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Andreas Ivarsson, Urban Johnson and Leslie Podlog

Context:

Athletes participating in sport are exposed to a high injury risk. Previous research has found a great number of risk factors (both physiological and psychological) that could increase injury risk.1 One limitation in previous studies is that few have considered the complex interaction between psychological factors in their research design.

Objective:

To study whether personality, stress, and coping predicted injury occurrence in an elite soccer population based on a hypothesized model.

Design:

Prospective.

Participants:

56 (n = 38 male, n = 18 female) Swedish Premiere League soccer players were selected based on convenience sampling.

Intervention:

Participants completed 4 questionnaires including the Swedish Universities Scales of Personality,2 Life Events Survey for Collegiate Athletes,3 and Brief COPE4 during the initial questionnaire administration. Subsequent to the first meeting, participants also completed the Hassle and Uplift Scale5 once per wk for a 13-wk period throughout the competitive season.

Main Outcome Measures:

A path analysis was conducted examining the influence of personality traits (ie, trait anxiety), state-level stressors (ie, negative-life-event stress and daily hassles), and coping on injury frequency.

Results:

Results of the path analysis indicated that trait anxiety, negative-life-event stress, and daily hassle were significant predictors of injury among professional soccer players, accounting for 24% of the variance.

Conclusion:

The findings highlight the need for athletes, coaches, and medical practitioners to attempt to reduce state-level stressors, especially daily hassles, in minimizing injury risk. Educating and training athletes and coaches in proactive stress-management techniques appears warranted.

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Joseph J. Knapik, Keith G. Hauret, Sara Canada, Roberto Marin and Bruce Jones

Background:

Associations between physical activity and injuries have been previously examined using self-reports. The present investigation examined this association using objective measures of activity and injury.

Methods:

To quantify ambulatory activity, pedometers were worn daily by recruits in 10 Army Basic Combat Training companies during the 9-week training cycle. Injuries were obtained from a medical surveillance system, defined as traumatic or overuse events resulting in a medical care provider visit. A daily questionnaire documented whether or not recruits wore the pedometers and trained with their companies for the entire day.

Results:

Training companies were categorized by activity level into 3 groups with higher activity (HA, 17,948 ± 550 steps/day), 4 with moderate activity (MA, 16,346 ± 768 steps/day) and 3 with lower activity (LA, 14,772 ± 400 steps/day). Among men, the MA and HA groups were at 1.52 (95% confidence interval [95% CI] = 1.15−2.01) and 1.94 (95% CI = 1.46−2.61) times higher injury risk, respectively, compared with the LA group. Among women, the MA and HA groups were at 1.36 (95% CI = 1.07−1.73) and 1.53 (95% CI = 1.24−1.89) times higher injury risk, respectively, compared with low LA group. The relationships remained significant after considering physical characteristics and physical fitness.

Conclusions:

In consonance with previous self-report studies, higher physical activity was associated with higher injury risk.

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Gary B. Wilkerson, Kevin A. Simpson and Ryan A. Clark

Context:

Neurocognitive reaction time has been associated with musculoskeletal injury risk, but visuomotor reaction time (VMRT) derived from tests that present greater challenges to visual stimulus detection and motor response execution may have a stronger association.

Objective:

To assess VMRT as a predictor of injury and the extent to which improvement may result from VMRT training.

Design:

Cohort study.

Setting:

University athletic performance center.

Participants:

76 National Collegiate Athletic Association Division-I FCS football players (19.5 ± 1.4 y, 1.85 ± 0.06 m, 102.98 ± 19.06 kg).

Interventions:

Preparticipation and postseason assessments. A subset of players who exhibited slowest VMRT in relation to the cohort’s postseason median value participated in a 6-wk training program.

Main Outcome Measures:

Injury occurrence was related to preparticipation VMRT, which was represented by both number of target hits in 60 s and average elapsed time between hits (ms). Receiver operating characteristic analysis identified the optimum cut point for a binary injury risk classification. A nonparametric repeated-measures analysis of ranks procedure was used to compare posttraining VMRT values for slow players who completed at least half of the training sessions (n = 15) with those for untrained fast players (n = 27).

