Leg Injuries Research Articles

Опыт применения чрескостного компрессионно-дистракционного остеосинтеза при открытом переломе средней трети костей голени

Abstract. Various lower leg injuries are among the most common injuries among adults, accounting for up to 15 % of the total number of injuries. The research purpose is to demonstrate the effectiveness of treatment of fractures of both tibia bones in the middle third with displacement of fragments using transosseous compression-distraction osteosynthesis. Materials and methods. For a conducted search in the open electronic scientific databases PubMed and Russian scientific electronic library eLibrary we used keywords and phrases: tibia fracture, surgical treatment, transosseous compression-distraction osteosynthesis, Ilizarov apparatus. Results. Transosseous osteosynthesis was performed using the Ilizarov apparatus for fractures of both bones of the middle third of the right leg with displacement of the fragments. On the fourth day after surgery, the patient was discharged for outpatient treatment by a traumatologist at his place of residence in satisfactory condition. Pain, tactile and temperature sensitivity of the lower limb are not impaired, blood supply is preserved. Discussion. Based on the results of surgical treatment in this case report, we can conclude that transosseous compression-distraction osteosynthesis using the Ilizarov apparatus is highly effective in the treatment of open fractures of both tibia bones in the middle third with displacement of fragments. Conclusion. One of the reliable methods for treating tibia bone fractures is the use of the Ilizarov transosseous compression-distraction apparatus. In addition, this method can be used in cases of extensive soft tissue damage. To perform reposition, open surgical access is not required, blood loss is minimal, which can significantly reduce the traumatic nature of the operation and can be performed in elderly and debilitated patients.

Endovenous laser ablation of great saphenous vein and pharmacotherapy of acute ascending thrombophlebitis: results of a three-month follow-up

Aim. In patients with acute ascending thrombophlebitis of the great saphenous vein and/or its large tributaries, assess the incidence of venous thrombosis progression over 3 months with 1,5-month fondaparinux sodium therapy and endovenous laser ablation of the saphenofemoral junction in combination with short-term (7-day) anticoagulant therapy or without anticoagulation.Material and methods. This single-center, prospective, randomized, open-label study included data from 91 patients with acute ascending thrombophlebitis of the great saphenous vein and/or its large tributaries, of which 30 were in the group of endovenous laser ablation without anticoagulation, 32 — in the group of endovenous laser ablation in combination with 7-day fondaparinux therapy, and 29 — in the 1,5-month fondaparinux therapy group. Venous thrombosis progression rate within 90±2 days was assessed. Compression ultrasonography of lower limb veins was performed on days 7±2, 45±2 and 90±2 after randomization, as well as in case of thrombosis progression suspicion.Results. The mean age of patients was 49,4±14,2 years. There were more women (73,6%). There was a low prevalence of risk factors for the development and progression of venous thrombosis: obesity — 6,6%, type 2 diabetes — in 2 patients, class 2 heart failure — in 1, autoimmune disease (scleroderma in remission) — in 1, prior cancer — in 1. Previous episodes of thrombophlebitis were noted in 3 cases (3,3%). Following external factors provoking venous thrombosis were identified in 19 patients (20,9%): lower leg injury in 14, high physical activity in 3, long flight in 1, recent coronavirus disease 2019 in 1. Median duration of thrombophlebitis manifestations was 6 days. Thrombosis was located in the trunk of the great saphenous vein in 96,7% of patients, while large tributaries were involved in 29,7%. The median distance from the thrombus proximal part to the saphenofemoral junction was 42,5 cm. Over 90±2 days, there were no cases of involvement of the suprafascial segment of the perforating vein in thrombosis to the fascia level, spread of thrombosis to the deep veins, or pulmonary embolism. Subsequently, a new episode of superficial vein thrombosis was noted only in 2 patients from the pharmacotherapy group with a history of thrombophlebitis.Conclusion. In patients with a low risk of venous thrombosis progression and predominantly distal location of acute ascending thrombophlebitis of the great saphenous vein and/or its large tributaries after endovenous laser ablation, progression of venous thrombosis is not expected over the next 3 months, despite an anticoagulation reduction to 7 days or its refusal.

