Framing racial disparities within sports related concussion (SRC): an ecological framework for understanding biases and disparities in concussion care for black athletes.

Privilege and marginalization associated with racial background have been posited as contributors to why Black athletes face disparities within their care, treatment, and recovery from sport-related concussion (SRC). However, empirical findings have limited exploration on how disparate outcomes have emerged, and the interaction with systems of biases, power and disenfranchisement. To understand concussion care disparities, a qualitative content analysis was conducted in three phases: [I] identifying salient literature on racial differences for Black athletes with SRC (N = 29), [II] qualitative analysis of literature to determine salient topics, themes and patterns within the literature, and [III] constructing a novel ecological-systems framework that encapsulates the 'why' and 'how' related to psychosocial and sociocultural experiences of power, access, and biases for Black athletes. The content analysis yielded two patterns, where concussion care decisions are influenced by (1) biased, unconscious beliefs that posit Black athletes as uniquely invincible to injury and pain, and (2) inadequate access to concussion knowledge and resources, which both moderate SRC injury risk, diagnosis, recovery and outcomes. Ultimately, our novel framework provides a clear thread on how historical, macro-level policy and perceptions can impact micro-level clinical care and decision-making for Black athletes with SRC.

More Than Skin Deep: Patient-Provider Racial and Ethnic Concordance and Discordance in Collegiate Athletics and Concussion Management.

CONTEXT: There is strong evidence that racial and ethnic disparities exist in multiple arenas of health and wellness. The causes of racial and ethnic differences in health care are multidimensional; one factor that may affect injury/illness communication, interactions, and outcomes is patient-provider racial and ethnic concordance. At present, it is unclear what role patient-provider racial and ethnic concordance and discordance plays in facilitating concussion care for collegiate athletes. OBJECTIVE: To investigate the presence of athlete-athletic trainer (AT) racial and ethnic concordance and discordance among diagnosed concussion cases and examine if racial and ethnic concordance and discordance influences time (in days) until diagnosis, symptom resolution, or return-to-sport clinical milestones in collegiate athletes. DESIGN: Retrospective cohort study. SETTING: Collegiate athletics. PATIENTS OR OTHER PARTICIPANTS: A total of 694 concussion cases (38.6% [n = 268] sustained by women, 61.4% [n = 426] sustained by men) that occurred within the 2015-2016 through 2019-2020 sport seasons at 9 institutions. MAIN OUTCOME MEASURE(S): The number of days from the date of injury to diagnosis, symptom resolution, and return to sport and from the date of diagnosis to symptom resolution and return to sport. RESULTS: Overall, 68.4% (n = 475) of concussion cases had patient-provider racial and ethnic concordance, and 31.6% (n = 219) were discordant. All concordant pairs included a White athlete and White AT. Time to diagnosis differed between the concordant and discordant groups (median [interquartile range] = 1 [0-2] versus 0 [0-1], respectively) only in the model adjusted for sex, sport type, and availability of an AT (odds ratio [95% CI] = 1.46 [1.07-1.85]). There were no other group differences. CONCLUSIONS: One-third of concussion cases had athlete-AT racial and ethnic discordance. Although this group was diagnosed with a concussion 1 day sooner than the concordant group, no differences were observed for any concussion recovery milestones. These findings suggest that patient-provider racial and ethnic concordance may play a minor role in concussion recognition or reporting but not necessarily in the management and recovery thereafter.

Epidemiology of patients with anterior cruciate ligament injuries undergoing reconstruction surgery in a multi-ethnic Asian population.

We conducted an epidemiological study to identify the demographics and pre-operative characteristics of patients undergoing primary anterior cruciate ligament (ACL) reconstruction in a multi-ethnic Asian population. A retrospective study was performed on 696 patients who registered in our ACL reconstruction registry from January 2013 to August 2016. Important inter-ethnic differences were found. Indian patients were significantly older compared to Malay and Chinese patients. Malay and Indian patients were more likely to be male, overweight, and obese compared to Chinese patients. Soccer was the predominant sport involved, although ethnic predominance in specific sports exists. Novel findings from this study include increased prevalence of concomitant chondral injuries in the Chinese population compared to Malays and Indians, and significantly higher rates of concomitant intra-articular injuries in soccer and basketball compared to netball. Identification of these high-risk subgroups would serve useful in guiding the formulation of prevention strategies within our multi-ethnic community.

ImPACT Normative Data of Ethnically Diverse Adolescent Athletes.

