Return to play protocols for musculoskeletal upper and lower limb injuries in tackle-collision team sports: A systematic review.

Athletes in tackle-collision teams are at high risk of musculoskeletal injuries resulting in absence from play due to the high impact nature of the sport. There is a paucity of research to guide the management and assessment methods needed to facilitate the return to play (RTP) process. This review aimed to describe, synthesise and evaluate RTP protocols implemented for musculoskeletal injuries in tackle-collision teams. A systematic search of Scopus, PubMed, Web of Science and Ebsco Host was conducted for RTP management protocols and assessment modalities following upper and lower limb musculoskeletal injuries in tackle-collision team athletes. Prospective and retrospective quantitative controlled trials, cohort, case-control, case-series and cross-sectional observation studies published between January 2000 and March 2020 were considered. The main outcome measures were the proportion of athletes to RTP, associated time-loss and reinjury risk. 5265 articles were screened. 34 studies met the eligibility criteria of which 23 involved management and 11 assessment modalities. Management involved surgical or conservative strategies along with exercise-based rehabilitation. Assessment modalities included radiographic assessment, clinical evaluation and subjective ratings. Promising RTP management included progressive weight-bearing and exercised-based rehabilitation for ankle sprains as well as surgery, the use of a sling and exercise-based rehabilitation for shoulder instability. MRI scans showed promise in predicting time-loss following hamstring and calf strains in tackle-collision athletes. There are currently no clear guidelines for RTP after musculoskeletal injuries in tackle-collision sports. Future research should investigate efficient management strategies evaluated through valid and reliable assessment methods to better guide clinicians.

Impact of a South African School-based Intervention, HealthKick, on Fitness Correlates.

OBJECTIVES: To assess the impact of a whole-of-school health promotion program targeting healthy eating and physical activity on physical fitness levels, and physical activity-related knowledge, attitudes and behavior of primary school children. METHODS: Sixteen primary schools were randomly assigned as intervention (N = 8) and control (N = 8) schools. A selection of tests from the Eurofit testing battery was used to assess changes in fitness levels over the 3 years of the intervention. Anthropometric measurements included height and weight. A physical activity knowledge, attitude and behavior (KAB) questionnaire was administered to participants. Multi-level mixed effect linear models were used to assess differences between intervention and control schools. RESULTS: No overall improvement in physical fitness was found. The sit-ups score improved significantly in the intervention group (p < .05). No overall intervention effects were found on the determinants of physical activity behavior. Knowledge improved in both the intervention (p = .005) and control (p < .001) groups. CONCLUSION: The lack of a specific intervention effect on fitness levels and physical activity-related KAB indicates that a "low intensity" intervention is not effective in South African primary school settings.

Factors Influencing Break-Time Physical Activity of South African Primary School Learners From Low-Income Communities.

BACKGROUND: The purpose of this study was to assess factors that influence physical activity (PA) levels during break-times in South African primary school children. METHODS: The System for Observing Play and Leisure Activities in Youth (SOPLAY) was used to observe PA levels during break-times at low-income schools (4 intervention, 4 control). The intervention was based on action-planning including: school environment, curriculum, and family involvement. Categories of observed activity included Sedentary, Eating, Walking, or Vigorous PA. Contextual factors assessed included teacher supervision, equipment, and crowding. Chi-square tests were used to determine associations between PA levels and contextual factors. RESULTS: In the 970 observations made, 31% of learners were sedentary, 14% were eating, 29% were walking, and 26% were engaged in vigorous PA. There were no differences in break-time PA between intervention and control groups (NS). With supervision, children were more likely to eat and less likely to do vigorous PA (P = .035). Playground crowding was associated with lower levels of vigorous activity and more sedentary behavior (P = .000). CONCLUSIONS: PA during break-time was adversely affected by over-crowding and lower with supervision. The results suggest that interventions may be targeted at the school policy environment to reduce these barriers to PA.