Lumbar multifidus characteristics and body composition in university level athletes

IntroductionBody composition is well known to affect sport performance and previous studies suggested that structural and functional lumbar multifidus (LM) impairments in athletes were associated with low back pain and lower leg injuries. However few studies have examined the relationship between LM characteristics and body composition in athletic populations.MethodsThis cross-sectional study included a total of 134 university varsity athletes (hockey, soccer, rugby, and football players). Ultrasound imaging was used to examined LM characteristics at the L5 bilaterally [e.g., size, thickness at rest, thickness during contraction, echo-intensity (EI) and % thickness change from rest to contraction] and body composition parameters (dual-energy x-ray absorptiometry). Pearson correlations were used to assess the relationship between LM characteristics and body composition parameters. One-way ANOVA assessed differences in LM characteristics and body composition between sports. All analyses were performed separately by sex.ResultsLM size and thickness were positively correlated with weight, height, lean body mass and total bone mass (male: r = 0.23–0.55, p < 0.01–0.05; female: r = 0.30–0.39, p < 0.01–0.05). LM EI was strongly correlated with % body fat (male: r = 0.62, female: r = 0.71, p < 0.01). LM thickness at rest (r = 0.42, p < 0.01) and contracted (r = 0.27, p < 0.05) were positively correlated and % thickness change was negatively correlated with % body fat in male athletes (r = −0.43, p < 0.01).DiscussionThe significant differences in body composition and LM characteristics between sports may be attributed to sport specific demands. Understanding connections between body composition and LM may aid in preseason screening for athletes at risk of low back pain or lower leg injuries during the season.

The successful treatment of a Gustilo–Anderson type IIIc distal leg injury with a large bone defect in elderly patient with severe osteoporosis: a case report

BackgroundGustilo–Anderson type IIIc tibial open fracture with large bone defects in elderly patients with severe osteoporosis is a rare injury that may be a challenging clinical scenario.Case presentationThis study presents the case of a 68-year-old Japanese man who sustained a Gustilo–Anderson type IIIc open tibial fracture with a large bone defect. The patient had severe osteoporosis and the bone was contaminated; therefore, we determined that the bone could not be returned to the tibia. The patient underwent acute limb shortening and gradual lengthening with an Ilizarov external fixator combined with low-intensity pulsed ultrasound and teriparatide administration for limb reconstruction, which allowed immediate full weight-bearing capacity. The fixator was removed at 12 months postoperatively, and by this time, the fracture had completely healed. At the most recent 5-year follow-up after the injury, the patient reported full weight-bearing capacity without walking aids and had full knee and ankle range of motion.ConclusionsTo the best of our knowledge, this is the first study to report the use of combined Ilizarov technique, low-intensity pulsed ultrasound, and teriparatide for limb reconstruction of Gustilo–Anderson type IIIc open tibial fractures with large bone defects in elderly patients with severe osteoporosis.

Learner's Stop the Bleed Outcomes Between Lay Instructor and Emergency Medical Services (EMS)-Trained Instructor Groups.

One of the most utilized Stop the Bleed courses, the "Bleeding Control Basic (BCon) course v. 1.0," requires instructors to have a specific healthcare license or pre-hospital credential (e.g., physician or paramedic) or specific emergency medical services (EMS) instructor certification and have completed the BCon provider course. This requirement provides a level of expertise in instructorsbutlimits the potential workforce for sharing life-saving knowledge and skills. Other Stop the Bleedcourses, such as the American Red Cross First Aid for Severe Trauma (FAST) course, do not have this requirement. This raises questions pertaining to the learners' outcomes between those facilitated by instructors with and without healthcare licenses or credentials. Learners' outcomes for applying a tourniquet (skill), knowledge (cognitive), and Intention to Aid (attitude for behavior) were compared between those taught by lay instructors and EMS-trained (emergency medical technician or paramedic) instructors. All were trained as new instructors in the FASTprogram. For the study's primary outcome, all of the learners (n=135) properly applied a tourniquet to a simulated leg injury at the end of the training based on video evidence (skill). Learners in the EMS-trained instructor groups (n=84, mean age 25.5 years, 68% female), who were olderandhad more education, scored significantly higher on knowledge of tourniquet use on the Stop the Bleed Educational Assessment Tool (SBEAT) (mean=90.0 vs. 83.9 on a scale of 0-100, p=0.001) with a small effect size than the lay instructor group (n=51, mean age 16.6 years, 88% female).There was no statistical difference in attitude toward helping behaviors in a bleeding emergency between the two groups on the Intention to Aid (I2A) survey. Lay instructors andEMS-trained instructors performed comparably in facilitating a widely available Red Cross Stop the Bleed course. Lay experience with tourniquets should not disqualify individuals from being a Stop the Bleed instructor. Using a standard curriculum with instructor development offers a way for people with and without an EMS background to teach life-saving competencies effectively.

