Context: Determination of return to play (RTP) after sport-related concussion (SRC) is critical given the potential consequences of premature RTP. Current RTP guidelines may not identify persistent exercise-induced neurocognitive deficits in asymptomatic athletes after SRC. Therefore, postexercise neurocognitive testing has been recommended to further inform RTP determination. To implement this recommendation, the effect of exercise on neurocognitive function in healthy athletes should be understood. Objective: To examine the acute effects of a high-intensity intermittent-exercise protocol (HIIP) on neurocognitive function assessed by the Symbol Digits Modality Test (SDMT) and Stroop Interference Test. Design: Cohort study. Setting: University laboratory. Participants 40 healthy male athletes (age 21.25 ± 1.29 y, education 16.95 ± 1.37 y). Intervention: Each participant completed the SDMT and Stroop Interference Test at baseline and after random allocation to a condition (HIIP vs control). A mixed between-within-subjects ANOVA assessed time- (pre- vs postcondition) -by-condition interaction effects. Main Outcome Measures: SDMT and Stroop Interference Test scores. Results: There was a significant time-by-condition interaction effect (P < .001, η 2 = .364) for the Stroop Interference Test scores, indicating that the HIIP group scored significantly lower (56.05 ± 9.34) postcondition than the control group (66.39 ± 19.6). There was no significant time-by-condition effect (P = .997, η 2 < .001) for the SDMT, indicating that there was no difference between SDMT scores for the HIIP and control groups (59.95 ± 10.7 vs 58.56 ± 14.02). Conclusions: In healthy athletes, the HIIP results in a reduction in neurocognitive function as assessed by the Stroop Interference Test, with no effect on function as assessed by the SDMT. Testing should also be considered after high-intensity exercise in determining RTP decisions for athletes after SRC in conjunction with the existing recommended RTP protocol. These results may provide an initial reference point for future research investigating the effects of an HIIP on the neurocognitive function of athletes recovering from SRC.
Enda F. Whyte, Nicola Gibbons, Grainne Kerr and Kieran A. Moran
Siobhan O'Connor, Noel McCaffrey, Enda Whyte and Kieran Moran
Context: Scapular dyskinesis has been identified as a possible risk factor for injury in overhead athletes. There is a need to develop a simple, inexpensive, time-efficient field-based test that can establish the presence and severity of both scapular dyskinesis and its individual components in a musculoskeletal preparticipation screening. To ensure confidence in the test results, high reliability must be displayed. Objective: To establish the intertester and intratester reliability of a simple field-based screening tool for scapular dyskinesis. Design: Reliability study. Setting: Athletic therapy facilities. Participants: 15 physically active men (19.46 ± 0.63 y) free from any orthopedic or neurological disorders, recruited from a convenience sample of college students. Intervention: Testers underwent 3 training sessions where the instructions and scoring system of the test were explained, demonstrations of the tests were given, and opportunities to practice the test were provided. Three testers independently rated 3 trials, and the process was repeated at the same time the following week. Main Outcome Measures: Scapular dyskinesis was assessed using the following components: winging, loss/lack of control when lifting, loss/lack of control when lowering, and scapular asymmetry. A 0-3 rating (0 = no issue, 1 = slight issue, 2 = moderate issue, 3 = severe issue) was provided by the tester independently on each side separately and on scapular asymmetry. The intraclass correlation coefficients (ICCs), 95% confidence intervals, and standard error of measurement (SEM) were computed to establish reliability. Results: Excellent ICC values were found for intertester reliability (ICCs .80-1.00) and good to excellent intratester reliability (ICCs .60-1.00 for tester A, .63-1.00 for tester B, and .75-1.00 for tester C) for all components of the test. The SEM was not found to be clinically significant. Conclusions: The simple field-based screening tool developed to assess scapular dyskinesis demonstrates high reliability and so is a reliable tool to use in preparticipation screenings. Future research should establish its validity.
Siobhán O’Connor, Conor Bruce, Calvin Teahan, Elaine McDermott and Enda Whyte
Context: Although Ladies Gaelic football is one of the most popular female sports in Ireland, just 2 previous injury surveillance studies have been completed, and both were retrospective in nature. Objective: To prospectively examine the injury incidence and injury profile in collegiate Ladies Gaelic football over 2 seasons. Design: Prospective cohort study. Setting: College. Patients (or Other Participants): Adult Ladies Gaelic footballers from one collegiate institution (season 1: n = 50, season 2: n = 82). Intervention(s): All time-loss injuries that occurred were recorded by certified athletic therapists and student-athletic therapists and trainers over 2 seasons. Main Outcome Measures: A standardized injury report form was used to record the injury onset, mechanism, location, nature, and outcome. Injury incidence proportion, repeat incidence proportion and total, match and training injury rates, and their 95% confidence intervals were calculated. The frequencies and proportions were also calculated. Results: The match and training injury rates were 42.48 and 7.93 injuries per 1000 hours, respectively. A low repeat incidence proportion per season was noted (11.7% and 0.0%). The injuries were predominantly acute (74.68%) and noncontact (66.25%), with hamstring injuries (21.52%) and strains (36.71%) the most frequent location and nature of injuries noted. Strains (104.92 d absent per 1000 h) and knee injuries (106.46 d absent per 1000 h) led to the greatest injury burden. Further investigations were not frequently required, with an X-ray and magnetic resonance imaging ordered in 8.00% and 6.67% of the cases, respectively. Surgery was completed following one injury. Conclusions: This is the first study to provide prospective injury data on Ladies Gaelic football. Priority needs to be given to preventing hamstring and knee injuries due to their occurrence and negative impact on player availability to play. Collegiate Ladies Gaelic football teams should be encouraged to implement an injury-prevention warm-up, such as the GAA15+, at training and matches.
