A 2D video-based assessment is associated with 3D biomechanical contributors to dynamic knee valgus in the coronal plane.

Introduction: Adolescent athletes involved in sports that involve cutting and landing maneuvers have an increased risk of anterior cruciate ligament (ACL) tears, highlighting the importance of identifying risky movement patterns such as dynamic knee valgus (DKV). Qualitative movement screenings have explored two-dimensional (2D) scoring criteria for DKV, however, there remains limited data on the validity of these screening tools. Determining a 2D scoring criterion for DKV that closely aligns with three-dimensional (3D) biomechanical measures will allow for the identification of poor knee position in adolescent athletes on a broad scale. The purpose of this study was to establish a 2D scoring criterion that corresponds to 3D biomechanical measures of DKV. Methods: A total of 41 adolescent female club volleyball athletes performed a three-task movement screen consisting of a single-leg squat (SLS), single-leg drop landing (SLDL), and double-leg vertical jump (DLVJ). A single rater scored 2D videos of each task using four criteria for poor knee position. A motion capture system was used to calculate 3D joint angles, including pelvic obliquity, hip adduction, knee abduction, ankle eversion, and foot progression angle. Receiver operating characteristic curves were created for each 2D scoring criterion to determine cut points for the presence of movement faults, and areas under the curve (AUC) were computed to describe the accuracy of each 2D criterion compared to 3D biomechanical data. Results: 3D measures indicated knee abduction angles between 2.4°-4.6° (SD 4.1°-4.3°) at the time point when the center of the knee joint was most medial during the three tasks. AUCs were between 0.62 and 0.93 across scoring items. The MEDIAL scoring item, defined as the knee joint positioned inside the medial border of the shoe, demonstrated the greatest association to components of DKV, with AUCs ranging from 0.67 to 0.93. Conclusion: The MEDIAL scoring criterion demonstrated the best performance in distinguishing components of DKV, specifically pelvic obliquity, hip adduction, ankle eversion, and foot progression. Along with the previously published scoring definitions for trunk-specific risk factors, the authors suggest that the MEDIAL criterion may be the most indicative of DKV, given an association with 3D biomechanical risk factors.

Correction: Currie et al. Reality Check 2: The Cost-Effectiveness of Policy Disallowing Body Checking in Non-Elite 13- to 14-Year-Old Ice Hockey Players. Int. J. Environ. Res. Public Health 2021, 18, 6322.

There was an error in our original publication [...].

One-Year Injury History and Safe Dance Practices Among Female Highland Dancers in Canada.

AIMS: Over 8,650 Highland dancers registered to compete in Royal Scottish Official Board of Highland Dancing events worldwide in 2019. While the burden of dance-related injuries is high among dancers, there are few studies examining Highland dance. The purpose of this study was to describe the prevalence of self-reported 1-year injury history and safe dance practices among female Highland dancers. METHODS: Sixty-five female Canadian Highland dancers (median age 18; range 14-47) completed an anonymous online survey at the beginning of the 2019 championship season. Demographics (i.e., age, body mass index), exposure (e.g., months/year dancing), safe dance practices (e.g., environmental, physical, psychological), and 1-year injury history (i.e., yes/no) were self-reported. Three definitions of dance-related injury were used: 1) time-loss (missed ≥1 class, practice, performance, and/or competition); 2) medical attention (requiring professional medical care); and 3) any physical complaint that affected full participation. RESULTS: Most participants were training at the elite standard/premier level (86%, 95%CI 75-93) and for ≥8 months/year (83%, 95%CI 75-93). The proportion of dancers reporting at least one physical complaint in the previous 1 year was 71% (95%CI 58-81). Sixty percent (95%CI 47-71) of dancers reported ≥1 medical attention and/or time-loss injury. All participants reported warming up regularly, with 59% (95%CI 46-70) participating in regular cool-downs. CONCLUSION: The prevalence of 1-year injury history among female Highland dancers is high. Education on the benefits of safe dance practice for Highland dancers may be useful. Prospective cohort studies are needed to understand the dynamic nature of dance injuries across a full competitive season.

Shoulder Check: Investigating Shoulder Injury Rates, Types, Severity, Mechanisms, and Risk Factors in Canadian Youth Ice Hockey.