Reliability and Safety of Cross-Leg Free Latissmus Dorsi Muscle Flap in Reconstruction of Mutilating Leg Injuries Using End-to-Side Anastomosis.

Background Free tissue transfer is considered the gold standard option for the reconstruction of distal leg defects. Free tissue transfer using recipient vessels in the contralateral leg (cross-leg bridge) is a potential option to supply the flap if there are no suitable recipient vessels in the injured leg. Most studies have described this technique using end-to-end anastomosis which sacrifices the main vessel in the uninjured leg. This study evaluated the use of a cross-leg free latissimus dorsi muscle flap for the reconstruction of defects in single-vessel legs, using end-to-side anastomosis to recipient vessels in the contralateral leg without sacrificing any vessel in the uninjured leg. Methods This is a retrospective study that included 22 consecutive patients with soft tissue defects over the lower leg. All the reconstructed legs had a single artery as documented by CT angiography. All patients underwent cross-leg free latissimus dorsi muscle flap using end-to-side anastomosis to the posterior tibial vessels of the contralateral leg. Results The age at surgery ranged from 12 to 31 years and the mean defect size was 86 cm 2 . Complete flap survival occurred in 20 cases (91%). One patient had total flap ischemia. Another patient had distal flap ischemia. Conclusion Cross-leg free latissimus dorsi muscle flap is a reliable and safe technique for the reconstruction and salvage of mutilating leg injuries, especially in cases of leg injuries with a single artery. As far as preservation of the donor limb circulation is concerned, end-to-side anastomosis is a reasonable option as it maintains the continuity of the donor leg vessels.

A Leg Injury In Soccer

A Leg Injury In Soccer

Lower Leg Injury - Football

Lower Leg Injury - Football

Review of the influence of farrowing and lactation housing and positive human contact on sow and piglet welfare

Farrowing crates continue to be the most common system of housing farrowing and lactating sows, however continuous confinement is one of the most contentious welfare issues in livestock production. This review aims to critically evaluate the scientific literature on the implications of two important determinants of sow and piglet welfare: housing and human contact. While the evidence in sows is contradictory, there is consistent evidence of a greater short-term cortisol response in gilts introduced to farrowing crates than pens and there is limited evidence of changes in the HPA axis consistent with sustained stress in gilts during the fourth week of lactation. Confinement of sows during lactation increases stereotypic behaviour, reduces sow-piglet interactions, nursing duration and lying behaviour, and may contribute to leg and shoulder injuries in sows. Piglets reared by sows in pens display more play and less oral manipulative behaviours and generally have better growth rates than those reared in farrowing crates. However, there is increasing interest in developing alternate housing systems with minimal sow confinement and reduced piglet mortality risk. Recent research on temporary crating of sows suggests that confinement briefly around farrowing may be the best compromise between continuous housing in farrowing crates and pens, as it may reduce live-born piglet mortality, while providing the opportunity for the sow to move more freely prior to parturition. Together with housing, the behaviour of stockpeople is a key determinant of pig welfare. Recent evidence shows that positive handling of piglets during lactation reduces fear behaviour and physiological stress responses of pigs to humans, novelty and routine husbandry practices, and thus may be enriching for piglets. As a source of enrichment, positive human interactions provide several advantages: close interactions with piglets usually occur several times daily, positive interactions can be combined with routine checks, human interactions invariably provide variability in their predictability which will minimise habituation, and positive interactions may not require additional physical resources. There is a clear need for comprehensive research examining both the short- and long-term welfare implications and the practicality of less confinement of the sow, and positive handling of both sows and piglets during lactation.

