Extremity Musculoskeletal Injury Research Articles

Soulful Rhythm, Dancing Bodies: Spirituality, Pain Tolerance, and the Risk of Lower Extremity Musculoskeletal Injuries Among Classical Kathak Dancers of India

Background: Dance and dancers reflect happiness, sadness, passion, anger, and all other emotions as every single dancing movement carries a significant signal that goes beyond words. Kathak, an Indian classical dance form, requires a divine balance between the soul and the physical body. This balance allows for a high pain tolerance of the dancers, but the spiritual nature of this dance form also generates ignorance and disinterest in their health seeking behavior towards injuries. Objectives: This comprehensive narrative review is aimed at exploring and examining the prevalence of lower extremity musculoskeletal injuries among Kathak dancers and proposes management strategies for their prevention and treatment. Methods: This review is based on a search of relevant articles, research papers, books and book chapters conducted across a wide array of online sources, utilizing the search engines like PubMed, Medline, CrossRef; etc. Considering the inclusion criterion, the review process included three stages: initial assessment of papers through title and abstract review, a detailed examination of relevant items, and systematic compilation of pertinent information into a categorized table under topical headings. Results: The review finds that the majority of injuries were reported in the foot and ankle region of dancers practicing Kathak. Conclusion: There is a need to develop supplementary exercise training programs and also spread awareness among dancers regarding their physical health and seeking medical care in time to delay/prevent lower extremity injuries.

Soulful Rhythm, Dancing Bodies: Spirituality, Pain Tolerance, and the Risk of Lower Extremity Musculoskeletal Injuries Among Classical Kathak Dancers of India

Background: Dance and dancers reflect happiness, sadness, passion, anger, and all other emotions as every single dancing movement carries a significant signal that goes beyond words. Kathak, an Indian classical dance form, requires a divine balance between the soul and the physical body. This balance allows for a high pain tolerance of the dancers, but the spiritual nature of this dance form also generates ignorance and disinterest in their health seeking behavior towards injuries. Objectives: This comprehensive narrative review is aimed at exploring and examining the prevalence of lower extremity musculoskeletal injuries among Kathak dancers and proposes management strategies for their prevention and treatment. Methods: This review is based on a search of relevant articles, research papers, books and book chapters conducted across a wide array of online sources, utilizing the search engines like PubMed, Medline, CrossRef; etc. Considering the inclusion criterion, the review process included three stages: initial assessment of papers through title and abstract review, a detailed examination of relevant items, and systematic compilation of pertinent information into a categorized table under topical headings. Results: The review finds that the majority of injuries were reported in the foot and ankle region of dancers practicing Kathak. Conclusion: There is a need to develop supplementary exercise training programs and also spread awareness among dancers regarding their physical health and seeking medical care in time to delay/prevent lower extremity injuries.

A - 51 Examining the Role of Cognition in Lower Extremity Musculoskeletal Injury and Concussion Risk in Elite Athletes

A - 51 Examining the Role of Cognition in Lower Extremity Musculoskeletal Injury and Concussion Risk in Elite Athletes

Playing surface and sport contact status modulate time to lower extremity musculoskeletal injury at a greater level than concussion history among collegiate student-athletes