Siobhán O’Connor, Noel McCaffrey, Enda F. Whyte, Michael Fop, Brendan Murphy and Kieran A. Moran
Context: Hamstring injuries are a leading cause of injury in Gaelic games. Hamstring flexibility as a risk factor for hamstring injury has not yet been examined prospectively in Gaelic games. Objective: To examine whether hamstring flexibility, using the modified active knee extension (AKE) test, and previous injury are risk factors for hamstring injury in Gaelic players and to generate population-specific AKE cutoff points. Design: Prospective cohort study. Setting: School and colleges. Patients (or Other Participants): Adolescent and collegiate Gaelic footballers and hurlers (n = 570). Intervention(s): The modified AKE test was completed at preseason, and hamstring injuries were assessed over the course of one season. Any previous hamstring injuries were noted in those who presented with a hamstring injury. Main Outcome Measures: Bilateral AKE scores and between-leg asymmetries were recorded. Receiver operating characteristic curves were implemented to generate cutoff points specific to Gaelic players. Univariate and backward stepwise logistic regression analyses were completed to predict hamstring injuries, hamstring injuries on the dominant leg, and hamstring injuries on the nondominant leg. Results: Mean flexibility of 64.2° (12.3°) and 64.1° (12.4°) was noted on the dominant and nondominant leg, respectively. Receiver operating characteristic curves generated a cutoff point of < 65° in the AKE on the nondominant leg only. When controlled for age, AKE on the nondominant leg was the only predictor variable left in the multivariate model (odds ratio = 1.03) and significantly predicted hamstring injury (χ2 = 9.20, P = .01). However, the sensitivity was 0% and predicted the same amount of cases as the null model. It was not possible to generate a significant model for hamstring injuries on the dominant leg (P > .05), and no variables generated a P value < .20 in the univariate analysis on the nondominant leg. Conclusions: Poor flexibility noted in the AKE test during preseason screening and previous injury were unable to predict those at risk of sustaining a hamstring strain in Gaelic games with adequate sensitivity.
Siobhán O Connor, Noel McCaffrey, Enda Whyte and Kieran Moran
Hamstring injuries are prevalent among team and field sport athletes, and poor flexibility has been theorized as a risk factor. The active knee extension test has been proposed as the gold standard for assessment of hamstring flexibility. Many variations of this test are employed, each of which utilizes a complex apparatus that is difficult to transport, time-consuming to set up, and often unavailable to most clinicians. Thus, a method that utilizes inexpensive and readily available equipment is needed for screening.
To establish the intertester and intratester reliability of a modified active knee extension test that requires minimal equipment.
Athletic therapy facilities.
Patients or Other Participants:
Fifteen male athletes (19.5 ± 0.6 years) free from any orthopedic or neurological disorders were recruited from a convenience sample of collegiate students.
Three testers participated in three training sessions before data collection. Participants completed three trials of the modified active knee extension test and returned the following week at the same time and day to repeat the process.
Main Outcome Measure(s):
The intraclass correlation coefficient (ICC), 95% confidence interval, and the standard error of measurement were calculated to assess inter- and intratester reliability.
High ICC values were found for intertester reliability (right leg = .98; left leg = .99) and intratester reliability (right leg = .78−.89; left leg = .79−.94).
The modified active knee extension test utilizes readily available equipment and offers a quick, reliable, and low-cost alternative for measurement of hamstring flexibility.
Siobhán O’Connor, Róisín Leahy, Enda Whyte, Paul O’Donovan and Lauren Fortington
Camogie is one of Ireland’s most popular sports, and the full contact nature presents a high potential for injury. This study aims to present the first overview of elite and nonelite camogie injuries by examining adult players’ self-reported worst injuries from one season. At least one injury was sustained by 88.2% of camogie players during the previous season and 60.0% sustained 2+ injuries. Knee and ankle ligaments, hamstring strains and hand/fingers/thumb fractures were key injuries identified, which can lead to substantive health and economic impacts. Further research to establish the mechanism of these injuries is required in order to start shaping potential measures for their prevention.