Effects of Photobiomodulation on Pain and Return to Play of Injured Athletes: A Systematic Review and Meta-analysis.

ABSTRACT: Morgan, RM, Wheeler, TD, Poolman, MA, Haugen, ENJ, LeMire, SD, and Fitzgerald, JS. Effects of photobiomodulation on pain and return to play of injured athletes: A systematic review and meta-analysis. J Strength Cond Res 38(6): e310-e319, 2024-The aims of this systematic review and meta-analysis were to evaluate the effect of photobiomodulation (PBM) on musculoskeletal pain in injured athletes and to determine if the effects of PBM allowed injured athletes to return to play faster. Electronic databases (MEDLINE Complete, CINAHL, and SPORTDiscus, PubMed, Web of Science, and Embase) were systematically searched (up to and including November 7, 2023) for peer-reviewed randomized controlled trials (RCTs) meeting criteria. Six RCTs, representing 205 competitive and recreational athletes with a mean age of 24 years, were included in the analysis. There were 6 intervention groups using standard physical therapy (n = 1), placebo PBM (n = 4), and aloe gel (n = 1) lasting between 10 minutes and 8 weeks in duration. The level of significance set for the study was p < 0.05. Overall, the use of PBM indicated a positive effect on pain reduction for PBM vs. control groups, standardized mean differences = 1.03, SE = 0.22, 95% confidence intervals = [0.43-1.63], p = 0.0089, but the 2 RCTs found evaluating the effect of PBM on time to return to play after injury in athletes do not support a benefit. Allied healthcare professionals may use PBM to reduce pain, thus allowing an athlete to return to their normal biomechanical movement faster; however, limited evidence suggests that PBM does not reduce time to return to play after an injury.

Field investigation of child restraints in side impact crashes.

OBJECTIVE: Various test procedures have been suggested for assessing the protection afforded by child restraints (CRS) in lateral collisions. Analyses of real world crashes can be used to identify relevant characteristics of the child, restraint, collision, and injury mechanisms that should be incorporated into the design of the test procedures as well as in the design of related ATDs and injury metrics. The objective of this work is to use in-depth crash investigations of children restrained in CRS in side impacts to elucidate specific sources and mechanisms of injuries and explore the role of crash severity variables such as magnitude and location of intrusion and specific impact angle. METHODS: Real world crashes involving children restrained in forward facing CRS in side impacts were analyzed from Partners for Child Passenger Safety, an on-going child specific crash surveillance system in which insurance claims are used to identify cases. In-depth crash investigations using standardized protocols were used to calculate the crash severity and determine the mechanisms and sources of the injuries sustained. RESULTS: Cases of 32 children restrained in CRS in 30 side impact crashes were examined. Twenty-five percent sustained AIS 2+ injuries. The most common injuries sustained by children restrained in CRS in side impact crashes were to the face, head, and lower extremity. Characteristics of the crashes that appeared related to injury were intrusion that entered the child's occupant space or caused an interior part of the vehicle to enter the child's occupant space, forward component of the crash, and the rotation of the CRS, restrained by a seat belt, towards the side of the impact. CONCLUSIONS: The ability to assess the injury potential in a laboratory setting for the body regions of common injury, the head, face, and lower extremity, must be explored. Characteristics of a regulatory-based test procedure to assess injury risk should include a frontal component to the crash and intrusion into the occupant's seating position. Design enhancements of the CRS should address rotation during lateral impacts. These results provide guidance to current efforts to design and regulate these restraints for the safety of child passengers in side impacts.

The 5(th) percentile dummy in a 56 kmph full-frontal barrier crash test.

In 1998, the National Highway Traffic Safety Administration (NHTSA) tested the 5(th) percentile dummy and the 50(th) percentile dummy in 48 KMPH (30 MPH) belted full-frontal crash tests. From these tests, it was concluded that the 5(th) percentile dummy experienced increased injury measures to the neck and tibia compared to the 50(th) percentile dummy when crashed in the same vehicle. In 2001, the agency conducted ten belted 56 KMPH (35 MPH) frontal vehicle crash tests using the 5(th) percentile dummy. This paper summarizes the results and findings of those tests. The results indicate that the 5(th) percentile dummy is a robust and very durable dummy, which could be used as a tool for safety information. The testing also showed that, for some vehicles, the 5(th) percentile dummy incurred greater injury measures than the 50(th) percentile dummy tested in the same vehicle, particularly for the neck and the lower extremities. The average Nij reading for the 5(th) percentile driver dummy was 0.82, while for the 50(th) percentile driver dummy, the average Nij reading was 0.39. Also, the average normalized neck tension reading for the 5(th) percentile driver dummy was 0.70, whereas it was 0.41 for the 50(th) percentile driver dummy for the vehicles of this test series. Average normalized neck tension readings for the 5(th) percentile passenger dummy were 0.40, whereas 0.28 was the average normalized reading for the 50(th) percentile passenger dummy in the vehicles tested. For the 5(th) percentile driver, all but three vehicles exceed one of the four indices for the tibia, whereas only four vehicles exceeded one of these indices for the 50(th) percentile driver. Finally, the testing revealed the need for different stature dummies to ensure equal protection for all occupants.

