In-season Injury Research Articles

Sleep Disturbances and Risk of Sports Injury Among Collegiate Student-Athletes.

The purpose of this study was to examine the relationship between collegiate student-athletes' sleep and injury status. This study was a secondary analysis of observational survey data of student-athletes collected across 2 time periods, October 2020 and January 2021. Data were collected as part of an ongoing national (USA) longitudinal survey investigating student-athletes' well-being in the aftermath of the COVID-19 pandemic. Participants were made-up of a subsample of participants from the parent study. Data from 89 exact matched pairs (across 5 demographics) of injured and noninjured student-athletes (68.5% NCAA Division I, 82.0% women) were assessed. Student-athletes' sleep disturbance levels were the primary independent variable of interest. Analytic models also covaried for gender, racial, and ethnic identities, sport in-seasons, and previous injury status. Participant endorsed injury status was the main outcome measure of interest. Hypotheses were formulated during the data collection of the parent study. Student-athletes injured in January 2021 reported higher average sleep disturbances in both October 2020 and January 2021 than noninjured student-athletes but not student-athletes injured in October. In addition, October 2020 sleep disturbances were a significant predictor (P = 0.007) of injury, such that odds of student-athletes being injured increased 1.07 times for each unit increase in their sleep disturbances controlling for their identities, sport in-season, and previous injury status. Findings signal support for the screening and targeting of student-athletes' sleep problems to reduce potential occurrences of sports-related injuries in student-athletes.

Epidemiology of Hamstring Strain Injuries in Elite Male Australian Football Players: An Analysis of 773 Injuries Over 7 Seasons

OBJECTIVE: To describe the incidence, recurrence, and time loss until achievement of recovery milestones of hamstring strain injuries (HSIs) across 7 playing seasons using data from the Soft Tissue Injury Registry of the Australian Football League (STRAFL). STUDY DESIGN: Descriptive epidemiology study. METHODS: Eighteen AFL teams participated in the STRAFL in at least 1 season between 2014 and 2020 (average 15.7 teams per season). Details of each clinically diagnosed HSI were recorded on a standardized injury surveillance form by medical staff. RESULTS: 773 HSIs from 424 different players were reported, with each team averaging 7 HSIs per season. Of all in-season injuries, 72% occurred during competitive games. The biceps femoris was most commonly injured (84%) followed by the semimembranosus (11%). Recurrent HSIs accounted for 26% of all injuries, with 52% occurring within 2 months of the index injury. The majority (93%) of recurrent injuries were to the biceps femoris. Return to play was 30 ± 19 days for index injuries and 36 ± 22 days for recurrent injuries. CONCLUSIONS: An average of 7 HSIs per season per club were sustained, including a recurrence of 26%, with most injuries occurring within in-season competitive games. The biceps femoris took longer than the medial hamstrings to reach recovery milestones of running at >90% top speed, return to full training, and return to play. JOSPT Open 2024;2(4):289-296. Epub 15 July 2024. doi:10.2519/josptopen.2024.0359

Predictive Value of the KOJI AWARENESS Self-Evaluation System for Running Injuries in Elite Male Long-Distance Runners: A Prospective Cohort Study.

The KOJI AWARENESS (KA) test is a practical self-evaluation tool that assesses body movements and may help develop individual conditioning plans to improve movement function. However, the association between preseason KA scores and in-season injury occurrence remains unexplored. To investigate whether the KA self-screening test score can predict running-related injuries in elite long-distance runners. Cohort study; Level of evidence, 2. A total of 47 elite college male long-distance runners (age, 18-22 years) were enrolled in this study in June 2022. The participants underwent the KA self-screening test to assess preseason upper limb, core, and lower limb function. Running-related injuries with a training time loss of >3 weeks were tracked for 6 months during the season. The participants were divided into injury and noninjury groups, and between-group comparisons and receiver operating characteristic (ROC) curve analysis were used to determine the association between the KA scores and the injury incidence. Chi-square tests and risk ratios were calculated based on the cutoff value- and injury-based grouping. Among the runners, 10 (21.3%) sustained an injury. There were no significant differences in the demographic characteristics between the injury and noninjury groups. The injury group had significantly lower KA scores than the noninjury group (median, 44.5 [interquartile range, 43-46.8] vs median, 48 [interquartile range, 46-50], respectively; P = .009). The ROC curve analysis determined a cutoff value of 46.5 points (sensitivity, 73%; specificity, 63.6%), indicating that the KA scores exhibited a relatively high predictive value for running-related injuries (area under the ROC curve, 0.764 [95% CI, 0.600-0.930]). The risk ratio for group division based on the cutoff value was 2.590 (95% CI, 1.329-5.047). These findings demonstrated that the KA test is an effective self-screening tool for predicting the risk of running-related injuries in elite male long-distance runners.

