Incidence, prevalence and risk factors for low back pain in adolescent athletes: a systematic review and meta-analysis.

OBJECTIVE: To investigate the incidence, prevalence, risk factors and morphological presentations of low back pain (LBP) in adolescent athletes. DESIGN: Systematic review with meta-analysis. DATA SOURCES: Medline, Embase, CINAHL via EBSCO, Web of Science, Scopus. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies evaluating the incidence and/or prevalence of LBP in adolescent athletes across all sports. RESULTS: There were 80 studies included. The pooled incidence estimate of LBP in adolescent athletes was 11% (95% CI 8% to 13%, I2=0%) for 2 years, 36.0% (95% CI 4% to 68%, I2=99.3%) for 12 months and 14% (95% CI 7% to 22%, I2=76%) for 6 months incidence estimates. The pooled prevalence estimate of LBP in adolescent athletes was 42% (95% CI 29% to 55%, I2=96.6%) for last 12 months, 46% (95% CI 41.0% to 52%, I2=56%) for last 3 months and 16% (95% CI 9% to 23%, I2=98.3%) for point prevalence. Potential risk factors were sport participation, sport volume/intensity, concurrent lower extremity pain, overweight/high body mass index, older adolescent age, female sex and family history of LBP. The most common morphology reported was spondylolysis. Methodological quality was deemed high in 73% of cross-sectional studies and in 30% of cohort studies. Common reasons for downgrading at quality assessment were use of non-validated survey instruments and imprecision or absence of LBP definition. SUMMARY/CONCLUSION: LBP is common among adolescent athletes, although incidence and prevalence vary considerably due to differences in study methodology, definitions of LBP and data collection. PROSPERO REGISTRATION NUMBER: CRD42020157206.

Custom-Fitted Compression Garments Enhance Recovery From Muscle Damage in Rugby Players.

ABSTRACT: Brown, F, Jeffries, O, Gissane, C, Howatson, G, van Someren, K, Pedlar, C, Myers, T, and Hill, JA. Custom-fitted compression garments enhance recovery from muscle damage in rugby players. J Strength Cond Res 36(1): 212-219, 2022-to evaluate the effects of custom-fitted compression garments (CG) on recovery from muscle damage in rugby players. Forty-five players were tested for lower-body strength, power, and indices of muscle damage before completing a damaging protocol (20 × 20-m sprints with 5-m deceleration, 100 drop jumps). Players were randomly assigned to wear either custom-fitted (CF, n = 13), or standard-sized CG (SSG, n = 16), or to receive sham ultrasound therapy (CON, n = 16) immediately after exercise. Players were retested immediately, then after 24 and 48 hours. Strength recovery was significantly different between groups (F = 2.7, p = 0.02), with only CF recovering to baseline values by 48 hours (p = 0.973). Time × condition effects were also apparent for creatine kinase activity (χ2 = 30.4, p < 0.001) and midthigh girth (F = 3.7, p = 0.005), with faster recovery apparent in CF compared with both CON and SSG (p < 0.05). Custom-fitted CG improved strength recovery and indices of muscle damage in rugby players, compared with controls and standard-sized garments. Athletes and coaches would be advised to use appropriately fitted CG to enhance strength recovery after damaging exercise.

Treating low back pain in athletes: a systematic review with meta-analysis.

OBJECTIVE: To summarise the evidence for non-pharmacological management of low back pain (LBP) in athletes, a common problem in sport that can negatively impact performance and contribute to early retirement. DATA SOURCES: Five databases (EMBASE, Medline, CINAHL, Web of Science, Scopus) were searched from inception to September 2020. The main outcomes of interest were pain, disability and return to sport (RTS). RESULTS: Among 1629 references, 14 randomised controlled trials (RCTs) involving 541 athletes were included. The trials had biases across multiple domains including performance, attrition and reporting. Treatments included exercise, biomechanical modifications and manual therapy. There were no trials evaluating the efficacy of surgery or injections. Exercise was the most frequently investigated treatment; no RTS data were reported for any exercise intervention. There was a reduction in pain and disability reported after all treatments. CONCLUSIONS: While several treatments for LBP in athletes improved pain and function, it was unclear what the most effective treatments were, and for whom. Exercise approaches generally reduced pain and improved function in athletes with LBP, but the effect on RTS is unknown. No conclusions regarding the value of manual therapy (massage, spinal manipulation) or biomechanical modifications alone could be drawn because of insufficient evidence. High-quality RCTs are urgently needed to determine the effect of commonly used interventions in treating LBP in athletes.