ObjectivesWhile previous investigations have demonstrated a positive correlation between previous concussion and risk of subsequent lower extremity musculoskeletal injury (LEMSKI), the effect of sport- and patient-specific factors on time to injury has not been thoroughly described. This study's main objective was to evaluate the relationship between prior concussion and time to LEMSKI among a population of collegiate student-athletes. Secondary objectives were to evaluate the relationship between playing surface, sport contact status, and biologic sex on time to LEMSKI. We hypothesized that those with previous concussions, those competing on synthetic surfaces, and those competing in collision sports would experience decreased latency to LEMSKI overall. MethodsA retrospective observational analysis of National Collegiate Athletic Association (NCAA) Division I student-athletes was conducted utilizing a mixed linear model analysis with contrasts. Inclusion criteria included participation in the Pac-12 Health Analytics Program with a documented LEMSKI between 2017 and 2020. Exclusion criteria included concurrent concussion and LEMSKI, injury resulting in serious morbidity or mortality, and incomplete medical record. Participants were classified by whether they sustained a concussion prior to LEMSKI in each athletic season. ResultsOf 1179 athletes included, 1140 had no previous concussion and 37 had a previous concussion. There was no observed effect of previous concussion (F ​= ​0.038; p ​= ​0.846) on time to LEMSKI overall. Student-athletes competing on constructed surfaces sustained a subsequent LEMSKI 14.5 days sooner (SE ​= ​5.255; p ​= ​0.045), and those competing on organic surfaces sustained a subsequent LEMSKI 23.5 days sooner (SE ​= ​4.018; p ​< ​0.001) in the season than those competing on synthetic surfaces. Contact sport student-athletes sustained a subsequent LEMSKI 52.1 days sooner than collision sport student-athletes (SE ​= ​5.248; p ​< ​0.001), and limited contact sport student-athletes sustained a subsequent LEMSKI 42.29 days sooner than collision sport student-athletes (SE ​= ​4.463; p ​< ​0.001). There was no observed effect of biologic sex (F ​= ​0.602; p ​= ​0.438) on time to LEMSKI overall. ConclusionThere was no observed impact of concussion on time on LEMSKI overall in this collegiate athletic population. Contact sports were associated with decreased time to LEMSK, while synthetic surfaces were associated with increased time to LEMSKI in this population. There was no observed impact of biologic sex on time to LEMSKI. Level of evidenceCase-control, level of evidence III.

Interrater Reliability of Performing a Step-by-Step Procedure for Selected Pain Provocation Tests for Hamstrings and Special Tests for Other Lower Extremity Musculoskeletal Injuries

Objective: Our study aims to establish interrater reliability in performing the step-by-step procedure of selected pain provocation tests for hamstrings and special tests for lower extremity musculoskeletal injuries. Study Design : An interrater reliability study Setting: University of Santo Tomas - Sports Science Laboratory Participants: Ten healthy adults (five females, five males; age = 22.2 ± 0.42) from the university community. Main Outcome Measures: Interrater reliability of performing step-by-step procedures for selected pain provocation tests for hamstrings (painful resisted knee flexion 90°, painful resisted knee flexion 30°, active slump test, Puranen-Orava Test, bent knee stretch) and special tests for lower extremity musculoskeletal injuries (Lachman’s test, McMurray’s test, posterior drawer test, valgus, and varus stress test). Results: Fleiss kappa showed perfect agreement (κ = 1.00) for all test procedures except for Lachman’s test procedure 1 (κ= -0.11 [95% CI, -0.36 to 0.14]), active slump test procedure 4 (κ= -0.03 [95% CI, -0.28 to 0.23]), active slump test procedure 5 (κ= -0.11 [95% CI, -0.28 to 0.23]), and active slump test procedure 6 (κ= -0.05 [95% CI, -0.31 to 0.20]), which resulted in negative agreements. Conclusions: The researcher developed protocols for each special and provocative test were consistent in measuring the intended procedures, and the raters were generally consistent with their ability to measure these tests. Keywords: Interrater reliability, special tests, pain provocation tests, lower extremity injuries

Modeling Risk for Lower Extremity Musculoskeletal Injury in U.S. Military Academy Cadet Basic Training.

Sport and tactical populations are often impacted by musculoskeletal injury. Many publications have highlighted that risk is correlated with multiple variables. There do not appear to be existing studies that have evaluated a predetermined combination of risk factors that provide a pragmatic model for application in tactical and/or sports settings. To develop and test the predictive capability of multivariable risk models of lower extremity musculoskeletal injury during cadet basic training at the U.S.Military Academy. Cadets from the class of 2022 served as the study population. Sex and injury history were collected by questionnaire. Body Mass Index (BMI) and aerobic fitness were calculated during testing in the first week of training. Movement screening was performed using the Landing Error Scoring System during week 1 and cadence was collected using an accelerometer worn throughout initial training. Kaplan-Meier survival curves estimated group differences in time to the first musculoskeletal injury during training. Cox regression was used to estimate hazard ratios (HRs) and Akaike Information Criterion (AIC) was used to compare model fit. Cox modeling using HRs indicated that the following variables were associated with injury risk : Sex, history of injury, Landing Error Scoring System Score Category, and Physical Fitness Test (PT) Run Score. When controlling for sex and history of injury, amodel including aerobic fitness and BMI outperformed the model including movement screening risk and cadence (AIC: 1068.56 vs. 1074.11) and a model containing all variables that were significant in the univariable analysis was the most precise (AIC: 1063.68). In addition to variables typically collected in this tactical setting (Injury History, BMI, and aerobic fitness), the inclusion of kinematic testing appears to enhance the precision of the risk identification model and will likely continue to be included in screening cadets at greater risk.

