Risk Factors for Lower Extremity Overuse Injuries in Female Youth Soccer Players.

BACKGROUND: Youth soccer injuries are common and of increasing concern, with sport specialization occurring at younger ages. Limited research is available regarding overuse injuries and risk factors in young female athletes. PURPOSE: To identify the number and rate of overuse injuries in female soccer players (ages 12-15 years), describe the anatomic location and type of injury, and evaluate contributing risk factors. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: A total of 351 female youth soccer players, ages 12 to 15 years, from Washington State were evaluated from 2008 to 2012. Players with lower extremity overuse injuries were identified through weekly emails and were interviewed by telephone to obtain data on injury type and body region. We evaluated the association between overuse injuries and preseason risk factors, including joint hypermobility, hip and knee muscle strength, and jump biomechanics, using Poisson regression to estimate relative risk (RR) and 95% CIs. RESULTS: The incidence rate for first-time lower extremity overuse injuries was 1.7 per 1000 athlete-exposure hours (AEH; 95% CI, 1.4-2.2), and that for repeat injuries was 3.4 per 1000 AEH (95% CI, 2.1-5.6). Knee injuries accounted for 47% of overuse injuries. Increased valgus was associated with a 3.2-fold increased risk (95% CI, 1.52-6.71) for knee injury. A 1-standard deviation (SD) increase in hamstring strength was associated with a 35% decreased risk (RR, 0.65; 95% CI, 0.46-0.91) for overuse knee injuries, and a 1-SD increase in quadriceps strength was associated with a 30% decreased risk (RR, 0.70; 95% CI, 0.50-0.98). A 1-SD increase in hip flexor strength was associated with a 28% decreased risk (RR, 0.72; 95% CI, 0.51-1.00) for overuse knee injuries, and a 1-SD increase in external rotation strength was associated with a 35% decreased risk (RR, 0.65; 95% CI, 0.46-0.91). Playing on more than 1 soccer team was associated with a 2.5-fold increased risk (95% CI, 1.08-5.35) for overuse knee injuries, and participating in other physical activities was associated with a 61% decreased risk (odds ratio, 0.39; 95% CI, 0.15-0.81). CONCLUSION: In this study, lower extremity overuse injuries in female youth soccer players affected primarily the knee. Lower knee separation distance, decreased lower extremity strength, and playing on more than 1 soccer team increased injury risk.

Is Heading in Youth Soccer Dangerous Play?

BACKGROUND: Soccer is among the most popular youth sports with over 3 million youth players registered in the U.S. Soccer is unique in that players intentionally use their head to strike the ball, leading to concerns that heading could cause acute or chronic brain injury, especially in the immature brains of children. METHODS: Pub Med search without date restriction was conducted in November 2014 and August 2015 using the terms soccer and concussion, heading and concussion, and youth soccer and concussion. 310 articles were identified and reviewed for applicable content specifically relating to youth athletes, heading, and/or acute or chronic brain injury from soccer. RESULTS: Soccer is a low-risk sport for catastrophic head injury, but concussions are relatively common and heading often plays a role. At all levels of play, concussions are more likely to occur in the act of heading than with other facets of the game. While concussion from heading the ball without other contact to the head appears rare in adult players, some data suggests children are more susceptible to concussion from heading primarily in game situations. Contributing factors include biomechanical forces, less developed technique, and the immature brain's susceptibility to injury. CONCLUSIONS: There is no evidence that heading in youth soccer causes any permanent brain injury and there is limited evidence that heading in youth soccer can cause concussion. A reasonable approach based on U.S. Youth Soccer recommendations is to teach heading after age 10 in controlled settings, and heading in games should be delayed until skill acquisition and physical maturity allow the youth player to head correctly with confidence.

Is Knee Separation During a Drop Jump Associated With Lower Extremity Injury in Adolescent Female Soccer Players?