OBJECTIVE: To describe shoulder-related injury rates (IRs), types, severity, mechanisms, and risk factors in youth ice hockey players during games and practices. DESIGN: Secondary analysis of data from a 5-year prospective cohort study, Safe-to-Play (2013-2018). SETTING: Canadian youth ice hockey. PARTICIPANTS: Overall, 6584 player-seasons (representing 4417 individual players) participated. During this period, 118 shoulder-related games and 12 practice injuries were reported. ASSESSMENT OF RISK FACTORS: An exploratory multivariable mixed-effects Poisson regression model examined the risk factors of body checking policy, weight, biological sex, history of injury in the past 12 months, and level of play. MAIN OUTCOME MEASURES: Injury surveillance data were collected from 2013 to 2018. Injury rates with 95% confidence interval (CI) were estimated using Poisson regression. RESULTS: The shoulder IR was 0.35 injuries/1000 game-hours (95% CI, 0.24-0.49). Two-thirds of game injuries (n = 80, 70%) resulted in >8 days of time-loss, and more than one-third (n = 44, 39%) resulted in >28 days of time-loss. An 83% lower rate of shoulder injury was associated with policy prohibiting body checking compared with leagues allowing body checking (incidence rate ratio [IRR], 0.17; 95% CI, 0.09-0.33). A higher shoulder IR was observed for those who reported any injury in the last 12-months compared with those with no history (IRR, 2.00; 95% CI, 1.33-3.01). CONCLUSIONS: Most shoulder injuries resulted in more than 1 week of time-loss. Risk factors for shoulder injury included participation in a body-checking league and recent history of injury. Further study of prevention strategies specific to the shoulder may merit further consideration in ice hockey.

Preseason Measures of Cervical Spine Function, Vestibulo-Ocular Reflex, Dynamic Balance, and Divided Attention in Youth Ice Hockey Players.

OBJECTIVES: Report typical scores and examine preseason cervical spine, vestibulo-ocular reflex, dynamic balance, and divided attention measures in competitive youth ice hockey players aged 10 to 18 years with and without a previous concussion history. DESIGN: Cross-sectional secondary analysis. METHODS: The exposure of interest was self-reported history of concussion. The main outcomes were cervical spine measures (Cervical Flexor Endurance [CFE; seconds], Cervical Flexion-Rotation Test [normal/abnormal], Anterolateral Cervical Spine Strength [kilograms], Head Perturbation Test (/8), and Joint Position Error [JPE; centimeters]), vestibulo-ocular reflex (Dynamic Visual Acuity [logMAR], Head Thrust Test [Positive/Negative]), dynamic balance (Functional Gait Assessment [/30]) and divided attention (Walking While Talking Test [seconds]). Multivariable linear or logistic regression, adjusted for age-group, sex, level of play, and clustered by team, were used to assess potential differences by concussion history. RESULTS: We included data from 2311 participants in this study (87.2% male, 12.8% female, 39.0% reported a previous concussion). No differences by concussion history were found across any of the measures (P values range: 0.17-0.99). Measures of cervical spine function and divided attention differed by age group (eg, Median Left Anterolateral Cervical Spine Strength [kilograms] for males: U13 = 7.46, U15 = 9.10, U18 = 9.67). CONCLUSION: Clinical outcomes scores in youth ice hockey players did not differ by concussion history. Performance on cervical spine strength, CFE, and JPE test outcomes may improve with age, highlighting the importance of developmental considerations when interpreting test scores. J Orthop Sports Phys Ther 2024;54(3):1-11. Epub 30 November 2023. doi:10.2519/jospt.2023.11958.

Differences in injury and concussion rates in a cohort of Canadian female and male youth Rugby Union: a step towards targeted prevention strategies.

OBJECTIVE: To examine differences in match and training musculoskeletal injury and concussion rates and describe mechanisms of concussion while considering previous playing experience in female and male Canadian high school Rugby Union ('rugby') players. METHODS: A 2-year prospective cohort study was completed in a high school league (n=361 females, 421 player-seasons; n=429 males, 481 player-seasons) in Calgary, Canada over the 2018 and 2019 rugby playing seasons. Baseline testing was completed at the start of each season and injury surveillance and individual player participation through session attendance was documented to quantify individual-level player exposure hours. Injury incidence rates (IRs) and incidence rate ratios (IRRs) were calculated using Poisson regression, offset by player exposure hours and clustered by team. RESULTS: Overall match IR for females was 62% higher than males (overall IRR=1.62, 95% CI: 1.20 to 2.18) and the overall training IR was twice as high for females (overall IRR=2.15, 95% CI: 1.40 to 3.32). The female match concussion IR was 70% higher than the males (concussion IRR=1.70, 95% CI: 1.08 to 2.69). Females had a 75% greater tackle-related IR compared with males (IRR=1.75, 95% CI: 1.20 to 2.56). Additionally, female tacklers had a twofold greater rate of injury compared with male tacklers (IRR=2.17, 95% CI: 1.14 to 4.14). Previous playing experience was not associated with tackle-related injury or concussion IRs. CONCLUSION: The rate of injury and concussion was significantly higher in females within this Canadian high school cohort. These results emphasise the need for development, implementation and evaluation of female-specific injury and concussion prevention strategies to reduce injury and concussion in female youth rugby.