A Long-Standing Case of Venous Leg Ulcer Treated with Constitutional Homoeopathic Medicine: A Case Report

AbstractVenous leg ulcers, also called varicose or stasis ulcers, are a result of damage to the valves in the veins of the legs, which increases venous pressure. Chronic venous insufficiency (CVI) is a well-known factor that contributes to the emergence of venous leg ulcer. Blood reflux, obstruction, or a combination of both mechanisms may result in CVI and lead to macro- and microcirculatory dysfunction. The primary risk factors for venous ulcer development are older age, obesity, previous leg injuries, deep venous thrombosis and phlebitis.A 57-year-old patient, with a pre-diagnosed case of venous leg ulcer, presented to the outpatient department of National Institute of Homoeopathy, Kolkata, with complaints of swelling and multiple ulcers in both legs. The ulcers were shallow and irregular in shape and presented with itching and persistent sticky discharge. The leg ulcer completely healed within two and half months of duration with Graphites 30/4 doses, which were given as a constitutional homoeopathic medicine. The outcome assessment of this case was done by using the Modified Naranjo Criteria (MONARCH) inventory. This case study suggests homoeopathic treatment as a promising complementary or alternative therapy, emphasising the significance of repertorisation in constitutional homoeopathic prescription for the management of ulcers.

Incidence of hoof and leg injuries in dairy cow under different floor

Present study explored the effect of different floor on hoof health and leg injuries of crossbred dairy cow. Animals (n=24), were randomly assigned into four groups with different floor combination in covered and open area, viz. T0 (concrete and brick paved), T1 (concrete and sand), T2 (rubber mat and sand) and T3 (rubber mat and brick paved). Hoof and limb lesion scores were recorded as per the standard protocol during study period. White line lesion score did not differ significantly, however, sole lesion score and inter-digital space lesion score differed significantly between the groups. Both, sole and interdigital space lesion scores were greater in T0 group. Total hoof lesion score was different between the groups with highest value in T0 group. Month wise hoof lesion scores differedsignificantly in 5th and 6th month between treatments. Decreasing trend was noticed in T1 and T2 from 5th month onwards. In contrast, T0 showed increase in hoof lesion score. Knee lesion score and hock lesion score were different between treatments. Higher scores were found in cows housed in T0 group, while lower scores were noted in T1 group. Knee lesion score decreased in T1 and T2 groups 4th month onwards, however no change was seen in T0 and T3 group. Similar trend was also seen for hock lesion score. In conclusion, provision of sand bed floor in open area of loose house with or without rubber mat floor in covered area was found superior for improving animal welfare in terms of lesser hoof and limb injuries.

Incidence of hoof and leg injuries in dairy cow under different floor

Present study explored the effect of different floor on hoof health and leg injuries of crossbred dairy cow. Animals (n=24), were randomly assigned into four groups with different floor combination in covered and open area, viz. T0 (concrete and brick paved), T1 (concrete and sand), T2 (rubber mat and sand) and T3 (rubber mat and brick paved). Hoof and limb lesion scores were recorded as per the standard protocol during study period. White line lesion score did not differ significantly, however, sole lesion score and inter-digital space lesion score differed significantly between the groups. Both, sole and interdigital space lesion scores were greater in T0 group. Total hoof lesion score was different between the groups with highest value in T0 group. Month wise hoof lesion scores differedsignificantly in 5th and 6th month between treatments. Decreasing trend was noticed in T1 and T2 from 5th month onwards. In contrast, T0 showed increase in hoof lesion score. Knee lesion score and hock lesion score were different between treatments. Higher scores were found in cows housed in T0 group, while lower scores were noted in T1 group. Knee lesion score decreased in T1 and T2 groups 4th month onwards, however no change was seen in T0 and T3 group. Similar trend was also seen for hock lesion score. In conclusion, provision of sand bed floor in open area of loose house with or without rubber mat floor in covered area was found superior for improving animal welfare in terms of lesser hoof and limb injuries.

The Impact of Differential Knee Laxity on Brain Activation During Passive Knee Joint Loading.

Although higher anterior knee laxity is an established risk factor of ACL injury, underlying mechanisms are uncertain. While decreased proprioception and altered movement patterns in individuals with anterior knee laxity have been identified, the potential impact of higher laxity on brain activity is not well understood. Thus, the purpose of this study is to identify the impact of different magnitudes of knee laxity on brain function during anterior knee joint loading. Twenty-seven healthy and active female college students without any previous severe lower leg injuries volunteered for this study. Anterior knee laxity was measured using a knee arthrometer KT-2000 to assign participants to a higher laxity (N=15) or relatively lower laxity group (N=12). Functional magnetic resonance images were obtained during passive anterior knee joint loading in a task-based design using a 3T MRI scanner. Higher knee laxity individuals demonstrated diminished cortical activation in the left superior parietal lobe during passive anterior knee joint loading. Less brain activation in the regions associated with awareness of bodily movements in females with higher knee laxity may indicate a possible connection between brain activity and knee laxity. The results of this study may help researchers and clinicians develop effective rehabilitation programs for individuals with increased knee laxity. This article is protected by copyright. All rights reserved.