BACKGROUND: Knee injuries are common in older adolescent and adult female soccer players, and abnormal valgus knee appearance characterized by low normalized knee separation (NKS) is a proposed injury risk factor. What constitutes normal NKS in younger adolescents and whether low NKS is an injury risk factor are unknown. PURPOSE: To determine the normal range of NKS using a drop-jump test in female perimenarchal youth soccer players and whether low NKS contributes to lower extremity injuries or knee injuries. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: From 2008 to 2012, a total of 351 female elite youth soccer players (age range, 11-14 years) were followed for 1 season, with complete follow-up on 92.3% of players. Baseline drop-jump testing was performed preseason. Lower extremity injuries during the season were identified using a validated, Internet-based injury surveillance system with weekly email reporting. Normalized knee separation at prelanding, landing, and takeoff was categorized 2 ways: as ≤10th percentile (most extreme valgus appearance) compared with >10th percentile and as a continuous measure of 1 SD. Poisson regression modeling with adjustment for clustering by team estimated the relative risk (RR) and 95% confidence interval (CI) of the association between the NKS and the risk of lower extremity and knee injury, stratified by menarche. RESULTS: Of the study participants, 134 players experienced 173 lower extremity injuries, with 43 (24.9%) knee injuries. For postmenarchal players (n = 210), those with NKS ≤10th percentile were at 92% increased risk of lower extremity injury (RR, 1.92; 95% CI, 1.17-3.15) and a 3.62-fold increased risk of knee injury (RR, 3.62; 95% CI, 1.18-11.09) compared with NKS >10th percentile at prelanding and landing, respectively. Among postmenarchal players, there was an 80% increased risk of knee injury (RR, 1.80; 95% CI, 1.01-3.23) with a decrease of 1 SD in landing NKS and a 66% increased risk of knee injury (RR, 1.66; 95% CI, 1.04-2.64) with a decrease of 1 SD in takeoff NKS. Among premenarchal players (n = 141), there was no statistically significant association between the NKS at prelanding, landing, and takeoff and the risk of lower extremity or knee injury. CONCLUSION: Low NKS was associated with increased risk of lower extremity and knee injury only among postmenarchal players.

Evaluation of the Zachery Lystedt Law among female youth soccer players.

BACKGROUND: Despite recent increased awareness about sports concussions, few studies have evaluated the effect of concussion laws on concussion outcomes among young athletes. The purpose of our study was to evaluate the effect of the Washington State Zachery Lystedt Concussion Law on playing with concussion symptoms and being evaluated by a health care provider. METHODS: We performed a prospective cohort study of 351 elite female soccer players, aged 12 to 15 years, from 33 randomly selected youth soccer teams in the Puget Sound region of Washington State from 2008 to 2012. The Washington State Zachery Lystedt Concussion Law went into effect on July 1, 2009. Among concussed players (N = 59), we assessed the risk of playing with symptoms, the evaluation by a health care professional, and receiving a concussion diagnosis before and after the law was passed using logistic regression to estimate odds ratios and 95% CIs. RESULTS: The majority of concussed players (59.3%) continued to play with symptoms, and we found no statistically significant difference in the proportion of players who played with symptoms before and after the law was passed. Only 44.1% of concussed players were evaluated by a health care provider, with no difference before and after the law was passed. Among those evaluated by a health care professional, players were 2.1-fold (95% CI, 1.0-10.1) more likely to receive a concussion diagnosis after the law was passed. CONCLUSION: The majority of concussed female youth soccer players report playing with symptoms. Legislation mandating concussion education and evaluation prior to returning to play was not associated with an increase in concussion evaluations by health care providers.

The evidenced-based shoulder evaluation.

The physical examination of the shoulder has been studied extensively, but the quality and statistical power of the published research often is lacking. The initial reports of new shoulder examination techniques commonly describe impressive performance. However recent meta-analyses have found that when the majority of these tests are used in isolation, they lack the ability to rule in or rule out the pathology in question, with few exceptions. The diagnostic accuracy of the physical examination improves when the shoulder tests are evaluated in combination, such as positive passive distraction and active compression identifying a superior labral anterior to posterior (SLAP) lesion. The accuracy also can be improved when the shoulder tests are evaluated in conjunction with specific historical findings, such as age greater than 39 years, history of popping or clicking, and a positive painful arc (pain experienced between 60° and 120° of abduction) identifying rotator cuff tendinopathy. The literature on shoulder imaging demonstrates that rotator cuff tears can be ruled in or ruled out by both ultrasound and magnetic resonance imaging. For SLAP lesions, magnetic resonance arthrography can be used to rule out a tear but may not be as accurate as combined physical examinations to rule in a tear.

Concussion among female middle-school soccer players.

