Mechanisms of anterior cruciate ligament injuries in elite women's netball: a systematic video analysis.

This study involved a systematic video analysis of 16 anterior cruciate ligament (ACL) injuries sustained by elite-level netball players during televised games in order to describe the game situation, the movement patterns involved, the player's behaviour, and a potential injury mechanism. Eight of the ACL injuries were classified as "indirect contact" and eight as "non-contact". Two common scenarios were identified. In Scenario A the player was jumping to receive or intercept a pass and whilst competing for the ball experienced a perturbation in the air. As a result the player's landing was unbalanced with loading occurring predominantly on the knee of the injured side. In Scenario B the player was generally in a good position at ground contact, but then noticeably altered the alignment of the trunk before the landing was completed. This involved rotating and laterally flexing the trunk without altering the alignment of the feet. Apparent knee valgus collapse on the knee of the injured side was observed in 3/6 Scenario A cases and 5/6 Scenario B cases. Players may benefit from landing training programmes that incorporate tasks that use a ball and include decision-making components or require players to learn to cope with being unbalanced.

Do key measurement parameters derived from specific cervical vertebral segments differ between lordotic and non-lordotic cervical spine alignments? A study of asymptomatic young adults.

BACKGROUND: Measurement parameters derived from specific cervical vertebral segments (e.g., C2 slope) can provide clinicians with important information on cervical sagittal balance and guide pre- and post-surgical decision-making processes. It is unclear however, what constitutes typical values for these types of measurements in an asymptomatic population of young adults, whether values change depending upon the classification of the cervical spine's global alignment, and if any non-lordotic cervical subtypes display values that are comparable to those reported for pre-surgery patients. METHODS: Neutral lateral cervical radiographs of 150 asymptomatic participants (18-30 years) were taken. Global cervical alignment was classified as lordotic or one of four non-lordotic subtypes using a multi-method subtyping protocol. Four key measurement parameters - the anterior translation of the head measure (ATHM), C0-C2 angle, C2 slope, and C7 slope - were derived from specific cervical segments. Independent samples t-tests were used to compare lordotic and non-lordotic groups. RESULTS: There was considerable variation in the four key measurement parameters amongst this asymptomatic population of young adults. Thirty-four percent of the sample were classified as lordotic and 66% were classified as non-lordotic. There was a significant difference (p ≤ 0.0125) between lordotic and non-lordotic groups for the C0-C2 angle, C2 slope and C7 slope. There was no difference between groups for the ATHM (p ≥ 0.0125). Within the non-lordotic group, the global-kyphotic (GK) subtype had the largest mean C2 slope, largest mean C0-C2 angle, and smallest mean C7 slope. CONCLUSIONS: Long term prospective investigations are required to determine whether possible biomarkers (alignment parameters/radiological measurements) for spinal degenerative changes can be identified so that early interventions can be put in place to try and reduce the impact of neck pain on society.

Mechanisms of lateral ankle ligament sprains in professional netball: A systematic video analysis.

OBJECTIVES: To undertake a systematic analysis of 17 medical attention and time-loss lateral ankle ligament sprain (LALS) events from televised Australian professional netball games during the 2020-2023 seasons. DESIGN: Case series. METHODS: Three analysts independently assessed the video footage and then convened to review and discuss each case until a consensus was reached. RESULTS: When in possession (7 cases) a player was commonly performing an agility-based manoeuvre to break free from an opponent and reposition themselves to be a passing option (5/7 cases). When out of possession (10 cases) a player was either attempting to intercept a pass (6 cases) or marking an opponent (4 cases). Players tended to land on the anterior one-third of the plantar surface of the foot - forefoot or shoe tip (7 cases). Players often landed on either the ground (7 cases) or the opponent's shoe then the ground (8 cases). In 9 cases the ankle-foot was considered to be in a neutral alignment in the frontal plane at landing. At the estimated index frame the players' weight tended to be all on the foot on the injured side (11 cases) or favouring the foot on the injured side (5 cases). Inversion and adduction was a common injury mechanism. Plantar-flexion was rarely involved. CONCLUSION: Landing on the anterior one-third of the plantar surface of the foot and subsequent weight transference onto the injured limb side was more important than ankle-foot inversion at initial ground contact. Exercises involving external perturbations that challenge the control of frontal and transverse plane ankle-foot motion and improve proprioception, neuromuscular control, and dynamic balance are warranted.