Cutaneous burn injury represents a major risk factor for the development of traumatic ectopic bone formation following blast-related extremity injury

Blast-related traumatic heterotopic ossification (tHO) impacts clinical outcomes in combat-injured patients, leading to delayed wound healing, inflammatory complications, and reduced quality of life. Blast injured patients often have significant burns. This study investigated whether a partial thickness thermal burn injury exacerbates blast-related tHO in a clinically relevant polytrauma animal model. Adult male Sprague Dawley rats were subjected to an established model involving a whole-body blast overpressure exposure (BOP), complex extremity trauma followed by hind limb amputation (CET) followed by the addition of a 10 % total body surface area (TBSA) second degree thermal burn (BU). Micro-CT scans on post-operative day 56 showed a significant increase in HO volume in the CET + BU as compared to the CET alone injury group (p < .0001; 22.83 ± 3.41 mm3 vs 4.84 ± 5.77 mm3). Additionally, CET + BU concomitant with BOP significantly increased HO (p < .0001; 34.95 ± 7.71 mm3) as compared to CET + BU alone, confirming BOP has a further synergistic effect. No HO was detectable in rats in the absence of CET. Serum analysis revealed similar significant elevated (p < .0001) levels of pro-inflammatory markers (Cxcl1 and Il6) at 6 h post-injury (hpi) in the CET + BU and BOP + CET + BU injury groups as compared to naïve baseline values. Real-time qPCR demonstrated similar levels of chondrogenic and osteogenic gene expression in muscle tissue at the site of injury at 168 hpi in both the CET + BU and BOP+CET + BU injury groups. These results support the hypothesis that a 10 % TBSA thermal burn markedly enhances tHO following acute musculoskeletal extremity injury in the presence and absence of blast overpressure. Furthermore, the influence of BOP on tHO cannot be accounted for either in regards to systemic inflammation induced from remote injury or inflammatory-osteo-chondrogenic expression changes local to the musculoskeletal trauma, suggesting that another mechanism beyond BOP and BU synergistic effects are at play. Therefore, these findings warrant future investigations to explore other mechanisms by which blast and burn influence tHO, and testing prophylactic measures to mitigate the local and systemic inflammatory effects of these injuries on development of HO.

OCCURRENCE OF LOWER EXTREMITY MUSCULOSKELETAL INJURIES DURING THE LOCKDOWN IN ATHLETES

OCCURRENCE OF LOWER EXTREMITY MUSCULOSKELETAL INJURIES DURING THE LOCKDOWN IN ATHLETES

Effect of barefoot exercises on dynamic balance in sub-elite marathon runners

Abstract Background: Runners who demonstrate poor balance performance are at a higher risk of lower extremity musculoskeletal injury. Barefoot running is hypothesized to improve joint proprioception and thereby enhance balance performance. However, the influence of barefoot weight-bearing exercise training on dynamic stability remains unexplored. Objectives: The current study explored the effect of barefoot exercise intervention on dynamic balance performance in sub-elite marathon runners. Settings and Design: The current experimental study was undertaken in the recreation parks of Navi Mumbai. Materials and Methods: Thirty runners (mean age = 40 years, BMI = 25.5 kg/m2) were randomly allocated to two groups. Dynamic balance was evaluated using the star excursion balance test, and agility was assessed using the agility t test at baseline and post 12 weeks of intervention. Runners in the experimental group performed balance exercises without shoes, whereas runners in the control group performed the same set of exercises with shoes on. Between-group comparison was performed using an independent t test and within-group comparison using a paired t test using SPSS Software version 23. The effect size was calculated using Cohen’s d statistic. Results: Both groups demonstrated improved dynamic balance in the posteromedial direction. The barefoot group demonstrated improved dynamic balance in the anterior and posterolateral directions as well, with a large effect size (P = 0.001, P = 0.001, and P = 0.001, respectively). Conclusion: Barefoot exercise training improved balance performance in sub-elite marathon runners. These exercises can be incorporated into conditioning programs to reduce the risk of musculoskeletal injuries in runners.

