2.35-3.98]). The rate of ACL injuries was higher in competition compared with practice for girls (RR, 14.77 [95% CI, 9.85-22.15]) and boys (RR, 8.69 [95% CI, 5.01-15.08]). Overall, a smaller proportion of ACL injuries were caused by player-player contact for girls (30.1%) compared with boys (48.6%) (IPR, 0.62 [95% CI, 0.41-0.93]).Conclusion:ACL injury rates and patterns in high school soccer players differed between sex, type of exposure (practice vs competition), and mechanism of injury.

Analysis of Football Injuries by Position Group in Division I College Football: A 5-Year Program Review.

The purpose of this study was to evaluate injury characteristics by position groups. Prospective, observational study. A single, major Division I collegiate football program. All players on a collegiate football program each fall regular season. Exposure to Division I collegiate football and position groups. Injury rates (IRs) per 1000 athlete exposures (AEs) and injury rate ratios (IRRs) were calculated and analyzed for all monitored injury variables, which included time in the season, body part, type of injury, game and practice injuries, mechanism of injury, and type of exposure. During the 2012 to 2016 fall regular seasons, there were 200 reported injuries sustained from 48 615 AE. The overall 5-year IR was 4.11 per 1000 AEs (3.57-4.72 95% confidence intervals). Skill players sustained the highest IR in the preseason (IR, 7.56) compared with line (IR, 4.26) and other (IR, 4.10) position groups. In addition, skill players demonstrated a significantly higher IRR compared with the line (IRR, 1.75, P < 0.05) and other (IRR, 1.85, P < 0.05) position groups. Skill players sustained most of their injuries in the preseason, whereas the linemen and other position groups suffered most of their injuries in the first half of the regular season. Skill players demonstrated a significantly higher IR in preseason, noncontact mechanism injuries, and injuries to the upper leg and thigh compared with line and other position groups. Efforts to reduce soft-tissue muscle strains in skill players targeting the preseason may provide one of the best opportunities to significantly decrease current football IRs, whereas efforts to reduce contact exposures may have the greatest effect on concussions and contact mechanism injuries for the other position group. There were no significant differences in IRs between position groups and type of exposure.

Injury in the Women’s National Basketball Association (WNBA) From 2015 to 2019

PurposeTo provide an overview of the injuries suffered by Women’s National Basketball Association (WNBA) athletes and to analyze the demographic data, injury rates, and games missed as a result of individual injuries.MethodsUsing publicly available data on WNBA player’s injury history, we generated a database cataloguing the quantity, location, frequency, and longitudinal impact of injuries sustained during the WNBA regular season from 2015 to 2019. We analyzed the data using SPSS-25 data manipulation software to assess the number of injuries per athletic exposure.ResultsLower-extremity injuries (n = 143, 73%) were the most common injury by body area and resulted in the greatest number of games missed (n = 1189, 88%). Lateral ankle sprains were the most frequent injury (n = 39, 20%), with a rate of 1.19 injuries per 1000 athletic exposures. Torn anterior cruciate ligaments (n = 18, 9.2%) were the most devastating, resulting in the greatest number of games missed (n=376, 28%).ConclusionsOur findings corroborate previous notions that lower-extremity injuries are the greatest source of injury in this population. Ankle injuries were the most frequent injury reported by pathology, while knee injuries carried the most long-term impact on games missed due to injury.Level of EvidenceIV, Epidemiological study