Backpack loading position and self-selected foot position as measured by foot tracings.

BACKGROUND: It is known that even under static conditions a backpack wearer will need to make some adjustments to maintain postural stability. There is a paucity of research exploring the impact of altering the position of the feet with imposed loads of variable distance from the posterior midline. OBJECTIVE: Therefore, the aim of this study was to determine if changes in the horizontal position of a fixed load when wearing a backpack affect specific variables derived from foot tracings of males and females standing with their self-selected natural feet position. METHODS: 150 healthy volunteer participants were instructed to adopt a natural stance across four conditions: Backpack with no weight, backpack with a weight (5% of body mass) placed at 0 cm, 20 cm, and 40 cm distance from the posterior body. Foot tracings were made for each condition. Base of Support (BoS), Feet Width (FW), and Feet Opening Angle (FOA) were calculated. RESULTS: The BoS significantly decreased in loaded conditions (0 cm, 20 cm and 40 cm) compared to unloaded. This was supported by FW and FOA significant findings that once the load was imposed the response was to approximate the feet and reduce 'toeout'. CONCLUSION: This reaction of people to reduce their BoS in response to added backpack load appears counter intuitive and raises the question of whether this is maladaptive. Clarification by further investigation will inform backpack wearers to counter this instinctive response to load and increase postural stability.

An investigation of the reproducibility of a self-selected natural feet position when standing: Implications for the assessment of upright standing posture.

BACKGROUND: Photogrammetry is often used to evaluate standing static postural alignment. Patients are often instructed to self-select a natural feet position but it's unclear whether this position can be consistently replicated across repeated assessments. OBJECTIVE: To determine whether people can replicate a self-selected natural feet position in upright standing across three sessions on different days. DESIGN: Between days test-retest reliability. SETTING: University laboratory. METHODS: Three variables - Base of Support (BoS), Foot Width (FW), Feet Opening Angle (FOA) - were measured from foot tracings of 150 participants (18-30 years) using established procedures. BoS data were assessed for systematic bias (Analysis of Variance), and absolute (Coefficient of Variation - CV%) and relative (Intraclass Correlation Coefficient - ICC) reliability. RESULTS: There was systematic bias in the BoS data across the three testing sessions. The CV% for the BoS data was 15.2%. The ICC (95% CI) for the BoS data was 0.84 (0.79-0.87). There were moderate-large correlations between the BoS and both FOA and FW respectively within each session. CONCLUSION: If clinicians want to allow patients to use their self-selected natural feet position for repeated photogrammetric assessment of their static postural alignment it would be better to standardise the position of the feet, for example, by creating a tracing of a patient's self-selected natural feet position.

Changing the horizontal position of a fixed backpack load: The effect on postural stability in young adults.

BACKGROUND: Modifying the horizontal position of the load in a backpack will change the size of the external torque it creates on the wearer but the effect on postural stability is unclear. OBJECTIVE: To determine if changing the horizontal position of a fixed backpack load affects postural stability in young adults. METHODS: A backpack was attached to a steel frame with a bar protruding posteriorly. A fixed load (5% body mass) was placed at three distances along the bar - 0 m, 0.20 m, and 0.40 m. Centre of pressure (CoP) derived measurements were recorded from a force platform sampling at 100 Hz. For each condition participants performed three 90s narrow stance trials with their eyes closed whilst standing on a firm surface. A comparison was made across unloaded (no backpack) and loaded conditions. RESULTS: There was an immediate decrease in postural stability when a loaded backpack was worn. Only two of the CoP derived measures (Total Excursion - TEx, and Mean Velocity Total Excursion - MVel TEx) differed between the loaded at 0.20 m and loaded at 0 m conditions. All CoP derived measures differed between the loaded at 0.40 m and loaded at 0 m conditions. Furthermore, three of the CoP derived measures (Anterior/Posterior Root Mean Square - A/P RMSq, TEx, and MVel TEx) differed between the loaded at 0.40 m and loaded at 0.20 m conditions. CONCLUSION: The distribution of a load within a backpack must be carefully considered. The findings for the 0.40 m condition are important for the use and design of large backpacks used by multi-day hikers, travellers, and the military.

Does lower extremity alignment during normal stance predict lower limb kinematics and kinetics during drop landings?