Results:

A preparticipation cut point of ≤85 hits (≥705 ms) discriminated injured from noninjured players with odds ratio = 2.30 (90% confidence interval, 1.05–5.06). Slow players who completed the training exhibited significant improvement in visuomotor performance compared with baseline (standardized response mean = 2.53), whereas untrained players exhibited a small performance decrement (group × trial interaction effect, L2 = 28.74; P < .001).

Conclusions:

Slow VMRT appears to be an important and modifiable injury risk factor for college football players. More research is needed to refine visuomotor reaction-time screening and training methods and to determine the extent to which improved performance values can reduce injury incidence.

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Michelle L. Weber, Kenneth C. Lam and Tamara C. Valovich McLeod

Clinical Question:

In youth and adolescent athletes, are jumping/plyometric exercises more effective than balance exercises in preventing sport-related injuries?

Objective:

The aim of this article is to examine the meta-analysis by Rössler et al.1 as it relates to the clinical question.

Conclusion:

Evidence in this meta-analysis suggests that injury prevention programs provide beneficial effects in injury reduction for youth and adolescent athletes. Prevention programs that contained jumping or plyometric exercises and were targeted toward females appeared to be especially beneficial for decreasing injury risk.

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Heidi R. Thornton, Jace A. Delaney, Grant M. Duthie and Ben J. Dascombe

Purpose:

To investigate the ability of various internal and external training-load (TL) monitoring measures to predict injury incidence among positional groups in professional rugby league athletes.

Methods:

TL and injury data were collected across 3 seasons (2013–2015) from 25 players competing in National Rugby League competition. Daily TL data were included in the analysis, including session rating of perceived exertion (sRPE-TL), total distance (TD), high-speed-running distance (>5 m/s), and high-metabolic-power distance (HPD; >20 W/kg). Rolling sums were calculated, nontraining days were removed, and athletes’ corresponding injury status was marked as “available” or “unavailable.” Linear (generalized estimating equations) and nonlinear (random forest; RF) statistical methods were adopted.

Results:

Injury risk factors varied according to positional group. For adjustables, the TL variables associated most highly with injury were 7-d TD and 7-d HPD, whereas for hit-up forwards they were sRPE-TL ratio and 14-d TD. For outside backs, 21- and 28-d sRPE-TL were identified, and for wide-running forwards, sRPE-TL ratio. The individual RF models showed that the importance of the TL variables in injury incidence varied between athletes.

Conclusions:

Differences in risk factors were recognized between positional groups and individual athletes, likely due to varied physiological capacities and physical demands. Furthermore, these results suggest that robust machine-learning techniques can appropriately monitor injury risk in professional team-sport athletes.

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Adriana M. Duquette and David M. Andrews

Considerable variability in tibial acceleration slope (AS) values, and different interpretations of injury risk based on these values, have been reported. Acceleration slope variability may be due in part to variations in the quantification methods used. Therefore, the purpose of this study was to quantify differences in tibial AS values determined using end points at various percentage ranges between impact and peak tibial acceleration, as a function of either amplitude or time. Tibial accelerations were recorded from 20 participants (21.8 ± 2.9 years, 1.7 m ± 0.1 m, 75.1 kg ± 17.0 kg) during 24 unshod heel impacts using a human pendulum apparatus. Nine ranges were tested from 5–95% (widest range) to 45–55% (narrowest range) at 5% increments. ASAmplitude values increased consistently from the widest to narrowest ranges, whereas the ASTime values remained essentially the same. The magnitudes of ASAmplitude values were significantly higher and more sensitive to changes in percentage range than ASTime values derived from the same impact data. This study shows that tibial AS magnitudes are highly dependent on the method used to calculate them. Researchers are encouraged to carefully consider the method they use to calculate AS so that equivalent comparisons and assessments of injury risk across studies can be made.

