Roundtable on Preseason Heat Safety in Secondary School Athletics: Heat Acclimatization.

OBJECTIVE: To provide best-practice recommendations for developing and implementing heat-acclimatization strategies in secondary school athletics. DATA SOURCES: An extensive literature review on topics related to heat acclimatization and heat acclimation was conducted by a group of content experts. Using the Delphi method, action-oriented recommendations were developed. CONCLUSIONS: A period of heat acclimatization consisting of ≥14 consecutive days should be implemented at the start of fall preseason training or practices for all secondary school athletes to mitigate the risk of exertional heat illness. The heat-acclimatization guidelines should outline specific actions for secondary school athletics personnel to use, including the duration of training, the number of training sessions permitted per day, and adequate rest periods in a cool environment. Further, these guidelines should include sport-specific and athlete-specific recommendations, such as phasing in protective equipment and reintroducing heat acclimatization after periods of inactivity. Heat-acclimatization guidelines should be clearly detailed in the secondary school's policy and procedures manual and disseminated to all stakeholders. Heat-acclimatization guidelines, when used in conjunction with current best practices surrounding the prevention, management, and care of secondary school student-athletes with exertional heat stroke, will optimize their health and safety.

First-time inversion ankle ligament trauma: the effects of sex, level of competition, and sport on the incidence of injury.

BACKGROUND: Inversion ankle trauma is disabling, yet little is known regarding the incidence rate of first-time ankle sprains and how it is influenced by factors including sex, level of competition, and sport. HYPOTHESIS: The incidence rates of first-time ankle ligament sprains are influenced by sex, level of competition (high school vs college), and type of sports participation (basketball, soccer, lacrosse, and field hockey). STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Between 1999 and 2003, high school and college athletes were evaluated before participation in their sports. Subjects were included in the study if they had not experienced a prior ankle or lower extremity injury and were then followed during participation in soccer, basketball, lacrosse, or field hockey to document their days of exposure to sport and injuries sustained. The relative risk associated with sex, level of competition, and sport was estimated by Cox regression. RESULTS: A total of 901 athletes had 50 680 person-days of exposure to sports, and 43 (4.8%) had an inversion injury that produced an ankle ligament sprain. Overall, the injury incidence rate was 0.85 sprains per 1000 person-days of exposure to sport. There were 0.68 and 0.97 ankle sprains per 1000 person-days of exposure to sport for the men and women, respectively. Although the risk of suffering an ankle sprain was higher for women than for men (relative risk, 1.51), the difference was not statistically significant (P = .21) and was owing to the increased risk in female basketball athletes compared to male basketball athletes (relative risk, 4.11; P = .045). Risk of injury was similar for the high school athletes in comparison to the college athletes (relative risk, 1.16). For the men, there was no difference in the risk of suffering an ankle sprain between the sports of basketball, soccer, and lacrosse, whereas for the women, the risk of suffering an ankle sprain was significantly greater during participation in basketball compared to lacrosse. CONCLUSION: In this study of first-time ankle sprains, for most sports, the incidence rate of inversion injury is less than 1 per 1000 days of exposure to sport, a value lower than previously reported. Among female athletes, ankle injury is associated with type of sport. Risk is highest for female basketball athletes, who are at significantly greater risk than male basketball athletes and female lacrosse athletes. The risk of first-time ankle injury is similar for high school and college-level athletes.

Predictive Factors for Lateral Ankle Sprains: A Literature Review.

OBJECTIVE: To review the prospective studies of ankle-ligament-injury risk factors. DATA SOURCES: We searched MEDLINE from 1978 to 2001 using the terms ankle, ligament, injury, risk factor, and epidemiology. DATA SYNTHESIS: The results included many studies on the treatment and prevention of ankle injuries. There were, however, very few prospective studies focusing on identifying the risk factors that predispose an athlete to ankle-ligament trauma. CONCLUSIONS/RECOMMENDATIONS: There is some agreement among authors with regard to the risk factors for ankle-ligament injury; however, considerable controversy remains. Although female athletes are at significantly greater risk of suffering a serious knee sprain, such as disruption of the anterior cruciate ligament, this does not appear to be the case for ankle-ligament sprains. Therefore, sex does not appear to be a risk factor for suffering an ankle-ligament sprain. Athletes who have suffered a previous sprain have a decreased risk of reinjury if a brace is worn, and the consensus is that generalized joint laxity and anatomical foot type are not risk factors for ankle sprains. However, the literature is divided with regard to whether or not height, weight, limb dominance, ankle-joint laxity, anatomical alignment, muscle strength, muscle-reaction time, and postural sway are risk factors for ankle sprains. Future research is needed on this topic to develop a consensus on all ankle-injury risk factors. This will allow future intervention studies to be designed that will reduce the incidence and severity of this common injury.