Background:
In female athletes, sports-related injuries to the anterior cruciate ligament (ACL) increase during adolescence and peak in incidence during the mid- to late teens. Although biomechanical ...investigations indicate that a potential window of opportunity exists for optimal timing for the initiation of integrative neuromuscular training (NMT) in young female athletes, the influence of the timing of initiation of these programs on the efficacy of ACL injury reduction has yet to be evaluated.
Hypothesis/Purpose:
The purpose of the current report was to systematically review and synthesize the scientific literature regarding the influence of age of NMT implementation on the effectiveness for reduction of ACL injury incidence. The hypothesis tested was that NMT would show a greater effect in younger populations.
Study Design:
Meta-analysis; Level of evidence 1a.
Methods:
Data were pooled from 14 clinical trials that met the inclusion criteria of (1) number of ACL injuries reported; (2) NMT program used; (3) female participants were included; (4) investigations used prospective, controlled trials; and (5) age of participants was documented or was obtainable upon contact with the authors. A meta-analysis with odds ratio (OR) was used to compare the ratios of ACL injuries between intervention and control groups among differing age categorizations.
Results:
A meta-analysis of the 14 included studies demonstrated significantly greater knee injury reduction in female athletes who were categorized in the preventive NMT group compared with those who were in the control group (OR: 0.54; 95% confidence interval CI: 0.35, 0.83). Lower ACL injuries in mid-teens (OR 0.28; CI: 0.18, 0.42) compared with late teens (OR 0.48; CI: 0.21, 1.07) and early adults (OR 1.01; CI: 0.62, 1.64) were found in participants undergoing NMT.
Conclusion:
The findings of this meta-analysis revealed an age-related association between NMT implementation and reduction of ACL incidence. Both biomechanical and the current epidemiological data indicate that the potential window of opportunity for optimized ACL injury risk reduction may be before the onset of neuromuscular deficits and peak knee injury incidence in female athletes. Specifically, it may be optimal to initiate integrative NMT programs during early adolescence, before the period of altered mechanics that increase injury risk.
Background:
Injury prevention neuromuscular training (NMT) programs reduce the risk for anterior cruciate ligament (ACL) injury. However, variation in program characteristics limits the potential to ...delineate the most effective practices to optimize injury risk reduction.
Purpose:
To evaluate the common and effective components included in ACL NMT programs and develop an efficient, user-friendly tool to assess the quality of ACL NMT programs.
Study Design:
Systematic review and meta-analysis.
Methods:
Study inclusion required (1) a prospective controlled trial study design, (2) an NMT intervention aimed to reduce incidence of ACL injury, (3) a comparison group, (4) ACL injury incidence, and (5) female participants. The following data were extracted: year of publication, study design, sample size and characteristics, and NMT characteristics including exercise type and number per session, volume, duration, training time, and implementer training. Analysis entailed both univariate subgroup and meta-regression techniques using random-effects models.
Results:
Eighteen studies were included in the meta-analyses, with a total of 27,231 participants, 347 sustaining an ACL injury. NMT reduced the risk for ACL injury from 1 in 54 to 1 in 111 (odds ratio OR, 0.51; 95% CI, 0.37-0.69). The overall mean training volume was 18.17 hours for the entire NMT (24.1 minutes per session, 2.51 times per week). Interventions targeting middle school or high school–aged athletes reduced injury risk (OR, 0.38; 95% CI, 0.24-0.60) to a greater degree than did interventions for college- or professional-aged athletes (OR, 0.65; 95% CI, 0.48-0.89). All interventions included some form of implementer training. Increased landing stabilization and lower body strength exercises during each session improved prophylactic benefits. A meta-regression model and simple checklist based on the aforementioned effective components (slope = −0.15, P = .0008; intercept = 0.04, P = .51) were developed to allow practitioners to evaluate the potential efficacy of their ACL NMT and optimize injury prevention effects.
Conclusion:
Considering the aggregated evidence, we recommend that ACL NMT programs target younger athletes and use trained implementers who incorporate lower body strength exercises (ie, Nordic hamstrings, lunges, and heel-calf raises) with a specific focus on landing stabilization (jump/hop and hold) throughout their sport seasons.
Clinical Relevance:
Clinicians, coaches, athletes, parents, and practitioners can use the developed checklist to gain insight into the quality of their current ACL NMT practices and can use the tool to optimize programming for future ACL NMT to reduce ACL injury risk.
•Trauma is a leading cause of morbidity and mortality in children, and many injuries are preventable. Trauma centers play an important role in injury prevention.•Determining custom injury prevention ...priorities for a trauma center's community is feasible and impactful.•Custom injury prevention priority ranking makes use of existing active trauma registry data and provides robust rank lists to empower injury prevention teams.
Trauma is the leading cause of morbidity and mortality in children. Many traumatic injuries are preventable and trauma centers play a major role in directing population-level injury prevention strategies. Given the constraint of finite resources, calculating priorities for injury prevention at an institutional level is essential. The Injury Prevention and Priority Score (IPPS) is a widely applicable tool that is more robust than simple prevalence rankings and considers injury severity – an important factor when developing prevention strategies. We developed an adapted-IPPS methodology to define our local injury prevention priorities using our institution's patient population.