IMPORTANCE: Despite recent increased awareness about sports concussions, little research has evaluated concussions among middle-school athletes. OBJECTIVES: To evaluate the frequency and duration of concussions in female youth soccer players and to determine if concussions result in stopping play and seeking medical care. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study from March 2008 through May 2012 among 4 soccer clubs from the Puget Sound region of Washington State, involving 351 elite female soccer players, aged 11 to 14 years, from 33 randomly selected youth soccer teams. Of the players contacted, 83.1% participated and 92.4% completed the study. MAIN OUTCOMES AND MEASURES: Concussion cumulative incidence, incidence rate, and description of the number, type, and duration of symptoms. We inquired weekly about concussion symptoms and, if present, the symptom type and duration, the event resulting in symptom onset, and whether the player sought medical attention or played while symptomatic. RESULTS: Among the 351 soccer players, there were 59 concussions with 43 742 athletic exposure hours. Cumulative concussion incidence was 13.0% per season, and the incidence rate was 1.2 per 1000 athletic exposure hours (95% CI, 0.9-1.6). Symptoms lasted a median of 4.0 days (mean, 9.4 days). Heading the ball accounted for 30.5% of concussions. Players with the following symptoms had a longer recover time than players without these symptoms: light sensitivity (16.0 vs 3.0 days, P = .001), emotional lability (15.0 vs 3.5 days, P = .002), noise sensitivity (12.0 vs 3.0 days, P = .004), memory loss (9.0 vs 4.0 days, P = .04), nausea (9.0 vs 3.0 days, P = .02), and concentration problems (7.0 vs 2.0 days, P = .02). Most players (58.6%) continued to play with symptoms, with almost half (44.1%) seeking medical attention. CONCLUSIONS AND RELEVANCE: Concussion rates in young female soccer players are greater than those reported in older age groups, and most of those concussed report playing with symptoms. Heading the ball is a frequent precipitating event. Awareness of recommendations to not play and seek medical attention is lacking for this age group.

Strength and jump biomechanics of elite and recreational female youth soccer players.

CONTEXT: Most researchers investigating soccer injuries have studied elite athletes because they have greater athletic-exposure hours than other athletes, but most youth participate at the recreational level. If risk factors for injury vary by soccer level, then recommendations generated using research with elite youth soccer players might not generalize to recreational players. OBJECTIVE: To examine injury risk factors of strength and jump biomechanics by soccer level in female youth athletes and to determine whether research recommendations based on elite youth athletes could be generalized to recreational players. DESIGN: Cross-sectional study. SETTING: Seattle Youth Soccer Association. PATIENTS OR OTHER PARTICIPANTS: Female soccer players (N = 92) aged 11 to 14 years were recruited from 4 randomly selected elite (n = 50; age = 12.5 years, 95% confidence interval [95% CI]) = 12.3, 12.8 years; height = 157.8 cm, 95% CI = 155.2, 160.3 cm; mass = 49.9 kg, 95% CI = 47.3, 52.6 kg) and 4 randomly selected recreational (n = 42; age = 13.2 years, 95% CI = 13.0, 13.5 years; height = 161.1 cm, 95% CI = 159.2, 163.1 cm; mass = 50.6 kg, 95% CI = 48.3, 53.0 kg) soccer teams. MAIN OUTCOME MEASURE(S): Players completed a questionnaire about demographics, history of previous injury, and soccer experience. Physical therapists used dynamometry to measure hip strength (abduction, adduction, extension, flexion) and knee strength (flexion, extension) and Sportsmetrics to measure vertical jump height and jump biomechanics. We compared all measurements by soccer level using linear regression to adjust for age and mass. RESULTS: Elite players were similar to recreational players in all measures of hip and knee strength, vertical jump height, and normalized knee separation (a valgus estimate generated using Sportsmetrics). CONCLUSIONS: Female elite youth players and recreational players had similar lower extremity strength and jump biomechanics. This suggests that recommendations generated from research with elite youth soccer players could be generalized to recreational players.

Survey of injuries in Seattle area levels 4 to 10 female club gymnasts.

