Risk Factors For Musculoskeletal Injuries Research Articles

The International Olympic Committee (IOC) Consensus Statement on Periodic Health Evaluation of Elite Athletes: March 2009

The International Olympic Committee (IOC) Consensus Statement on Periodic Health Evaluation of Elite Athletes: March 2009

Evaluation of a Four Year Intervention to Reduce Musculoskeletal Hazards Among Berry Growers

Problem Fresh market berry production workers are exposed to physical risk factors for musculoskeletal injury. Method We disseminated information through trade publications and other sources to berry managers in seven U.S. states about five prevention through design practices that were both safer and more profitable than traditional methods. We administered mail evaluation questionnaires prior to the intervention and after each of four intervention years to rolling, independent U.S. samples and to comparison New Zealand berry farm manager samples after years one through three. Results U.S. manager self-reports of reading trade publication information increased compared to baseline values for two of five practices and self-reported awareness increased for four of five practices. There were no increases in adoption. More U.S. than New Zealand managers reported getting information about two practices from trade publications and about four practices from public events. No U.S. versus New Zealand differences were observed in reported awareness or adoption for any practice. Impact on Industry This study showed that even a modest campaign can build awareness of safer practices fairly quickly in three to four years among small agricultural firms but that increasing adoption apparently requires more time. Widespread adoption of safer practices could help keep operators in business longer as they age by reducing the workload and musculoskeletal strain associated with labor intensive crop production for them and their workforce. Adoption of practices that also improve profits, like the five practices featured in this study, could also help managers stay in business.

Epistemology and the Performing Arts

Epistemology is the branch of philosophy that studies the nature of knowledge, its presuppositions and foundations, and its extent and validity. It is as relevant to performing arts medicine as it is to any other area of human inquiry, and the article by Wu in this issue is a new brick in the foundation of what we know about risk factors for musculoskeletal injuries in musicians. In this editorial I will attempt to put Dr. Wu's systematic review of the literature on this subject in context. Readers should be aware that I was a coauthor of one of the articles reviewed by Wu and the author of others that apparently did not “make the cut.”

A novel wireless data acquisition system for the measurement of hoof accelerations in the exercising horse

A device is needed to safely and wirelessly evaluate accelerations experienced by the horse hoof under a variety of surface conditions with the horse exercising at training or racing speeds. To develop a miniaturised wireless data acquisition system (WDAS) which reliably records hoof accelerations and the times over which they occur in a minimally invasive manner in the exercising Thoroughbred. The following criteria were set for device development: production of a lightweight and minimally invasive system, which provides an adequate acceleration range, appropriate frequency response to capture high speed events, and compatibility with a low power wireless telemetry system. Following device development, the WDAS was calibrated, and tested in 6 Thoroughbred horses over a variety of surfaces. Collection of acceleration in seven trials using 6 horses over a variety of surfaces resulted in repeatable acceleration data with respect to the overall characteristic shape of the impact profile. Impact accelerations varied with surface, ranging 34.8-191.7 g. Accelerations on take off were in a similar range, although higher in some trials. Peak impact accelerations tended to larger over the grass paddock surface, than either the indoor arena or the dirt track. During dirt track trials, accelerations on take-off were often comparably larger than those observed on impact within the same footfall. This study reports the development of a wireless system that successfully measures hoof acceleration in a minimally invasive manner over a variety of surface and exercise conditions. The WDAS will be used in further studies to evaluate various components of the horse-racetrack interface, in an attempt to identify risk factors for musculoskeletal injury in the Thoroughbred racehorse.

Physical Risk Factors and Controls for Musculoskeletal Disorders in Construction Trades

Adoption of the Washington State Ergonomics Rule in 2000 initiated seven different demonstration projects in nine high-risk construction trades. The Ergonomics Rule was repealed in 2003, however valuable cooperative field research was conducted in construction prior to rule dissolution. This paper presents summaries and results of each project with the aim of providing the results to construction professionals and researchers seeking to identify and reduce injury risks and building costs. The projects were organized independently but each with the specific aims of conducting work in conjunction with industry, identifying “hazard zone” risk factors as defined by the rule, and identifying feasible solutions in agreement with company partners to mitigate these risk factors. Musculoskeletal injury risk factors were evaluated by ergonomist field observation and working group analysis. Solutions were developed through field work and consensus agreement with industry and labor representatives. Identified injury ...

