Gender differences in female and male Australian football concussion injury: A prospective observational study of emergency department presentations.

OBJECTIVE: To examine gender differences in Australian football (AF)-related concussion presentations to EDs in regional Australia. METHODS: A prospective observational study of patients presenting to 1 of the 10 EDs in Western Victoria, Australia, with an AF-related concussion was conducted. Patients were part of a larger study investigating AF injuries over a complete AF season, including pre-season training and practice matches. Information regarding concussion injuries was extracted from patient medical records, including clinical features, concurrent injuries, mechanism and context of injury. Female and male data were compared with chi-squared and Fisher's exact tests. P < 0.05 was considered significant. RESULTS: From the original cohort of 1635 patients with AF-related injuries (242 female and 1393 male), 231 (14.1%) patients were diagnosed with concussion. Thirty-eight (15.7%) females had concussions versus 193 (13.9%) males (P > 0.05). Females over the age of 16 were more likely to be concussed than males in the same age range (females n = 26, 68.4% vs males n = 94, 48.7%; P = 0.026). Neurosurgically significant head injury was rare (one case). Similar rates of concurrent injury were found between females 15 (39.5%) and males 64 (33.2%), with neck injury the single most common in 24 (10.3%) concussions. Sixty-nine patients (29%) were admitted for observation or to await the results of scans. The majority of concussions occurred in match play (87.9%). Females were more likely injured in contested ball situations (63.2% vs 37.3%; P < 0.05). CONCLUSION: Concussion rates for community-level AF presentations to regional EDs were similar between genders. Serious head injury was rare, although hospital admission for observation was common. Concurrent injuries were common, with associated neck injury most often identified. Match play accounted for the majority of head injuries.

Wrist, hand and finger injuries in Australian football: A prospective observational study of emergency department presentations.

OBJECTIVES: Investigate the characteristics of wrist, hand and finger (WHF) injuries in Australian footballers presenting to EDs and determine if injury profiles differed between females and males, and between children and adults. METHODS: In this prospective observational study that took place during an entire football season, patients attended 1 of 10 EDs in Victoria, Australia with a WHF injury sustained while playing Australian football. Data were extracted from patient medical records by trained researchers. Data included injury type (e.g. fracture), body part (e.g. metacarpal) and mechanism of injury. Males versus females, and children versus adults were compared using chi-squared tests or Fisher's exact tests. RESULTS: In total, 528 patients had a WHF injury, of which 105 (19.9%) were female and 308 (59.2%) were children. Fractures and sprains were the most common injury types (45.3% and 38.6%, respectively). Fingers were more often injured than wrists or hands (62.5%, 23.5% and 15.0%, respectively). Ball contact was the most common mechanism of injury (38.1% of injuries). Females were more likely than males to (i) have a sprain/strain injury, (ii) injure a finger (rather than wrist or hand) and (iii) injure themselves through ball contact. Children were more likely to injure their wrists, have a sprain/strain injury, or be injured falling to the ground. Adults were more likely to dislocate a joint or injure their hands. CONCLUSIONS: Differences in injury type, location and mechanism between females and males, and children and adults, suggest an opportunity for customised injury prevention and management strategies by sex and age.

Economic consequences of injury in female Australian footballers: A prospective observational study of emergency department presentations.

OBJECTIVE: Investigate the economic consequences of injuries to female Australian footballers from a health sector and societal perspective. METHODS: This prospective observational study invited 242 females to complete an online questionnaire 3-6 months following an Australian football injury which involved presentation to an ED in Victoria, Australia. The questionnaire inquired regarding healthcare use, time off work, return to playing football and extent of recovery following injury. Relevant information was also extracted from respondents' medical records regarding injury-type, body part injured, investigations and treatments. Healthcare costs were determined for each respondent's ED presentation, hospital admission/s (when relevant), and subsequent healthcare use. Societal costs were determined as lost income to the respondent and/or carer. RESULTS: A total of 108 people responded to the questionnaire. Sprains/strains and fractures accounted for 84.2% of respondents' injuries. Sixteen respondents (14.8%) required admission to hospital at the time of injury and 81 (75.0%) required subsequent healthcare appointments following discharge from the ED or hospital. Time off work or school following the injury was common (64.8% of respondents) and 27.8% of respondents had a carer take time off work. More than 80% of respondents missed training and matches following the injury. The median healthcare cost per respondent was AUD$753 and the median cost due to work absence was AUD$1393. One-quarter of respondents reported a full recovery. CONCLUSIONS: Injuries to female Australian footballers can produce substantial healthcare and societal costs, which has important implications for healthcare provision and prioritising and implementing injury prevention programmes and post-injury rehabilitation.

Gender differences in female and male Australian Football injuries - A prospective observational study of emergency department presentations.