2021 consensus statement for preventing and managing low back pain in elite and subelite adult rowers.

PURPOSE: To synthesise evidence on low back pain (LBP) in adult rowers and to create a consensus statement to inform clinical practice. METHODS: There were four synthesis steps that informed the consensus statement. In step one, seven expert clinicians and researchers established the scope of the consensus statement and conducted a survey of experienced and expert clinicians to explore current practice. In step two, working groups examined current evidence relating to key scope questions and summarised key issues. In step three, we synthesised evidence for each group and used a modified Delphi process to aid in the creation of the overall consensus statements. Finally, in step four, we combined information from step three with the findings of the clinician survey (and with athlete and coach input) to produce recommendations for clinical practice. RESULTS: The scope of the consensus statement included epidemiology; biomechanics; management; the athlete's voice and clinical expertise. Prevention and management of LBP in rowers should include education on risk factors, rowing biomechanics and training load. If treatment is needed, non-invasive management, including early unloading from aggravating activities, effective pain control and exercise therapy should be considered. Fitness should be maintained with load management and progression to full training and competition. The role of surgery is unclear. Management should be athlete focused and a culture of openness within the team encouraged. CONCLUSION: Recommendations are based on current evidence and consensus and aligned with international LBP guidelines in non-athletic populations, but with advice aimed specifically at rowers. We recommend that research in relation to all aspects of prevention and management of LBP in rowers be intensified.

Association between eccentric knee flexor strength and hamstring injury risk in 185 elite Gaelic football players.

Hamstring strains are the most common time-loss injury in elite Gaelic football affecting over 20% of players per season. Thus, there is a need to identify factors contributing to the onset of hamstring injuries in order to inform injury risk management strategies. The current study investigated whether eccentric knee flexor strength and between-limb imbalances were associated with increased risk of sustaining a time-loss hamstring injury in elite Gaelic football players. A total of 185 elite male players (26.9 ± 2.7 years, 86.4 ± 6.2 kg, 183.4 ± 5.6) were prospectively followed for 12 weeks from the day of testing. Injury data were provided by the team medical staff. Twenty-eight players (16%) sustained a time-loss hamstring injury following testing. Players that did not sustain a hamstring injury had greater average between-limb asymmetries (uninjured = 9.1%, 95% CI 7.8-10.1; injured = 5.1%, 95% CI 3.7-6.7; P = .001). Eccentric knee flexor strength profiles were not associated with increased or decreased risk of sustaining a hamstring injury and did not alter the post-test probability of sustaining a hamstring injury across the investigation period. These findings do not support the use of eccentric knee flexor strength metrics in managing hamstring injury risk in elite male Gaelic football players.

Identification of dropout predictors to a community-based physical activity programme that uses motivational interviewing.

BACKGROUND: Participant dropout reduces intervention effectiveness. Predicting dropout has been investigated for Exercise Referral Schemes, but not physical activity (PA) interventions with Motivational Interviewing (MI). METHODS: Data from attendees (n = 619) to a community-based PA programme utilizing MI techniques were analysed using a chi-squared test to determine dropout and attendance group differences. Binary logistic regression investigated the likelihood of dropout before 12 weeks. RESULTS: A total of 44.7% of participants dropped out, with statistical (P < 0.05) differences between groups for age, PA and disability. Regression for each variable showed participants aged 61-70 years (OR = 0.28, CI = 0.09-0.79; P = 0.018), >70 years (OR = 0.30, CI = 0.09-0.90; P = 0.036), and high PA (OR = 0.40, CI = 0.20-0.75; P = 0.006) reduced dropout likelihood. Endocrine system disorders (OR = 4.24, CI = 1.19-19.43; P = 0.036) and musculoskeletal disorders (OR = 3.14, CI = 1.84-5.45; P < 0.001) increased dropout likelihood. Significant variables were combined in a single regression model. Dropout significantly reduced for 61-70 years old (OR = 0.31, CI = 0.10-0.90; P = 0.035), and high PA (OR = 0.39, CI = 0.19-0.76; P = 0.008). Musculoskeletal disorders increased dropout (OR = 2.67, CI = 1.53-4.75; P < 0.001). CONCLUSIONS: Age, PA and disability type significantly influence dropout at 12 weeks. These are the first results specific to MI based programmes indicating the inclusion of MI and highlighting the need for further research.