Development of a tailored concussion education program for athletes: a pragmatic multimethods design and integrated knowledge translation approach from needs assessment to design.

OBJECTIVES: To understand Canadian university athletic programme concussion management needs, and to describe development and content of a tailored online concussion education tool for Canadian university/college athletes. DESIGN: An integrated knowledge translation multiphased, multimethods approach was used. Phases included a needs assessment survey with university representatives and athletes, content selection, mapping behavioural goals to evidenced-based behaviour change techniques, script/storyboard development, engagement interviews with university athletes and tool development using user-centred design techniques. SETTING: Canadian U SPORTS universities (n=56). PARTICIPANTS: Overall, 64 university representatives (eg, administrators, clinicians) and 27 varsity athletes (52% male, 48% female) completed the needs assessment survey. Five athletes participated in engagement interviews. OUTCOME MEASURES: Surveys assessed previous athlete concussion education, recommendations for concussion topics and tool design, concussion management challenges and interest in implementing a new course. RESULTS: Institutions used a median (Med) of two (range 1-5) approaches when educating athletes about concussion. Common approaches were classroom-style education (50%), online training (41%) and informational handouts (39%). University representatives rated most important topics as: (1) what is a concussion, (2) how to recognise a concussion and (3) how to report a concussion (Medall=4.8/5). Athletes felt symptom recognition (96%) and effects on the brain (85%) were most important. The majority of athletes preferred learning via computer (81%) and preferred to learn alone (48%) versus group learning (7%). The final resource was designed to influence four behaviours: (1) report symptoms, (2) seek care, (3) encourage teammates to report symptoms and (4) support teammates through concussion recovery. Examples of behaviour change techniques included: knowledge/skills, problem-solving scenarios, verbal persuasion and social comparison. Athletes are guided through different interactions (eg, videos, flip cards, scenarios, testimonials) to maximise engagement (material review takes ~30 min). CONCLUSIONS: The Concussion Awareness Training Tool for athletes is the first Canadian education tool designed to address the needs of Canadian university/college athletes.

Unravelling the web: Experiences of adolescents returning to school following a concussion.

One in five adolescents will sustain a concussion in their lifetime. A concussion may result in symptoms that affect an adolescent's ability to attend school and engage in learning tasks. This study was guided by interpretivism. We conducted one-on-one semi-structured interviews to explore the perspectives of 20 adolescents (ages 14-18) returning to school after a concussion. Interviews were coded inductively and analyzed using reflexive thematic analysis. Five interconnected themes emerged with returning to school and accessing school supports: (1) concussion symptoms affected adolescents' schoolwork; (2) access to academic accommodations eased adolescents' return to school; (3) having supportive and understanding friends, family, and teachers facilitated adolescents' return to school; (4) communication amongst school stakeholders was desired, but often lacking; and (5) feeling anxious, frustrated, and sad with the return to school process. Adolescents' experiences were multifaceted and many factors contributed to their return to school experiences. Our findings can inform our understanding of the experiences of adolescents returning to school following concussion and can inform the development of concussion management supports at schools.

Academic Accommodations for Middle and High School Students Following a Concussion: Perspectives of Teachers and School Administrators.

BACKGROUND: An estimated 1 in 5 adolescents have sustained a concussion in North America. Teachers and school administrators are responsible for implementing academic accommodations and other supports for optimal return to learn following a concussion. The primary objective of this study was to describe the prevalence and feasibility of providing academic accommodations to students following concussion from the perspectives of middle and high school teachers and school administrators. METHODS: A cross-sectional survey was administered to teachers and school administrators (grades 7-12) across Canada online via REDCap. Participants were recruited via word-of-mouth and social media sampling. Survey responses were analyzed descriptively using proportions. RESULTS: The survey was completed by 180 educators (138 teachers and 41 school administrators), of whom 86% had previously provided academic accommodations to students following concussion, and 96% agreed that students should have access to accommodations following concussion. Some accommodations (eg, breaks, extra time) were provided more often and were more feasible to provide than others (eg, no new learning, reduced bright light). Educators reported limited preparation time and limited school personnel support to assist students following concussion. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: The most feasible accommodations should be prioritized, ensuring students are supported within the school environment. CONCLUSIONS: Teachers and school administrators confirmed the importance of providing accommodations to students following concussion.