OBJECTIVES: To compare injury-profiles of females and males presenting to Emergency Departments (EDs) with an Australian Football injury. DESIGN: Prospective observational study. METHODS: All patients presenting to one of 10 EDs in Victoria, Australia, with an Australian Football injury were included in the study. Data were prospectively collected over a 10 month period, coinciding with a complete Australian Football season, including pre-season training and practice matches. Relevant information was extracted from patient medical records regarding injury-type, body part injured, investigations and treatments required. Female and male data were compared with chi-squared and Fisher's exact tests. RESULTS: 1635 patients were included, of whom 242 (14.8%) were female. Females had a higher proportion of hand/finger injuries (34.3% v 23.4%), neck injuries (6.6% v 2.5%) and patella dislocations (2.9% v 0.6%). Males had a higher proportion of shoulder injuries (11.5% v 5.8%), skin lacerations (8.0% v 1.7%), and thorax/abdominal/pelvic injuries (5.7% v 2.1%). Concussion rates were similar between the genders, occurring in 14.1% of all patients. Anterior cruciate ligament injuries were infrequent (1.0%) and not significantly different between genders. Females received more imaging investigations (83.1% v 74.7%) and analgesia (62.4% v 48.5%). A higher proportion of males required admission to hospital (5.0% v 2.1%), usually for surgery. CONCLUSION: Australian Football injury profiles differed between females and males. Gender-specific injury prevention and management programs would be indicated based on the study findings.

National Osteoarthritis Strategy brief report: Prevention of osteoarthritis.

BACKGROUND: Osteoarthritis (OA) is one of the most common and debilitating chronic joint conditions in Australia. A National Osteoarthritis Strategy (the Strategy) was developed to outline a national plan to achieve optimal health outcomes for people at risk of, or with, OA. OBJECTIVE: This article focuses on the theme of prevention of OA within the Strategy. DISCUSSION: The Strategy was developed by a leadership group, three working groups, an implementation planning committee, multisectoral stakeholders and public consultation. The Strategy's 'Prevention Working Group' identified two priorities for action: 1) implement programs that target the prevention of obesity and increase physical activity, 2) adhere to joint injury prevention programs. The lack of implementable policies that promote OA prevention exposes Australians and the public health system to an enormous burden. A set of evidence-based strategies was proposed to assist implementation throughout Australia.

Operative shoulder instability injury management in Australian Football League players: A case series.

OBJECTIVES: The purpose of this study was to review the surgical management procedures of shoulder instability injuries in Australian Football League (AFL) players, and determine outcomes regarding return to sport and injury recurrence. DESIGN: Retrospective cohort study. METHODS: Elite AFL players with shoulder instability resulting in surgery were assessed in a retrospective cohort design (72 players/77 shoulders). Type of initial injury, surgical management, return to sport and injury recurrence were obtained. The mean follow-up period post-surgery was 2.9 years. Return to sport outcomes were compared between arthroscopic and open surgery using a Kaplan-Meier survival analysis. Logistic regression modelling was used to determine associations between injury recurrence, type of injury, participant age and method of surgery. RESULTS: Shoulder instability injuries occurred most frequently during tackling (40%). Arthroscopic surgery was preferred for primary shoulder instability. Nine (16%) recurrences occurred in those who underwent arthroscopic surgery compared to two (9%) following open surgery. Return to the elite level was slightly but significantly (2 weeks, p=0.049) longer for open compared to arthroscopic surgery. Recurrence was 5 times more likely if the primary injury was a dislocation and more likely in players who were younger at the time of surgery. CONCLUSION: Tackling was the predominant mechanism for shoulder instability injuries in AFL players and arthroscopic surgery was more commonly performed for primary injuries. Sustaining a dislocation as the primary injury and younger age increased the likelihood of recurrent instability. Careful consideration should be given to the operative management of these individuals.

Intention to use sport concussion guidelines among community-level coaches and sports trainers.

OBJECTIVES: Sporting bodies have developed guidelines for managing community-level players with suspected concussion in response to international consensus statements on concussion in sport. The purpose of this study was to examine the factors that influence the intended use of concussion guidelines among community-level coaches and sports trainers from two popular football codes in Australia: Australian football and rugby league. DESIGN: Cross-sectional survey. METHODS: The survey, based on an extended theory of planned behaviour model, was completed by 183 Australian football coaches, 121 Australian football sports trainers, 171 rugby league coaches, and 142 rugby league sports trainers. RESULTS: Personal norms and self-efficacy were significant predictors of intention to use concussion guidelines, although the relationship between self-efficacy and intention was stronger among Australian football coaches than rugby league coaches. Analysis of the salient beliefs that underpin self-efficacy found that coaches, irrespective of football code, felt less familiar (χ(2)=25.70, p<0.001) and less experienced (χ(2)=31.56, p<0.001) than sports trainers in using the concussion guidelines. At the same time, Australian football personnel, irrespective of their team role, felt that they had insufficient time (χ(2)=8.04, p<0.01) and resources (χ(2)=12.31, p<0.001) to implement the concussion guidelines relative to rugby league personnel. CONCLUSIONS: Programmes aimed at increasing the intended use of sport concussion guidelines should focus on enhancing self-efficacy and leveraging personal norms. Increasing coaches' familiarity and experience in using the concussion guidelines would also be warranted, as would finding ways to overcome the perceived time and resource constraints identified among Australian football personnel.