OBJECTIVE: The aim of this research was to develop preliminary norms for the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) administered to a large sample of adolescent athletes from diverse ethnic backgrounds. DESIGN: A retrospective records review. SETTING: Middle and high school athletic departments. PARTICIPANTS: A total of 5741 male and female adolescent athletes in Hawaii, aged 13 to 18 years, in grades 9 to 12 were included in the study. INDEPENDENT VARIABLES: Age, sex, ethnicity, and sport. MAIN OUTCOME MEASURES: ImPACT Composite scores (Verbal Memory, Visual Memory, Visual Motor Speed, Reaction Time, and Impulse Control) and Total Symptom score from baseline testing. RESULTS: The results indicated statistically significant differences between age and sex groups, as well as between ethnic and sport groups. CONCLUSIONS: The findings support the continued use of stratified norms for age and sex for ethnically diverse adolescent athletes. Comparisons of ethnic and sport groups deserve further investigation. When baseline scores are not available for postconcussion comparison, present observations tentatively support the cautious use of standard ImPACT norms with ethnically diverse athletes.

Socioeconomic Factors for Sports Specialization and Injury in Youth Athletes.

BACKGROUND: The effect of socioeconomic status (SES) on rates of sports specialization and injury among youth athletes has not been described previously. HYPOTHESIS: Young athletes from lower socioeconomic status will have lower rates of sports specialization and subsequently lower risk of overuse injuries. STUDY DESIGN: Cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: Injured athletes aged 7 to 18 years were recruited from 2 hospital-based sports medicine clinics and compared with uninjured athletes presenting for sports physicals at primary care clinics between 2010 and 2013. Participants completed surveys on training patterns. Electronic medical records provided injury details as well as patient zip code, race, and health insurance type. SES was estimated from zip codes. The sample was divided into SES tertiles. Analysis of variance and multivariate regression were used for continuous variables, and multivariate logistic regression analyses were conducted to explore relationships between risk factors and injury. RESULTS: Of 1190 athletes surveyed, 1139 (96%) had satisfactory SES data. Compared with low-SES athletes, high-SES athletes reported more hours per week spent playing organized sports (11.2 ± 6.0 vs 10.0 ± 6.5; P = 0.02), trained more months per year in their main sport (9.7 ± 3.1 vs 7.6 ± 3.7; P < 0.01), were more often highly specialized (38.9% vs 16.6%; P < 0.01), and had increased participation in individual sports (64.8% vs 40.0%; P < 0.01). The proportion of athletes with a greater than 2:1 ratio of weekly hours in organized sports to free play increased with SES. Accounting for age and weekly organized sports hours, the odds of reporting a serious overuse injury increased with SES (odds ratio, 1.5; P < 0.01). CONCLUSION: High-SES athletes reported more serious overuse injuries than low-SES athletes, potentially due to higher rates of sports specialization, more hours per week playing organized sports, higher ratio of weekly hours in organized sports to free play, and greater participation in individual sports. CLINICAL RELEVANCE: As SES increases, young athletes report higher degrees of sports specialization, greater participation in individual sports, and more serious overuse injuries.

Advanced Treatment Monitoring for Olympic-Level Athletes Using Unsupervised Modeling Techniques.

CONTEXT: Analysis of injury and illness data collected at large international competitions provides the US Olympic Committee and the national governing bodies for each sport with information to best prepare for future competitions. Research in which authors have evaluated medical contacts to provide the expected level of medical care and sports medicine services at international competitions is limited. OBJECTIVE: To analyze the medical-contact data for athletes, staff, and coaches who participated in the 2011 Pan American Games in Guadalajara, Mexico, using unsupervised modeling techniques to identify underlying treatment patterns. DESIGN: Descriptive epidemiology study. SETTING: Pan American Games. PATIENTS OR OTHER PARTICIPANTS: A total of 618 U.S. athletes (337 males, 281 females) participated in the 2011 Pan American Games. MAIN OUTCOME MEASURE(S): Medical data were recorded from the injury-evaluation and injury-treatment forms used by clinicians assigned to the central US Olympic Committee Sport Medicine Clinic and satellite locations during the operational 17-day period of the 2011 Pan American Games. We used principal components analysis and agglomerative clustering algorithms to identify and define grouped modalities. Lift statistics were calculated for within-cluster subgroups. RESULTS: Principal component analyses identified 3 components, accounting for 72.3% of the variability in datasets. Plots of the principal components showed that individual contacts focused on 4 treatment clusters: massage, paired manipulation and mobilization, soft tissue therapy, and general medical. CONCLUSIONS: Unsupervised modeling techniques were useful for visualizing complex treatment data and provided insights for improved treatment modeling in athletes. Given its ability to detect clinically relevant treatment pairings in large datasets, unsupervised modeling should be considered a feasible option for future analyses of medical-contact data from international competitions.