Prevalence and risk factors for back pain in sports: a systematic review with meta-analysis.

OBJECTIVES: We aimed to determine the prevalence of low back pain (LBP) in sport, and what risk factors were associated with LBP in athletes. DESIGN: Systematic review with meta-analysis. DATA SOURCES: Literature searches from database inception to June 2019 in Medline, Embase, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Web of Science and Scopus, supplemented by grey literature searching. ELIGIBILITY CRITERIA: Studies evaluating prevalence of LBP in adult athletes across all sports. RESULTS: Eighty-six studies were included (30 732, range 20-5958, participants), of which 45 were of 'high' quality. Definitions of LBP varied widely, and in 17 studies, no definition was provided. High-quality studies were pooled and the mean point prevalence across six studies was 42%; range 18%-80% (95% CI 27% to 58%, I2=97%). Lifetime prevalence across 13 studies was 63%; range 36%-88% (95% CI 51% to 74%, I2=99%). Twelve-month LBP prevalence from 22 studies was 51%; range 12%-94% (95% CI 41% to 61%, I2=98%). Comparison across sports was limited by participant numbers, study quality and methodologies, and varying LBP definitions. Risk factors for LBP included history of a previous episode with a pooled OR of 3.5; range 1.6-4.0 (95% CI 1.9 to 6.4). Statistically significant associations were reported for high training volume, periods of load increase and years of exposure to the sport. CONCLUSION: LBP in sport is common but estimates vary. Current evidence is insufficient to identify which sports are at highest risk. A previous episode of LBP, high training volume, periods of load increase and years of exposure are common risk factors.

Sports-related injuries in New Zealand: National Insurance (Accident Compensation Corporation) claims for five sporting codes from 2012 to 2016.

OBJECTIVES: To provide epidemiological data and related costs for sport-related injuries of five sporting codes (cricket, netball, rugby league, rugby union and football) in New Zealand for moderate-to-serious and serious injury claims. METHODS: A retrospective analytical review using detailed descriptive epidemiological data obtained from the Accident Compensation Corporation (ACC) for 2012-2016. RESULTS: Over the 5 years of study data, rugby union recorded the most moderate-to-serious injury entitlement claims (25 226) and costs (New Zealand dollars (NZD$)267 359 440 (£139 084 749)) resulting in the highest mean cost (NZD$10 484 (£5454)) per moderate-to-serious injury entitlement claim. Rugby union recorded more serious injury entitlement claims (n=454) than cricket (t(4)=-66.6; P<0.0001); netball (t(4)=-45.1; P<0.0001); rugby league (t(4)=-61.4; P<0.0001) and football (t(4)=66.6; P<0.0001) for 2012-2016. There was a twofold increase in the number of female moderate-to-serious injury entitlement claims for football (RR 2.6 (95%CI 2.2 to 2.9); P<0.0001) compared with cricket, and a threefold increase when compared with rugby union (risk ratio (RR) 3.1 (95%CI 2.9 to 3.3); P<0.0001). Moderate-to-serious concussion claims increased between 2012 and 2016 for netball (RR 3.7 (95%CI 1.9 to 7.1); P<0.0001), rugby union (RR 2.0 (95% CI 1.6 to 2.4); P<0.0001) and football (RR 2.3 (95%CI 1.6 to 3.2); P<0.0001). Nearly a quarter of moderate-to-serious entitlement claims (23%) and costs (24%) were to participants aged 35 years or older. CONCLUSIONS: Rugby union and rugby league have the highest total number and costs associated with injury. Accurate sport exposure data are needed to enable injury risk calculations.

Hamstring injuries in elite Gaelic football: an 8-year investigation to identify injury rates, time-loss patterns and players at increased risk.

