Injury In Division Research Articles

Effect of Physical and Academic Stress on Illness and Injury in Division 1 College Football Players.

Stress-injury models of health suggest that athletes experience more physical injuries during times of high stress. The purpose of this study was to evaluate the effect of increased physical and academic stress on injury restrictions for athletes (n = 101) on a division I college football team. Weeks of the season were categorized into 3 levels: high physical stress (HPS) (i.e., preseason), high academic stress (HAS) (i.e., weeks with regularly scheduled examinations such as midterms, finals, and week before Thanksgiving break), and low academic stress (LAS) (i.e., regular season without regularly scheduled academic examinations). During each week, we recorded whether a player had an injury restriction, thereby creating a longitudinal binary outcome. The data were analyzed using a hierarchical logistic regression model to properly account for the dependency induced by the repeated observations over time within each subject. Significance for regression models was accepted at p ≤ 0.05. We found that the odds of an injury restriction during training camp (HPS) were the greatest compared with weeks of HAS (odds ratio [OR] = 2.05, p = 0.0003) and LAS (OR = 3.65, p < 0.001). However, the odds of an injury restriction during weeks of HAS were nearly twice as high as during weeks of LAS (OR = 1.78, p = 0.0088). Moreover, the difference in injury rates reported in all athletes during weeks of HPS and weeks of HAS disappeared when considering only athletes that regularly played in games (OR = 1.13, p = 0.75) suggesting that HAS may affect athletes that play to an even greater extent than HPS. Coaches should be aware of both types of stressors and consider carefully the types of training methods imposed during times of HAS when injuries are most likely.

Patterns of Bone Stress Injuries in Division I Collegiate Distance Runners: A Retrospective Cohort Study

Patterns of Bone Stress Injuries in Division I Collegiate Distance Runners: A Retrospective Cohort Study

Knee Injury in Division 1 Football Player

HISTORY: A 20-year-old collegiate football player presented after sustaining an injury to his right leg. His right leg was planted, knee slightly flexed, and he was struck forcefully from the left side. He was unable to ambulate. Swelling was evident 20 minutes later. He had no history of prior injury to the knee and no significant medical history. PHYSICAL EXAMINATION: 5 days post-injury, inspection revealed ecchymosis along the medial aspect of the knee and visible patella alta. ROM was limited due to patient guarding. Palpation revealed 3+ effusion and a defect of the patella tendon. He was unable to perform a straight leg raise and was still unable to ambulate. Grade 3 MCL insufficiency was present. He was stable to varus stress. Lachman and pivot shift tests were limited secondary to pain and swelling. DIFFERENTIAL DIAGNOSIS: Patellar tendon rupture MCL tear Meniscal injury ACL tear Tibial plateau fracture Femoral condyle fracture TESTS AND RESULTS: MRI 4 days post-injury: full thickness tear of the proximal ACL, full thickness tear of the distal tibial insertion of the superficial MCL with 2.5cm of retraction, full thickness rupture of the patella attachment of the patellar tendon with 2cm of retraction, and a posterolateral corner meniscal tear. FINAL/WORKING DIAGNOSIS: Simultaneous rupture of patellar tendon, ACL, and MCL. TREATMENT AND OUTCOMES: He was treated in a staged manner with acute primary repair of the patellar tendon followed by a 3-month rehabilitation period during which serial increases in flexion while in the knee immobilizer were permitted. Physical therapy was begun at 2 weeks post-op. At 2 months, patient had 4/5 quadriceps strength, normal patellar tracking and no MCL instability to lateral stress. At 3 months, he returned to the operating room for ACL reconstruction and intraoperative assessment of the MCL and menisci. The MCL was treated conservatively given its stability with 30 degrees valgus load, and the medial and lateral menisci were found to be normal upon probing. He was placed on a standard postop ACL protocol. At 6 months, he had negative Lachman’s, anterior drawer, and pivot shift tests. He had no effusion and only mild quad atrophy. He was able to straight leg raise and was ambulating well. He returned to sport at 12 months after ACL reconstruction.

Association of y balance test reach asymmetry and injury in division I athletes.