THE IMPACT OF RULE CHANGES AND LEGISLATION ON THE INCIDENCE OF CONCUSSION IN HIGH SCHOOL SOCCER

Background:There is much concern over the incidence of concussion in high school sports, with a growing focus on soccer, necessitating the need for legislation and formal rule changes for safety reasons.Objective:To note differences in concussive injury between boys and girls soccer and determine the change in reported concussion rates from 2011 vs. 2017 in order to study the impact of legislation and rule changes on the rates of concussion in high school soccer in the state of New Jersey.Design:Comparative StudyMethods:Licensed athletic trainers working in the secondary school setting in the state of New Jersey voluntarily participated in an online survey on the incidence of concussion in boys and girls soccer. This de-identified data was compared with data collected from a similar survey conducted in 2011.Results:In 2017 there were 168 concussions occurred among 3255 male soccer athletes. Eight-five percent of concussions (145/168) occurred during games, with the remainder occurring in practice. Forty-five percent (76/168) occurred to varsity players with the majority occurring during games (84%). Fewer concussions were reported to junior varsity and freshman players.. In 2017, Incidence Rate (IR) for all male soccer athletes was calculated at 0.36 concussions per 1000 athletic exposures (AE). Injury Proportion (IP) was 5%. Clinical Incidence was 0.05 concussions per athlete. This represented a 38% increase in IR/1000 AE from 2011 to 2017, and a 39% increase in IP 2011 vs 2017In 2017, a total of 2604 female soccer athletes, reported 195 concussions with the majority occurring during games (83%). Varsity athlete reported the higher number of concussions relative to junior varsity and freshman soccer athletes IR/1000 AE was 0.48 vs 0.43 in 2011 (12% increase), while IP was 7% vs 6% in 2011 (17% increase Females had a greater IR/1000 AE than males (.48 vs. .36). Clinical incidence was also greater for female soccer athletes than male soccer athletes (0.075 vs. 0.05).Conclusion:Despite legislation and rule changes, the incidence of concussion in both boys and girls high school soccer is increasing and particularly during games. Playing at the varsity level and game play has the highest association with injury and should be subject to greater scrutiny. Additionally, more concussions are occurring to female soccer athletes than male players. This information provides a snapshot of a significant problem that deserves greater attention.Table 1.Boys Soccer ComparisonBoys Soccer:Overall201762 Highs Schools Reporting3255 Athletes168 Concussions Reported201145 Schools Reporting1984 Athletes72 Concussions ReportedIncidence Proportion:5%; SE(IP)= 0.0038; 95% CI: 4.3%, 5.8% 3.6%; SE(IP)=0.0041; 95% CI:2.8%, 4.4%Incidence Rate:0.35 concussions/1,000 AE; SE(IR)=2.75E-05; 95% CI:0.3, 0.4.26/1,000 AE; SE(IR)3.03E-05;95% CI:02,0.32Clinical Incidence:.05 concussions/athlete; SE=0.0038; 95% CI: 0.04, 0.06.36 concussions/athlete; SE(IP); 95% CI: .03, 0.04 Games: Incidence Proportion4.93%; SE(IP)=0.004; 95% CI: 0.37, 0.512.9%; SE(IP)=0.004; 95%CI: 2.2%,3.7%Incidence Rate1.722 concussions/1,000 AE; SE(IR):0.00014; 95% CI: 1.722, 1.7230.975 concussions/1,000 AE; SE(IR)= 0.00013; 95% CI: 0.724, 1.23Clinical Incidence0.04 concussions/athlete; SE=0.004; 95% CI: 0.037, 0.0510.029 concussions/athlete; SE=0.004; 95% CI: 0.029, 0.037 Practices: Incidence Proportion0.7%; SE(IP)=0.002; 95% CI: 0.4%, 1.1%0.7%; SE(IP)= 0.002; 95% CI: 0.3%,1%Incidence Rate0.069 concussions/1,000 AE: SE(IR):1.39E-05; 95% CI:0.03, 0.080.066 concussions/1,000 AE; SE(IR)=1.82E-05; 95% CI: 0.03, 0.1Clinical Incidence0.007 concussions/athlete; SE=0.004, 95% CI: 0.004, 0.0110.07 concussions/athlete; SE=0.002; 95% CI: 0.03, 0.01Table 2.Girls Soccer Comparison:Girls SoccerOverall 201760 High Schools Reporting2604 athletes195 concussions201145 High Schools Reporting1987 Athletes119 ConcussionsIncidence Proportion7%; SE(IP)= 0.0049; 95% CI: 6%, 8%6%; SE(IP)=0.005; 95% CI: 5%,7%Incidence Rate0.48 Concussions/1,000 AE; SE(IR)=3.58E; 95% CI: 0.4, 0.60.44 concussions/1,000 AE; SE(IR)=0.006; 95% CI: 0.43, 0.45Clinical Incidence0.075 concussions/athlete; SE=0.0049; 95% CI: 0.07, 0.090.06 concussions/athlete; SE=0.005, 95% CI: 0.05, 0.07 Games: Incidence Proportion5.7%; SE(IP)=0.005; 95% CI: 4.8%, 6.6%5.6%; SE(IP) = 0.005; 95% CI: 4.6%, 6.6%Incidence Rate2.24 concussions/1,000 AE; SE(IR)= 0.00018; 95% CI: 1.88, 2.601.86 concussions/1,000 AE; SE(IR) = 0.00013; 95% CI: 1.85, 1.87Clinical Incidence0.06 concussions/athlete; SE = 0.005; 95% CI: 0.05, 0.070.056 concussions/athlete; SE= 0.005; 95% CI: 0.046, 0.066Practices: Incidence Proportion1.2%; SE(IP)= 0.002; 95% CI: 0.8%, 1.7%,0.6%; SE(IP)= 0.002; 95% CI: 0.2%, 0.9%Incidence Rate0.11 concussions/1,000 AE; SE(IR)= 1.97E-05; 95% CI: 0.07, 0.150.055 concussion/1,000 AE; SE(IR) = 0.002; 95% CI: 0.05, 0.06Clinical Incidence0.01 concussions/athlete; SE= 0.002; 95% CI: 0.008, 0.0170.06 concussions/athlete; SE= 0.002; 95% CI: 0.002, 0.009