BACKGROUND: Static lower extremity alignment (LEA) during normal stance has been used clinically as a tool to determine the presence of known anterior cruciate ligament (ACL) risk factors during dynamic tasks. Previous work investigating the relationship between static LEA during normal stance and risk factors for ACL injury is limited by the use of imprecise methods or because it focuses on knee valgus only and no other potentially important variables. The aim of this investigation was to determine the relationships between static LEA and the corresponding LEA during drop landings. METHODS: Forty-one female athletes were recruited for the study (age: 19.8 ± 2.5 years, height: 1.73 ± 0.06 m, mass: 64.03 ± 6.66 kg). Lower limb kinematic data were collected using a 10 camera infrared motion capture system (500 Hz) with retro-reflective markers placed over key anatomical landmarks. This system was linked to two force platforms (1000 Hz) with subsequent three-dimensional kinematic and kinetic data developed using standard software (Visual3D). Following an appropriate warm-up, data collection involved participants standing with their arms partially abducted to record static LEA. This was following by a series of drop landings from a 0.4 m box onto the force platforms. Maximum LEA data during drop landings were then compared with static LEA. RESULTS: Analyses showed that in comparison to static stance, during landings the anterior tilt of the pelvis decreased while hip abduction and knee internal rotation increased. At best, static LEA variables were moderately correlated (r = -0.51 to 0.58) with peak values measured during drop landings. Additionally, regression analysis did not yield any significant predictors of any key peak hip or knee variables measured during drop landings (p = 0.15 to 0.89). CONCLUSION: When combined, the poor relationships observed between kinematics during static LEA and LEA during drop landings calls into question the practice of using static measures to predict LEA during even simple landing tasks. These findings suggest static assessments of LEA may have minimal value as an ACL injury screening tool.

Alternatives to common approaches for training change of direction performance: a scoping review.

BACKGROUND: Research focuses heavily upon the effect of strength and power training on change of direction performance. The objective of this scoping review is to highlight alternative approaches to training change of direction. METHODS: Four databases (Scopus, PubMed, Web of Science and SPORTDiscus) were searched with no date restrictions. To be included studies must (i) investigate change of direction performance following an intervention or investigate the relationships between variables of interest and change of direction performance; (ii) recruit participants > 18 years old; (iii) recruit participants involved in competitive sport. The majority of included studies investigated the effect of strength and/or power training, or, relationships between strength and/or power variables with change of direction performance. RESULTS: Despite fewer studies, alternative training methods resulted in greater improvements (compared with strength and/or power) in change of direction performance, with smaller training durations. Few studies included reactive agility as an outcome measure. CONCLUSION: Despite much of the literature focusing on strength and/or power, there are alternative training modalities that demonstrate merit for improving change of direction performance. Future studies should investigate the effect of alternative training interventions on reactive agility performance, to provide a more valid indication of transfer to competition.

Long-term Return to Sports After Anterior Cruciate Ligament Injury: Reconstruction vs No Reconstruction-A Comparison of 2 Case Series.

BACKGROUND: Reconstruction is considered to provide the best opportunity for return to sports (RTS) after anterior cruciate ligament (ACL) rupture. However, recent studies report that <50% of athletes return to preinjury sporting levels and that RTS rates at 1 year after injury are the same for athletes undergoing reconstruction and nonoperative management. Long-term studies are essential to confirm these findings and guide decisions regarding surgery. PURPOSE: First, to compare long-term sports participation after ACL reconstruction and nonreconstruction and, second, to relate RTS level to strength and stability. STUDY DESIGN: Cohort study; Level of evidence, 3. METHOD: Patients with ACL deficiency (n = 101) who were referred for physical therapy at the time of diagnosis were followed long term: 56 were treated surgically 2.5 years (interquartile range [IQR], 1-4) after injury and 45 were treated nonoperatively. At long-term follow-up, the reconstructed group was at 9 years (IQR, 7-11) after injury and aged 33.3 ± 6.2 years (mean ± SD, 70% male; 61% meniscal injury), and the nonreconstructed group was at 11 years (IQR, 7-14) after injury and aged 38.7 ± 8.3 years (67% male; 58% meniscal injury). Measures of objective stability, subjective stability, and quadriceps/hamstring strength were compared between groups using independent-samples t tests. Current RTS level, scored on a 6-point scale, was compared between groups using chi-square tests. Spearman rho correlated RTS with outcome measures. RESULTS: Of the total group of patients, 96% with reconstruction and 93% without continued to play sports. In the reconstructed and nonreconstructed groups, 4% and 7% did not RTS, and 8% and 17% returned to safe sports, respectively: 13% and 12% to running, 20% and 26% to sports involving limited twisting, 12% and 24% to recreational pivoting sports, and 43% and 14% to competitive pivoting sports. The only significant difference was in return to competitive pivoting sports (P = .003). Five patients with reconstruction ruptured the contralateral ACL, and 1 ruptured his graft. Most patients treated nonoperatively modified their sports participation. Their RTS levels correlated significantly with quadriceps strength (r = 0.65; P < .001), hamstring strength (r = 0.721; P < .001), and subjective stability (r = 0.405; P = .01). CONCLUSION: Surgically treated patients returned to competitive pivoting sports at 3 times the rate of those managed nonoperatively, confirming that reconstruction provides the best opportunity for continued participation in competitive pivoting sports. Regardless of grouping, RTS correlated with modifiable factors, including strength and stability. Higher rates of subsequent injuries observed after reconstruction may result from increased participation in competitive pivoting sports.