Results of 2 decades of injury surveillance and public release of data in the Australian Football League.

BACKGROUND: Injuries are common in all professional football codes (including soccer, rugby league and union, American football, Gaelic football, and Australian football). PURPOSE: To report the epidemiology of injuries in the Australian Football League (AFL) from 1992-2012 and to identify changes in injury patterns during that period. STUDY DESIGN: Descriptive epidemiology study. METHODS: The AFL commenced surveying injuries in 1992, with all teams and players included since 1996. An injury was defined as "any physical or medical condition that causes a player to miss a match in the regular season or finals (playoffs)." Administrative records of injury payments (which are compulsory as part of salary cap compliance) to players who do not play matches determined the occurrence of an injury. The seasonal incidence was measured in units of new injuries per club (of 40 players) per season (of 22 matches). RESULTS: There were 4492 players listed over the 21-year period who suffered 13,606 new injuries/illnesses and 1965 recurrent injuries/illnesses, which caused 51,919 matches to be missed. The lowest seasonal incidence was 30.3 new injuries per club per season recorded in 1993, and the highest was 40.3 recorded in 1998. The injury prevalence (missed matches through injury per club per season) varied from a low of 116.3 in 1994 to a high of 157.1 in 2011. The recurrence rate of injuries was highest at 25% in 1992 and lowest at 9% in 2012 and has steadily fallen across the 21 years (P < .01). The most frequent and prevalent injury was hamstring strain (average of 6 injuries per club per season, resulting in 20 missed matches per club per season; recurrence rate, 26%), although the rate of hamstring injuries has fallen in the past 2 seasons after a change to the structure of the interchange bench (P < .05). The rate of knee posterior cruciate ligament injuries fell in the years after a rule change to prevent knee-to-knee collisions in ruckmen (P < .01). CONCLUSION: Annual public reporting (by way of media release and reports available freely online) of injury rates, using units easily understood by laypeople, has been well received. It has also paved the way for rule changes with the primary goal of improving player safety.

Comparison of injury incidences between football teams playing in different climatic regions.

Australian Football League (AFL) teams in northern (warmer) areas generally have higher rates of injury than those in southern (cooler) areas. Conversely, in soccer (football) in Europe, teams in northern (cooler) areas have higher rates of injury than those in southern (warmer) areas, with an exception being knee anterior cruciate ligament (ACL) injuries, which are more common in the southern (warmer) parts of Europe. This study examined relative injury incidence in the AFL comparing 9,477 injuries over 229,827 player-weeks from 1999-2012. There was a slightly higher injury incidence for teams from warmer parts of Australia (relative risk [RR] 1.05, 95% confidence interval [CI] 1.01-1.10) with quadriceps strains (RR 1.32, 95% CI 1.10-1.58), knee cartilage injuries (RR 1.42, 95% CI 1.16-1.74), and ankle sprains (RR 1.17, 95% CI 1.00-1.37) all being more likely in warmer region teams. Achilles injuries followed a reverse pattern, tending to be more common in cooler region teams (RR 0.70, 95% CI 0.47-1.03). In conclusion, common findings from the AFL and European soccer are that ankle sprains and ACL injuries are generally more likely in teams playing in warmer climate zones, whereas Achilles tendinopathy may be more likely in teams playing in cooler zones. These injuries may have climate or surface risk factors (possibly related to types and structure of grass and shoe-surface traction) that are universal across different football codes.

Relationship between interchange usage and risk of hamstring injuries in the Australian Football League.