TRENDS IN US HIGH SCHOOL AND CLUB CHEER PRACTICE CONCUSSION REPORTING FROM 2012-2017

Background:Sport-related concussion (SRC) is one of the leading injuries among the 3.24 to 4.03 million athletes participating in cheerleading from 2012-2017. The purpose of this study was to provide a descriptive epidemiology of SRC in the school and club cheerleading practice setting from the 2012 to 2017 calendar years.Methods:Female cheerleading athletes, ages 12 to 18 participating in school or club cheer from 2012 to 2017 were included in the current study. Injury and exposure data from school and club cheerleading practices from the Rank One Health Injury Surveillance Database (ROH ISD) were analyzed. SRC counts, percentages, rates per 10,000 athletic exposures (AEs), rate ratios (RRs), and injury proportion ratios (IPRs) were reported with 95% confidence intervals (CIs). Any RR or IPR with a 95% CI not containing 1.0 were considered statistically significant.Results:From 2012-2017, 951 SRCs were recorded from a sample of 51,812 females participating in school cheerleading and 12,643 females participating in club cheerleading. Cheerleading SRCs accounted for 0.40% of all injuries in sports from 2012-2017. The total SRC rate in school cheerleading was 6.02/10,000 AEs (95% CI = 5.87, 6.17). The total SRC rate in club cheerleading was 11.98/10,000 AEs (95% CI = 11.74, 12.22). The SRC rate was higher in club practices than in school practices (RR = 1.99; 95% CI = 1.89, 2.09). More SRCs occurred at school cheerleading practices (65.62%) than club practices (34.48%). The proportion of SRCs from falls onto hardwood surfaces was higher in club cheerleading practices than school cheerleading practices (IPR = 1.69; 95% CI = 1.61, 1.77) while the proportion of falls onto padded surfaces was higher in school cheerleading practices than club cheerleading practices (IPR = 2.26; 95% CI = 2.18, 2.34).Conclusions:The findings from this study provide the largest SRC incidence rates for school and club cheerleading practices to date and reveal evidence of differences in the club and school practice settings. Club cheerleading practice SRCs occurred at a higher rate than school cheerleading practice SRCs and appear to be significantly reduced by practicing on padded surfaces. These findings should be considered when educating cheerleading coaches, parents, and athletes regrading concussion injury risks as well as identifying potential areas of injury prevention. Further research is warranted to identify potential causes for injury trends observed in the current study.

FAIR PLAY AS AN INJURY PREVENTION INTERVENTION: DO YELLOW CARD ACCUMULATION POLICIES REDUCE HIGH SCHOOL SOCCER INJURIES?