BACKGROUND: Hamstring injuries occur frequently in field sports, yet longitudinal information to guide prevention programmes is missing. AIM: Investigate longitudinal hamstring injury rates and associated time loss in elite Gaelic football, while identifying subgroups of players at increased risk. METHODS: 38 data sets from 15 elite male Gaelic football teams were received by the National Gaelic Athletic Association (GAA) Injury Surveillance Database between 2008 and 2015. Injury and exposure data were provided by the team's medical staff via an online platform. RESULTS: 391 hamstring injuries were sustained accounting for 21% (95% CI 20.0% to 21.7%) of all injuries. Prevalence was 21% (95% CI 19.2% to 23.4%). Incidences were 2.2 (95% CI 1.9 to 2.4) per 1000 exposure hours, and 7.0 (95% CI 6.5 to 7.1) times greater in match play than in training. Typically each team sustained 9.0 (95% CI 7.0 to 11.0) hamstring injuries per season affecting the: bicep femoris belly (44%; 95% CI 39.4% to 48.7%); proximal musculotendinous junction (13%; 95% CI 9.8% to 16.3%); distal musculotendinous junction (12%; 95% CI 8.6% to 14.9%) and semimembranosis/semitendinosis belly (9%; 95% CI 6.3% to 11.7%). ∼36% (95% CI 31.5% to 41.0%) were recurrent injuries. Mean time loss was 26.0 (95% CI 21.1 to 33.0) days, which varied with age, injury type and seasonal cycle. Hamstring injuries accounted for 31% (95% CI 25.8% to 38.2%) of injury-related time loss. Previously injured players (rate ratio (RR)=3.3), players aged 18-20 years (IRR=2.3) or >30 years (RR=2.3), as well as defensive (IRR=2.0) and midfield players (RR=1.5), were most at risk of sustaining a hamstring injury. Comparisons of 2008-2011 with 2012-2015 seasons revealed a 2-fold increase in hamstring injury incidences. Between 2008 and 2015 training incidence increased 2.3-fold and match-play incidences increased 1.3-fold. CONCLUSIONS: Hamstring injuries are the most frequent injury in elite Gaelic football, with incidences increasing from 2008-2011 to 2012-2015. Tailoring risk management strategies to injury history, age and playing position may reduce the burden of hamstring injuries.

Ischemic preconditioning enhances critical power during a 3 minute all-out cycling test.

This study tested the hypothesis that ischemic preconditioning (IPC) would increase critical power (CP) during a 3 minute all-out cycling test. Twelve males completed two 3 minute all-out cycling tests, in a crossover design, separated by 7 days. These tests were preceded by IPC (4 x 5 minute intervals at 220 mmHg bilateral leg occlusion) or SHAM treatment (4 x 5 minute intervals at 20 mmHg bilateral leg occlusion). CP was calculated as the mean power output during the final 30 s of the 3 minute test with W' taken as the total work done above CP. Muscle oxygenation was measured throughout the exercise period. There was a 15.3 ± 0.3% decrease in muscle oxygenation (TSI; [Tissue saturation index]) during the IPC stimulus, relative to SHAM. CP was significantly increased (241 ± 65 W vs. 234 ± 67 W), whereas W' (18.4 ± 3.8 vs 17.9 ± 3.7 kJ) and total work done (TWD) were not different (61.1 ± 12.7 vs 60.8 ± 12.7 kJ), between the IPC and SHAM trials. IPC enhanced CP during a 3 minute all-out cycling test without impacting W' or TWD. The improved CP after IPC might contribute towards the effect of IPC on endurance performance.

Effects of the Gaelic Athletic Association 15 on Lower Extremity Injury Incidence and Neuromuscular Functional Outcomes in Collegiate Gaelic Games.

Schlingermann, BE, Lodge, CA, Gissane, C, and Rankin, PM. Effects of the Gaelic Athletic Association 15 on lower extremity injury incidence and neuromuscular functional outcomes in collegiate Gaelic games. J Strength Cond Res 32(7): 1993-2001, 2018-The purpose of this observational analytical cohort study was to assess the effectiveness of an injury prevention program (IPP)-Gaelic Athletic Association 15 (GAA15)-on the incidence of injury in collegiate Gaelic games. One hundred and thirty-one Gaelic games players (mean age 20.5 years ± SD 3.0) were used for analysis in this study. Participants completed preseason and postseason testing which involved performance of the Y-Balance Test. The GAA15 was used for the intervention group; coaches were instructed to implement the program before every training session and match throughout the collegiate Gaelic Athletic Association (GAA) season. The control group adopted their normal warm-up procedures for the season. The players' injuries were documented on a weekly basis by allied health care professionals working with the teams using an online database system. Results showed significant improvements in composite Y-Balance scores in favor of the intervention group (adjusted mean difference Right: 1.8 % normalized mean reach distance (%NMRD) [p = 0.007]/Left: 2.3 %NMRD [p = 0.001]). Injury rates in the intervention group (2.62 injuries per 1,000 hours) were reduced by 66% (p = 0.001) in comparison with an age-matched control group (7.62 per 1,000 hour). Training injuries, hamstring injuries, noncontact injuries, and severe injuries were also reduced as a result of the implementation of the GAA15 (injury rate ratio: 0.20, 0.59, 0.39, and 0.45, respectively). Implementation of an IPP such as the GAA15 can reduce the risk of injury in Gaelic games and influence players' neuromuscular performance assessed through the Y-Balance Test.