The effect of backpack load position on photographic measures of craniovertebral posture in 150 asymptomatic young adults.

BACKGROUND: Altering the horizontal position of the weight in a backpack will influence the magnitude of the external torque it creates but the effect on posture is unclear. OBJECTIVE: To use photogrammetry to determine if changes in the horizontal position of a fixed backpack weight affect external measures of craniovertebral posture in 150 asymptomatic young adults. METHODS: A backpack was attached to a steel frame with a bar protruding posteriorly. A fixed load (5% body mass) was placed at three distances along the bar -0 m, 0.20 m, and 0.40 m. Sagittal and frontal plane photogrammetry was used to measure the craniovertebral angle (CVA), upper cervical gaze angle (UCGA) and lateral head tilt angle (LHTA). A comparison was made across unloaded (no backpack) and loaded conditions. RESULTS: There was a significant decrease in the CVA between unloaded and loaded conditions. Changes in the UCGA were small and, while significant, may not have practical importance. There were no differences in the LHTA between the conditions. CONCLUSIONS: Changes in the horizontal position of a fixed load affect external measures of craniovertebral posture so consideration needs to be given to not only the weight of a backpack but how the weight is positioned within the backpack.

Do the landing mechanics of experienced netball players differ from those of trained athletes competing in sports that do not require frequent landings?

OBJECTIVES: This study examined whether young (15-19 years old) high-performance netball players exhibit different landing mechanics compared to female controls who do not participate in sports requiring frequent landings. DESIGN: Comparative, cross-sectional. METHODS: Lower limb kinematics and kinetics from 23 youth high performance female netball players (age: 17.5±1.7 years, height: 1.77±0.06m, mass: 66.5±6.33kg, netball experience: 8.5±2.3 years) were compared to data from 23 females (age: 22.0±3.2 years, height: 1.70±0.05m, mass: 64.4±6.7kg) who were involved in competitive sport, but had minimal experience playing a jump-landing sport. The jump landing task required participants to perform a countermovement jump and grab a netball suspended at 85% of the participant's maximum jump height. On random trials the ball was raised rapidly to 100% maximum jump height as the participant initiated her jump. RESULTS: The netball group landed with significantly less contribution from the knee extensors to total work for the non-preferred leg (P<0.001, ds=1.10) than the inexperienced group. Although no other significant differences were found between groups, there were several small to moderate differences in several of the key biomechanical variables identified as being risk factors for ACL injury or associated with ACL strain. CONCLUSIONS: Both groups had similar knee valgus and internal rotation angles and moments, with nearly all participants presenting with relatively poor frontal plane knee control. Overall, results suggest that experience playing a netball may not be enough to develop low-risk landing mechanics.

A pilot study of the front foot ground reaction forces in elite female fast bowlers.