Background:Pediatric sports-related injuries are common, yet prevention efforts too often go unevaluated. Collins et al. studied nine U.S. high school (HS) sports during 2005/06-2006/07, finding boys’ and girls’ soccer had the highest injury rates related to illegal activity. Several states have implemented yellow card accumulation policies (YCPs) in an effort to prevent injuries.Hypothesis/Purpose:Purpose: Evaluate the effectiveness of YCPs in reducing HS soccer competition injuries by comparing injury rates and patterns in states with and without YCPs. Hypotheses: Athlete-athlete contact injury rates are lower in states with YCPsSevere injuries (concussion, fracture, ACL, injury requiring surgery, injury resulting in > 3 weeks’ time loss) are less prevalent in states with YCPsGender differences influence the effectiveness of YCPs Methods:Retrospective cohort study of NHFS member state association HS soccer players injured during competition in 2005/06-2017/18. Athlete exposure (AEs) and injury data collected from a national sports injury surveillance system, High School RIO. Poisson regression assessed the effects of YCPs on injury rates and patterns.Results:Of 50 NFHS member states associations, high schools from 47 were represented. Overall, 901 athlete-athlete contact injuries occurred during 352,775 competition AEs in states with YCPs and 3,525 during 1,459,708 AEs in states without YCPs. There was no significant difference in overall contact injury rates (rate ratio [RR] 1.06; 95% confidence interval [CI]: 0.98-1.14) between schools in states with and without YCPs. A small, significant increase in overall contact injury rates was discernable after states’ adoption of YCPs (RR 1.17; 95% CI: 1.03, 1.34), particularly in boys’ soccer (RR 1.32; 95% CI 1.08-1.62). A significantly lower proportion of injuries resulting in > 3 weeks’ time loss occurred in states with YCPs (injury proportion ratio [IPR] 0.81; p=0.047), while other severe injuries did not differ. There were no significant differences in YCPs’ effect by gender (p=0.319).Conclusion:Among HS boys’ and girls’ soccer players, playing in states with YCPs did not lower athlete-athlete contact injury rates, although injuries resulting in > 3 weeks’ time loss were less prevalent in states with YCPs. Athlete-athlete contact injury rates were slightly higher in states following adoption of YCPs, particularly in boys’ soccer. Enactment of YCPs alone, without proper enforcement, may not be a sufficient injury prevention strategy. Further studies assessing the impact of HS soccer YCPs need to consider the effects of state level YCP enforcement, documented illegal activity/foul play, and Fair Play education.Tables/Figures:Table 1.Rate of Athlete-Athlete Contact Injuries Sustained During Soccer Competition in High Schools in States with and without Yellow Card Policies, National High School Sports-Related Injury Surveillance Study, USA, 2005/06-2017/18 # Injuries# Competition AEsRate per 10,000 AERR (95% CI) a Overall With YCP90135277525.51.06 (0.98, 1.14)Without YCP3525145970824.1RefBoys’ Soccer With YCP43018862622.81.10 (0.99, 1.22)Without YCP162578385120.7RefGirls’ Soccer With YCP47116414928.71.02 (0.92, 1.13)Without YCP190067585728.1Ref aRate Ratio (RR) is the ratio of total injury rate in YCP schools to total injury rate in No YCP schools.Table 2.Rate of Athlete-Athlete Contact Injuries Sustained During Soccer Competition in High Schools in states with Yellow Card Policies Pre- and Post- Policy Enactment, National High School Sports-Related Injury Surveillance Study, USA, 2005/06-2017/18 # Injuries# Competition AEsRate per 10,000 AERR (95% CI) a Overall Post-YCP90135277525.51.17 (1.03, 1.34)Pre-YCP28513068621.8RefBoys’ Soccer Post-YCP43018862622.81.32 (1.08, 1.62)Pre-YCP1186826217.3RefGirls’ Soccer Post-YCP47116414928.71.07 (0.90, 1.28)Pre-YCP1676242426.8Ref aRate Ratio (RR) is the ratio of total injury rate in Post YCP enactment to total injury rate in Pre YCP enactment.Table 3.Severe Athlete-Athlete Contact Injuries Sustained During Soccer Competition in High Schools in states with and without Yellow Card Policies, National High School Sports-Related Injury Surveillance Study, USA, 2005/06-2017/18InjuryYCP# (%)b No YCP# (%)IPR (95% CI)a Concussion247 (27.4)945 (26.8)1.03 (0.88,1.22)Fracture72 (8.0)321 (9.1)0.87 (0.66,1.13)ACL34 (3.8)120 (3.4)1.11 (0.76,1.64)Injury required surgical intervention51 (5.7)199 (5.7)1.00 (0.73,1.38)Injury resulting in >3 weeks’ time lossc 124 (13.8)581 (16.5)0.81 (0.66, 1.00)d aInjury Proportion Ratios (IPRs). For all IPRs, No YCP is the referent category. bFor each category of injury above, % indicates what proportion of all athlete-athlete contact injuries sustained during soccer competition were accounted for by the specific injury category. cInjury resulting in >3 weeks’ time loss includes the following categories: “Returned to activity in 22 days or more,” “medical disqualification for season,” or “medical disqualification for career.” dAn upper limit of 95% CI equals 0.997, which is less than 1.00.