Blood flow restriction training in clinical musculoskeletal rehabilitation: a systematic review and meta-analysis.

BACKGROUND AND OBJECTIVE: Low-load exercise training with blood flow restriction (BFR) can increase muscle strength and may offer an effective clinical musculoskeletal (MSK) rehabilitation tool. The aim of this review was to systematically analyse the evidence regarding the effectiveness of this novel training modality in clinical MSK rehabilitation. DESIGN: This is a systematic review and meta-analysis of peer-reviewed literature examining BFR training in clinical MSK rehabilitation (Research Registry; researchregistry91). DATA SOURCES: A literature search was conducted across SPORTDiscus (EBSCO), PubMed and Science Direct databases, including the reference lists of relevant papers. Two independent reviewers extracted study characteristics and MSK and functional outcome measures. Study quality and reporting was assessed using the Tool for the assEssment of Study qualiTy and reporting in EXercise. ELIGIBILITY: Search results were limited to exercise training studies investigating BFR training in clinical MSK rehabilitation, published in a scientific peer-reviewed journal in English. RESULTS: Twenty studies were eligible, including ACL reconstruction (n=3), knee osteoarthritis (n=3), older adults at risk of sarcopenia (n=13) and patients with sporadic inclusion body myositis (n=1). Analysis of pooled data indicated low-load BFR training had a moderate effect on increasing strength (Hedges' g=0.523, 95% CI 0.263 to 0.784, p<0.001), but was less effective than heavy-load training (Hedges' g=0.674, 95% CI 0.296 to 1.052, p<0.001). CONCLUSION: Compared with low-load training, low-load BFR training is more effective, tolerable and therefore a potential clinical rehabilitation tool. There is a need for the development of an individualised approach to training prescription to minimise patient risk and increase effectiveness.

The Effects of the Gaelic Athletic Association 15 Training Program on Neuromuscular Outcomes in Gaelic Football and Hurling Players: A Randomized Cluster Trial.

O'Malley, E, Murphy, JC, McCarthy Persson, U, Gissane, C, and Blake, C. The effects of the Gaelic Athletic Association 15 training program on neuromuscular outcomes in Gaelic football and hurling players: A randomized cluster trial. J Strength Cond Res 31(8): 2119-2130, 2017-Team-based neuromuscular training programs for injury prevention have been tested primarily in female and adolescent athletes in soccer, handball, and basketball with limited research in adult male field sports. This study explored whether the GAA 15, a multifaceted 8-week neuromuscular training program developed by the Gaelic Athletic Association (GAA), could improve risk factors for lower limb injury in male Gaelic footballers and hurlers. Four Gaelic sports collegiate teams were randomized into intervention or control groups. Two teams (n = 41), one football and one hurling, were allocated to the intervention, undertaking a 15 minutes program of neuromuscular training exercises at the start of team training sessions, twice weekly for 8 weeks. Two matched teams (n = 37) acted as controls, participating in usual team training. Lower extremity stability (Y-Balance test [YBT]) and jump-landing technique using the Landing Error Scoring System (LESS) were assessed preintervention and postintervention. There were moderate effect sizes in favor of the intervention for right (d = 0.59) and left (d = 0.69) composite YBT scores, with adjusted mean differences between intervention and control of 3.85 ± 0.91% and 4.34 ± 0.92% for right and left legs, respectively (p < 0.001). There was a greater reduction in the mean LESS score in favor of the intervention group after exercise training (Cohen's d = 0.72, adjusted mean difference 2.49 ± 0.54, p < 0.001). Clinically and statistically significant improvements in dynamic balance and jump-landing technique occurred in collegiate level Gaelic football and hurling players who adopted the GAA 15, when compared with usual training. These findings support application and evaluation of the GAA 15 in other player groups within the Gaelic games playing population.

Physical activity guidelines: is the message getting through to adults with rheumatic conditions?