This pilot study aimed to determine the magnitude of ground reaction forces experienced by female cricket fast bowlers at front foot contact in the delivery stride of the bowling action. The peak vertical force, peak horizontal braking force and vertical loading rate were assessed in 15 elite Australian female fast bowlers. A sequential averaging procedure indicated that a mean of twelve trials (+/-2.8) were required to achieve performance stability across these ground reaction force variables and this demonstrated the importance of analyzing a sufficient number of trials to obtain representative data. The mean peak vertical ground reaction force was 3.49kN (+/-0.81) and the mean peak horizontal braking force was 2.13kN (+/-0.52). Statistical analyses revealed that differences in body mass explained only 2.3% of the variance in peak vertical force and 2.0% of the variance in peak horizontal braking force so normalization using body mass a covariate is not recommended when reporting front foot ground reaction forces in elite female fast bowlers. The mean time to the peak vertical force was 0.033s (+/-0.009) and the vertical loading rate was 121.31kNs(-1) (+/-73.78). Further work is required to determine the best ways to minimise and attenuate front foot ground reaction forces.

Internal and external sagittal craniovertebral alignment: A comparison between radiological and photogrammetric approaches in asymptomatic participants.

BACKGROUND: Photogrammetric measures are a commonly applied, highly reliable tool for appraising craniovertebral postures during clinical assessments, rehabilitation, and research interventions. OBJECTIVE: This study aimed to compare and contrast three external measures of postural alignment (EMPA) using photogrammetric and radiological approaches, and to discuss whether the craniovertebral angle (CVA) reflects the shape of the underlying cervical spine. DESIGN: Cross Sectional Correlation Study. METHOD: Young adults attended three assessment sessions (S1, S2 and S3). S1 involved a standardised photogrammetric protocol. S2 involved radiographic image acquisition. S3 followed the same protocol in S1 but excluded the self-balancing procedure. Each session's EMPA were compared through either paired or independent samples t-tests. The different radiographic cervical subtypes and their corresponding CVAs were assessed. RESULTS: There were no significant differences in any EMPA between the two photogrammetric sessions. The CVA was the only EMPA to show a significant difference between photogrammetric (S3) and radiographic approaches. Cervical subtype variability is present throughout the full CVA range. CONCLUSIONS: Despite the statistically significant difference in the CVA between approaches, the mean difference was small and unlikely to be clinically meaningful. Accordingly, the quantification of EMPA can be undertaken with high levels of precision and reliability using standardised photogrammetric procedures. The CVA, however, does not provide an indication of the shape of the underlying cervical spine. The distinct radiological differences in the inter-segmental orientation of each vertebral motion segment in conjunction with the differences in the overall global cervical alignment, both within and between participants, negate this possibility.

The effect of cervical spine subtypes on center of pressure parameters in a large asymptomatic young adult population.

BACKGROUND: Recent research highlighted that non-lordotic subtypes are common within an asymptomatic population of young adults. The potential mechanisms responsible for the decreased postural control witnessed in healthy participants exhibiting non-lordotic cervical alignment are unclear. RESEARCH QUESTION: Therefore, the aim of this study is to compare and contrast asymptomatic radiographically derived sagittal cervical alignment subtypes with Center of Pressure (CoP) parameters. METHODS: In this cross-sectional study strict asymptomatic inclusion criteria were met by 150 of the original 182 volunteers. All radiographs were assessed using a multi-method subtype system with participants classified into lordotic and non-lordotic groups. Participants performed 90s narrow stance trials with their eyes closed whilst standing on both a firm surface (FS) and compliant surface (CS) (3 trials per surface). CoP parameters were recorded from a force platform sampling at 100 Hz. Nonparametric statistical tests were conducted to assess differences between groups for each surface type and to determine differences in CoP parameters between FS and CS types. RESULTS: Significant differences were found between groups on both surfaces for the anterior to posterior range (FS: p = 0.013; CS: p = 0.023), total excursion (FS: p = 0.029; CS: p = 0.005) and mean velocity of total excursion (FS: p = 0.032; CS: p = 0.004). SIGNIFICANCE: Our data suggest that sagittal plane cervical alignment is a measure capable of distinguishing between the postural control of asymptomatic lordotic and non-lordotic young adult participants on both surfaces types. Furthermore, decreased postural control is present in asymptomatic participants across all non-lordotic subtypes and is not isolated exclusively to those with forward head posture. Consequently, future research endeavours should investigate the clinical significance of these non-lordotic findings in relation to both the potential for early cervical osseous degeneration and the transitional stages of non-specific pain sufferers from previously asymptomatic young adults.

Exploring the Justifications for Selecting a Drop Landing Task to Assess Injury Biomechanics: A Narrative Review and Analysis of Landings Performed by Female Netball Players.