Sports injury and illness epidemiology: Great Britain Olympic Team (TeamGB) surveillance during the Sochi 2014 Winter Olympic Games.

BACKGROUND: Sports injury and illness surveillance is the first step in injury and illness prevention, and is important for the protection of both athlete health and performance in major competitions. AIM: To identify the prevalence, severity nature and causes of athlete injuries and illnesses in the Great Britain Olympic Team (TeamGB) during the Sochi 2014 Winter Olympic Games. METHODS: The observational prospective cohort study followed the Great Britain Injury/Illness Performance Project surveillance methodology and obtained information on injuries and illnesses that occurred during the Games between 30 January and 23 February 2014 in TeamGB athletes (n=56). RESULTS: Among the 56 TeamGB athletes, there were 27 injuries and 11 illnesses during the Olympic Games period. This equated to 39% sustaining at least one injury and 18% at least one illness, with an incidence of 48.2 injuries and 19.6 illnesses per 100 athletes, respectively. Of all injuries and illnesses, 9% and 7%, respectively, resulted in time loss. The risk of sustaining an injury was highest for freestyle skiing, skeleton and snowboarding; and lowest for curling, biathlon and Alpine skiing (with no reported injuries); with the lower limb being the most commonly injured location. Respiratory system illnesses were most frequently reported overall, and older female athletes were the ones most affected by illness. CONCLUSIONS: The risk of injury was double the risk of illness for TeamGB athletes. Overall, the rate of time-loss issues was low. Methodological considerations are important when interpreting data, and prevention strategies should focus on those issues causing the greatest risk, in terms of prevalence and severity, to athlete health and performance.

Incidence of injury among male Brazilian jiujitsu fighters at the World Jiu-Jitsu No-Gi Championship 2009.

CONTEXT: Brazilian jiujitsu is a modern combat martial art that uses joint locks to submit an opponent and achieve victory. This form of martial art is a relatively young but rapidly growing combat sport worldwide. OBJECTIVE: To determine the cumulative injury incidence and risk of injury by belt rank and body region at an international-level Brazilian jiujitsu tournament. DESIGN: Descriptive epidemiology study. SETTING: World Jiu-Jitsu No-Gi Championship 2009 in Long Beach, California. PATIENTS OR OTHER PARTICIPANTS: We monitored 951 athletes (age range, 18-50 years) enrolled to compete in the World Jiu-Jitsu No-Gi Championship 2009. INTERVENTION(S): Fighters were categorized by belt level for group comparisons (belt experience). Incidence rates per 1000 athlete-exposures (AEs) and incidence rate ratios were compared by belt rank. MAIN OUTCOME MEASURE(S): Incidence rates and incidence rate ratios. RESULTS: During the tournament, 1606 AEs and 62 total injuries were reported. Of these injuries, 40 affected the joints, for an overall incidence rate of 24.9 per 1000 AEs. The joint incidence rate by belt rank was 21.5 per 1000 AEs for blue, 21.3 per 1000 AEs for purple, 25.2 per 1000 AEs for brown, and 35.1 per 1000 AEs for black. We found no differences for incidence rate ratios of joint injury among individual belt groups (P > .05). More experienced (brown belt and black belt) competitors had a higher injury risk than the less experienced (blue belt and purple belt) competitors; however, the difference was not significant (incidence rate ratio = 1.65, 95% confidence interval = 0.9, 2.9; P = .06). The incidence of joint injury was highest at the knee (7.5 per 1000 AEs) and elbow (7.5 per 1000 AEs). CONCLUSIONS: The data from this international Brazilian jiujitsu tournament indicated that the risk of joint injury was similar among belt ranks or experience during this Brazilian jiujitsu competition. The knee and elbow were the joints most susceptible to injury. Future investigation of injury mechanism is warranted to develop strategies to reduce potential risk factors attributed to injury.

Prediction of the graft size of 4-stranded semitendinosus tendon and 4-stranded gracilis tendon for anterior cruciate ligament reconstruction: a Chinese Han patient study.