The Y balance test (YBT) is a screen of dynamic balance requiring stance leg balance while the contralateral leg reaches in anterior (ANT), posteromedial (PM), and posterolateral (PL) directions. YBT has been proposed as a screen for injury risk; however, limited research has examined the association between YBT and injury. The purpose of this study was to examine the association between YBT (asymmetry and composite score (CS)) and noncontact injury in a sample of Division I (DI) college athletes from multiple sports. DI college athletes were screened with the YBT during the preparticipation examination to determine asymmetry (absolute difference between legs in ANT, PL, and PM) and CS (summed average of right/left ANT, PL, and PM normalized to leg length). Participants were followed throughout the sport season, and noncontact injuries requiring athletic training staff intervention were recorded for analysis. Demographic variables between injured and uninjured athletes were assessed with independent t-tests. Receiver operating characteristic (ROC) curves determined optimal cut points for predicting injury on the basis of CS and asymmetry. CS was analyzed as a continuous variable, as ROC curves were unable to maximize sensitivity and specificity. Logistic regression models adjusted for sport and previous injury determined the odds of injury on the basis of asymmetry and CS. One hundred and eighty-four participants were included in analysis; 81 were injured. ROC curves determined asymmetry >4 cm (sensitivity, 59%; specificity, 72%) as the optimal cut point for predicting injury. Only ANT asymmetry was significantly associated with noncontact injury (odds ratio, 2.33; 95% confidence interval, 1.15-4.76). ANT asymmetry >4 cm was associated with increased risk of noncontact injury. CS in this sample of DI athletes was not associated with increased risk of injury.

Association of the Functional Movement Screen with injuries in division I athletes.

The Functional Movement Screen (FMS) evaluates performance in 7 fundamental movement patterns using a 4-point scale. Previous studies have reported increased injury risk with a composite score (CS) of 14/21 or less; these studies were limited to specific sports and injury definition. To examine the association between FMS CS and movement pattern scores and acute noncontact and overuse musculoskeletal injuries in division I college athletes. An exploratory objective was to assess the association between injury and FMS movement pattern asymmetry. Prospective cohort. College athletic facilities. 167 injury-free, college basketball, football, volleyball, cross country, track and field, swimming/ diving, soccer, golf, and tennis athletes (males = 89). The FMS was administered during pre-participation examination. Noncontact or overuse injuries that required intervention from the athletic trainer during the sport season. FMS CS was not different between those injured (n = 74; 14.3 ± 2.5) and those not (14.1 ± 2.4; P = .57). No point on the ROC curve maximized sensitivity and specificity; therefore previously published cut-point was used for analysis with injury (≤ 14 [n = 92]). After adjustment, no statistically significant association between FMS CS and injury (odds ratio [OR] = 1.01, 95% CI 0.53-1.91) existed. Lunge was the only movement pattern that was associated with injury; those scoring 2 were less likely to have an injury vs those who scored 3 (OR = 0.21, 95% CI 0.08-0.59). There was also no association between FMS movement pattern asymmetry and injury. FMS CS, movement patterns, and asymmetry were poor predictors of noncontact and overuse injury in this cohort of division I athletes.

Case series of first metatarsophalangeal joint injuries in division 1 college athletes.

Context:Injuries of the first metatarsophalangeal (hallux MP) joint can be debilitating in the athletic population. Turf toe and plantar plate injuries are typically diagnosed similarly. However, variance in injury mechanism as well as compromised integrity of soft tissue and ligamentous structures make it difficult to accurately diagnose specific hallux MP injuries. Recent literature has supported the use of both radiographic imaging and the Lachman test as reliable indicators of joint instability in the presence of hallux MP injuries. To date, research supporting specific rehabilitation interventions and return-to-play decision making for hallux MP injuries has been limited to case studies and suggested guidelines from literature reviews. There is limited evidence suggesting specific criteria for surgical and nonsurgical decision making in conjunction with rehabilitation progressions to return an athlete to sport when managing hallux MP injuries.Evidence Acquisition:A literature search was performed using Medline, PubMed, and Google Scholar to find and review articles from 1970 to 2013 that addressed the basic anatomy of the plantar plate, injuries to this anatomical structure, and the evaluation, diagnosis, surgical and nonsurgical management, and rehabilitation of these injuries, specifically in the athletic population. Medical information for each case was gathered from electronic medical records from the individual athletes cited in this case series, which included imaging reports, rehabilitation documentation, and both evaluation and surgical reports. No statistical analysis was used.Study Design:Case series.Level of Evidence:Level 4.Results:Treatment plans for each case varied depending on surgical and nonsurgical intervention and rehabilitation outcomes. However, each athlete was able to return to sports-specific activities.Conclusion:Successful outcomes for hallux MP injuries are contingent on thorough evaluation, appropriate clinical decision making with regard to surgical versus nonsurgical treatment planning, and a multidisciplinary team approach for ensuring a safe return to sport.Strength-of-Recommendation Taxonomy (SORT):C.