Impact and injury patterns in between-rails frontal crashes of vehicles with good ratings for frontal crash protection.

This research investigated (1) what are the key attributes of the between-rail, frontal crash, (2) what are the types of object contacted, and (3) what is the type of resulting trauma. The method was to study with both weighted and in-depth case reviews of NASS-CDS crash data with direct damage between the longitudinal rails in frontal crashes. Individual case selection was limited to belted occupants in between-rail, frontal impacts of good-rated, late-model vehicles equipped with air bags.This paper evaluates the risk of trauma for drivers in cars and LTVs in between-rail, frontal crashes, and suggests the between-rail impact is more dangerous to car drivers. Using weighted data-representing 227,305 tow-away crashes-the resulting trauma to various body regions was analyzed to suggest greatest injury is to the chest, pelvis/thigh/knee/leg, and foot/ankle. This study analyzed the type of object that caused the direct damage between the rails, including small tree or post, large tree or pole, and another vehicle; and found that the struck object was most often another vehicle or a large tree/pole. Both the extent of damage and the occupant compartment intrusion were explored, and suggest that 64% of the serious injuries are associated with increasing intrusion. Individual NASS cases were reviewed to gain a deeper understanding of the mechanical particulars in the between-rail crash.

A reexamination of the small overlap frontal crash.

The objective of this study was to examine and rank the Small Overlap Frontal Crash as one of the eight-group taxonomy proposed by Ford. The Ford taxonomy classifies real-world frontal-impact crashes based on the National Automotive Sampling System (NASS). Frontally-impacted vehicles were identified for 1985 - 2008 model year passenger vehicles with Collision Deformation Classification (CDC) data from the 1995 - 2008 years of NASS. Small overlap frontal cases were identified where there was no engagement of the vehicle frame rails, and the direct damage was located entirely outside of the vehicle frame rails. The results are that full engagement and offset (offset category means the direct damage overlaps the vehicle frame rail, with the center of direct damage between the frame rails) were the most frequent crashes contributing 35% each. The frequency of the small overlap frontal was 6%. The risks of injury (AIS ≥ 2) for the full engagement, offset, and small overlap were 8%, 6%, and 3% respectively. For this study, the number of small overlap vehicles was 1,118 and the number of injured nearside occupants was 100. This study-following the Ford approach and reasonably identifying the location of the longitudinal rails based on CDC-suggests that the small overlap is at worst a moderately dangerous crash in the overall scheme of frontal crashes. The implications of this study are that the safety community should reexamine the significance of the small overlap frontal crash against an overall taxonomy of crashes.

Vehicle related factors that influence injury outcome in head-on collisions.

This study specifically investigated a range of vehicle-related factors that are associated with a lower risk of serious or fatal injury to a belted driver in a head-on collision. This analysis investigated a range of structural characteristics, quantities that describes the physical features of a passenger vehicle, e.g., stiffness or frontal geometry. The study used a data-mining approach (classification tree algorithm) to find the most significant relationships between injury outcome and the structural variables. The algorithm was applied to 120,000 real-world, head-on collisions, from the National Highway Traffic Safety Administration's (NHTSA's) State Crash data files, that were linked to structural attributes derived from frontal crash tests performed as part of the USA New Car Assessment Program. As with previous literature, the analysis found that the heavier vehicles were correlated with lower injury risk to their drivers. This analysis also found a new and significant correlation between the vehicle's stiffness and injury risk. When an airbag deployed, the vehicle's stiffness has the most statistically significant correlation with injury risk. These results suggest that in severe collisions, lower intrusion in the occupant cabin associated with higher stiffness is at least as important to occupant protection as vehicle weight for self-protection of the occupant. Consequently, the safety community might better improve self-protection by a renewed focus on increasing vehicle stiffness in order to improve crashworthiness in head-on collisions.

Mechanisms of traumatic rupture of the aorta and associated peri-isthmic motion and deformation.

This study investigated the mechanisms of traumatic rupture of the aorta (TRA). Eight unembalmed human cadavers were tested using various dynamic blunt loading modes. Impacts were conducted using a 32-kg impactor with a 152-mm face, and high-speed seatbelt pretensioners. High-speed biplane x-ray was used to visualize aortic motion within the mediastinum, and to measure deformation of the aorta. An axillary thoracotomy approach was used to access the peri-isthmic region to place radiopaque markers on the aorta. The cadavers were inverted for testing. Clinically relevant TRA was observed in seven of the tests. Peak average longitudinal Lagrange strain was 0.644, with the average peak for all tests being 0.208 +/- 0.216. Peak intraluminal pressure of 165 kPa was recorded. Longitudinal stretch of the aorta was found to be a principal component of injury causation. Stretch of the aorta was generated by thoracic deformation, which is required for injury to occur. The presence of atherosclerosis was demonstrated to promote injury. The isthmus of the aorta moved dorsocranially during frontal impact and submarining loading modes. The aortic isthmus moved medially and anteriorly during impact to the left side. The results of this study provide a better understanding of the mechanisms associated with TRA, and can be used for the validation of finite element models developed for the examination and prediction of TRA.