Hamstring Strain Injury Risk Factors in Australian Football Change over the Course of the Season.

This study aimed to determine which factors were most predictive of hamstring strain injury (HSI) during different stages of the competition in professional Australian Football. Across two competitive seasons, eccentric knee flexor strength and biceps femoris long head architecture of 311 Australian Football players (455 player seasons) were assessed at the start and end of preseason and in the middle of the competitive season. Details of any prospective HSI were collated by medical staff of participating teams. Multiple logistic regression models were built to identify important risk factors for HSI at the different time points across the season. There were 16, 33, and 21 new HSIs reported in preseason, early in-season, and late in-season, respectively, across two competitive seasons. Multivariate logistic regression and recursive feature selection revealed that risk factors were different for preseason, early in-season, and late in-season HSIs. A combination of previous HSI, age, height, and muscle thickness were most associated with preseason injuries (median area under the curve [AUC], 0.83). Pennation angle and fascicle length had the strongest association with early in-season injuries (median AUC, 0.86). None of the input variables were associated with late in-season injuries (median AUC, 0.46). The identification of early in-season HSI and late in-season HSI was not improved by the magnitude of change of data across preseason (median AUC, 0.67). Risk factors associated with prospective HSI were different across the season in Australian Rules Football, with nonmodifiable factors (previous HSI, age, and height) mostly associated with preseason injuries. Early in-season HSI were associated with modifiable factors, notably biceps femoris long head architectural measures. The prediction of in-season HSI was not improved by assessing the magnitude of change in data across preseason.

Higher age and present injury at the start of the season are risk factors for in-season injury in amateur male and female football players—a prospective cohort study

PurposeTo describe the injury prevalence, injury pattern, and potential baseline risk factors for injuries in male and female adolescent and adult amateur football players.MethodsThis prospective study followed adolescent and adult amateur football players over one season March–October 2020. The study was completed by 462 players (130 men, age 20.0 ± 5.7, 14–46 years) who answered a baseline survey and a weekly web survey during the season. A total of 1456 weekly surveys were registered from males and 5041 from females. Injuries were recorded with the Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC-O2). Potential baseline risk factors (age, performance of strength/conditioning training, participation in other sports, perceived importance of sporting success, self-rated training and match load, perceived balance between training/match load and recovery, previous/present injury at start of season, and injury beliefs) and their association with injury were analysed with Poisson regressions within each sex.ResultsMales reported 95 injuries (262 injury weeks, weekly prevalence 18.0% (95% CI 16.1–20.1)) and females 350 injuries (1206 injury weeks, weekly prevalence 23.9% (95% CI 22.8–25.1)). Gradual-onset injuries accounted for 57% of the injuries in males and 66% in females. For males, substantial injuries were most common in the hip/groin (weekly prevalence 3.8%), ankle (2.1%), posterior thigh (2.0%), and knee (2.0%); and for females, in the knee (4.3%), ankle (2.5%), and lower leg/Achilles tendon (2.0%). Significant risk factors for injury were higher age (rate ratio males 1.05 per year increase (95% CI 1.02–1.08), females 1.03 (95% CI 1.01–1.05)), and present injury at baseline (males 1.92 (95% CI 1.27–2.89), females 1.58 (95% CI 1.19–2.09)).ConclusionAt any given week, almost one in five male and one in four female amateur football players reported new or ongoing injuries. Hip/groin injuries were more frequent in males, while female players had a higher prevalence of knee injuries. Older players and those with an existing injury at the start of the season were more prone to new injury during the season. Rehabilitation of pre-season injury and complaints are key to reduce the injury burden in amateur football.Level of evidenceLevel II.Trial registration number NCT04272047, Clinical trials

Poster 382: A Multi-Center Epidemiologic Analysis of the Injuries Affecting Female and Male Collegiate Basketball Players