When assessing biomechanics in a laboratory setting, task selection is critical to the production of accurate and meaningful data. The injury biomechanics of landing is commonly investigated in a laboratory setting using a drop landing task. However, why this task is so frequently chosen is unclear. Therefore, this narrative review aimed to (1) identify the justification/s provided within the published literature as to why a drop landing task was selected to investigate the injury biomechanics of landing in sport and (2) use current research evidence, supplemented by a new set of biomechanical data, to evaluate whether the justifications are supported. To achieve this, a comprehensive literature search using Scopus, PubMed, and SPORTDiscus online databases was conducted for studies that had collected biomechanical data relating to sport injuries using a drop landing task. In addition, kinematic and kinetic data were collected from female netball players during drop landings and maximum-effort countermovement jumps from the ground to grab a suspended ball. The literature search returned a total of 149 articles that were reviewed to determine the justification for selecting a drop landing task. Of these, 54% provided no explicit justification to explain why a drop landing task was chosen, and 15% stated it was selected because it had been used in previous research. Other reasons included that the drop landing provides high experimental control (16%), is a functional sports task (11%), and is a dynamic task (6%). Evidence in the literature suggests that the biomechanical data produced with drop landings may not be as externally valid as more sport-specific tasks. Biomechanical data showed that the drop landing may not control center of mass fall height any better than maximum-effort countermovement jumps from the ground. Further, the frequently used step-off technique to initiate drop landings resulted in kinematic and kinetic asymmetries between lower limbs, which would otherwise be symmetrical when performing a countermovement jump from the ground. Researchers should consider the limitations of a drop landing task and endeavor to improve the laboratory tasks used to collect biomechanical data to examine the injury biomechanics of landing.

Shoulder strength and range of motion in elite female cricket fast bowlers with and without a history of shoulder pain.

This study aimed to determine the prevalence of shoulder pain in female cricket fast bowlers and compare the shoulder rotation range of motion and strength of those bowlers with and without a history of shoulder pain. The active range of motion and isokinetic strength of the shoulder internal and external rotators was assessed in the bowling and non-bowling shoulders of 26 elite Australian female fast bowlers. Twelve bowlers had a history of shoulder pain. There were significant bilateral differences in external rotation range of motion for those bowlers without a history of shoulder pain (p<0.05), and in internal rotation range of motion for both the total cohort and those bowlers with a history of shoulder pain (p<0.05). There were no bilateral differences in average torques or average torque ratios, nor were there any differences in rotation range of motion, torques or torque ratios in the bowling shoulder between bowlers with and without a history of shoulder pain. There was an association between concentric internal rotation torque for the bowling shoulder and years of fast bowling (r(s)=0.45). Given the relatively small number of elite female cricketers, future research in this field will need to recruit fast bowlers from other cricket playing nations to increase the power of studies and provide more confidence in the statistical outcomes.

The efficacy of sagittal cervical spine subtyping: Investigating radiological classification methods within 150 asymptomatic participants.

AIMS: The aim of this study is to (1) compare and contrast cervical subtype classification methods within an asymptomatic population, and (2) identify inter-methodological consistencies and describe examples of inconsistencies that have the potential to affect subtype classification and clinical decision-making. METHODS: A total of 150 asymptomatic 18-30-year-old participants met the strict inclusion criteria. An erect neutral lateral radiograph was obtained using standard procedures. The Centroid, modified Takeshima/Herbst methods and the relative rotation angles in cases of nonagreement were used to determine subtype classifications. Cohen's kappa coefficient (κ) was used to assess the level of agreement between the two methods. RESULTS: Nonlordotic classifications represented 66% of the cohort. Subtype classification identified the cohort as, lordosis (51), straight (37), global kyphosis (30), sigmoidal (13), and reverse sigmoidal (RS) (19). Cohen's kappa coefficient indicated that there was only a moderate level of agreement between methods (κ = 0.531). Methodological agreement tended to be higher within the lordotic and global kyphotic subtypes whereas, straight, sigmoidal, and RS subtypes demonstrated less agreement. CONCLUSION: This is the first study of its type to compare and contrast cervical classification methods. Subtypes displaying predominantly extended or flexed segments demonstrated higher levels of agreement. Our findings highlight the need for establishing a standardized multi-method approach to classify sagittal cervical subtypes.

Wrist Injuries in Tennis Players: A Narrative Review.