Amsterdam 2022 process: A summary of the methodology for the Amsterdam International Consensus on Concussion in Sport.

The purpose of this paper is to summarise the consensus methodology that was used to inform the International Consensus Statement on Concussion in Sport (Amsterdam 2022). Building on a Delphi process to inform the questions and outcomes from the 5th International Conference on Concussion in Sport, the Scientific Committee identified key questions, the answers to which would help encapsulate the current science in sport-related concussion and help guide clinical practice. Over 3½ years, delayed by 2 years due to the pandemic, author groups conducted systematic reviews on each selected topic. The 6th International Conference on Concussion in Sport was held in Amsterdam (27-30 October 2022) and consisted of 2 days of systematic review presentations, panel discussions, question and answer engagement with the 600 attendees, and abstract presentations. This was followed by a closed third day of consensus deliberations by an expert panel of 29 with observers in attendance. The fourth day, also closed, was dedicated to a workshop to discuss and refine the sports concussion tools (Concussion Recognition Tool 6 (CRT6), Sport Concussion Assessment Tool 6 (SCAT6), Child SCAT6, Sport Concussion Office Assessment Tool 6 (SCOAT6) and Child SCOAT6). We include a summary of recommendations for methodological improvements for future research that grew out of the systematic reviews.

Health care impact of implementing a clinical pathway for acute care of pediatric concussion: a stepped wedge, cluster randomised trial.

OBJECTIVES: To test the effects of actively implementing a clinical pathway for acute care of pediatric concussion on health care utilization and costs. METHODS: Stepped wedge, cluster randomized trial of a clinical pathway, conducted in 5 emergency departments (ED) in Alberta, Canada from February 1 to November 30, 2019. The clinical pathway emphasized standardized assessment of risk for persistent symptoms, provision of consistent information to patients and families, and referral for outpatient follow-up. De-identified administrative data measured 6 outcomes: ED return visits; outpatient follow-up visits; length of ED stay, including total time, time from triage to physician initial assessment, and time from physician initial assessment to disposition; and total physician claims in an episode of care. RESULTS: A total of 2878 unique patients (1164 female, 1713 male) aged 5-17 years (median 11.00, IQR 8, 14) met case criteria. They completed 3009 visits to the 5 sites and 781 follow-up visits to outpatient care, constituting 2910 episodes of care. Implementation did not alter the likelihood of an ED return visit (OR 0.77, 95% CI 0.39, 1.52), but increased the likelihood of outpatient follow-up visits (OR 1.84, 95% CI 1.19, 2.85). Total length of ED stay was unchanged, but time from physician initial assessment to disposition decreased significantly (mean change - 23.76 min, 95% CI - 37.99, - 9.52). Total physician claims increased significantly at only 1 of 5 sites. CONCLUSIONS: Implementation of a clinical pathway in the ED increased outpatient follow-up and reduced the time from physician initial assessment to disposition, without increasing physician costs. Implementation of a clinical pathway can align acute care of pediatric concussion more closely with existing clinical practice guidelines while making care more efficient. TRIAL REGISTRATION: ClinicalTrials.gov NCT05095012.