Objectives: Basketball is a high-intensity sport associated with acute and overuse injuries in both females and males. With the growing popularity of basketball at all levels domestically and globally, there has been an increased emphasis in understanding the injury patterns of these athletes. A large proportion of the current literature on basketball injuries utilize publicly available websites to obtain medical data. Thus, there is a need for prospectively collected data from healthcare professionals as it pertains to basketball injuries. By utilizing a conference-specific injury database, this study sought to characterize the types of injuries affecting elite intercollegiate female and male basketball players. Upon establishing commonly recognized injury patterns as well as associated return to sport data, this study can potentially help guide prevention and treatment protocols. Methods: A blinded conference-specific injury database was utilized to perform a retrospective review of injuries for male and female Division I collegiate basketball players from 2017 to 2021. Analysis included musculoskeletal injuries stratified by anatomic location, gender, time missed and injury diagnosis. Time missed was categorized as no time away from sport, less than three weeks away from sport and more than three weeks away from sport. “Estimated athlete risk per year” was used as a surrogate for risk per athlete-year since observation periods were not known for each individual athlete due to the data being blinded. On average, athletes were followed for 2.3 years, which assumes an equal number of freshmen, sophomores, juniors, and seniors per year and no athletes transferring/quitting. To estimate athlete exposure hours (AEH), total season length in weeks was multiplied by 20 hours per week as this is the maximum duration of sport-related activity according to the National Collegiate Athletic Association bylaws. Team rosters as well as season start and end dates were obtained from publicly available schedules on the Pac-12 website. Injury rate (IR) per 1000 AEHs was calculated by the following formula: IR per 1000 AEH= [(Number of total in-season injuries) / (Season length in weeks * 20 hrs / week * number of athletes on the team)] * 1000. Relative risk (RR) was used to compare estimated athlete risk per year between genders with statistical significance being defined by a 95% confidence interval (CI) not including one (p < 0.05). Results: A total of 663 college basketball players out of 853 (77.7%) suffered 4532 total injuries. Significantly more females suffered an injury (314 out of 360, 87.2%) when compared to males (349 of 493, 70.8%; RR: 1.23 [95% CI: 1.15 - 1.32]). The most common injuries across genders were ankle and hindfoot injuries accounting for 1007 out of 4532 (22.2%), knee injuries accounting for 750 injuries (16.5%), head/face injuries accounting for 532 injuries (11.7%), forefoot injuries accounting for 446 injuries (9.8%) and hand/wrist/forearm injuries accounting for 359 injuries (7.9%). Women were significantly more likely to suffer a knee injury (RR: 1.49 [95% CI: 1.27-1.75]), a head/face injury (RR: 1.32 [95% CI: 1.09-1.60]) or a midfoot/forefoot injury (RR: 1.42 [95% CI: 1.14-1.76]) (Table 1). Although ankle sprains were the most common injury, 259 ankle sprains out of 660 (39.2%) did not result in any time away from sport and 306 ankle sprains (46.4%) resulted in time away from sport but less than three weeks. One hundred and ninety-one concussions affected 146 out of 853 athletes (17.1%). Eighty-two out of 360 female athletes (22.8%) suffered a concussion as compared to 64 out of 493 male athletes (13.0%; RR: 1.23, [95% CI: 1.15-1.32]). Return to sport data was not specified for 22 out of 191 concussions. Of the remaining 169 concussions, 17 (10.1%) resulted in more than three weeks away from sport (Table 2). Conclusions: Lower extremity injuries were expectedly the most common injuries seen in both male and female basketball players, however these injuries did not result in substantial periods of missed playing time. Most current injury prevention strategies and proprioceptive training exercises focus on the lower extremity, with the ankles in particular. The current study, however, demonstrates that basketball players suffer from a variety of injuries suggesting that injury prevention techniques should be expanded to include all areas of the body. Females suffered significantly more injuries than males. Specifically, females suffered more knee injuries, head/face injuries, midfoot/forefoot injuries and concussions. Variations in anatomy, muscle strength and proprioceptive patterns are all possible rationales for this increased injury rate in females, however the definitive rationale is not completely understood. One additional possible rationale is that psychosocial factors have been shown to cause males to underreport symptoms. Understanding the injury patterns and the prognoses of such injuries can help physicians guide the expectations of these athletes, optimize the patient-athlete relationship and ultimately keep our collegiate basketball players safe. [Table: see text][Table: see text]

Influence of Heliothinae (Lepidoptera: Noctuidae) pests on cotton yield components across a range of planting dates in the southeastern USA

Because of H. zea resistance to Bt toxins, there is renewed interest in cotton IPM, including adjusting planting date. Later planted crops often receive more damage or support larger populations of Heliothinae pests, but this has not been well-documented in cotton. We explored the effects of planting date relative to Heliothinae pests in cotton across various planting windows in the southeastern USA during 2020 and 2021. In-season injury, plant mapping, box mapping, and yield were assessed. In 2021, these planting dates were split with a protective insecticide. Peak boll injury by Heliothinae larvae was not different by planting date and insecticide sprays were usually effective to minimize injury. In general, there were more bolls in position one. Boll retention was usually similar across positions, but was sometimes higher in the lower positions. Bolls that contributed the most to yield tended to be in position one or monopodia bolls, and the yield contribution tended to decrease as boll position increased. As planting date progressed, the highest percent contribution to yield tended to be on lower nodes in the plant. Yields tended to be higher in the early and middle planting dates and were higher in insecticide sprayed plots when the economic threshold was exceeded. We found clear evidence for plant compensation from H. zea feeding in one trial. Planting date relative to Heliothinae pressure level was negligible, given the plant's ability to compensate and the extended window reproductive tissue was available in earlier planting dates relative to later planting dates.