Trunk and lower extremity biomechanics differ between female athletes with and without a concussion history.

Athletes with a history of concussion are at a greater risk for lower extremity musculoskeletal injury. Female athletes may be at an even greater risk. Previous landing biomechanics research post-concussion has focused on the lower extremities, but the trunk plays a crucial role as an injury risk factor. To compare lower extremity and trunk biomechanics during jump landing and cutting maneuvers between female athletes with and without a concussion history. Cross-sectional. Biomechanics laboratory. Our study included 26 athletes with (age:19.0±1.3years, BMI:22.6±2.0kg/m2, time since most recent concussion: median=37.5 months [interquartile range (25.0, 65.8)]), and 38 athletes without (age:19.0±1.1years, BMI:22.1±1.8kg/m2) a concussion history. Peak kinetics (vertical ground reaction force, vertical loading rate, external knee abduction moment, external knee flexion moment) and kinematics (trunk flexion angle, trunk lateral bending angle, dorsiflexion angle, knee flexion angle, knee abduction angle, hip flexion angle) were obtained during the eccentric portion of the task. Separate 2 (group) × 2 (limb) between-within analyses of covariance compared outcomes between groups. We covaried for time since most recent concussion and limb which had a history of musculoskeletal injury. Athletes with a concussion history displayed a greater nondominant knee abduction angle compared to their dominant limb (p=0.010, np2=0.107) and athletes without a concussion history nondominant limb (p=0.023, np2=0.083) during the jump landing. Athletes with a concussion history displayed less trunk lateral bending during cutting compared with athletes without a concussion history (p=0.005, np2=0.126). Our results indicate landing biomechanics are different between female athletes with and without a concussion history. This may be due to impairments in neuromuscular control post-concussion which may ultimately increase the risk of subsequent lower extremity injury, although further research is warranted given the cross-sectional nature of our study.

Effects of short foot exercise on Q-angle in individuals with flatfoot

Background: Flatfoot is a predominant chronic condition associated with lower extremity musculoskeletal injuries. Current studies have illustrated that a flatfoot deformity may result in an increased Q-angle which can cause knee disorders. Short foot exercise (SFE) is a broadly acknowledged strategy for strengthening the intrinsic foot muscles. The exercise is recommended to be performed to improve the medial longitudinal arch (MLA). However, there is a lack of studies examining the effects of SFE on the Q-angle. Objectives: The primary purpose of this study was to investigate the effects of SFE on Q-angle in individuals with flatfoot. The second purpose was to examine the effects of SFE on the navicular drop test (NDT). Materials and methods: This randomized controlled trial study included 16 participants aged 18-25 years with flexible flatfoot on both feet based on the results of NDT. Q-angle and NDT were measured at the beginning of the study. The participants were randomly assigned to either the experimental or control groups. The experimental group performed SFE three days a week for five consecutive weeks, while the control group did not perform the exercise. Q-angle and NDT were reassessed after five weeks of the exercise. Results: Q-angle significantly decreased in the exercise group after the program for both legs (Right leg: from 21.62±1.87 to 19.83±1.63 degrees; Left leg: from 21.42±1.92 to 20.04±1.89 degrees). In addition, NDT significantly improved in the exercise group after SFE for both feet (Right foot: from 11.08±1.18 to 6.83±2.09 mm; Left foot: from 10.58±1.50 to 6.58±1.60 mm). Conclusion: This present study demonstrated that SFE effectively improved Q-angle and NDT in individuals with flexible flatfoot.