BACKGROUND: Little information is available regarding parameters that would enable a surgeon to predict the size and length of 4-stranded semitendinosus (ST) and 4-stranded gracilis tendon (GT) grafts. PURPOSE: To evaluate whether certain preoperative anthropometric data enable prediction of the size of 4-stranded ST and GT autograft for anterior cruciate ligament (ACL) reconstruction. STUDY DESIGN: Cohort study (prevalence); Level of evidence, 2. METHODS: This study involved 235 Chinese Han patients who underwent double-bundle ACL reconstruction with 4-stranded autogenous ST and GT grafts. Preoperatively, the authors recorded height, weight, body mass index (BMI), gender, age, and sports activity. During surgery, the usable length of the ST and GT and the diameter of the 4-stranded grafts made of ST and GT were measured. Multiple regression analysis was used to determine relationships between anthropometric measurements and the length and diameter of intraoperatively measured ST and GT grafts. RESULTS: Strongest correlations for ST and GT length and GT graft diameter were height and weight. The strongest correlations for ST graft diameter were gender and weight. Body mass index had only moderate correlations with ST and GT graft size. Self-reported activity level was not correlated. Women had significantly smaller GT and ST graft diameters and shorter tendon lengths than did men. Semitendinosus graft size was significantly larger and longer than was the GT graft (7.4 ± 0.7 mm vs 5.9 ± 0.6 mm and 279.9 ± 20.8 mm vs 251.5 ± 20.8 mm, respectively). Simple regression analysis demonstrated that height, weight, and BMI can be used to predict ST and GT autograft length and diameter. CONCLUSION: Several preoperative anthropometric measurements showed correlation with the length of the ST and GT and diameter of 4-stranded ST and GT grafts. The current data may provide surgeons with important preoperative information about size of ST and GT grafts and would be useful for patient counseling and alternative graft source planning.

Epidemiological characteristics of adult SCIWORA in Tianjin, China: a preliminary study.

INTRODUCTION: The epidemiology of spinal cord injury without radiographic abnormality (SCIWORA) is less frequently reported in adults as compared with children. The annual incidence of SCIWORA was approximately 5.74% per million in Tianjin from 2004 to 2008. Importantly, the epidemiological characteristics of adult SCIWORA may be different from that in children. The aim of this study was to evaluate the radiological-clinical data of patients with adult SCIWORA, and to relatively analyze the epidemiological features. MATERIALS AND METHODS: Inpatients with cervical SCIWORA who were 16 and above in Tianjin were admitted in municipal hospitals in Tianjin from 2004 to 2008; all the patients received MRI scanning in sagittal and axial views. Epidemiological characteristics, such as injury origin, injury level or severity, neurological scale and MRI feature were acquired. RESULTS: In total, 203 patients were enrolled. The average age among the adult groups was 55.9 years (men 55.8 years, women 53.6 years). SCIWORA occurred more commonly in adults in the 46-60 age group, and falls were the leading cause of injury (52.2%), followed by vehicular injury (28.6%). The most predominantly affected level was C4/5 (48.7%), followed by C5/6 (30.5%) and C3/4 (12.8%), respectively. The occurrence of central cord syndrome (50.2%) with posterior longitudinal ligament tear (43.8%) was relatively higher than other injury patterns. CONCLUSION: It is clear that adult cervical SCIWORA is different from that in the pediatric group. Our study highlights the epidemiological properties of adult SCIWORA in Tianjin, China. Differing from other reports, particularly epidemiology study, we represent the first report regarding adult SCIWORA from China. As the geriatric population increases, it is very important to set up an individualized evaluation system based on a nationally scaled epidemiological database. The results from our study will be useful in assisting in the creation of such a database.

Motor sport in France: testing-ground for the world.

The birth of the automobile in the late nineteenth century was greeted with a mixture of awe, scepticism and sometimes even disdain from sections of the European public. In this article, the steps taken in France to pioneer and promote this new invention are examined. Unreliable and noisy, the early automobile owes a debt of gratitude to the French aristocracy who organised and codified motor racing in an effort to test these new inventions while at the same time introduce them to a wider public. City-to-city races demonstrated the potential of the automobile before the initiative of Gordon Bennett proved to be the catalyst for the birth of international motor sport as we recognise it today. Finally this article looks at the special connection between Le Mans and the automobile. Le Mans has, through its 24-hour race, maintained a strong link with the development of everyday automobile tourism and offers the enthusiast an alternative to the machines that reach incredible speeds on modern-day closed circuits. This article examines how French roads were veritable testing grounds for the earliest cars and how the public roads of Le Mans maintain the tradition to this day.

Daredevils and early birds: Belgian pioneers in automobile racing and aerial sports during the belle époque.