Preseason lower extremity range of motion, flexibility, and strength in relation to in-season injuries in NCAA division I gymnasts

ABSTRACT Objectives To determine if preseason lower extremity ROM, flexibility, and strength differ in collegiate gymnasts (NCAA Division 1) who do or do not sustain an injury during the competitive season. Methods Over four seasons, a total of 15 female gymnasts (age = 20.5 ± 1.0 years) underwent preseason screening (30 gymnast-season). We tested joint ROM (hip: flexion, internal and external rotation; ankle: weightbearing dorsiflexion), muscle flexibility (passive straight leg raise, Thomas,’ Ober’s, Ely’s tests) and strength (hip extensors, abductors, and flexors isometric strength via a handheld dynamometer; knee: quadriceps and hamstring isokinetic strength at 60°/sec). The team athletic trainer tracked overuse lower extremity injuries (restricted gymnasts from full participation, occurred as from participation in organized practice or competition, and required medical attention) during each season. For athletes that tested multiple seasons, each encounter was considered independent, and each preseason assessment was linked to overuse injuries sustained during the same competitive season. Gymnasts were dichotomized into injured and non-injured groups. An independent t-test was used to measure differences in preseason outcomes between injured and non-injured groups. Results During four years, we recorded 23 overuse lower extremity injuries. Gymnasts that sustained an in-season overuse injury demonstrated significantly lower hip flexion ROM (mean difference: −10.6°; 95% confidence interval: −16.5, −4.6; p < 0.01) and lower hip abduction strength (mean difference: −4.7% of body weight; 95% confidence interval: −9.2, −0.3; p = 0.04). Conclusion Gymnasts who sustain an in-season overuse lower extremity injury have significant preseason deficit of hip flexion ROM and weakness in the hip abductors. These findings indicate potential impairments in the kinematic & kinetic chains responsible for skill performance and energy absorption during landing.

Low Pre-Season Hamstring-to-Quadriceps Strength Ratio Identified in Players Who Further Sustained In-Season Hamstring Strain Injuries: A Retrospective Study from a Brazilian Serie A Team

A common pre-season injury prevention assessment conducted by professional football clubs is the hamstring-to-quadriceps (H:Q) strength ratio calculated by peak torque (PT). However, it is debatable whether players that present low pre-season H:Q ratios are more susceptible to further sustaining in-season hamstring strain injuries (HSI). Based upon retrospective data from a Brazilian Serie A football squad, a particular season came to our attention as ten out of seventeen (~59%) professional male football players sustained HSI. Therefore, we examined the pre-season H:Q ratios of these players. H:Q conventional (CR) and functional (FR) ratios, and the respective knee extensor/flexor PT from the limbs of players further sustaining in-season HSI (injured players, IP) were compared to the proportional number of dominant/non-dominant limbs from uninjured players (UP) in the squad. FR and CR were ~18-22% lower (p < 0.01), whereas quadriceps concentric PT was ~25% greater for IP than UP (p = 0.002). Low scores of FR and CR were correlated (p < 0.01) with high levels of quadriceps concentric PT (r = -0.66 to -0.77). In conclusion, players who sustained in-season HSI had lower pre-season FR and CR compared to UP, which appears to be associated with higher levels of quadriceps concentric torque than hamstring concentric or eccentric torque.

Noncontact Injury Distribution and Relationship With Preseason Training Load and Nonmodifiable Risk Factors in Rugby Union Players Across Multiple Seasons.

Evans, SL, Whittaker, G, Elphinstone Davis, E, Jones, ES, Hardy, J, and Owen, JA. Noncontact injury distribution and relationship with preseason training load and non-modifiable risk factors in Rugby Union players across multiple seasons. J Strength Cond Res 37(7): 1456-1462, 2023-This study examined the distribution of noncontact injury during phases of the competitive season and the association between preseason training load (TL) and nonmodifiable risk factors on injury risk during these phases. Injury data were recorded from 1 senior academy team over 3 seasons (2017-2020) and analyzed across early-season, midseason, and late-season phases. A generalized estimating equation was used to model risk factors with noncontact injury for selected phases. The highest noncontact injury incidence occurred in the late-season phase (22.2 per 1,000 hours) compared with early (13.7 per 1,000 hours, p < 0.001) and midseason phases (15.5 per 1,000 hours, p = 0.001). Low preseason TL (8,949-12,589 arbitrary units; odds ratio [OR], 95% confidence interval [CI] = 4.7, 1.0-21.6; p = 0.04) and low preseason TL combined with high early-season TL and injury in the early-season phase (OR, 95% CI = 6.5, 1.1-35.5; p = 0.03) were associated with greater midseason noncontact injury risk. In addition, low preseason TL combined with previous injury was associated with increased risk of noncontact injury risk in the late season (OR, 95% CI = 12.2, 0.9-15.6, p = 0.05). Our results suggest players are at a greater injury risk during the late-season phase, with low preseason cumulative loads combined with a history of previous injury associated with increased in-season injury risk. Strength and conditioning coaches should therefore monitor cumulative preseason TL alongside screening for previous injury history to identify athletes at greater risk of noncontact injury risk during the competitive season.