Reaction-time At Unrestricted Return To Activity Following Concussion Is Associated With Lower Extremity Musculoskeletal Injury

Reaction-time At Unrestricted Return To Activity Following Concussion Is Associated With Lower Extremity Musculoskeletal Injury

Poster 217: Changes in Dynamic Hip Muscle Moment Arms During Activities of Daily Living

Objectives: Hip muscle function is affected by surgical intervention and is of particular concern when considering post-operative rehabilitation of the joint1. However, little is known about the dynamic, in vivo function of the hip muscles during activities of daily living. Marker-based motion capture studies have associated dysplastic hip anatomy with shorter abductor moment arm lengths during walking2, but these measurements are complicated by soft tissue artifact3. Biplane radiography is a highly accurate technique for measuring in vivo bone motion of the hip4 and has recently been utilized to estimate dynamic muscle moment arms, which are important factors influencing force and torque capabilities. Previous research studies utilizing biplane radiography have identified shorter muscle lengths and moment arms in the implanted hip compared to the contralateral hip of individuals with total hip arthroplasty during the double support phase of gait2, but normative in vivo moment arms of the hip musculature in asymptomatic individuals have yet to be established. Further, it remains unknown how moment arms change between activities of daily living, particularly during deep flexion activities that challenge hip stability. Developing a normative dataset of dynamic in vivo moment arm lengths would provide a valuable reference for clinicians and physical therapists developing rehabilitation protocols to strengthen the hip musculature and increase stability. The objective of this study was to determine in vivo moment arms of the hip abductors, adductors, and external rotators during gait and squatting in a cohort of asymptomatic adults. We hypothesized that the maximum moment arm length during squatting would be longer than during walking and static standing. Methods: Young adults with no history of hip surgery, chronic hip pathology, or severe lower extremity musculoskeletal injury were recruited to participate in this IRB-approved study. Participants performed bodyweight squats and treadmill walking within a biplane radiography system while ground reaction forces were collected at 1000 Hz from a dual-belt instrumented treadmill. The support phase of gait was defined by vertical ground reaction forces over 50 N. Synchronized biplane radiographs were collected at 50 images per second to image three trials of each hip for each activity. Subject-specific bone models of the pelvis and proximal femur were created from computed tomography (CT) scans (average 0.37x0.3 mm in-plane resolution, 0.625mm slice thickness). Coordinate systems5 and muscle origin and insertion points for the gluteus medius (hip abductor), gluteus minimus (hip abductor), pectineus (hip adductor), and grouped external rotators1 were identified based upon bony landmarks on the 3D bone models (Figure 1). In-vivo bone motion during each activity was determined by matching digitally reconstructed radiographs, created from the CT-based bone models, to the biplane radiographs using a registration process with a validated accuracy4 of 0.3mm. The line of action for each muscle segment was determined for each frame of the biplane radiographs as the vector from the muscle origin to the insertion. Moment arm length (MAL) was calculated for each frame of the dynamic biplane radiographs as the perpendicular distance between the hip joint center (acetabulum center) and the line of action of each muscle1 and interpolated to gait cycle for walking or percent maximum hip flexion during squatting. Differences between the maximum MAL during static standing, walking, and squatting were assessed within each muscle group using ANOVA with post-hoc pairwise comparisons performed as necessary. Results: Data from 186 trials of 43 hips from 22 individuals were included in the analysis (9M, 13F; mean age 22.0±2.2years; BMI 21.3±5.2kg/m2). Average walking velocity was 1.0±0.2m/s and the average maximum hip flexion during squatting was 101.6±16.1°. Average static standing MAL was greatest in the gluteus medius and smallest in the pectineus (Table 1). Maximum MAL was significantly different between all activities for all muscle groups (all p&lt;0.001) (Table 1, Figure 2). Contrary to our hypothesis, moment arms of the abductors were smaller during squatting compared to other motions. Conclusions: This study demonstrates the in vivo torque generating capabilities of muscles surrounding the hip (reflected by their moment arm) change considerably from the standing position to positions encountered during active functional motions. Muscles involved in hip abduction and stabilization have less mechanical advantage at greater hip flexion, highlighting the importance of strengthening these muscle groups during rehabilitation. Specifically, moment arms of the hip abductors and external rotators are shorter during walking and squatting compared to standing, while moment arms of the adductors are shorter during walking and greater during squatting and standing. Knowledge of these postural changes in mechanical advantage can be useful when designing targeted rehabilitation protocols to strengthen the hip musculature and improve stability. Further research into relationships between dynamic in vivo hip muscle moment arms and lengths will yield additional insight into force and torque generating capacity of muscles during activities of daily living. These results are limited to treadmill walking and bodyweight squatting in asymptomatic young adults.