OBJECTIVE: To evaluate incidence, distribution, and contributing factors of injury in club gymnastics. DESIGN: Cross-sectional survey. SETTING: Five randomly selected gymnastics clubs near Seattle, WA. PARTICIPANTS: Ninety-six club gymnasts from competitive levels 4 to 10. INTERVENTIONS: The participants completed a questionnaire regarding demographics, injuries and contributing factors, and exposure time in the last competitive season. MAIN OUTCOME MEASURES: Acute and overuse injury incidence rates stratified by practice and competition, age categories, and level using relative risks and 95% confidence intervals (CIs). Chi-square testing was used to compare demographic-specific and gymnastic-specific variables between injured and uninjured. Multivariate regression modeling was used to assess independent risk factors for risk of acute and overuse injuries. RESULTS: Acute injury rate was 1.3 per 1000 hours and in univariate, but not multivariate analysis, it was 3.6-fold greater (95% CI, 1.6-9.1) among 10 to 12 year olds and 3.1-fold greater (95% CI, 1.3-8.0) among 13 to 17 year olds compared with 7 to 9 year olds. The most common acutely injured body parts were foot (21.0%), ankle (19.3%), knee (14.0%), and wrist (8.8%). The majority of injuries occurred in practice, but the meet injury rate was higher. Most injuries occurred on floor exercise (32.1%), beam (20.7%), and bars (17.0). Injury was most common during landing. The overuse injury rate was 1.8 per 1000 hours. During their gymnastics careers, concussions occurred in 30.2% and stress fractures affecting mostly low back and foot occurred in 16.7% of the gymnasts. CONCLUSIONS: Gymnasts are at similar risk of acute and overuse injuries, and acute injury rates were greater among older gymnasts. However, this predictor did not remain significant in multivariate analysis. Concussions and stress fractures are common. Gymnastics injury prevention studies should focus on older gymnasts, concussion education, and landing after a skill.

Soccer injuries in female youth players: comparison of injury surveillance by certified athletic trainers and internet.

CONTEXT: Few authors have evaluated sports injury-surveillance systems that use parental, Internet-based surveys for data collection. OBJECTIVE: To determine whether certified athletic trainers (ATs) and parental, Internet-based surveys provided comparable data for identifying soccer injuries. DESIGN: Prospective feasibility cohort study. SETTING: A soccer association in Seattle, Washington. PATIENTS OR OTHER PARTICIPANTS: Eighty female youth soccer players, ages 12 to 14 years. MAIN OUTCOME MEASURE(S): We compared the data provided by ATs attending 1 soccer practice per week with a weekly soccer-parent, Internet-based system. We measured athlete-exposure hours (AEHs) for each player. We compared injury rates reported by ATs only, Internet-based surveys only, and both systems combined. We evaluated the 2 surveillance systems for agreement on injured body region and laterality of injury using the kappa statistic. RESULTS: For ATs only, Internet-based surveys only, and both systems combined, we found acute injury rates of 3.0 per 1000 AEHs, 3.9 per 1000 AEHs, and 4.7 per 1000 AEHs and overuse injury rates of 1.0 per 1000 AEHs, 2.9 per 1000 AEHs, and 2.9 per 1000 AEHs, respectively. Players sustained 27 acute injuries (44% ankle, 11% knee, 11% hip) reported by at least 1 of the 2 systems, with 63% reported by ATs and 85% by Internet-based survey. Players sustained 17 overuse injuries (35% knee, 29% lower leg) reported by either system, with 35% reported by ATs and 100% by Internet-based survey. Among players for whom we had both ATs' and Internet-based survey injury data, body region injured and laterality had very good agreement (kappa = 0.73 to 1.0). CONCLUSIONS: The injury rate based on the weekly parental, Internet-based survey was similar to the rate based on the ATs' reporting and had comparable classifications of injured body region and laterality of injury.

Cerebral microhemorrhages in a collegiate football player: clinical implications in the management of sports concussion.

Most concussions in sports medicine are managed without advanced neurological imaging. However, computed tomography and magnetic resonance imaging are sometimes used in the management of complex sports concussions to identify acute/delayed intracranial bleeding or other associated pathology. Advances in imaging techniques have led to greater resolution and the identification of pathology of uncertain clinical significance. This report describes the presence of persistent cerebral microhemorrhages identified on magnetic resonance imaging in a collegiate football player who suffered a concussion. The associated risks and clinical significance of cerebral microhemorrhages have not been determined in the young athletic population. This case highlights provocative issues in the management of sports concussions as related to findings on modern neurological imaging and their potential implication on to return-to-play considerations.

Back pain in former intercollegiate rowers. A long-term follow-up study.