Risk factors for musculoskeletal injuries in 2-year-old Thoroughbred racehorses

Musculoskeletal injuries (MSI) in racehorses have been identified as the most common cause of lost training days and weeks spent resting at pasture. Several training-, track- and horse-related risk factors have been identified. However, there is no clear understanding of the inter-relationship between these factors. The aim of this longitudinal cohort study was to investigate risk factors for MSI in 2-year-old Thoroughbred racehorses. Australian Thoroughbred trainers were convenience sampled and enrolled in a 27-month longitudinal cohort study. The study population consisted of all 2-year-old Thoroughbred racehorses trained by a participating trainer. Horses were followed from the time of enrolment until the completion of the study or until they were lost to follow-up. Trainers were visited at approximately 14-day intervals to collect training and injury data. Training days were categorised as fast days if the maximum speed during training exceeded 800 m/min. For each horse, the first training period that included one or more fast days was analysed. A multiple logistic regression model was used to determine those horse- and training-related variables that were associated with MSI. Data from 274 horses trained by 14 trainers at five racetracks were analysed. Forty percent of the horses sustained a MSI during their first fast preparation. The average distance trained at speeds ≥800 m/min and the percentages of fast days from the first fast day until the end of the preparation were the only variables associated with MSI. After accounting for these variables there were still significant differences between trainers. This suggests that there are other training-related variables such as the rate of increase in distance trained at speeds ≥800 m/min that may be risk factors for MSI. In addition, other factors such as the level of veterinary involvement and the training centre/racetrack may be risk factors for MSI. More analysis using multi-level modelling is required to determine the relationship between trainer- and track-related risk factors.

A case-control study of factors associated with pelvic and tibial stress fractures in Thoroughbred racehorses in training in the UK

Few epidemiological studies have investigated risk factors for musculoskeletal injury occurring in Thoroughbred racehorses during training, although it is the major cause of wastage in the racing industry. We recently conducted a large-scale epidemiological study to estimate the incidence of fracture in racehorses in training in the UK and to identify associated risk factors. Thirteen racehorse trainers provided data on horses in their care, with daily recording of training information and provision of details on any fractures incurred. Data were collected for 2 years, including two consecutive flat racing seasons (1999 and 2000). This paper describes findings from a nested case-control study investigating factors associated with the occurrence of pelvic and tibial stress fractures in our study population. Cases were identified from the main study and defined as horses with a pelvic or tibial stress fracture, confirmed through routine diagnostic imaging. Randomly selected controls were matched on date of fracture in the case. Age and gender of the horse, its exercise history and training surfaces were examined as explanatory variables. Exercise was quantified as cumulative distances cantered and worked at high speed in 30- and 60-day periods prior to date of fracture in the case. Conditional logistic regression was used to construct multivariable models for the 30- and 60-day periods, respectively. We hypothesised that larger cumulative exercise distances would be associated with an increased risk of pelvic or tibial stress fracture and that different training surfaces would be associated with differences in fracture risk. In the 30-day period, when adjusting for trainer, the risk of pelvic or tibial stress fracture increased with increasing distance cantered, reaching a peak at around 50 km, after which the risk reduced. This trend was not obvious in the 60-day period, with no significant association between exercise distances and risk of stress fracture. Predominant use of one particular sand-based all-weather surface was related to an increased risk of pelvic or tibial stress injury, although this finding should be interpreted with caution. Surface maintenance and construction may play a role; variables that were not considered in the current analyses, which were based on a relatively small number of cases. Trainer was associated with differences in stress fracture risk after adjusting for exercise distances and surface but age and gender were not.

Effects of negatively sloped keyboard wedges on risk factors for upper extremity work-related musculoskeletal disorders and user performance

Several changes to computer peripherals have been developed to reduce exposure to identified risk factors for musculoskeletal injury, notably in keyboard designs. Negative keyboard angles and their resulting effects on objective physiological measures, subjective measures and performance have been studied, although few angles have been investigated despite the benefits associated with their use. The objective of this study was to quantify the effects of negative keyboard angles on forearm muscle activity, wrist posture, key strike force, perceived discomfort and performance and to identify a negative keyboard angle or range of keyboard angles that minimizes exposure to risk factors for hand/wrist injuries. Ten experienced typists (four males and six females) participated in a laboratory study to compare keyboard angles ranging from 0° to −30°, at 10° increments, and a keyboard with a 7° slope, using a wedge designed for use with standard QWERTY keyboards. Repeatability of exposures was examined by requiring participants to complete two test sessions 1 week apart. Dependent variable data were collected during 10 min basic data entry tasks. Wrist posture data favoured negative keyboard angles of 0° (horizontal) or greater, compared to a positive keyboard angle of 7°, especially for the flexion/extension direction. In general, the percentage of wrist movements within a neutral zone and the percentages of wrist movements within ±5° and ±10° increased as keyboard angle became more negative. Electromyography results were mixed, with some variables supporting negative keyboard angles whilst other results favoured the standard keyboard configuration. Net typing speed supported the −10° keyboard angle, whilst other negative typing angles were comparable, if not better than, with the standard keyboard. Therefore, angles ranging from 0° to −30° in general provide significant reductions in exposure to deviated wrist postures and muscle activity and comparable performance.