ABSTRAIT: OBJECTIFS: Mettre à l'essai les effets de la mise en œuvre active d'une voie clinique pour le traitement aigu des commotions cérébrales chez les enfants sur l'utilisation et les coûts des soins de santé. MéTHODES: Essai randomisé en grappes d'une voie clinique, échelonné, mené dans cinq services d'urgence en Alberta, au Canada, du 1 février au 30 novembre 2019. Le cheminement clinique mettait l'accent sur l'évaluation normalisée du risque de symptômes persistants, la fourniture de renseignements uniformes aux patients et aux familles, et l'aiguillage vers un suivi externe. Les données administratives dépersonnalisées ont permis de mesurer six résultats : visites de retour à l'urgence; visites de suivi en clinique externe; durée du séjour à l'urgence, y compris le temps total. le temps entre le triage et l'évaluation initiale du médecin, et le temps entre l'évaluation initiale du médecin et la décision; et le nombre total de demandes de remboursement du médecin dans un épisode de soins. RéSULTATS: Un total de 2878 patients uniques (1164 femmes, 1713 hommes) âgés de 5 à 17 ans (médiane 11,00, IQR 8, 14) répondaient aux critères de cas. Ils ont effectué 3009 visites aux 5 sites et 781 visites de suivi aux soins ambulatoires, ce qui représente 2910 épisodes de soins. La mise en œuvre n'a pas modifié la probabilité d'une visite de retour à l'urgence (RC 0,77, IC à 95 %, 0,39, 1,52), mais a augmenté la probabilité de visites de suivi en clinique externe (RC 1,84, IC à 95 %, 1,19, 2,85). La durée totale du séjour à l'urgence est demeurée inchangée, mais le temps écoulé entre l'évaluation initiale du médecin et la décision a diminué considérablement (changement moyen : -23,76 minutes, IC à 95 %, -37,99, -9,52). Le nombre total de demandes de règlement de médecins a augmenté de façon significative à seulement 1 site sur 5. CONCLUSIONS: La mise en œuvre d'un cheminement clinique à l'urgence a augmenté le suivi des patients externes et réduit le temps entre l'évaluation initiale du médecin et son élimination, sans augmenter les coûts des médecins. La mise en œuvre d'un cheminement clinique peut harmoniser davantage les soins de courte durée en cas de commotion cérébrale pédiatrique avec les lignes directrices de pratique clinique existantes tout en rendant les soins plus efficaces. ENREGISTREMENT D'ESSAI: ClinicalTrials.gov NCT05095012.

Validity and Reliability of the Pre-Adolescent Dance Injury and Participation Questionnaire (PADIP-Q).

INTRODUCTION: Dancers generally begin training in a variety of styles at a young age. Across ages and levels of participation, dancers are at high risk for injury. Most available injury surveillance tools, however, have been developed for adult populations. Valid, reliable tools that monitor injury and exposure of pre-adolescent dance populations are limited. Therefore, the purpose of this study was to determine the validity and reliability of a dance injury and participation questionnaire specifically for pre-adolescent private studio dancers. METHODS: Four stages of validity and reliability testing assessed a novel questionnaire: initial design based on previous literature, expert panel review, cognitive interviews, and test-retest reliability. The target population was 8 to 12-year-olds who participate in at least 1 class/week at a private studio. Feedback from a panel review and cognitive interviews was incorporated. Test-retest analyses included Cohen's kappa coefficients and percent agreement for categorical variables, and intraclass correlation coefficients [ICCs (3,1)], absolute mean difference (md) and Pearson's correlation coefficients (r) for numerical data. RESULTS: The final questionnaire was comprised of 4 sections: demographics, dance training history, current dance participation (previous 1-year and 4-months), and dance-related injury history (previous 1-year and 4-months). Items with categorical responses estimated kappa coefficients from 0.32 to 1.00, and percent agreement between 81% and 100%. For items with numeric responses, ICC estimates ranged between .14 and 1.00, r values between .14 and 1.00, and the largest absolute md was 0.46. The 4-month recall sections revealed higher agreement than the 1-year sections. CONCLUSION: This valid pre-adolescent dance injury and participation questionnaire demonstrates good to excellent reliability across all items. To support participant completions, assistance from a parent/guardian is suggested. To move dance epidemiology research forward among private studio dancers aged 8 to 12 years, employment of this questionnaire is therefore recommended.

Injury Rates, Mechanisms, Risk Factors and Prevention Strategies in Youth Rugby Union: What's All the Ruck-Us About? A Systematic Review and Meta-analysis.