Preseason Body Composition Is Associated With In-season Player Availability in Elite Male Australian Footballers.

McCaskie, CJ, Sim, M, Newton, RU, Heasman, J, Rogalski, B, and Hart, NH. Preseason body composition is associated with in-season player availability in elite male Australian footballers. J Strength Cond Res 37(5): 1089-1095, 2023-The purpose of this study was to examine whether end of preseason body composition characteristics was associated with in-season match availability and injury. Sixty ( n = 60) elite Australian football players had body composition characteristics assessed using dual-energy X-ray absorptiometry across 3 seasons (2016, 2018, and 2021). Match availability and injury were recorded throughout each season. Pearson's correlations were calculated to assess the associations between body composition and in-season match availability and injury. Logistic regression models were used to assess the odds of missing games as a result of injury throughout a season. Regional lean soft tissue mass asymmetry and its relationship to injury and availability was explored. Statistical significance was set at p ≤ 0.05. Body composition characteristics expressed as relative values seemed to be more highly associated with in-season availability and injury than characteristics expressed as absolute values. Players with lower relative fat mass (FM) (<12.1% total body FM) were available for 89.7% of in-season matches compared with 80.7% for players with higher relative FM (>12.1% total body FM). Subsequently, players with higher relative FM had 3.3-3.5 times greater odds of missing one game to injury (odds ratio [OR] = 3.33; 95% confidence interval [CI] = 1.00-11.14; p ≤ 0.05) and missing 2 or more games to injury (OR = 3.50; 95% CI = 1.20-10.20; p ≤ 0.05) throughout a season compared with players with lower relative FM. Higher proportions of fat mass may accelerate the onset of fatigue and place players at a greater risk of injury. Reducing players' FM across the preseason phase should be a key aim for practitioners to reduce the odds of injury throughout the competitive season.

Relationship of Pre-Season Strength Asymmetries, Flexibility and Aerobic Capacity with In-Season Lower Body Injuries in Soccer Players

The present study aimed to assess the differences in pre-season knee strength asymmetries, flexibility, and aerobic capacity of soccer players that sustained lower-body injuries during the in-season period compared to those that did not have a lower-body injury. A secondary purpose was to compare the aforementioned parameters between the players that sustained a knee ligament injury and hamstring strain. One hundred and thirty-three division 1 soccer players participated in the study. Fitness testing was conducted at the end of the pre-season period, and the players were followed for a total of 20 games. The anthropometric, lower body strength, flexibility and aerobic capacity parameters were compared between the players that sustained hamstring strains and knee ligament injuries and those that did not sustain any injuries. Results indicated that injured players were significantly older and less flexible than non-injured players (p&lt;0.05). Additionally, injured players appeared significantly weaker on the right and left quadriceps and hamstring muscles (p&lt;0.05). Furthermore, injured players had significantly greater asymmetries for the hamstrings muscle (p&lt;0.05) and significantly lower VO2max values and running time than the non-injured players (p&lt;0.05). Lastly, a significant difference between the players that sustained a hamstring injury compared to those who sustained a knee injury was indicated in right hamstring strength, right side ratio, and hamstring asymmetries (p&lt;0.05). Our findings suggest that off- and pre-season interventions should be tailored toward increasing aerobic fitness and lower body strength and flexibility while minimizing strength asymmetries and imbalances to reduce in-season injury risk.

The Relationship Between Performance and Injury in Junior Australian Football Athletes.