The wrist/hand complex forms the crucial final link in the kinetic chain between the body and the racquet and therefore has a number of important roles in the production of all tennis strokes. However, the internal and external loads that are created at the wrist during these strokes have the potential to contribute to pain and injury. Therefore, the purposes of this narrative review are to (1) determine the extent of the problem of wrist pain/injury in tennis players, (2) identify bony and soft tissue structures of the wrist that are susceptible to damage as a result of tennis play and (3) explore factors that may influence the development of wrist pain/injury in tennis players. The epidemiological data revealed two important points. First, some evidence suggests wrist pain/injury accounts for a higher percentage of total injuries in more recent studies (2014-2015) than in early studies (1986-1995). Second, the relative frequency of wrist pain/injury compared with other well-recognized problem areas for tennis players such as the shoulder complex, elbow and lumbar spine is noticeably higher in more recent studies (2014-2015) than in early studies (1986-1995), particularly among females. Collectively, this would seem to indicate that the problem of wrist pain/injury has increased in the modern game. In fact, some wrist injuries appear to be related to the use of certain forehand grip types and the predominant use of the two-handed backhand. While the loads experienced at the wrist during tennis stroke production seem to be below threshold levels for a single event, the cumulative effects of these loads through repetition would appear to be an important consideration, especially when inadequate time is allowed to complete normal processes of repair and adaptation. This is supported by the evidence that most wrist injuries in tennis are associated with overuse and a chronic time course. The complex interaction between load, repetition, and training practices in tennis, particularly among young developing players who choose a path of early specialization, needs to be further explored.

The identification of risk factors for ankle sprains sustained during netball participation.

OBJECTIVES: Ankle sprains account for a large percentage of injuries sustained in netball. The identification of risk factors for ankle sprain is the preliminary action required to inform future prevention strategies. DESIGN: Prospective study. PARTICIPANTS: Ninety-four netball players from club and inter-district teams. METHODS: Preseason data were collected for; vertical jump height, perceived ankle instability, sprain history, arthrometry inversion-eversion angles, star excursion balance test reach distances, the number of foot lifts during unilateral stance and demi-pointe balance test results. Participants were followed for the duration of one netball season and ankle sprains were recorded. RESULTS: Eleven sprains were recorded for eleven players using a time-loss definition of injury. Ankle sprains occurred at an incidence rate of 1.74/1000 h of netball exposure. One risk factor was identified to increase the odds of sustaining an ankle sprain during netball participation - a reach distance in the posterior-medial direction of the star excursion balance test of less than or equal to 77.5% of leg length (OR = 4.04, 95% CI = 1.00-16.35). CONCLUSIONS: The identified risk factor can be easily measured and should be considered for preseason injury risk profiling of netball players. Netball players may benefit from training programs aimed at improving single leg balance.

A snapshot of chronic ankle instability in a cohort of netball players.

OBJECTIVES: Ankle injuries account for the highest percentage of injuries in netball, yet the chronic nature of ankle sprains is under reported within this population group. Chronic ankle instability is a term used to describe certain insufficiencies that persist after an acute ankle sprain. The aim of this study was to investigate recurrent sprain, perceived ankle instability and mechanical ankle instability in a cohort of netball players. DESIGN: Cross-sectional study. METHODS: Ninety-six female netball players (24.1±7.9 years) were recruited (42 club players and 54 inter-district players). Recurrent sprain was defined as two or more lifetime sprains to the same ankle. Perceived ankle instability was quantified with the Cumberland Ankle Instability Tool - Youth. Mechanical ankle instability was quantified via inversion-eversion rotations using an ankle arthrometer at torques of 3Nm. RESULTS: Forty-seven percent of the cohort had recurrently sprained an ankle. Of the 69 players with a previously sprained ankle, 64% had a moderate-severe degree of perceived ankle instability. The total inversion-eversion angle was 31.1±8.7 degrees. Club players had more cases of moderate-severe perceived ankle instability (p=0.01) and larger inversion-eversion angles (p=0.001) compared to inter-district players. CONCLUSIONS: Recurrent ankle sprain and perceived ankle instability are easily identifiable aspects of chronic ankle instability shown to be prevalent within this cohort. Additional research is required to quantify a cut-off value for mechanical instability. Club netball players were found to have more counts of moderate-severe perceived ankle instability and larger inversion-eversion angles when compared to the inter-district netball players.