MRI Utilization for Musculoskeletal Injuries in Division 1 Collegiate Athletes

Purpose: 1) Describe MRI utilization for musculoskeletal injuries in a cohort of Division 1 collegiate athletes over a two year period (8/07 - 8/09). 2) Determine associations between MRI use and subsequent musculoskeletal surgeries; MRI utilization for upper (UE) vs. lower extremity (LE) injuries and impact of gender. Methods: Prospective cohort study (8/07 - 8/09). Data was collected for 36 varsity sports at one NCAA Division 1 college including all musculoskeletal MRI scans completed, body part scanned, gender and all musculoskeletal surgeries performed. Descriptive statistics for all variables and ANOVA and Fisher's Exact testing were performed. Significance was p<0.05. (STATA 10.0) Results: There were 418 musculoskeletal MRI scans. 98 were of UE and spine with shoulder most common (43). 316 were of LE with knee most common (125). 99 surgeries were performed: 33 UE and spine with shoulder most common (19) and 66 LE with knee most common (40). 60/99 surgeries had an MRI scan performed prior to surgery. Football ranked first in number of MRIs ordered and surgeries performed. When data was normalized for roster size, football did not have the highest utilization of MRIs or surgeries per athlete. Comparison of LE vs. UE showed significance (p=0.025) with LE having significantly higher MRIs completed and surgeries performed without an MRI. There was no difference between LE vs. UE in surgeries with an MRI done prior to surgery. Gender was not significant (p=0.066). When comparing MRIs and surgeries performed with no MRI, there was a significant difference among the groups (p=0.033). This was due to a larger number of surgeries of the shoulder and less number of surgeries of the LE (excluding the knee) than expected. Conclusions: In Division 1 collegiate athletes, the shoulder and knee are the most common body parts being imaged with MRI. Football has the highest gross number of MRIs and surgeries done but did not have the highest number of MRIs or surgeries per athlete. There are significant differences between UE and LE with respect to MRIs ordered and surgeries done without an MRI, but not in surgeries performed with a prior MRI. Gender was not a significant predictor. Further study is needed to see if these trends are similar in other Division 1 collegiate athletic programs.

Bone Stress Injury in Division I Collegiate Long-Distance Runners: A Five Year Retrospective Analysis

Stress fractures continue to be a common source of injury in competitive athletes, especially those that participate in high impact exercise. These overuse injuries cause considerable loss of training time, inability to compete and in extreme cases can be career ending for the competitive athlete. Over the last decade much emphasis has been rightly placed on the female athlete triad and their risk of bone stress injury. Incidence rates of injury however, appear to be more closely distributed between males and females in the athletic population as demonstrated in studies by Nattiv et al and Bennell et al. PURPOSE: To study the incidence of bone stress injury over the course of five years in male and female Division I collegiate distance runners. METHODS: A retrospective chart review was undertaken to identify male and female long distance runners of the University of Colorado Cross Country and or Track and Field teams who were diagnosed with bony stress injuries during the time from August 1st 2004 to July 31st 2009. Our definition of distance runners were athletes that raced distances of at least 5000m, were not cut from the team during the academic year and competed and trained as active members of the team for at least six months of the academic year. RESULTS: 102 athletes met the criteria standard for inclusion into our analysis and were evenly split with 51 female and 51 male distance runners. There were a total of 56 stress fractures/stress reactions diagnosed by MRI and or bone scan during the 5 year interval with 31 occurring in female athletes and 25 in males. Annual incidence of bone stress injury ranged from 16.7% to 41.2% in females with an annual incidence rate of 28.1% averaged over 5 years, and ranged from 14.3% to 31.8% in the men with an annual incidence rate of 21.8% when averaged over 5 years. CONCLUSIONS: Bone stress injury rates in our study population of Division I collegiate distance runners remain persistently high, with elevated rates in both male and female runners alike.

Major Hip Injuries in Division I College Athletes: An Evaluation of Injury Mechanism, Treatment Strategies, and Clinical Outcome 1090

Major Hip Injuries in Division I College Athletes: An Evaluation of Injury Mechanism, Treatment Strategies, and Clinical Outcome 1090