Risk of Upper Extremity Musculoskeletal Injury Within the First Year After a Concussion.

Emerging evidence suggests that athletes and military personnel are at increased risk for lower extremity musculoskeletal injury after a concussion; however, the association between concussion and subsequent upper extremity (UE) musculoskeletal injury is unknown. To prospectively examine the association between concussion and UE musculoskeletal injury risk within the first year after returning to unrestricted activity. Cohort study; Level of evidence, 3. A total of 316 cases of concussion 42% (132/316 women) were observed among 5660 Concussion Assessment, Research and Education Consortium participants at the United States Military Academy from May 2015 to June 2018. Active injury surveillance within the cohort was conducted for 12 months after unrestricted return to activity to identify any incident cases of acute UE musculoskeletal injury. Injury surveillance during the follow-up period was also conducted for nonconcussed controls who were matched by sex and competitive sport level. Univariate and multivariable Cox proportional hazards regression models were used to estimate hazard ratios between concussed cases and nonconcussed controls for time to UE musculoskeletal injury. During the surveillance period, 19.3% of concussed cases and 9.2% of nonconcussed controls sustained a UE injury. In the univariate model, concussed cases were 2.25 times (95% CI, 1.45-3.51) more likely to sustain a UE injury during the 12-month follow-up period when compared with the nonconcussed controls. In the multivariable model, adjusted for history of concussion, sport level, somatization, and history of UE injury, concussed cases were 1.84 times (95% CI, 1.10-3.07) more likely to sustain a UE injury during the surveillance period compared with nonconcussed controls. Sport level remained an independent risk factor for UE musculoskeletal injury; however, concussion history, somatization, and history of UE injury were not independent risk factors. Concussed cases were more than twice as likely to sustain an acute UE musculoskeletal injury within the first 12 months after unrestricted return to activity when compared with nonconcussed controls. The higher hazard of injury remained in the concussed group after adjusting for other potential risk factors.

Clinical Mental Health Measures and Prediction of Postconcussion Musculoskeletal Injury.

The rate of lower extremity musculoskeletal injury (LE MSK) is elevated after concussion; however, the underlying mechanism has not been elucidated. Physical characteristics have been investigated despite poorer mental health being a common postconcussion complaint and linked to MSKs. To evaluate the role of mental health as a predictor of postconcussion LE MSK. Case-control study. Intercollegiate athletic training facility. A total of 67 National Collegiate Athletic Association Division I student-athletes (n = 39 females) who had been diagnosed with a sport-related concussion. The Brief Symptom Inventory-18, Hospital Anxiety and Depression Scale, and Satisfaction With Life Scale (SWLS) measures were completed at baseline (preseason) and on the day participants were cleared for unrestricted return to play (RTP) after a concussion. Two binary logistic regressions were used to predict postconcussion LE MSK within a year, one for the baseline time point and the second for the RTP time point. A 2 (group: LE MSK, no LE MSK)-by-2 (time: baseline, RTP) repeated-measures analysis of variance compared performance between baseline and RTP. Subsequent LE MSKs were sustained by 44 participants (65.7%). The only significant predictor of postconcussion LE MSK was the SWLS score at RTP, with Exp(B) = 0.64, indicating that an increased (improved) SWLS score was associated with a lower LE MSK rate. No significant interactions were present between mental health measures and subsequent MSK (P values = .105-.885). Limited associations were evident between postconcussion LE MSK and scores on commonly used measures of anxiety, depression, and satisfaction with life. Reported increased satisfaction with life was associated with a decreased injury risk, which warrants further attention. Our results suggest that these measures of anxiety, depression, and satisfaction with life have limited value in assisting sports medicine clinicians with determining which student-athletes are at elevated risk of postconcussion LE MSK.

Risk of Lower Extremity Ligamentous Injury Following Concussion Diagnosis: A TriNetX Database Study.