BACKGROUND: Rugby Union is a collision team sport played globally. Despite this, significant concerns have been raised regarding the sport's safety, particularly in youth players. Given this, a review of injury rates, risk factors and prevention strategies is required across different youth age groups as well as in males and females. OBJECTIVE: The objective of this systematic review (SR) and meta-analysis was to investigate injury and concussion rates, risk factors and primary prevention strategies in youth rugby. METHODS: To be included, studies were required to report either rates, risk factors or prevention strategies in youth rugby and to have a randomised controlled trial, quasi-experimental, cohort, case control, or ecological study design. Exclusion criteria included non-peer-reviewed grey literature, conference abstracts, case studies, previous systematic reviews and studies not written in English. Nine databases were searched. The full search strategy and list of sources are available and pre-registered on PROSPERO (Ref: CRD42020208343). Each study was assessed for risk of bias using the Downs and Black quality assessment tool. Meta-analyses were conducted using a DerSimonian Laird random effect model for each age group and sex. RESULTS: Sixty-nine studies were included in this SR. The match injury rates (using a 24-h time-loss definition) were 40.2/1000 match hours (95% CI 13.9-66.5) in males and 69.0/1000 match hours (95% CI 46.8-91.2) in females. Concussion rates were 6.2/1000 player-hours (95% CI 5.0-7.4) for males and 33.9/1000 player-hours (95% CI: 24.1-43.7) for females. The most common injury site was lower extremity (males) and the head/neck (females). The most common injury type was ligament sprain (males) and concussion (females). The tackle was the most common event associated with injury in matches (55% male, 71% females). Median time loss was 21 days for males and 17 days for females. Twenty-three risk factors were reported. The risk factors with the strongest evidence were higher levels of play and increasing age. Primary injury prevention strategies were the focus of only eight studies and included law changes (n = 2), equipment (n = 4), education (n = 1) and training (n = 1). The prevention strategy with the most promising evidence was neuromuscular training. The primary limitations included a broad range of injury definitions (n = 9) and rate denominators (n = 11) used, as well as a limited number of studies which could be included in the meta-analysis for females (n = 2). CONCLUSION: A focus on high-quality risk factor and primary prevention evaluation should be considered in future studies. Targeting primary prevention and stakeholder education remain key strategies in the prevention, recognition and management of injuries and concussions in youth rugby.

High Sport Specialization Is Associated With More Musculoskeletal Injuries in Canadian High School Students.

OBJECTIVE: To describe levels of sport specialization in Canadian high school students and investigate whether sport specialization and/or sport participation volume is associated with the history of musculoskeletal injury and/or concussion. DESIGN: Cross-sectional study. SETTING: High schools, Alberta, Canada. PARTICIPANTS: High school students (14-19 years) participating in various sports. INDEPENDENT VARIABLES: Level of sport specialization (high, moderate, low) and sport participation volume (hours per week and months per year). MAIN OUTCOME MEASURES: Twelve-month injury history (musculoskeletal and concussion). RESULTS: Of the 1504 students who completed the survey, 31% were categorized as highly specialized (7.5% before the age of 12 years). Using multivariable, negative, binomial regression (adjusted for sex, age, total yearly training hours, and clustering by school), highly specialized students had a significantly higher musculoskeletal injury rate [incidence rate ratio (IRR) = 1.36, 95% confidence interval (CI), 1.07-1.73] but not lower extremity injury or concussion rate, compared with low specialization students. Participating in one sport for more than 8 months of the year significantly increased the musculoskeletal injury rate (IRR = 1.27, 95% CI, 1.02-1.58). Increased training hours significantly increased the musculoskeletal injury rate (IRR = 1.18, 95% CI, 1.13-1.25), lower extremity injury rate (IRR = 1.16, 95% CI, 1.09-1.24), and concussion rate (IRR = 1.31, 95% CI, 1.24-1.39). CONCLUSIONS: Approximately one-third of Canadian high school students playing sports were categorized as highly specialized. The musculoskeletal injury rate was higher for high sport specialization students compared with low sport specialization students. Musculoskeletal injuries and concussion were also more common in students who train more and spend greater than 8 months per year in one sport.

It Takes Two to Tango: High Rates of Injury and Concussion in Ball Carriers and Tacklers in High School Boys' Rugby.

OBJECTIVE: To examine injury and concussion rates, mechanisms, locations, and types of injury in Canadian high school male rugby. DESIGN: Prospective cohort study. SETTING: High school male rugby. PARTICIPANTS: A total of 429 high school players (2018: n = 225, 2019: n = 256) were recruited from 12 teams in 7 schools in Calgary, Canada. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Injury surveillance included baseline questionnaires, weekly exposure, and injury reports. Injuries included those requiring medical attention, resulted in time loss and/or inability to complete a session. Concussion was defined as per the fifth Consensus on Concussion in Sport, and all players with a suspected concussion were referred to a study sport medicine physician. RESULTS: A total of 134 injuries were captured, leading to an injury incidence rate (IR) of 57.9/1000 hours [95% confidence intervals (CIs): 45.4-73.8]. Median time loss was 6 days (range: 0-90). Injuries to the head were the most common (40%), followed by shoulder (12%) and ankle (10%). The concussion IR was 22.0/1000 hours (95% CIs: 15.9-30.4), which was the most common injury type (38%), followed by sprain (20%) and strain (15%). Sixty-five percent of injuries occurred in the tackle (ball carrier 35%, tackler 30%) and 76% of concussions (ball carrier 41%, tackler 35%). CONCLUSIONS: The rate of injury and concussion in Canadian youth high school male rugby is high, with tackle-related injuries and concussions the most common. Given this, there is a critical need for implementation of prevention strategies, in particular targeting concussion and the tackle event (eg, neuromuscular, tackle training, and law changes).