Heterologous Platelet-Rich Plasma in the Treatment of Severe Skin Damage

Accidental soft tissue injuries are a frequent injury. Platelet-rich plasma (PRP) is an interesting therapeutic option for wounds and skin damage. In this case report, we describe a 37-year-old man that presented to our ward of pain medicine for an accidental severe leg injury associated with skin and soft tissue loss, with severe pain and poor sensation. History revealed the use of recreational drugs without viral infections or systemic diseases. Wound debridement, wound dressings, systemic antibiotics (amoxicillin 1000 mg tid and azithromycin 500 mg od), and non-steroidal anti-inflammatory drugs (ibuprofen 600 mg bid) reduced pain but did not improve the skin and soft tissue. A fibrin membrane with concentrated growth factors was applied, yielding an improvement in the injury in 16 months without the need for skin grafting.

Poster 358: Minutes Per Game and Usage Rate Associated with Time Loss after Ankle Injury: A Characterization of Foot and Ankle Injuries and Associated Risk Factors in National Basketball Association Athletes

Objectives: Injuries to the foot and ankle are more common in National Basketball Association (NBA) basketball compared to other professional sports. The goal of this study is to report the incidence and associated risk factors of foot and ankle injuries in the NBA athletes. Methods: Foot and ankle injury data from the 2015-16 through 2020-21 NBA seasons was queried and verified using a publicly available database. The truncated 2019-20 season was omitted from this study due to the COVID-19 pandemic. The primary outcome was the incidence of foot and ankle injuries, reported per 1000 game exposures (GEs). Secondary analysis was performed to identify risk factors for ankle injuries through bivariate analysis and multivariable logistic regression of player demographics, performance statistics, injury characteristics, and previous lower extremity injuries. Additionally, factors influencing the length of absence were assessed via negative binomial regression. Results: There were 728 structural foot and ankle injuries (5.34 per 1000 GEs) sustained by NBA players over 5 NBA seasons, with sprain/strain as the most common injury type (4.27 per 1000 GEs) (Table 1). The majority of ankle injury events (55%) resulted in 2-10 game absences (Table 4). The likelihood of sustaining an ankle injury was significantly associated with a greater number of games played, previous upper leg injury, and more games missed due to injury (Table 2). Increased length of absence due to ankle injury was significantly associated with greater height, minutes per game, usage rate, points per game, total rebounds per game, and a prior history of foot, ankle, and knee injuries (Table 3). Conclusions: The incidence of foot and ankle injuries was 5.34 per 1000 GEs in professional basketball players. Games played and previous history of upper leg injuries were found to be risk factors for ankle injuries. Factors associated with physiologic burden such as minutes per game and usage rate were associated with an increased severity of injury. [Table: see text][Table: see text][Table: see text][Table: see text]

Intrepid Ghosts and Writing Identities

When I suffered a serious leg injury recently, an emerging feeling of bewilderment shook my self-perception, activating a downward slide in my self-identity and general confidence. My ability to convey the physical pain and attendant emotions was further undermined in my attempts to seek medical advice where I found myself increasingly positioned and disadvantaged by the discourses prevalent in these medical settings. Indeed, I was struggling to explain the physical and psychological manifestations to the health professionals. However, I found a degree of solace from my exploration of writing that centers on illness and injury, with a number of these investigations assisting me with my visits to health specialists, as I explain in this paper. As such, this paper utilizes autoethnography as testimony to chart aspects of my experiences in relation to the connections between discourse, identity, pain, and writing. In doing so, I describe a series of emotions and events related to this injury as a means for tracking changes in my autobiographical self during this period and providing unique insights into my experience.

Sex differences in musculoskeletal injury epidemiology and subsequent loss of tactical readiness during Marine Corps Officer Candidates School

IntroductionThe US Marine Corps (USMC) Officer Candidates School (OCS) is a 10-week training course for Marine Officer Candidates (MOCs). OCS training is rigorous and demanding, which results in a high...