Determine the impact of preseason and between-seasons changes in individual physical performance on injury risk in elite junior Australian football players and if injuries sustained during a season impact subsequent-season performance improvement. This prospective cohort study assessed individual performance measures (sprint speed, jump, agility, and aerobic endurance) during preseason over 4 consecutive seasons. Injury status (injured/not injured) was tracked weekly to determine the relationship between individual performance and in-season injury occurrence. Mixed models were used to determine the relationship between physical performance and injury, and the effect of injury on physical performance improvement. A total of 206 players played 2 consecutive seasons and were included (17.6y, 181.9cm, 75.7kg). Faster players during preseason experienced higher injury incidence (injuries/season) during that playing season (incidence rate ratio = 0.127; P = .034). Injury incidence was not influenced by between-seasons change in any performance measure. Players injured during their first season maintained their aerobic fitness, which declined in noninjured players (d = 0.39; P = .013). Players who sustained a lower-limb injury during their first season saw smaller improvements in sprint speed than players who did not get injured (d = 0.39; P = .035). Faster players experience higher injury incidence than slower players and may require specific prevention interventions. Players who experience a lower-limb injury during the playing season do not improve sprint speed between seasons to the same extent as players who do not get injured, highlighting the need for targeted high-speed running ability development as part of rehabilitation.

Rib Stress Injuries Among Female National Collegiate Athletic Association Rowers: A Prospective Epidemiological Study

Rib stress injuries (RSIs) are debilitating injuries that competitive rowers often sustain during their careers, losing up to 10 weeks of training per year. Minimal research exists on RSIs and associated risk factors among National Collegiate Athletic Association women’s open-weight rowers. The purpose of this study was to determine the prevalence of RSIs and assess injury risk factors in intercollegiate female rowers. A prospective 14-week in-season injury surveillance was conducted via online surveys to collect demographic information, identify intrinsic and extrinsic risk factors, and document RSIs and other rowing-related injuries. During one National Collegiate Athletic Association season, 26% of our participants reported a rib cage injury, with six of these injuries identified as potential RSIs. Estimated prevalence for rib cage injuries is 6–33% in National Collegiate Athletic Association women’s rowing teams. RSI reporting and recognition was followed by aggressive clinical management in the population sampled, suggesting the need for larger scale epidemiological studies to determine the true prevalence, severity, and typical clinical course of these injuries.

ACL Tears in the National Football League From 2013 to 2020: Analysis of the 2020 Season After Delays and Schedule Changes From the Early COVID-19 Pandemic Relative to Prior Seasons.

Background:The impact of fatigue and preseason preparation on anterior cruciate ligament (ACL) tears in the National Football League (NFL) are not well described. The 2020 NFL season did not include the standard preseason in response to changes secondary to the coronavirus disease-2019 (COVID-19) pandemic.Purpose:To evaluate the association of game play on ACL tears in NFL athletes and to determine if differences in ACL tear epidemiology were present based on season of play from 2013 to 2020.Study Design:Descriptive epidemiology study.Methods:ACL tears in NFL athletes were identified using publicly available data. Games played and snap counts at the time of injury were recorded for each athlete sustaining game-related injuries. Tear rates were determined, and injuries were also calculated per 1000 athlete-exposures. Incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated.Results:Overall, 379 ACL tears were identified, including 256 (67.6%) during game play and 118 (31.1%) during practice. Practice-based injuries were significantly higher in the preseason versus the remainder of the season. Games and snaps at the time of injury did not differ by year. The incidence rate of preseason injuries was significantly greater relative to in-season injuries (IRR = 2.68; 95% CI, 2.18-3.29; P < .00001). There was an elevated incidence rate of in-season injuries in 2020 relative to 2014-2019 combined (IRR = 1.49; 95% CI, 0.98-2.19; P = .048). In 2013 to 2019, the most frequent month of injury was the first month of the preseason in August (119/334 tears; 35.6%), whereas in 2020, the most frequent month was September (13/41 tears, 31.7%). The proportion of tears in September 2020 was not different from the proportion of tears in August 2013 to 2019.Conclusion:There was an increased proportion of in-season ACL tears in the 2020 NFL season relative to 2014 to 2019; this is attributable to a frameshift in the consistent trend of injuries in the 1st month to return of competitive play, with 2020 being in the regular season in September as opposed to the preseason in August.

The Impact of COVID-19 Related Disruption on Injury Rates in Elite Men's Domestic Cricket.

This study aimed to investigate the impact of COVID-19 enforced prolonged training disruption and shortened competitive season, on in-season injury and illness rates. Injury incidence and percent proportion was calculated for the 2020 elite men's senior domestic cricket season and compared to a historical average from five previous regular seasons (2015 to 2019 inclusive). The injury profile for the shortened 2020 season was generally equivalent to what would be expected in a regular season, except for a significant increase in medical illness as a proportion of time loss (17% compared to historic average of 6%) and in-season days lost (9% compared to historic average of 3%) due to COVID-19 related instances (most notably precautionary isolation due to contact with a confirmed or suspected COVID-19 case). There was a significant increase in the proportion of in-season days lost to thigh injuries (24% compared to 9%) and a significant decrease in the proportion of days lost to hand (4% compared to 12%) and lumbar spine (7% compared to 21%) injuries. These findings enhance understanding of the impact prolonged period of training disruption and shortened season can have on cricket injuries and the challenges faced by practitioners under such circumstances.