The Effect of Physical Exertional Testing on Postconcussion Symptom Scale Scores in Male and Female High School Students.

PURPOSE: Symptom scores commonly measured following concussion were compared between male and female adolescents with (Hx+) and without (Hx-) a history of concussion, pre and post physical exertion testing. METHODS: Eighty (males [n = 60; Hx+ = 19], female [n = 20; Hx+ = 5]) high school students (ages 15-17 y) completed the Buffalo Concussion Treadmill Test once and the modified shuttle run test twice. Symptom scores were collected using the 22-point Symptom Evaluation Scale on the Sport Concussion Assessment Tool (version 5) immediately pre and post physical exertion testing. RESULTS: The symptoms most reported during preexertional testing were fatigue/low energy, feeling slowed down, and nervous/anxious, whereas feeling slowed down, fatigue/low energy, "pressure in head" (males only), and headache (females only) were most frequently reported during postexertion testing. CONCLUSION: An understanding of the common exertion-related symptoms at baseline in a laboratory or field-based setting in adolescents may be advantageous for clinicians as they manage individual recovery postconcussion. This is particularly important during an adolescent's recovery and return to play when exertional testing may be implemented, especially since symptoms were reported pre and post exertional testing in both males and females regardless of concussion history.

Concussions and Injuries in Sledge Hockey: Grassroots to Elite Participation.

OBJECTIVE: To examine injury (including concussion) rates, location, type, mechanisms, and risk factors in sledge hockey players. DESIGN: Cross-sectional survey. SETTING: Sledge hockey players, worldwide, across all levels of play. PARTICIPANTS: Sledge hockey players (ages ≥14 years) who played in the 2019 to 2020 season were recruited through email, social media, and word of mouth communication. ASSESSMENT OF RISK FACTORS: Participant characteristics (eg, age, sex, disability) were examined as potential injury risk factors. MAIN OUTCOME MEASURES: Injury rates (IR) and incidence rate ratios (IRR) examining potential risk factors were reported based on univariate Poisson regression analyses. Injury proportions by type, location, and mechanism were described. RESULTS: Ninety-two players initiated the survey, and 77 (83.7%) provided some injury information. Forty-seven injuries included 16 concussions in 9 of 77 players (11.7%) and 31 non-concussion injuries in 20 of 77 players (26.0%) were reported. The overall IR was 13.2 injuries/1000 athlete-exposures [95% confidence interval (CI); 9.6-17.6]. The game IR (28.4 injuries/1000 game-exposures, 95% CI; 18.6-41.7) was higher than practice IR (4.4 injuries/1000 practice-exposures, 95% CI; 2.2-7.9) (IRR = 6.5, 95% CI; 3.1-14.5). The most common injury locations were the head (34.0%), wrist/hand (14.8%), and shoulder (10.6%). The most common significant injury types were concussion (36.2%) and bone fracture (8.5%). Body checking was the primary mechanism for injuries caused by contact with another player (42.1%) Age, sex, disability, and level of play were not found as injury risk factors. CONCLUSIONS: Concussions and upper extremity injuries were the most common sledge hockey injuries reported, with body checking being the most common mechanism. This research will inform development of prevention strategies in sledge hockey.

Concurrent Validity of Movement Screening Criteria Designed to Identify Injury Risk Factors in Adolescent Female Volleyball Players.