Background Concussion is one of the most frequently reportedsports-related injuries in the United States; there is evidence that residual deficits in neurocognition may increase the risk of lower extremity musculoskeletal injury after concussion in high school, college, and professional athletes. The purpose of this study is to identify whether similar trends are identified in community-based populations. Methods The TriNetX Research Network database was queried for patients 10-60 years old who experienced an ambulatory or emergency visit from 2018-2020. Cohorts were defined by patients seen for concussion and patients seen for other reasons. These cohorts were then propensity score matched based on significant differences in demographics; after matching, each cohort included 97,708 patients. The propensity score-matched cohorts were then evaluated to identify patients who experienced subsequent lower extremity ligamentous injury within 12 months. Results Patients with a history of concussion were more likely to experience posterior cruciate ligament (PCL) sprain (0.04% vs. 0.02%, risk ratio (RR)=1.79, p=.039), medial collateral ligament (MCL) sprain (0.18% vs. 0.08%, RR=2.355, p<.001), lateral collateral ligament (LCL) sprain (0.05% vs. 0.02%, RR=2.202, p=.003) and ankle sprain (1.05% vs. 0.47%, RR=2.265, p<.001). Conclusion Patients diagnosed with concussion were more likely to experience a lower extremity ligamentous injury when compared with patients who did not have concussion. Patients should be counseled regarding this increased risk and additional neuromuscular evaluation and injury prevention education may be indicated following concussion diagnosis.

Upper Extremity Musculoskeletal Injuries Presenting to an Emergency Department Before and During the Initial COVID-19 Pandemic Surge.

The SARS-CoV-2 (COVID-19) pandemic significantly impacted emergency department volume and acuity. The Delta and Omicron variants contributed to additional surges. We describe the impact that the initial pandemic phase had on frequency and severity of typically non-life-threatening emergencies using upper extremity injuries as a model for other potentially emergent presentation as compared to pre-pandemic times. We do this using the epidemiology of pre-defined significant upper extremity injuries at our facility as a specific example of what occurred at an urban trauma center. We conducted a comparison of two 6-month periods: between March 2019 and August 2019 (prior to COVID-19) and between March 2020 and August 2020 after the onset of the initial COVID-19 wave. We performed a retrospective chart review of patients who presented with upper extremity injury chief complaints using analysis of the electronic medical record at a single urban tertiary care trauma center in the Midwestern United States. We investigated examination findings, imaging, frequency of surgical procedures and final diagnosis. In the 2019 study period, there were 31,157 ED patients, including 429 with upper extremity injuries, of which 108 patients had significant injuries. In the 2020 study period, there were 24,295 patient presentations, of which 118 of 296 upper extremity presentations were significant. We a priori defined significant injury as follows: fractures, dislocations, neurovascular injuries, or need for operative intervention within 24 hours of ED presentation. Specifically, 25.2% of injuries were significant pre-COVID-19 and 39.9% (p < 0.001) during the initial COVID-19 surge. The absolute number and percentage of significant injuries increased from pre-COVID-19 compared to the initial COVID-19 surge despite an overall 22% decrease in total patient volume. The incidence of significant upper extremity musculoskeletal injuries increased during the pandemic even though the overall number of ED presentations for upper extremity musculoskeletal injuries decreased.

Reactive postural responses predict risk for acute musculoskeletal injury in collegiate athletes.

Examine if objective assessments of reactive postural responses, quantified using wearable inertial measurement units, are associated with the risk for acute lower extremity musculoskeletal injuries in collegiate athletes. Prospective survival analysis. 191 Division I National Collegiate Athletic Association athletes completed an instrumented version of a modified Push and Release (I-mP&R) test at the beginning of their competitive season. The I-mP&R was performed with eyes closed under single- and dual-task (concurrent cognitive task) conditions. Inertial measurement units recorded acceleration and angular velocity data that was used to calculate time-to-stability. Acute lower extremity musculoskeletal injuries were tracked from first team activity for six months. Cox proportional hazard models were used to determine if longer times to stability were associated with faster time to injury. Longer time-to-stability was associated with increased risk of injury; every 250 ms increase in dual-task median time-to-stability was associated with a 36% increased risk of acute, lower-extremity musculoskeletal injury. Tests of reactive balance, particularly under dual-task conditions, may be able to identify athletes most at risk of acute lower extremity musculoskeletal injury. Clinically-feasible, instrumented tests of reactive should be considered in assessments for prediction and mitigation of musculoskeletal injury in collegiate athletes.