The association between physical fitness parameters and in-season injury among adult male rugby players: a systematic review.

The high prevalence of injury among rugby players emphasizes the need for research related to injury risk factors. Physical fitness-related risk factors are likely culprits contributing to both contact and non-contact injuries. Establishing associations between preseason measured physical fitness aspects and injury risk, not only provide players' baseline fitness parameters but could also identify injury prone players, thereby contributing to injury prevention strategies. Therefore, the objective of this review was to assess and summarize scientific literature related to the association between preseason measured physical fitness tests and in-season injury among male rugby players. A systematic review was performed in compliance with the PRISMA 2020 Guidelines. This review considered observational, prospective cohort study designs. Studies that included male rugby (rugby union, rugby league, Australian football rules and rugby sevens) players aged 18 years or above from all levels of participation, evaluating the association between physical fitness test outcome and injury, were considered for inclusion. The three-step search strategy aimed at finding both published and unpublished studies in any language. Searched databases included Medline via PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Physiotherapy Evidence Database (PEDro), the Cochrane Controlled Trials Register in the Cochrane Library, ProQuest 5000 International, ProQuest Health and Medical Complete, EBSCO MegaFile Premier, SPORTDiscus with Full Text, SCOPUS and Science Direct. Key words used were "rugby," "injury," "physical fitness," and "risk factors." Papers that met the inclusion criteria were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal tool for cohort studies from the Joanna Briggs Institute (JBI SUMARI). A total of 16 studies were eligible for inclusion in this review. The mean critical appraisal score was 82.63% (SD=17.86). Forty-meter sprint speed was associated with injury in all three (100%) studies that included the test. Inconsistencies in the statistical analysis, however, make comparison difficult. None of the studies that investigated upper (N.=1) and/or lower body power (N.=3) identified power as a risk factor. Conflicting results were found for the association between strength, flexibility, cardiorespiratory fitness, and injury. Identifying factors associated with injury risk is an important step in the injury prevention paradigm. Once identified, players can be screened for risk factors prior to participation in sport. Interventions, based on screening results, which not only improve performance but also decrease players' risk of sustaining injuries (i.e., physical fitness related risk factors), provide additional incentive for compliance. Overall, this review highlights the inconsistency in testing methods used to gauge specific physical fitness constructs among rugby players, limiting the extent to which comparison of results and pooling of data is possible.

Despite a high daily training availability, a quarter of Academy athletes start the season with an injury and three quarters finish with one

Introduction: The development (or academy) phase of an athlete forms the foundation for a successful athletic career. Injuries affect an athlete’s availability to train, compete, and perform. Context-specific understanding of the injury burden and risk factors can enable prevention strategies to be prioritised, developed, and implemented to positively impact academy athlete longevity and trajectory towards elite levels. Medical servicing is a key component of the health system around an athletic population. Currently there are no data pertaining to the delivery of medical services in Australian academy athletes. We aim to investigate the incidence, prevalence, burden and characteristics of injuries; and to describe the frequency and type of medical servicing for elite sports academy athletes over a 12-month season. Methods: Medical attention and time-loss injuries were prospectively recorded for 94 athletes (72.3% females) during the 2019-2020 scholarship season. The number and type of linked medical treatments was also recorded. Injury incidence rates (IIR), point and period prevalence, and injury burden were calculated and compared by athlete sex, sport, and categorisation using incidence rate ratios (IRR). Results: 193 injuries were reported in 71 (75.5%) athletes. The IIR was 2.08 (95%CI=1.80-2.40) injuries per 365 days, with no sex difference observed (IRR=1.05, 95%CI=0.77-1.43, p=0.761). The injury burden was 43.52 (95%CI=37.79-50.11) days absence per 365 days. More than one-quarter (point prevalence, 26.6%) of athletes commenced the season with an injury. In-season injury risk was 2.5 times higher in athletes commencing the season with an injury (IRR=2.49, 95%CI=1.85-3.35, p<0.0001). 75.5% of athletes sustained a medical-attention injury within the 12 month period, medical servicing was not uniform across sports, and despite this, a mean daily athlete availability rate of 87% was observed which fluctuated significantly across the period between 79% and 92%. 81.2% of the 1164 treatments recorded were physiotherapy, with an overall 4.3:1.0 physiotherapy to medicine treatment ratio. Discussion: This is the first study to report the incidence, prevalence, burden, and characteristics of injuries, and the frequency and type of medical servicing delivered to athletes across multiple sports at a State Academy of Sport in Australia. One in four athletes began the elite pathway season with a pre-existing injury, while also demonstrating a 2.5 increased risk of subsequent injury in the scholarship period. Injury profiles and medical servicing varied across sports highlighting the need for service delivery models, prevention programs, and scholarship selection processes to be flexible and supportive of athlete health requirements. Conflict of interest statement: My co-authors and I acknowledge that a conflict of interest may exist as author DS works at ACTAS, and authors LT, NP, and MK work at the AIS, which could potentially bias this research.