Risk factors for musculoskeletal injuries of the lower limbs in Thoroughbred racehorses in New Zealand

AIM: To investigate risk factors for injury to musculoskeletal structures of the lower fore- and hind-limbs of Thoroughbred horses training and racing in New Zealand. METHODS: A case-control study analysed by logistic regression was used to compare explanatory variables for musculoskeletal injuries (MSI) in racehorses. The first dataset, termed the Training dataset, involved 459 first-occurrence cases of lower-limb MSI in horses in training, and the second, the Starting dataset, comprised a subset of those horses that had started in at least one trial or race in the training preparation that ended with MSI (n=294). All training preparations for horses that did not suffer from MSI for which complete data were available were used in the analyses as controls, and provided 2,181 and 1,639 preparations for the Training and Starting datasets, respectively. Multivariate logistic regression was used to evaluate risk factors, and results were reported as odds ratios (OR) and 95% confidence intervals (CI). RESULTS: Horses aged ≥5 years were at higher risk of injury than 2-year-olds. Elevated odds of MSI occurred in horses in the Starting dataset that were training in the 1997–1998 year compared with the 1999–2000 year, and in those horses where trials comprised >20% of all starts in a preparation. Training preparations that ended in winter, and horses in their third or later training preparation, had lower odds of MSI compared with those ending in other seasons or the first preparation, respectively. Reduced odds of MSI were observed in preparations in which starts occurred compared with those that had no starts, and in the Starting dataset, preparations that included more than one start had a reduced likelihood of MSI compared with preparations that had only one start. In the Training dataset, preparations longer than 20 weeks were associated with reduced odds of MSI compared with those shorter than 20 weeks. Cumulative racing distance in the last 30 days of a training preparation was best modelled with linear and quadratic terms. Results indicated that increasing cumulative racing distances were associated with an initial reduction in the odds of MSI that then levelled out and finally appeared to increase again as the explanatory variable continued to increase. The risk of MSI varied significantly between trainers. CONCLUSION: This study identified intrinsic (age) and extrinsic risk factors for MSI in training and racing Thoroughbreds in New Zealand. The risk of MSI initially decreased, then increased, as cumulative racing distance increased. Significant variation between trainers indicated management and training methods influence the risk of MSI.

The Relationship Between Amenorrhea and Injury Among Girls High School Cross Country Runners

0260 Recent studies indicate amenorrhea may be a risk factor for musculoskeletal injury and osteopenia/osteoporosis. The relationship between amenorrhea and injury among female runners has been primarily reported in collegiate, military and adult populations, but few studies have reported this relationship among female high school runners. PURPOSE: To determine the prevalence and relationship of amenorrhea and injury among female athletes participating in high school cross country running. METHODS: This prospective study of 186 high school female cross country runners involved pre- and post-season measures of self-reported menstrual cycle history. Coaches/athletic used the Athletic Health Care System Daily Injury Report to report running-related injuries. Relative risk estimates and 95% CIs were used to determine the relationship of amenorrhea and risk of running injury. RESULTS: Runners reported a prevalence of amenorrhea of 30.1% pre-season. At post-season, 64 runners (34.4%) reported a history of amenorrhea during the past year. Of these, 1.6% (n = 3) reported primary amenorrhea (no onset of menarche by age 16), and 32.8% (n = 61) secondary amenorrhea (<9 menstrual cycles during the past year). Relative risk estimates between amenorrhea and all running injuries (RR = 1.3, 95% CI: 0.9–1.9; p>.05), shin injuries only (RR = 1.3, 95% CI: 0.7–2.3; p>.05), and stress fractures (RR = 2.9, 95% CI: 0.5–16.7; p>.05) were found. CONCLUSIONS: In this study, no significant relationship was found between amenorrhea and injury among high school cross country runners. However, the prevalence estimates and observed trend between amenorrhea and incidence of stress fractures reported here confirm the need for additional studies in this population. Supported by a grant from the American Physical Therapy Association

OCCUPATIONAL PHYSIOLOGY IN ACTION

Past occupational physiology programs have dissected the process of workplace intervention into job analyses, development of physical abilities tests, determination of cut scores and analysis of gender fairness. Few presentations have provided start to finish examples of an intervention and analyzed outcome variables. This program will provide concrete examples of occupational interventions to reduce injuries and share lessons learned from these interventions. Three experienced practitioners will describe a recent workplace intervention and provide an assessment of the strengths and weaknesses of the approach taken. Speakers will outline the problem, the intervention, the cost/benefits and any difficulties encountered. The first speaker will discuss the effectiveness of a physical abilities test in reducing injuries over a five-year period, involving 12,000 newly hired railroad workers. The second speaker will discuss an intervention involving changes to the physical training program in U.S. Army Basic Combat Training. The modified program was designed to reduce injuries and improve physical capacity for performing soldiering tasks. The third speaker will discuss a multi-disciplined intervention for a large electronics manufacturer, in which managers and employees were trained to recognize and prevent musculoskeletal injury risk factors. Time will be left at the end of the session for a general discussion period.