Lower Extremity Musculoskeletal Injuries After Concussion in Collegiate Student-Athletes

Background: An association has been identified between concussion and lower extremity musculoskeletal injury (LEMSKI) after return to sports participation. However, the collegiate student-athlete studies have relied on relatively small single-institution studies, which limits generalizability. Purpose: To assess odds of, and time to, LEMSKI after concussion in US collegiate athletes, using the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP). Study Design: Descriptive epidemiology study. Methods: Data from the NCAA ISP during the 2010-2011 through 2019-2020 athletic seasons were considered for analysis. Frequency distributions were examined for details related to the initial and subsequent injuries (injuries to bone, bursa, joint, ligament, muscle, or tendon). Multivariable logistic regression models and random-effects Poisson regression models examined odds of time loss (TL) and non–time loss (NTL) LEMSKI after concussion, as well as the time interval between initial concussion and subsequent LEMSKI in a single athletic season, or initial musculoskeletal injury (MSKI) and subsequent LEMSKI in a single athletic season. Analyses were performed separately for football and other sports. Results: A total of 31,556 initial injuries were recorded (football: 11,900; other sports: 19,656), which were followed by 0 or 1 injury in the same season. Overall, first injury type was not a significant predictor of subsequent LEMSKI, although certain contrasts yielded significant estimates. In football, the odds of NTL LEMSKI were higher after concussion than after upper extremity MSKI (UEMSKI; adjusted odds ratio [ORAdj], 1.56; 95% CI, 1.06-2.31). In football, the odds of TL LEMSKI were lower after concussion than after UEMSKI (ORAdj, 0.71; 95% CI, 0.51-0.99). No other significant effect estimates were observed for football or other sports. Conclusion: First injury type, either concussion or upper extremity, was not associated with an elevated risk of LEMSKI. Specifically, the results of this study did not identify an elevated odds of LEMSKI after a concussion. However, the authors observed greater odds of NTL LEMSKI and lower odds of TL LEMSKI in football.

Mild Quadriceps and Hamstring Strength Deficits Do Not Persist After Sport-Related Concussion.

Risk for lower extremity musculoskeletal injury increases after sport-related concussion (SRC) and may result from unresolved motor control deficits. Muscle weakness is a deficit that could contribute to musculoskeletal injury risk. Athletes with SRC will demonstrate quadriceps and hamstring muscle weakness at the time of return to sport and 30 days later compared with controls. Prospective matched cohort. Level 3. A total of 31 athletes with SRC (CONCUSSION) were matched by sex, age, and activity level to controls (CONTROL). Testing was conducted at initial assessment and 30 days later; initial assessment in CONCUSSION occurred when cleared for return to play. Isokinetic testing assessed quadriceps and hamstring strength of the dominant and nondominant legs at 60 and 180 deg/s. Peak torque values were normalized to body mass (N-m/kg). Data were analyzed with repeated measures general linear models (group × time), and effect sizes were calculated. Analysis at 60 deg/s included 26 matched pairs (15 male per group) and at 180 deg/s included 30 matched pairs (17 males per group). Time from concussion to initial assessment was 21.3 (7.8) mean (standard deviation) days. No significant interactions or main effects were detected (P > 0.05). Across muscle groups, legs, and testing speeds, effect sizes at initial assessment were small (d = 0.117 to 0.353), equating to a strength deficit in CONCUSSION of 0.04 to 0.18 N-m/kg, and effect sizes were further reduced at 30-day follow-up (d = -0.191 to 0.252). In athletes with SRC, quadriceps and hamstring strength were decreased only minimally at return to play compared with controls and the difference lessened over 30 days. Strength deficits may not be a major contributor to increased lower extremity musculoskeletal injury risk after SRC. Strength training could be implemented before return to play after SRC to mitigate any strength deficits.