During the belle époque, Belgium was a trend-setting nation in many domains, including motorised sports. Belgian automobile racers and pilots shattered world records and became international stars. Striking was the shift in sports. Indeed, around 1896, sporting members of the leisure class stepped from the bicycle into the automobile and, around 1908, from the automobile into the airplane. Although these motorised sports were extremely expensive, this article shows that sportsmen and sportswomen from the working class could achieve upward social mobility through their performances. The achievements of these motorised pioneers had a major impact and wide-ranging significance. They laid the foundations for the expansion of the automobile industry and the emergence of civilian and military aviation.

Groin pain and hip range of motion is different in Indigenous compared to non-indigenous young Australian football players.

OBJECTIVES: Hip and groin pain are common problems in Australian football. Although indigenous (I) players are at greater risk of soft tissue injury than their non-indigenous (non-I) counterparts, Aboriginal descent has not previously been identified as a risk factor for hip and groin injury. The aim of this study was to investigate if hip and groin screening tests would demonstrate differences between indigenous and non-indigenous junior elite AF players. DESIGN: Cross-sectional study. METHOD: Two hundred and seventy elite junior Australian football players were screened using five hip and groin musculoskeletal tests. RESULTS: Thirty-three players (12%) were indigenous. Differences were demonstrated between the two groups for right prone hip internal rotation (I X = 27.60 ± 9.16, non-I X = 33.39 ± 8.88, p < 0.001) and left prone hip internal rotation (I X = 25.83 ± 10.25, non-I X = 31.36 ± 8.75, p < 0.001), pressure on squeeze test with knees at 90° (I X = 165.71 ± 40.32, non-I X = 188.17 ± 62.32, p = 0.001) and pressure on squeeze tests with knees at 0° (I X = 172.57 ± 35.98, non-I X = 202.57 ± 49.14, p = 0.049), and pain provocation during squeeze test with knees at 90° (I X = 3.19 ± 2.26, non-I X = 1.03 ± 1.78, p > 0.001). CONCLUSIONS: The indigenous players displayed less range of passive hip internal rotation with the hip in neutral, reduced adductor squeeze force and higher levels of groin pain with the squeeze test at 90°. The differences observed between indigenous and non-indigenous players suggest indigenous players are at greater risk of hip and groin injuries in Australian football.

The civilizing and sportization of Gaelic football in Ireland: 1884­2009.

Over the course of the last 125 years the sport of Gaelic football in Ireland has undergone a sportization and civilizing process as the rules governing the sport became stricter and players developed greater levels of self-control. However, the civilizing of Gaelic football was a particularly fragile and uneven process. The growing social desire to diminish displays of violence was moderated by ambivalence towards violence. Gradually the external social controls on players increased and, greater and more stable levels of internalization occurred reflected by more advanced levels of player self-restraint in the control of violence. At the same time the threshold of shame toward displays of violence advanced. This transformation was shaped by lengthening chains of social interdependencies in Ireland.

Women's rugby league injury claims and costs in New Zealand.

AIM: There is scarce information on rugby league injuries in female players. This paper provides an overview of the epidemiology of women's rugby league injuries requiring medical treatment and associated costs in New Zealand. METHOD: New Zealand Accident Compensation Corporation injury data for the period 1999-2007 were searched for rugby league injury cases occurring in females. Data were analysed by demographics, body region, nature/severity of injury, and medical procedure and costs. RESULTS: There were 320 moderate to serious injury claims recorded for females participating in rugby league activities over the study period. There was a mean (SD) of 37.9 (9.5) injury claims per year. The mean cost per year for the study period was $196 514 ($99,133) (£76,066 (£38,374)) with half of the injury claims occurring in New Zealand Maori. Concussion/brain injuries accounted for 3.8% of total female moderate to serious injury claims but accounted for 5.4% of female injury costs ($84,399 (£32,688)) with the highest mean cost per claim ($7033 (£2724)). The lower limb accounted for 65% of the total female injury claims and 58.7% of total injury costs ($922,296 (£356,968)). The mean cost per claim was higher for the lower limb ($4434 (£1714)) than the upper ($3331 (£1288)) limb. Clerks recorded 16.3% of the total injury claims, 20.3% of total injury costs ($319,474 (£123,211)) and had the highest mean cost per claim ($6144 (£2370)). The 25-29 age group recorded 31.9% of injury claims and 33.8% of injury costs. The 35-39 age group recorded the highest mean cost per claim ($6200 (£2392)) but only 10.9% of total claims and 13.8% of total costs. DISCUSSION: When compared with other studies in rugby league injuries, it appears that females incur substantially fewer injuries (5.7%) than males (94.3%). Although no participation data by sex are available, it is likely that participation percentages are reflected in the injury percentages. The high frequency (65%) and cost proportion (58.7%) for lower limb injuries was higher in females than in male rugby league players (previously reported as 42.4% of the injury claims and 31.5% of the total injury claim costs for the lower limb). CONCLUSIONS: Injury prevention programmes for women's rugby league should focus on the 25-29 age group and address ways to prevent concussion and lower limb injuries.