BACKGROUND: Research has shown that 32% of intercollegiate rowers develop back pain during their college career. HYPOTHESIS: Rowers who develop back pain in college are more likely than the general population to have back pain later in life. STUDY DESIGN: Survey. METHODS: Surveys from 1561 former intercollegiate rowing athletes were analyzed. Subjects who completed the surveys had graduated from college at a mean and median of 13 years previously, with a range of 0 to 20 years between graduation and completion of the survey. The survey was designed to determine the presence of back pain and its severity before, during, and after intercollegiate rowing. Back pain was defined as pain that lasted at least 1 week. RESULTS: Age was a significant predictor of back pain after college. Nevertheless, the lifetime prevalence of back pain in former intercollegiate rowers was no different from that of the general population (51.4% versus 60% to 80%). However, rowers who developed back pain in college had more subsequent back pain than rowers who were asymptomatic in college (78.9% versus 37.9%). Rowers who were asymptomatic in college had significantly lower rates of back pain as they aged than did the general population. The mean severity of current back pain was 3.5 +/- 1.9 on a scale of 1 to 10. CONCLUSIONS: Intercollegiate rowers are no more likely than the general population to have back pain later in life.

Effect of preexisting back pain on the incidence and severity of back pain in intercollegiate rowers.

BACKGROUND: Back pain is a common problem among rowers. PURPOSE: To determine whether preexisting back pain is a significant risk factor for back pain in intercollegiate rowers and how it relates to the ability of athletes to participate in college rowing. STUDY DESIGN: Survey. METHODS: Surveys from 1829 former intercollegiate rowing athletes were analyzed. The surveys included questions concerning back pain before the subjects' college career, back pain during intercollegiate rowing, missed practices, the duration of time lost from college rowing because of back pain, and career-ending back pain. Back pain was defined as pain lasting longer than 1 week. RESULTS: More subjects with preexisting back pain developed back pain during their college rowing career than subjects without preexisting back pain (57.1% versus 36.6%). Of those with preexisting pain, 55% missed practice because of back pain and 8% ended their college rowing careers; for those without preexisting pain, the percentages were 62% and 17%, respectively. For subjects with pain before their college rowing career, 78.8% missed less than 1 week and 5.9% missed more than 1 month. For subjects with no preexisting pain, 61.9% missed less than 1 week and 18.1% missed more than 1 month. CONCLUSIONS: While rowers with preexisting back pain are more likely to have back pain in college, they are less likely to miss extended periods of practice time or end their college rowing careers because of back pain.

Prevalence of obesity in adult population of former college rowers.

BACKGROUND: The prevalence of adolescent and adult obesity in the United States is increasing at an alarming rate. This study examined the prevalence of obesity in adults aged 20 through 60 years, comparing established national norms with a selected population of former college rowers. METHODS: Selected for study were 4,680 male and female former intercollegiate rowing athletes who graduated in 1928 through 1998. The participants were surveyed regarding duration of rowing career and training methods, current and college height and weight, and questions regarding lifetime episodes of back pain. After two mailings, 2,165 (46%) questionnaires were returned. Our study data were compared with national cross-sectional survey data obtained through the National Health and Nutritional Examination Survey III (NHANES III). RESULTS: Male and female former rowers had a significantly lower prevalence of obesity than the general population both in college and through their lifetime (P < .001). For rowers of both sexes, there was a trend of slightly higher body mass index (BMI) in each older age-group (P < .001). CONCLUSIONS: Former collegiate rowers were less obese than the general population. BMI increases with age, and encouraging athleticism for those who are of college age and younger might be an effective method to decrease adult obesity.

Upper respiratory infection: helpful steps for physicians.

Upper respiratory infections (URIs) are extremely common in adults. Most adults have multiple URIs each year, with athletes being more or less susceptible, depending on training intensity. Most URIs are viral nasopharyngeal infections that will improve in 7 to 10 days with symptomatic treatment and result in little time lost from athletic participation. Physicians must recognize the symptoms consistent with bacterial pharyngitis, infectious mononucleosis, and sinusitis to provide appropriate diagnostic testing, treatment, and return-to-play recommendations.

Coping with upper respiratory infections.

Your doctor has diagnosed your problem as an upper respiratory tract infection (URI). Common URIs include viral rhinitis (the common cold), sore throat, and sinusitis (sinus infection). Most URIs are caused by viruses, but some are caused by bacteria. Your physician may have recommended medication to treat your symptoms; these include acetaminophen, ibuprofen, or naproxen for pain or fever and antihistamines and/or decongestants to treat congestion and runny nose. Because they treat bacterial infections, antibiotics will not help a viral URI.