Flat, hurdle and steeple racing: risk factors for musculoskeletal injury.

A retrospective case-control study was conducted to identify and quantify risk factors for serious musculoskeletal injury sustained at 4 Australian metropolitan racetracks. During the period of study (August 1988-July 1995) there were 196 cases from flat racing, 52 cases from hurdle racing and 53 cases from steeplechases. The incidences of fatal musculoskeletal injuries per start for flat, hurdle and steeple races were 0.06, 0.63 and 1.43% respectively. Logistic regression identified harder track surfaces, horses being older than age 3 years, one racecourse (Flemington) and jumping races as significant risk factors which increased the risk of musculoskeletal breakdown. The incidence of fatal musculoskeletal injuries for flat races at the 4 study tracks was similar to that reported in the UK but less than the USA. Death rates for hurdle and steeple races in the study population were higher than in the UK. Strategies to reduce the incidence of serious musculoskeletal injuries may include avoidance of excessively hard track surfaces through closer regulation of track moisture content; implementation of more rigorous prerace lameness examinations of horses, particularly older horses; and altering the design and number of jumps in hurdle and steeple races. The quantification of risk, as we have reported here, is the first step towards addressing the causes of musculoskeletal breakdown and should help in applying a reasoned approach to intervention measures that may be effective in reducing racing injuries.

Risk factors associated with musculoskeletal injuries in Australian Thoroughbred racehorses

Risk factors for musculoskeletal injury in racing Thoroughbreds were investigated in a case-control study conducted at racetracks administered by the Australian Jockey Club. Univariable analysis of 137 cases from the official Veterinary Surgeon's reports and an equal number of randomly selected controls from the Australian Race Results identified field size, barrier position and class of race as being significantly associated with breakdown (P < 0.05). Multiple logistic regression was then used to investigate the effect of each putative risk factor whilst controlling for all others. Horses at greater risk were older, started from a wider barrier position, ran at the same distance as their previous race and raced in the highest class of race. There was no significant difference between tracks or significant association with track condition. The incidence of fatalities in the study population was less than that reported in the UK and USA.

Age, body composition, aerobic fitness and health condition as risk factors for musculoskeletal injuries in conscripts.

Musculoskeletal injuries occur frequently in connection with physical activity. More information was sought on pretraining factors that may predispose to such injuries. Data were obtained on the age, height, weight, aerobic fitness as measured by a 3000-m run test, and health as assessed on the basis of a medical examination, of 912 male conscripts prior to an 8-week period of basic military and physical training. Injuries were registered as they occurred by doctors attached to the training camp. Every fourth to fifth conscript suffered one or more musculo-skeletal injuries during basic training. Achilles tendinitis, low back pain, periostitis or compartment syndromes, and overuse knee injuries were the most frequent diagnosis groups. In 74% of the injuries, a tentative cause was related to organized service activities. According to univariate analyses, risk factors were age over 23 years, high body mass index (BMI), slow run times and dysfunctions of the back or lower limbs. A lower classification of mental health, but not dysfunctions of the lower limbs, was an additional risk factor if only injuries with causes connected with organized service activities were considered. Height and weight were not associated with injuries. In multiple logistic regression analysis, age and 3000-m run times were masked by correction for BMI, while BMI, dysfunctions of the back and lower limbs, and reduced mental health showed the same significance as in the univariate analyses.

Consistency of Visual Assessments of Arch Height among Clinicians

Flat feet and high-arched feet have been cited as risk factors for musculoskeletal injury and functional problems among runners and other active individuals, although there are no established quantitative definitions or measures for assessing either condition. As part of a larger study, four-plane photographs were made of the weight-bearing right foot of 246 young male Army trainees. These photographs were independently evaluated by six clinicians and rated on a scale of clearly flat-footed (category 1) to clearly high arched (category 5). There was much interclinician variability in the assessments, even for extremes of foot type. The probability of a clinician assessing a foot as clearly flat, given that another clinician had rated the foot as clearly flat, ranged from 0.32 to 0.79, with a median probability of 0.57, while for clearly high-arched feet, probabilities ranged from 0.0 to 1.00, with a median of 0.17. These findings demonstrate the need for objective standards and quantitative methods of evaluating foot morphology.