Sociodemographic predictors of sport injury in adolescents.

OBJECTIVE: To examine sociodemographic risk factors for sport injury in adolescents. METHODS: This is a cross-sectional survey design in which a random sample of high school students (ages 14-19) completed an in-class survey (N = 2721). Students were asked questions regarding sociodemographic factors, sport participation, and sport injury in the past year. RESULTS: The incidence proportion of self-reported and medically treated sports injury, adjusting for the clustering effect of school, was 67.5 (95% CI; 64.2-71.1) and 43.2 (95% CI; 40.4-46.3) per 100 adolescents per year, respectively. Students from small towns had a lower risk of injury than those in the larger urban center (ORadjusted = 0.76, 95% CI 0.63-0.92). Non-Caucasian students had a lower risk of injury than did Caucasian students (ORadjusted = 0.63 (95% CI 0.5-0.79) for all sport injury and 0.57 (95% CI 0.47 - 0.7) for medically treated sport injury. Students with BMI in the 50th-90th percentiles had the greatest risk of sport injury. The risk of injury increased with weekly hours of participation. CONCLUSIONS: Location of residence, weekly exposure (participation hours), ethnicity, and BMI were simultaneous predictors of sport injuries in adolescents.

Intercondylar notch width measurement differences between African American and white men and women with intact anterior cruciate ligament knees.

BACKGROUND: A recent report of professional women's basketball found that white European American female players were 6.5 times more likely to tear their anterior cruciate ligament than their nonwhite European American counterparts. African Americans accounted for 95% of the nonwhite European American group. HYPOTHESIS: African American men and women have wider intercondylar notches than white men and women. STUDY DESIGN: Cohort study (prevalence); Level of evidence, 2. METHODS: We obtained 45 degrees flexed weightbearing posteroanterior radiographs on 517 patients who had knee problems other than an anterior cruciate ligament injury or arthrosis. One experienced observer measured the intercondylar notch width with no knowledge of race or gender, and the measurements were analyzed based on race and gender. RESULTS: The mean intercondylar notch width was 15.5 mm (SD = 2.8; range, 9-22) for African American women and 14.1 mm (SD = 2.5; range, 8-21) for white women; this difference was statistically significant (P = .009). Similarly, the mean intercondylar notch width was 18.0 mm (SD = 3.6; range, 10-27) for African American men and 16.9 mm (SD = 3.1; range, 9-27) for white men; these values were statistically significantly different (P = .003). CONCLUSION: We conclude that African Americans have statistically significantly wider intercondylar notch widths on 45 degrees flexed weightbearing posteroanterior radiographs than whites of the same gender. This relationship may offer an explanation for the difference between races with regard to risk of anterior cruciate ligament tears.

Self-reported injury history in Native American professional rodeo competitors.

OBJECTIVE: Evaluation of rodeo injury and the use of protective equipment. DESIGN: Cross-sectional survey. SETTING: Indian National Finals Rodeo 2004 in San Jacinto, CA. PARTICIPANTS: One hundred sixty-nine native American, professional rodeo competitors. ASSESSMENT: On-site survey completed before competition. A total of 180 native American competitors received the survey. Respondents reported the event of participation, prior injury histories (including number, type and disability), use of protective equipment, and access to health care. MAIN OUTCOME MEASUREMENTS: Main outcomes were determined before survey distribution and included self-reported injury rate, time away from rodeo secondary to injury, and protective equipment usage during competition. RESULTS: Total 94% response rate. There was a range of injury history-from 100% of bull riders to only 24% of tie-down ropers-reporting a history of injuries. Forty percent of competitors reported using protective equipment; of these, 32% reported wearing vests. Twenty-six percent of the competitors had a history of injury that prevented them from working an average of 3.2 months. CONCLUSIONS: As hypothesized, a greater injury rate resulted from rough stock events; older competitors are more likely to have had work time loss from injury; and vests are the most frequently used protective equipment in rodeo.