ANKLE BRACE USE AND RISK OF ACUTE LOWER EXTREMITY INJURY AMONG FEMALE HIGH SCHOOL VOLLEYBALL PLAYERS

Background:Lower extremity injuries (LEIs), particularly ankle sprains, are the most common injury reported among female volleyball players. Many athletes wear ankle braces to help prevent injury; however, it is unknown whether ankle brace use reduces the rate and severity of ankle and LEI in these athletes.Hypothesis/Purpose:Determine if ankle brace use is associated with a reduced rate and severity of LEIs and ankle injuries among female high school volleyball players.Methods:2073 female volleyball players from 78 high schools were prospectively followed for injury, including acute LEI, during their fall 2018 volleyball season. Baseline data was collected on each participant including ankle brace use and type worn. Brace type was classified as soft- (e.g. fabric) or hard-shell. Injury severity was measured as days lost from sport. Incidence rates are reported per 1000 athlete exposures.Results:210 acute LEIs were observed during the season, of which 122 (58%) were ankle injuries. 76% of non-contact LEIs were due to jumping/landing or rotating around a planted foot. Similarly, 76% of contact LEIs were due to the floor or a teammate. The rate of LEI for athletes wearing soft-shell(SS) braces was 1.14 (95% CI: 0.76, 1.72), compared to 0.53 (95% CI: 0.25, 1.10) for those wearing hard-shells (HS) and 0.52 (95% CI: 0.37, 0.71) for those not wearing braces (NONE). The rate of a LEI for athletes wearing SS was 2.22 (95% CI: 1.31, 3.74) times as high as that for NONE (p=0.003). No association was found between LEI risk in athletes wearing HS versus NONE (IRR: 1.02, 95% CI: 0.45, 2.30). Similarly, the rates of ankle injury for HS, SS and NONE were 0.08 (95% CI: 0.01, 0.530), 0.40 (95% CI: 0.20, 0.79), and 0.16 (95% CI: 0.09, 0.28), respectively. The rate of ankle injury was 2.5 times as great in participants wearing SS compared to NONE (p=0.04). No association was detected for HS braces (p=0.48). No difference in median days lost for LEI (HS: 2[IQR 1,13], SS: 4[1, 10] None: 3[1,9]) or ankle injury (HS: 7[IQR 2,13], SS: 5[1, 11] None: 3[1,10]) was detected by brace use (p=0.99, p=0.79, respectively).Conclusion:The use of SS braces resulted in an increased risk of LEI and ankle injury among female high-school volleyball players; moreover, HS braces were not found to be associated with injury risk nor did ankle brace use affect severity of LEI and ankle injury in this population.

BRAIN WHITE MATTER ALTERATIONS IN STRUCTURAL INTEGRITY AND CONNECTIVITY FOLLOWING A SPORTS-RELATED CONCUSSION: EVALUATION OF THE POTENTIAL AMELIORATING EFFECT OF A JUGULAR VEIN COMPRESSION COLLAR DEVICE