OBJECTIVES: This study examines the awareness and self-report knowledge of physical activity (PA) guidelines among adults with rheumatic conditions and evaluates rates of adherence to PA recommendations. Secondary aims include (i) investigating perceived benefits and barriers to exercise and (ii) exploring correlates associated with PA. METHODS: This cross-sectional study involved adults attending an outpatient rheumatology clinic completing a questionnaire. Closed- and open-ended questions enquired about awareness and knowledge of PA guidelines, and a single-item self-report measure of PA was included. Perceptions of exercise were assessed using the Exercise Benefits and Barriers Scale. Descriptive statistics described participant characteristics and age-adjusted bivariate analyses explored associations between socio-demographic and condition-related factors and PA. RESULTS: A total of 401 adults (134 males, 267 females) completed the questionnaire. Only 17.6% of respondents were aware of national PA guidelines and 17.4% accurately identified the frequency and duration of the recommendations. A quarter of respondents (26.7%) reported adherence to the guidelines, while 30.5% reported no weekly PA. Higher perceived benefits and lower perceived barriers to exercise were positively associated with PA behaviour. CONCLUSION: A large majority of respondents were not aware of PA guidelines and self-report knowledge of PA recommendations was largely inaccurate. Despite the role of PA in health promotion and in the management of rheumatic conditions, adherence to PA recommendations was low. Level of education, perceived benefits and barriers to exercise, and awareness and self-report knowledge of PA guidelines are associated with PA behaviour.

Ergometer training volume and previous injury predict back pain in rowing; strategies for injury prevention and rehabilitation.

The most commonly reported injury site in rowers is the lower back. Research in recent years has focused on epidemiology and biomechanical analyses to try and understand mechanisms that contribute to this injury's onset. Injury surveillance mainly comprises retrospective questionnaires and reviews of medical records with a lack of prospective data. Of studies that reported 12-month data, the incidence of low back pain ranged from 31.8 to 51% of the cohort. Of the limited studies that specifically examined low back pain in rowers, (1) history of lumbar spine injury and (2) volume of ergometer training were the most significant risk factors for injury onset. Studies of technique on the rowing ergometer have indicated the importance of lumbopelvic rotation during rowing. Greater pelvic rotation at either end of the stroke is ideal-as opposed to lumbar flexion and extension; this tends to be poorly demonstrated in novice rowers on ergometers. Furthermore, technique can deteriorate with the demands of rowing intensity and duration, which puts the rower returning from injury at additional risk.

Sagittal plane motion of the lumbar spine during ergometer and single scull rowing.

Lumbar spine injury in rowers is common and ergometer rowing has been cited as a risk factor for this injury. The purpose of this study is to compare lumbar kinematics between ergometer and single scull rowing and to examine the effect of fatigue on kinematics. The sagittal lumbar spine motion of 19 elite male rowers (lumbar spine injury free in the previous six months) was measured with an electrogoniometer during a 'step test' on an ergometer and in a single sculling boat. Maximum range of lumbar flexion was recorded in standing for reference. Power output and heart rate were recorded during the ergometer tests. Heart rate was used as a surrogate for power output in the sculling test. Maximum lumbar flexion increased during the step test and was significantly greater on the ergometer (4.4 degrees +/- 0.9 degrees change), compared with the boat (+1.3 degrees +/- 1.1 degrees change), (3.1 degrees difference, p = 0.035). Compared to the voluntary range of motion, there is an increase of 11.3% (ergometer) and 4.1% (boat). Lumbar spine flexion increases significantly during the course of an ergometer trial while changes in a sculling boat were minimal. Such differences may contribute to the recent findings linking ergometer use to lower-back injury.

Injury in elite county-level hurling: a prospective study.