Injuries in Ballroom DanceSport: A Retrospective Study on Prevalence and Relation With Demographic Data.

DanceSport is a variant of Ballroom dancing, a style that is performed as a couple dancing together. Although there are many participants worldwide, the amount of research on injuries done in this style of dancing is limited. The aim of this study was obtaining information about the DanceSport Athletes in the Netherlands including anthropometrics, level, frequency and duration of dance training per week. Our second objective was to investigate injury prevalence and type of injuries. Retrospective questionnaire study. All 816 registered active dancers within the Dutch DanceSport Association received an online questionnaire with questions on anthropometrics, level of dancing, frequency and duration of dance training, and questions on injuries. The Chi-Square test was used to calculate differences between categorical variables. A total of 218 dancers (33.7%) completed the questionnaire, 107 males (49.1%), and 111 females (50.9%). The mean age for men was 42 ± 15.9 and 36 ± 15.1 for women. 176 dancers (80.7%) reported 1 or more injuries. Foot, ankle, and lower leg injuries were reported most frequently, 49 males (45.8%), and 60 females (54.1%). No significant difference was found in the total number of injuries for the variables sex (P = .761) and discipline (P = .225). Significantly more head and neck injuries were identified in female Standard dancers (P < .001) compared to male dancers. Also, Standard dancers have more back injuries compared to dancers in both disciplines (P < .009). With the described anthropometrics and an 80% lifetime prevalence of injuries, this group can be compared to other dance forms. Significant differences in injuries of the head and neck for female Standard dancers compared to male dancers and significantly more back injuries in Standard dancers compared to dancers in both disciplines were found. Future studies need to translate and validate existing questionnaires in Dutch for use in this population.

Herd-Level Risk Factors for Lameness, Leg Injuries, Thin Body Condition and Mastitis on Algerian Dairy Farms

Abstract This present study aims to investigate the relationship of herd characteristics and management practices with the prevalence of clinical and severe lameness, hock and knee injuries, thin cows, and mastitis at the herd level on Algerian dairy farms. Altogether 1210 dairy cows from 107 farms were examined and the clinical aspects related to studied affections were recorded. Multivariable regression models were built to analyse the relationship between the risk factors and the occurrence of health indicators. Overlay, the health outcomes were multifactorial, with pasture access (P &lt; 0.001), scraping frequency (P &lt; 0.01), and floor regularity (P = 0.05) as the main factors causing lameness. Factors associated with both hock and knee injuries (score ≥ 2) were lower cow number (P &lt; 0.01), more days spent on pasture (P &lt; 0.001), and poorer straw amount for bedding (P &lt; 0.001). Some farming practice, in particular, providing proper amount of concentrate feeds (P &lt; 0.001), higher scraping frequency (P &lt; 0.01), thicker bedding (P &lt; 0.001), and having younger dairy cows (P = 0.058), were associated with a lower within-herd prevalence of thin cows. While, more days on pasture increased the percentage of under-conditioned cows (P &lt; 0.01). The inadequate hygienic conditions of the floor (P &lt; 0.001), improper milking procedures (P &lt; 0.05), and shorter dry period (P &lt; 0.05) increased the clinical mastitis occurrence. Our results highlighted the specific management practices responsible for increasing health risks and provided useful information for the farmers and veterinarians to make preventive and controlling strategies for lameness, leg injuries, low body condition and mastitis on dairy farms.

The associations between unilateral leg strength, asymmetry and injury in sub-elite Rugby League players

ObjectivesThe aim of this study was to analyse the relationship between unilateral leg strength, associated asymmetries and the injuries suffered by sub-elite Rugby League (RL) players in one competitive season. DesignA prospective cohort design was used. MethodUnilateral leg strength was measured using the rear foot elevated split squat five repetition maximum test. Injuries were recorded using the Orchard classification system and were used to quantify relative risk (RR), mean severity, burden, player availability and survival time. ResultsNo measures of leg strength were related to RR, relative leg strength was found to have a significant, but not meaningful correlation with total time lost to lower body injury, lower body injury burden and lower body injury survival time. ConclusionsThe data from the current study indicates a possible positive effect of increasing relative leg strength for injury outcomes in sub-elite RL players. This supports a heuristic that multi-joint lower body strength training for RL players has a potential dual effect of enhancing physical performance and reducing injury time loss, with minimal risk of harm.