The institution-specific trauma registry was used, which includes patients presenting to a level 1 pediatric trauma center July 2018 - June 2022. Causes of injury were categorized into injury mechanisms based on external cause codes. Mechanisms of injury were ranked by frequency and severity (based on mean Injury Severity Score, ISS). An IPPS was calculated for each of the injury mechanisms, which were then ranked from highest to lowest priority injury mechanism.
In ranking injury mechanisms by IPPS, “falls” remain the top priority mechanism despite their relatively low severity, given their overwhelming frequency (n = 1993, mean ISS = 5.9). The injury mechanisms “motor vehicle” (n = 434, mean ISS = 10.9) and “pedestrian” (n = 13, mean ISS = 15), become higher priority given their injury severity, despite lower frequency. “Pedestrian” includes non-traffic incidents such as patients run over by cars in driveways or rural settings.
Computing the IPPS for each injury mechanism, using data collected routinely for trauma registries, enables trauma centers to use local data to inform injury prevention efforts in their communities. Calculating rankings based on an injury mechanism's relative frequency and severity allows a more robust understanding of their impact.
IV
BackgroundDespite being a common cause of time loss, information regarding best practice for calf muscle strain injuries (CMSI) in sport is scarce.ObjectiveTo establish best practice for the ...assessment and management of CMSI.DesignQualitative.SettingIn-depth interviews.Patients (or Participants)20 expert medical professionals working in elite sport and/or researchers specialising in the field; representing seven countries and seven sports.Interventions (or Assessment of Risk Factors)Semi-structured interviews using a schedule of questions canvassing pre-identified topics. Thematic coding to analyse findings.Main Outcome MeasurementsData were evaluated in three key areas: (i) injury characteristics, (ii) injury management, and (iii) injury prevention.ResultsCMSI have unique injury characteristics compared to other common muscle strain injuries (e.g. hamstring), but a criteria-based approach can assist forming the most accurate impression of prognosis. Similarly, a structured approach should be followed to ensure the athlete returns to a high level of performance and the risk of re-injury is minimized, focusing on: re-strengthening, plyometric and ballistic exercises, as well as running-based reconditioning specific to the sport. For the best chance to prevent index CMSI, strategies should span multiple domains of athlete management: screening and monitoring, field-based exposure (e.g. workload data), and off-field interventions (e.g. strengthening). Injury prevention strategies should be tailored to the individual, considering extrinsic (the sport, position played, club culture/coach expectations) and intrinsic (previous injury history, age, training history) factors that may increase susceptibility to CMSI.ConclusionsKnowledge about the unique injury characteristics of CSMI can clarify the likely prognosis and best approach to rehabilitation. Practitioners attempting to prevent CMSI should use a multi-faceted approach given that the aetiology of CMSI is complex and often unique to the individual.
BackgroundThe metabolomics approach, aiming to link variation of metabolic profile to pathologic conditions, is a vital tool for personalized medicine and biomarker discovery. In the context of ...athletes’ monitoring and injury prevention, measuring the dynamic metabolic changes resulting from pathologic conditions is crucial.ObjectiveWe aimed to develop an NMR-based metabolomic workflow to spot specific metabolic signature of athletes’ fitness and recovery. Our purpose was to provide valuable information about the metabolic status of athletes by comparing metabolomic data coming from two group of individuals: Ultra-trail athletes (UT) and, sedentary individuals.DesignLongitudinal, cohort studySettingUT individuals were participating to the UltraTour, a 67 km ultra-trail running, 1500 D+ in Liège (Belgium). Sedentary individuals ran 1 hour on a treadmill at the maximum of their capacity.Participants20 UT participants, 15 sedentary.Intervention (or Assessment of risk factors)Blood samples were collected at three time points: before (TO), immediately after (T1), and three hours after the start of their effort (T3). NMR-based metabolomic analysis was employed to analyze intragroup and intergroup metabolic variations.Main outcome measurements1H-NMR spectra were recorded and processed through an in-house pipeline to generate metabolic profiles. Intragroup and intergroup variations were analyzed using non-discriminant PCA models dedicated to multivariate analysis.ResultsIntragroup metabolic profile changes from T0 to T3 were observed for both groups. Indeed, three hours of recovery were insufficient for athletes to return to their baseline metabolic status. Significant differences between athletes and sedentary individuals were also highlighted. ConclusionThis proof-of-concept study spotted the importance of metabolomics approach in the field of athletes’ follow-up, performance monitoring and injury prevention. Indeed, by following the metabolic changes over the time, we can assess the fitness of the studied individuals and gather information about their recovery and avoid situation of high-risk of muscle injury.