OBJECTIVES: To study risk factors for hamstring injury in the Australian Football League (AFL), in particular the effect of recent changes in match participation (increased use of the interchange bench) on hamstring injury. DESIGN: Analysis of hamstring match injury statistics extracted from an injury database combined with match participation statistics extracted from a player statistics database. METHODS: 56,320 player matches in the AFL over the period 2003-2010 were analyzed, in which 416 hamstring injuries occurred. RESULTS: In a Generalized Estimating Equation (GEE) analysis accounting for clustering of different teams, significant predictors of hamstring injuries were recent hamstring injury (RR 4.16, 95% CI 3.19-5.43), past history of ACL reconstruction (RR 1.69, 95% CI 1.09-2.60), past history of calf injury (RR 1.58, 95% CI 1.37-1.82), opposition team making 60 or more interchanges during the game (RR 1.38, 95% CI 1.12-1.68) and player having made 7 or more interchanges off the field in the last 3 weeks (protective RR 0.74, 95% CI 0.59-0.93). CONCLUSIONS: These findings suggest that regular interchanges protect individual players against hamstring injuries, but increase the risk of hamstring injury for opposition players. These findings can be explained by a model in which both fatigue and average match running speed are risk factors for hamstring injury. A player who returns to the ground after a rest on the interchange bench may himself have some short-term protection against hamstring injury because of the reduced fatigue, but his rested state may contribute to increased average running speed for his direct opponent, increasing the risk of injury for players on the opposition team.

Towards a national sports safety strategy: addressing facilitators and barriers towards safety guideline uptake.

BACKGROUND: Limited information exists about how best to conduct intervention implementation studies in community sport settings. Research should be directed towards understanding the context within which evidence-based injury prevention interventions are to be implemented, while continuing to build the evidence-base for the effectiveness of sports injury interventions. OBJECTIVES: To identify factors that influence the translation of evidence-based injury prevention interventions into practice in community sport, and to provide specific evidence for the effectiveness of an evidence-based exercise training programme for lower limb injury prevention in community Australian football. SETTING: Community-level Australian football clubs, teams and players. METHODS: An exercise-based lower limb injury prevention programme will be developed and evaluated in terms of the implementation context, infrastructure and resources needed for its effective translation into community sport. Analysis of the community sports safety policy context will be undertaken to understand the barriers and facilitators to policy development and uptake. A randomised group-clustered ecological study will be conducted to compare the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) of the intervention over 2 years. OUTCOME MEASURES: The primary outcome will be evidence-based prevention guidelines that are fully supported by a comprehensively evaluated dissemination plan. The plan will detail the support structures and add-ons necessary to ensure sustainability and subsequent national implementation. Research outcomes will include new knowledge about how sports safety policy is set, how consensus is reached among sports safety experts in the community setting and how evidence-based safety guidelines are best developed, packaged and disseminated to community sport.

Characteristics of anterior cruciate ligament injuries in Australian football.

Anterior cruciate ligament (ACL) injuries are the most costly injuries in football at both professional and amateur levels (Orchard J, Seward H, McGivern J, Hood S. Intrinsic and extrinsic risk factors for anterior cruciate ligament injury in Australian footballers. Am J Sports Med 2001;29:196-200.). In this study video analysis of 34 ACL injuries in Australian football was performed to investigate the causes of these injuries. Factors that may have contributed to the cause of the injury were analysed, rated and reported. The factors analysed were: type of manoeuvre, direction the knee 'gave way', running speed, knee angle, cutting angle and if the player was accelerating or decelerating. The majority of the injuries analysed occurred in non-contact situations (56%). Of these 37% occurred during sidestepping manoeuvres, 32% in landing, 16% land and step, 10% stopping/slowing and 5% crossover cut manoeuvres. Ninety-two percent of the non-contact injuries occurred at extended knee angles of 30 degrees or less, which is also commonly known to place stress on the ACL and reduce the protective role of hamstrings. Over half (54%) of non-contact injuries occurred whilst decelerating. It would be expected that greater speed and angle cut too would increase the frequency of ACL injury. The results could not confirm this with most injuries occurring at running speeds of slow jogging to running and equal number of injuries occurred at cutting to angles of the ranges 15-45 degrees and 45-75 degrees. These results give greater understanding into potential causes or contributors of ACL injury and information to assist in the development of knee injury prevention programs.

6. Doctor on the sidelines.

Effectively managing on-field emergencies is the most important role of the doctor on the sidelines. Pre-event preparation is essential and should include a formulated plan for dealing with emergencies and access to emergency equipment such as a stretcher and a bag and mask. Game day injuries should be assessed by adhering as closely as possible to a normal clinical consultation, with a proper history and examination being performed for all injuries. The athlete with an on-field head injury should be treated as having a concomitant cervical spine injury until proven otherwise. Athletes with any symptoms after head injury should be comprehensively and continuously assessed. Return-to-play decisions are made by balancing the risk of injury recurrence, the potential severity of injury recurrence and the benefits of returning to the field (which are higher at elite than amateur level). There is currently a shortage of doctors willing to cover sports events in Australia, which is partially explained by inadequate remuneration, inadequate facilities provided at venues, inadequate training opportunities in sports medicine, and fear of the medicolegal consequences in taking on the role as a team doctor.