Background:Sports-related concussion is a significant public health problem which may result in exacerbated or prolonged neurologic deficits. A neck collar device has been developed to apply mild jugular vein compression, increasing intracranial blood volume, with the intent of reducing brain slosh and preventing damage to brain microstructure from head impact exposure.Hypothesis/Purpose:We aimed to quantify the alterations in white matter (WM) diffusion properties and network structural connectivity in high school athletes after sports-related concussion and to test the effect of a jugular vein compression collar device worn during the concussive event.Methods:379 athletes (male American football and female Soccer) were included in this report. Of the 16693 total athlete exposures, 40 resulted in a diagnosed concussion and were included in these analyses. Prospective longitudinal MRI data were collected at pre-season and post-concussion: 20 athletes were in the non-collar group (12M, age =15.93±1.27yrs) and 20 athletes were in the non-collar group (16M, age=16.37±1.06yrs). DTI parameters, including fractional anisotropy (FA), and mean, axial and radial diffusivity (MD/AD/RD), were calculated to determine post-concussion alterations in WM diffusion properties. Graph analysis was utilized to quantify post-concussion changes in WM structural connectivity.Results:Diffusion property results revealed significant pre-season to post-concussion increases in MD, AD and RD within the non-collar group (p<0.05), but no change was found in the collar group (p>0.05). The pre-season to post-concussion MD, AD, or RD increase was significantly greater (p<0.05, Figure 1) in the non-collar group than the collar group. Graph analysis revealed a pre-season to post-concussion decrease in mean local efficiency in the non-collar group (p=0.036) and a significant increase in mean local efficiency in the collar group (p=0.017). The pre-season to post-concussion change in the mean local efficiency was significantly different in the non-collar group, when compared to the collar group (p=0.0024, Figure 2).Discussion & Conclusion:Results indicate that sports related concussion is associated with alterations in WM diffusion properties. The mean local efficiency of the network, a structural connectivity index reflecting network wiring redundancy and tolerance to brain injury, was also found to decrease after the concussion. Results indicate that wearing a neck collar device has the potential to limit these WM changes following a concussive event. Further studies are warranted to investigate the temporal progression of these changes for preventing long-term, neurologic squeala.Figure 1.White matter regions with significant greater increase in MD, AD, and/or RD in the non-collar group than the collar group.Figure 2.Mean local efficiency of brain network showed significant decrease in the non-collar group (p=0.036) and significant increase in the collar group (0.017), with a significant group difference in the change (p=0.0024).

The Effects of Strength and Conditioning on Functional Movement Screen™ Scores in Secondary School Basketball

Purpose: Injury prevention and mitigation are among the primary responsibilities of Athletic Trainers. Research has indicated that basketball players at the secondary-school level suffer up to 2.1 time loss injuries (TLI) per 1,000 athletic exposures (AE). It has been suggested that Functional Movement Screen (FMS™) composite and individual task scores may help determine injury risk. Researchers have suggested that a variety of strength and conditioning strategies may positively alter both composite and individual FMS™ task scores and reduce movement asymmetry. Methods: During a retrospective analysis of the records of all junior varsity and varsity basketball players at one secondary school over one season, no TLI was recorded over 1900 AE following the implementation of team-specific strength and conditioning programming. Results: Significant increases in pre-season and post-season composite FMS™ scores (pre-season mean = 14.33 ± 1.84; post-season mean = 16.44 ± 1.72; p < 0.001), and FMS™ individual task scores; deep squat (DS) (p < 0.001), hurdle step (HS) (p = 0.002), in-line lunge (INL) (p = .011), active straight leg raise (ASLR) (p = .02), and rotatory stability (RS) (p = .005) were noted across 27 male and female participants. Among females, composite FMS™ scores changed significantly (pre-season mean = 14.92 ± 1.38; post-season mean = 17.00 ± 1.04; p < 0.001), as did HS (p < 0.001) and INL (p = .025). Among males, significant changes were noted in composite FMS™ scores (pre-season mean = 13.87 ± 2.07; post-season mean = 16.00 ± 2.04; p < 0.001), as well as DS (p = 0.007), and RS (p = .025). Reductions in the number of scores of one and movement asymmetries were also evident during post-season FMS™ screening. Conclusions: Emphasizing movement competency and strength and conditioning training has positive effects on injury risk reduction in secondary school basketball players.

The Effects of a Mindfulness-Based Program on the Incidence of Injuries in Young Male Soccer Players.

The authors tested the effectiveness of a mindfulness-based program in reducing sport-injury incidence. A total of 168 young male elite soccer players were randomly assigned to mindfulness and control groups. The mindfulness group consisted of seven sessions based on the mindfulness-acceptance-commitment approach, while the control group consisted of seven presentations on sport-injury psychology. Athlete exposure and injury data were recorded during one season. State and trait mindfulness, sport anxiety, stress, and attention control of participants were assessed. Number of injuries, average of injuries per team, and days lost to injury in the mindfulness group were significantly lower than those in the control group. Mindfulness and attention control were lower and sport anxiety and stress were higher in injured players than in noninjured players. Psychological variables were associated with injury. Mindfulness training may reduce the injury risk of young soccer players due to improved mindfulness and attention control and reduced sport anxiety.