BackgroundThoracic disc herniation, though clinically infrequent, presents unique challenges, especially in elite athletic settings. We delve into an intriguing instance of a professional ...weightlifter, experiencing back and chest discomfort, traced to thoracic disc herniationObjectiveHighlight a rare thoracic disc herniation case and the need for effective training programs to minimize injury risks.DesignThis clinical case was diagnosed using a combination of clinical examination and MRI imaging.SettingOur subject is a weightlifter competing in the 55 kg category.PatientsThis is a case presentation of a senior weightlifter, notorious for poor grip during warm-ups, who experienced acute lumbago during a training session and was diagnosed with degeneration in four discs.Assessment of Risk FactorsA study from the Rio de Janeiro 2016 Summer Olympic Games revealed weightlifting had the second-highest sport-specific rate of spinal pathology. Repetitive and intense physical demands on the spine from weightlifting activities, characterized by heavy lifting, places athletes at risk.Main Outcome MeasurementsSports injuries, including sprains, strains, fractures, and herniated disc, are primary reasons athletes seek medical care. Although lumbar herniated discs are frequent, our case underscores a thoracic disc herniation in an athlete, which is rare yet significant.ResultsMRI scans, with specific parameters, unveiled multiple herniated discs of both thoracic and lumbar regions. Treatment involved an integrated approach, considering immediate relief and long-term recuperation.ConclusionsIt’s pivotal for athletes to engage in proper conditioning, alongside adhering to injury prevention measures. While herniated thoracic discs are less prevalent, they can occur, demanding specialized management. Collaborative efforts between athletes, coaches, and healthcare professionals can aid in strategizing injury prevention and ensuring safe sporting practices.
BackgroundSuccessful implementation of injury prevention exercise programmes (IPEPs) is necessary to maximise programme effectiveness. However, there is a lack of knowledge on how to reduce barriers ...to enable implementation and maintenance of IPEPs.ObjectiveTo describe players´ perceptions of the injury prevention exercise programmes, Knee Control and Knee Control+, and how challenges to implement these can be overcome.DesignQualitative study with focus group discussions. Analysed with inductive qualitative content analysis.SettingYouth floorball on community level.ParticipantsMale and female youth floorball players, aged 12–17 years, from different clubs in southern Sweden, were strategically selected regarding sex, age group and geographic variation. The players should have used Knee Control or Knee Control+ during the current season. In total, 42 players in six different focus groups, separated by age and sex, were recruited.InterventionsThe Knee Control and Knee Control+ programs consist of six main exercises and take 10–15 minutes to perform.Main Outcome MeasurementsN/A due to study design.ResultsThe players illustrated their practical and personal prerequisites for Knee Control/Knee Control+ implementation and use. Barriers that need to be overcome were negative player attitudes, like lack of player motivation and negative perceptions of the programme, and injury related barriers as pain. Facilitators for implementation and use were commitment to Knee Control and team spirit as well as a positive attitude towards the programme together with good structure and continuity.ConclusionsFavourable prerequisites, positive player attitudes and established routines seemed to be crucial to overcome challenges for the sustainable implementation of IPEPs, results that may inform future development of implementation strategies.
Background:
Soccer has one of the highest incidences of anterior cruciate ligament (ACL) injuries for both males and females. Several injury prevention programs have been developed to address this ...concern. However, an analysis of the pooled effect has yet to be elicited.
Purpose:
To conduct a systematic review and meta-analysis of ACL and knee injury prevention programs for soccer players, assess the heterogeneity among the studies, and evaluate the reported effectiveness of the prevention programs.
Study Design:
Systematic review and meta-analysis.
Methods:
A systematic search of the literature was conducted on PubMed (Medline), Embase, CINAHL, and Central-Cochrane Database. Studies were limited to randomized controlled trials (RCTs) of injury prevention programs specific to the knee and/or ACL in soccer players. The Cochrane Q test and I
2 index were independently used to assess heterogeneity among the studies. The pooled risk difference, assessing knee and/or ACL injury rates between intervention and control groups, was calculated by random-effects models with use of the DerSimonian-Laird method. Publication bias was assessed with a funnel plot and Egger weighted regression technique.
Results:
Nine studies met the inclusion criteria as RCTs. A total of 11,562 athletes were included, of whom 7889 were analyzed for ACL-specific injuries. Moderate heterogeneity was found among studies of knee injury prevention (P = .041); however, there was insignificant variation found among studies of ACL injury prevention programs (P = .222). For studies of knee injury prevention programs, the risk ratio was 0.74 (95% CI, 0.55-0.89), and a significant reduction in risk of knee injury was found in the prevention group (P = .039). For studies of ACL injury prevention programs, the risk ratio was 0.66 (95% CI, 0.33-1.32), and a nonsignificant reduction in risk of ACL injury was found in the prevention group (P = .238). No evidence of publication bias was found among studies of either knee or ACL injury prevention programs.
Conclusion:
This systematic review and meta-analysis of ACL and knee injury prevention program studies found a statistically significant reduction in injury risk for knee injuries but did not find a statistically significant reduction of ACL injuries.
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