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Joshua T. Weinhandl, Mukta Joshi and Kristian M. O’Connor

The increased number of women participating in sports has led to a higher knee injury rate in women compared with men. Among these injuries, those occurring to the ACL are commonly observed during landing maneuvers. The purpose of this study was to determine gender differences in landing strategies during unilateral and bilateral landings. Sixteen male and 17 female recreational athletes were recruited to perform unilateral and bilateral landings from a raised platform, scaled to match their individual jumping abilities. Three-dimensional kinematics and kinetics of the dominant leg were calculated during the landing phase and reported as initial ground contact angle, ranges of motion (ROM) and peak moments. Lower extremity energy absorption was also calculated for the duration of the landing phase. Results showed that gender differences were only observed in sagittal plane hip and knee ROM, potentially due to the use of a relative drop height versus the commonly used absolute drop height. Unilateral landings were characterized by significant differences in hip and knee kinematics that have been linked to increased injury risk and would best be classified as “stiff” landings. The ankle musculature was used more for impact absorption during unilateral landing, which required increased joint extension at touchdown and may increase injury risk during an unbalanced landing. In addition, there was only an 11% increase in total energy absorption during unilateral landings, suggesting that there was a substantial amount of passive energy transfer during unilateral landings.

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Ina Janssen, Jeremy M. Sheppard, Andrew A. Dingley, Dale W. Chapman and Wayne Spratford

Countermovement jumps loaded with a weighted vest are often used for the training of lower body power to improve jump performance. However, it is currently unknown how this added load affects the lower extremity kinematics and kinetics, in particular whether this results in an increased injury risk. Therefore, the purpose of this investigation was to determine how lower extremity kinematics and kinetics during landing are affected by loaded jumps as demonstrated in a volleyball block jump landing. Ten elite male volleyball players performed block jump landings in an unloaded and loaded (9.89 kg) condition. Kinematic and kinetic landing data from the three highest jumps were collected and assessed. Paired samples t test was used to establish whether load condition had a significant effect on lower extremity kinematics and kinetics. Hip flexion was significantly greater in the unloaded condition compared with the loaded condition (p = .004). There was no significant difference in any other kinematic or kinetic variables measures between the unloaded and loaded conditions. These results suggest that landing from loaded volleyball block jumps does not increase injury risk compared with unloaded jumps in elite male volleyball players.

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Emma Sconce, Paul Jones, Ellena Turner, Paul Comfort and Philip Graham-Smith

Context:

Hamstring injury-risk assessment has primarily been investigated using isokinetic dynamometry. However, practical issues such as cost and availability limit the widespread application of isokinetics for injury-risk assessment; thus, field-based alternatives for assessing eccentric hamstring strength are needed.

Objective:

The aim of this study was to investigate the validity of the angle achieved during Nordic hamstring lowers (break-point angle) as a field-based test for eccentric hamstring strength.

Design:

Exploratory study.

Setting:

Laboratory.

Participants:

Sixteen male (n = 7) and female (n = 9) soccer players (mean ± SD age 24 ± 6 y, height 1.77 ± 0.12 m, and body mass 68.5 ± 16.5 kg) acted as subjects for the study.

Main Outcome Measures:

The authors explored relationships between the Nordic break-point angle (the point at which the subject can no longer resist the increasing gravitational moment during a Nordic hamstring lower) measured from video and isokinetic peak torque and angle of peak torque of right- and left-knee flexors.

Results:

The results revealed a meaningful relationship between eccentric knee-flexor peak torque (average of right and left limbs) and the Nordic break-point angle (r = −.808, r 2 = 65%, P < .00001). However, there was a weak relationship observed (r = .480, r 2 = 23%, P = .06) between break-point angle and the angle of peak torque (average of right and left limbs).

Conclusions:

The results suggest that the break-point angle achieved during Nordic hamstring lowers could be used as a field-based assessment of eccentric hamstring strength.

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Irene S. McClay, John R. Robinson, Thomas P. Andriacchi, Edward C Frederick, Ted Gross, Philip Martin, Gordon Valiant, Keith R. Williams and Peter R. Cavanagh

Basketball is a sport that involves multiple impacts with the ground through a variety of moves such as running Jumping, and cutting. Repetitive impacts have been associated with stress-related injuries in other sports such as running. The purpose of this investigation was to gain an understanding of the typical stresses the body experiences during common basketball moves. To this end, the ground reaction forces from 24 players from five professional basketball teams were studied. In addition, a game analysis was performed to determine the frequency of selected moves. These data indicated that certain common movements, such as jump landings and shuffling, resulted in absolute and relative forces much greater than many of those reported previously in studies of other sports. These movements were also identified in a companion paper as being associated with large angular excursions and velocities. Findings are discussed with respect to injury risks, and suggestions for future study are made.