Despite maintaining a high daily training availability, a quarter of athletes start the season injured and three quarters experience injury in an Australian State Academy of Sport

ObjectivesTo 1) investigate the incidence, prevalence, burden and characteristics of injuries; and 2) explore the frequency of physiotherapy and medical servicing for elite sports academy athletes over a 12-month season. DesignProspective cohort study. MethodsMedical attention and time-loss injuries were prospectively recorded by Physiotherapy and Medical (Sports Physician) staff for 94 athletes (72.3% females). The number of linked physiotherapy and medical servicing appointments was also recorded. Injury incidence rates (IIR), point and period prevalence, and injury burden were calculated and compared by athlete gender, sport, and categorisation (performance level) using incidence rate ratios (IRR). ResultsThe number of injuries reported was 193 in 71 (75.5%) athletes. The IIR was 2.1 (95%CI: 1.8 to 2.4) injuries per 365 days, with no gender difference observed (IRR: 1.1, 0.8 to 1.4). The injury burden was 43.5 (95%CI: 37.8 to 50.1) days absent per 365 days. More than one-quarter (point prevalence, 26.6%) of athletes commenced the season with an injury. In-season injury risk was 2.5 fold greater in athletes who started the season with an injury compared to athletes who started the season without an injury (IRR: 2.5, 1.9 to 3.4). The majority (81.2%) of the 1164 appointments recorded were physiotherapy, with an overall 4.3:1.0 physiotherapy to medical appointment ratio. ConclusionsOne in four athletes began the elite pathway season with a pre-existing injury, while also demonstrating a 2.5 fold greater risk of subsequent injury in the scholarship period. Sports should not assume their athletes are uninjured at the beginning of their scholarship. Injury profiles, and physiotherapy and medical servicing varied across sports. To reduce health as a barrier in the successful transition of talented young athletes to elite athletes, injury management strategies at the commencement of recruitment and throughout the scholarship should be prioritised in the development pathway.

Decreased Sleep and Subjective Well-Being as Independent Predictors of Injury in Female Collegiate Volleyball Players.

Background:The relationship among sleep duration, subjective well-being, and injury risk in athletes is poorly defined.Purpose:To evaluate the independent effects of sleep duration, sleep quality, and subjective well-being on in-season injuries in collegiate female volleyball athletes.Study Design:Cohort study; Level of evidence, 2.Methods:During a 9-month competitive season, 17 female National Collegiate Athletic Association (NCAA) Division I volleyball players reported mood, fatigue, stress, soreness, sleep duration (hours), and sleep quality every morning. Well-being measures were recorded from 0 (worst) to 5 (best), and all time-loss injuries were recorded by the team athletic trainer. Separate mixed-effects logistic regression models were used to evaluate the effects of sleep and subjective well-being on in-season injury. Each well-being variable was also included in a separate mixed-effects logistic regression model with sleep duration as a covariate.Results:A total of 54 injuries were recorded during the study period. Compared with days without an injury, mood, fatigue, stress, soreness, sleep quality, and sleep duration were significantly worse the day before an injury occurred. In the separate prediction models, in-season injury was significantly predicted by fatigue (odds ratio [OR], 0.56 [95% CI, 0.36-0.86]; P = .008), mood (OR, 0.52 [95% CI, 0.35-0.78]; P = .002), stress (OR, 0.63 [95% CI, 0.42-0.94]; P = .023), soreness (OR, 0.54 [95% CI, 0.38-0.79]; P = .001), sleep quality (OR, 0.49 [95% CI, 0.34-0.7]; P < .001), and sleep duration (OR, 0.69 [95% CI, 0.55-0.87]; P = .001). In the multivariable models, sleep duration remained a significant independent predictor in each of the subsequent multivariable models (OR, 0.72-0.74; P < .05 for all), as did mood (OR, 0.55 [95% CI, 0.36-0.83); P = .005) and soreness (OR, 0.57 [95% CI, 0.39-0.83]; P = .003), while fatigue (OR, 0.65 [95% CI, 0.42-1]; P = .054) and stress (OR, 0.68 [95% CI, 0.45-1]; P = .061) no longer reached statistical significance.Conclusion:Increased sleep duration, mood, and decreased soreness were independently associated with a reduced risk of in-season injury in this cohort of female NCAA volleyball players.