Concussions in U.S. youth soccer players: results from the U.S. soccer online concussion survey

ABSTRACTPurpose: This study aimed to describe incidence rates of concussion from alarge online survey of United States (U.S.) male and female youth soccer players; and to compare rates by age group, sex, competitive level, and practices compared to games.Methods: The survey was conducted through US Soccer consisting of three sections; demographic data, soccer heading exposure and awareness of US Soccer heading guidelines, and concussion data.Results: Respondents (n = 8,104) completed aretrospective online survey during the fall 2016 season representing 101,699 (42,048 girls; 41%) youth soccer players aged 7–14. Outcomes were concussion prevalence per 100 players and incidence per 10,000 athletic exposures (AE). Total concussion incidence for the sample was 8.48/10,000 athlete exposures (AE). Games (rather than practice) and older age (11–14) players had higher rates of concussion (Games: IRR = 5.67, Older Age: IRR = 2.68). Fewer than 1 in 5 concussions (47/253; 19%) occurred during attempted purposeful heading of the ball.Discussion: Overall, 82% (208/253) of all reported concussions received some form of clinical care. A majority of players sought care following their concussion suggesting that awareness and education efforts are having a positive effect on behavior.

The Effect Of Playing Surface On Anterior Cruciate Ligament Injury In NCAA Soccer

Objectives: Previous orthopaedic literature has examined the effect of synthetic playing surfaces on the risk of anterior cruciate ligament (ACL) injury in athletes and produced varying and inconclusive results. The objective of this study was to examine the role of playing surface on the incidence and risk of ACL injury in collegiate soccer athletes. Methods: The NCAA Injury Surveillance Program (ISP) database was queried for ACL injuries for male and female soccer players from the 2004-05 through the 2013-14 seasons at all levels of competition. The number of athlete exposures (AEs), defined as 1 athlete participating in 1 practice or competition in which they were exposed to the possibility of athletic injury, were recorded for grass and synthetic playing surfaces. Both the reported injuries and exposures provided were weighted in order to represent the entire NCAA collegiate soccer population. Normalized ACL incidence rates were calculated as well as 95% confidence intervals (95%CI). Rate ratios comparing competition type amongst both competition and practice were calculated. Results: ACL injuries were more common on grass surfaces (1.16 per 10,000 AEs, 95%CI 1.12-1.20) than artificial turf (0.92 per 10,000 AEs, 95%CI 0.84-1.04). This difference was statistically significant (IRR 1.26, p&lt;0.0001), and driven primarily by the difference in injury incidence during practice. The injury incidence during practice on natural grass (1.18 per 10,000 AEs, 95% CI 1.11-1.26) was significantly greater than the injury incidence rate during practice on artificial turf (0.067 per 10,000 AEs, 95%CI 0.043-0.096). Players were 17.7 times more likely (95%CI 10.6678-27.2187, p&lt;0.0001) to sustain an ACL injury during practice on natural grass when compared to practice on artificial turf. However, there was no significant difference in injury incidence during matches (IRR 0.96, p=0.44), with matches on natural grass (3.35 per 10,000 AEs, 95% CI 3.21-3.51) equivalent to matches on artificial surfaces (3.49 per 10,000 AEs, 95%CI 3.18-3.81). When comparing exposure type, the injury rate was significantly greater during matches (3.38 per 10,000 AEs, 95% CI 3.25-3.52) compared to practices (0.82 per 10,000 AEs, 95%CI 0.77-0.88), with a 4.10-fold increase in ACL injury incidence during matches compared to practice (p&lt;0.0001). Conclusion: Between 2004 and 2014, NCAA soccer players experienced a greater number of ACL injuries on natural grass playing surfaces compared with artificial turf playing surfaces. This difference is driven by injuries during practice, where athletes were nearly 18 times more likely to suffer an ACL injury on grass versus artificial turf. While ACL injuries were more likely during matches compared to practices, no difference in incidence was noted between playing surfaces. Additional study is warranted investigating potential causes for this observed increased risk with soccer practice on grass fields.