Anterior cruciate ligament (ACL) injuries in female adolescent athletes occur at disproportionately high levels compared to their male counterparts. However, limited prospective data exist on the validity of low-cost screening tools that can proactively identify ACL injury risk, specifically for female athletes. The purpose of this study was to assess the concurrent validity of a three-task injury risk factor assessment by comparing visually derived outcome scores from two-dimensional (2D) video data with dichotomized three-dimensional (3D) biomechanical variables collected using motion capture technology. A total of 41 female club volleyball athletes (14.7 ± 1.4 years) were tested and asked to perform three tasks: double-leg vertical jump (DLVJ), single-leg squat (SLS), and single-leg drop landing (SLDL). One rater was trained on the scoring criteria for the 2D data and independently scored one forward-facing and one side-facing video for each task. Risk factors identified included poor knee position, lateral trunk lean, and excessive trunk flexion/extension. In addition, 3D joint angles were calculated for the trunk and knee in the sagittal and frontal planes and converted to dichotomous variables based on biomechanical thresholds of injury risk. For comparison of 2D and 3D outcomes, percent agreement and Cohen's kappa were calculated for each risk factor individually. Overall, 2D scores were found to exhibit moderate to excellent percent agreement with 3D outcomes for trunk position (69.1-97.1%). Specifically, ipsilateral trunk lean during single-leg tasks exhibited the highest agreement (85.3-88.2%) with moderate reliability (κ = 0.452-0.465). In addition, moderate to substantial reliability was found for trunk flexion during double-leg tasks (κ = 0.521-0.653); however, an evaluation of single-leg tasks resulted in only fair reliability (κ = 0.354). Furthermore, 2D scores were not successful in identifying poor knee position as percent agreement fell below 50% for both the single-leg tasks and averaged 60% agreement across both the phases of the DLVJ. Kappa coefficients further emphasized these trends indicating no to slight concurrent validity (κ = -0.047-0.167) across tasks. Overall, these findings emphasize the potential for valid, low-cost screening tools that can identify high-risk movement patterns. Further study is needed to develop improved assessment guidelines that may be employed through visual assessment in sports environments.

Bodychecking experience and rates of injury among ice hockey players aged 15-17 years.

BACKGROUND: Although high rates of injury occur in youth ice hockey, disagreements exist about the risks and benefits of permitting bodychecking. We sought to evaluate associations between experience with bodychecking and rates of injury and concussion among ice hockey players aged 15-17 years. METHODS: We obtained data from a prospective cohort study of ice hockey players aged 15-17 years in Alberta who played in leagues that permitted bodychecking. We collected data over 3 seasons of play (2015/16-2017/18). We compared players based on experience with bodychecking (≤ 2 v. ≥ 3 yr), estimated using local and national bodychecking policy and region of play. We used validated methodology of ice hockey injury surveillance to identify all injuries related to ice hockey games and defined concussions according to the Consensus Statement on Concussion in Sport. RESULTS: We included 941 players who contributed to 1168 player-seasons, with 205 players participating in more than 1 season. Compared with players with 2 years or less of bodychecking experience, those with 3 or more years of experience had higher rates of all injury (adjusted incidence rate ratio [IRR] 2.55, 95% confidence interval [CI] 1.57-4.14), injury with more than 7 days of time loss (adjusted IRR 2.65, 95% CI 1.50-4.68) and concussion (adjusted IRR 2.69, 95% CI 1.34-5.42). INTERPRETATION: Among ice hockey players aged 15-17 years who participated in leagues permitting bodychecking, more experience with bodychecking did not protect against injury. This provides further support for removing bodychecking from youth ice hockey.

Feasibility and Reliability of a Novel Game-Based Test of Neurological Function in Youth: The Equilibrium Test Battery.

Background: An estimated 11% of Canadian adolescents will sustain a sport-related concussion each year. However, diagnostic tools to detect and monitor concussive outcomes are limited. Purpose: To evaluate the feasibility and test-retest reliability of the Highmark Interactive Equilibrium (HIEQ) test battery in uninjured adolescents. Study Design: Observational study with repeated measurements. Methods: Participants completed the HIEQ test battery, a game-based platform on an iPad application, that assesses balance, cognitive function, and visual function, for up to 15 consecutive school days in a group classroom setting. Feasibility for use of the HIEQ was evaluated by (1) recruitment rates; (2) retention rates; (3) test completion without assistance; and (4) adverse events. Test-retest reliability was examined using Bland Altman 95% limits of agreement and intraclass correlation coefficients comparing the first and second and second and third obtained scores. Reliability across multiple baseline assessments was also analyzed using intraclass correlations for the second to sixth and seventh to eleventh obtained scores. Results: Fifty-five uninjured high school students (31 females and 24 males, mean age = 16.24 [1.09]) from three high schools participated in the study. Three participants (5%) completed all 15 days of testing, and 73% completed at least 10 of 15 test days. No adverse events were reported. Although the test was feasible, all subtests showed wide limits of agreement from first to second and from second to third testing occasions. Results indicate poor-to-moderate reliability (<0.50 to 0.75) across those intervals, as well as across the second to sixth and seventh to eleventh testing occasions. Conclusion: The HIEQ is feasible in high school students; however, performance was characterized by wide limits of agreement and poor-to-moderate reliability across test occasions. Future evaluation of the HIEQ in visual and auditory distraction free individual testing settings is warranted. Level of Evidence: Level 3.