OBJECTIVE: To determine the incidence, prevalence and nature of sports injuries in elite male hurling players. DESIGN: Prospective study of county-grade hurling teams. Incidence, prevalence and descriptions of injuries were collated. SETTING: Four county teams during the 2007 season; January to September inclusive. PARTICIPANTS: A total of 127 male players were followed over 34 weeks. Data were collected on a median (IQR) of 31 (30-32) players per team per week. The mean age was 23.3±2.5 years. RESULTS: There were 204 injuries to 104 players (82%, 95% CI (74 to 88)). Injury incidence rate during match-play (102.5 (84.4 to 123.2)) was 19 times higher than for training (5.3 (4.2 to 6.5)) (RR=19.5 (14.8 to 25.6)). The mean weekly prevalence of injury was 13.9% (12.5 to 14.8). Most injuries were new (n=170, 83.3%, (77.6 to 87.8)) and acute (n=165, 80.9% (74.9 to 85.7)). Muscle strain (n=86) accounted for 42.2% (35.6 to 49) of the total. 71% of injuries were to the lower limb (n=143, (63.5 to 76.0)) with hamstring strain (n=33, 16.5% (11.8 to 21.8)) predominating. Fractures constituted 7.4% injuries (n=15, 95% CI (4.5 to 11.8)), 12 of which were to the upper limb. There were three (1.5% (0.5 to 4.2)) eye injuries and one concussion injury (0.5% (0.1 to 2.7)). CONCLUSIONS: These results provide data on hurling injuries using definitions that reflect international consensus statements. Injury incidence from match-play in particular is high compared with other sports. These findings have relevance for clinicians and coaches.

Time-loss injuries versus non-time-loss injuries in the first team rugby league football: a pooled data analysis.

OBJECTIVE: To describe the injury rates in first team rugby league in terms of those injuries that require missed playing time and those that do not. DESIGN: A pooled data analysis from 2 independent databases. SETTING: Rugby league match and training environment over several seasons from 1990 to 2003. MAIN OUTCOME MEASURES: Injuries were reported as rates per 1000 hours of participation and as percentages with their associated 95% confidence intervals (CIs). RESULTS: A total of 1707 match injuries were recorded. Of these injuries, 257 required players to miss the subsequent match. The remaining 1450 injuries did not require players to miss the next game. They represented 85% (95% CI, 83-87) of all injuries received and recorded. The ratio of non-time-loss (NTL) to time-loss (TL) injuries was 5.64 (95% CI, 4.96-6.42). There were 450 training injuries, of which 81 were TL injuries and 369 NTL injuries. The NTL training injury rate was 4.56 (95% CI, 3.58-5.79) times higher than TL injury rate. CONCLUSIONS: Non-time-loss injuries represent the largest proportion of injuries in rugby league. If NTL injuries are not recorded, the workload of practitioners is likely to be severely underestimated.

The effect of rowing to exhaustion on frontal plane angular changes in the lumbar spine of elite rowers.

Lumbar spine injury is common in rowers and examination of spinal kinematics may improve the understanding of this injury's prevalence. This study aimed to examine the range of frontal plane angular displacement (AD) in the lumbar spine at L3 during ergometer rowing and to investigate the effect of exhaustion on lumbar kinematics. Twelve elite male rowers completed an incremental test on a concept 2 ergometer. Lumbar AD at L3 was measured continually throughout the rowing trial using a Spectrotilt Inclinometer and blood lactate was sampled at 3-minute intervals. AD of between 4.7° and 8.8° was recorded at L3. There was a significant increase in AD between the first and last stage of the test (mean increase = 4.1 ± 1.94°, 95% Confidence Interval [CI], 2.9 to 5.3°, t = 7.36, P = 0.000014). Incremental rise in AD was associated with an incremental rise in blood lactate but regression confirmed that only stroke rate was a significant predictor for increasing angle. Thus there is a statistically significant increase in frontal plane AD at L3 over the course of an incremental exercise test although it cannot be confirmed if this is as a result of exhaustion. The values of AD confirm that there is motion in the frontal plane in ergometer rowing.

Annual Baseline King-Devick Oculomotor Function Testing Is Needed Due to Scores Varying by Age.

OBJECTIVE: To document baseline King-Devick (K-D) oculomotor function scores for male and female participants aged between 4 and 20 years old. METHODS: Utilising a cross section of schools, rugby clubs and gymnastic clubs, 1936 participants (1300 male, 636 female) completed the spiral-bound K-D test for the identification of disturbed oculomotor function. RESULTS: This study identified that overall, the baseline scores of the K-D test became faster by 1.4 (0.3 to 4.5) s per year, when compared with the previous age group in the same number of reading card groups. When comparing normative values of the original K-D validation study with the same age groups of the current cohort, participants aged 6 to 11 years recorded a faster baseline time (range 3.5 to 8.6 s), while those in the 12 to 14 years. age group recorded slower baseline times (range -3.9 to -7.9 s). DISCUSSION: In general, there were age group differences, but not sex differences, for K-D test times in the current cohort. Analysis of single card times, across all age groups, showed changes likely due to improved reading time. CONCLUSION: The results support the need for individualised annual pre-injury baseline testing of the K-D test.