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[Tibial diaphyseal fracture in sports - clinical outcome and sports ability after operative treatment].

Sports-related tibial diaphyseal fractures occur mainly in contact sports and in downhill skiing. Due to the demand for rapid healing and the need for an early recovery of the mostly young patients, surgery is almost imperative. The clinical outcome and sports ability of 38 patients with sports-related tibial diaphyseal fractures were investigated 29 months after the initial trauma. Soccer and wintersport accounted for the majority of injuries. Operative treatment has been mainly unreamed nailing. After an average of 10.3 months 32 patients (84 %) returned to sports. Almost one-third, however did change over to a less stressful sport. 6 patients discontinued their sports activity. The activity score of Tegner and Lysholm declined from 5.4 before the injury to 3.4 six months after surgery. At the time of the follow-up examination this rose to 4.6. The long-term result scored after Merchant and Dietz showed 87 % excellent and good results. For the majority of sports-related tibial diaphyseal fractures, unreamed nailing is the treatment of choice.

Athletic Injuries↗

Incidence rate of injuries during sport activity and physical exercise in a rural Swedish municipality: incidence rates in 17 sports.

A prospective study of acute injuries from sports and physical exercise was carried out during 1 year in a total population of a municipality with 31,620 inhabitants. Data on exposure were collected: the number of participants in each sport, the hours of participation, and number of weeks in the season per year. The number of injuries was used as numerator and the exposure data as denominator in a formula modified from Chambers for the calculation of population at risk in sports. A total of 571 injuries occurred in 28 different sports: 65% of the injured were males. The majority of the injuries were from soccer: 50% of the males and 27% of the females. Incidence rates in 17 sports are presented. The ranking order differs, when calculating not only the number, but also the exposure. Ice hockey and handball were then found to have the highest risk followed by soccer. Team and contact sports on the whole had the highest rates in both genders. As a group, intercompany players had the highest rate, especially in soccer. The lowest rates were found in individual sports such as downhill skiing, horseback riding, racket sports, and running. Gymnastics, except in school physical education, had no injuries at all. Sprains and strains were diagnosed in nearly half of the cases and the foot and ankle were the most frequent sites. Preventive measures are proposed.

Adolescent↗

Biomechanics: an integral part of sport science and sport medicine.

Biomechanics is one of the disciplines in the field of Human Movement and Exercise Science and it can be divided into three broad categories from a research perspective. Clinical biomechanics involves research in the areas of gait, neuromuscular control, tissue mechanics, and movement evaluation during rehabilitation from either injury or disease. Occupational biomechanics typically involves research in the areas of ergonomics and human growth or morphology as they influence movement. While these two categories will briefly be discussed, the primary aim of this paper is to show the role of biomechanics in sports science and sports medicine. Research in sports biomechanics may take the form of describing movement from a performance enhancement (such as matching of impulse curves in rowing) or injury reduction perspective (such as diving in swimming or the assessment of knee joint loading during downhill walking). However, the strength of sports biomechanics research is the ability to establish an understanding of causal mechanisms for selected movements (such as the role of internal rotation of the upper arm in hitting or striking, and the influence of elastic energy and muscle pre-stretch in stretch-shorten-cycle actions). The growth of modelling and computer simulation has further enhanced the potential use of sports biomechanics research (such as quantification of knee joint ligament forces from a dynamic model and optimising gymnastics performance through simulation of in-flight movements). Biomechanics research may also play an integral role in reducing the incidence and severity of sporting injuries (such as identification of the causes of back injuries in cricket, and the causes of knee joint injuries in sport). In the following discussion no attempt will be made to reference all papers published in each of these areas because of the enormity of the task. Published and current work from the biomechanics laboratory at the Department of Human Movement and Exercise Science at The University of Western Australia will generally be used to illustrate the scope of biomechanics research within that institution.

Athletic Injuries↗

ESC Study Group of Sports Cardiology: recommendations for participation in leisure-time physical activity and competitive sports for patients with ischaemic heart disease.

BACKGROUND: Evidence for the proper management of ischemic heart disease (IHD) in the general population is well established, but recommendations for physical activity and competitive sports in these patients are scarce. The aim of the present paper was to provide such recommendations to complement existing ESC and international guidelines on rehabilitation and primary/secondary prevention. DESIGN AND METHODS: Due to the lack of studies in this field, the current recommendations are the result of consensus among experts. Sports are classified into low/moderate/high dynamic and low/moderate/high static, respectively. RESULTS: Patients with a definitive IHD and higher probability of cardiac events are not eligible for competitive sports (CS) but for individually designed leisure time physical activity (LPA); patients with definitive IHD and lower probability of cardiac events as well as those with no IHD but with a positive exercise test and high risk profile (SCORE > 5%) are eligible for low/moderate static and low dynamic (IA-IIA) sports and individually designed LPA. Patients without IHD and a high risk profile+ a negative exercise-test and those with a low risk profile (SCORE < 5%) are allowed all LPA and competitive sports with a few exceptions. CONCLUSIONS: Individually designed LPA is possible and encouraged in patients with and without established IHD. Competitive sports may be restricted for patients with IHD, depending on the probability of cardiac events and the demands of the sport according to the current classification.

Adult↗

Increased blood fibrinolytic activity after physical exercise: comparative study in individuals with different sporting activities and in patients after myocardial infarction taking part in a rehabilitation sports program.

The activation of fibrinolysis during bicycle ergometry was studied in two pairs of age-matched groups. Group A: 18 healthy male competitive athletes (23 +/- 3.5 years of age, mean +/- SD), Group B: 18 healthy male volunteers (25.7 +/- 2.7) not engaged in any sports, Group C: 17 healthy male volunteers (50.6 +/- 7.7) regularly practicing sports, and Group D: 18 male survivors from myocardial infarction (MI-patients, 54.2 +/- 7.9) who took part in a rehabilitation sports program. Before ergometry, healthy participants with regular sporting activities showed significantly lower plasma plasminogen activator inhibitor capacities (PAI cap) than the members of the respective age-matched control groups: Group A 13.9 +/- 2.6 AU/ml, Group B 18.5 +/- 5.5, p less than 0.005; Group C 15.2 +/- 2.9, Group D 20.7 +/- 5.5, p less than 0.05. During ergometry the release of tPA antigen did not differ significantly between the age-matched groups, however, tissue plasminogen activator (tPA) activities after ergometry were higher in groups presenting lower pre-test PAI cap values. Group A 5.5 +/- 6.4 AU/ml, Group B 1.1 +/- 2.9 AU/ml, p less than 0.05; Group C 2.9 +/- 3.3, Group D 0.2 +/- 0.7, p less than 0.05. Levels of the fibrin split product (D-dimer) did not change in any of the groups. This investigation indicates that (1) regular vigorous sporting activities enhance blood fibrinolysis by reducing blood PAI cap in healthy individuals, (2) rehabilitation sport is not capable of reducing blood PAI cap in MI-patients to values measured in age matched healthy individuals regularly practicing sports and (3) the activation of fibrinolysis during physical exercise has no systemic fibrinolytic effect.

Adult↗

Pediatric neurodevelopment and sports participation. When are children ready to play sports?

A fundamental knowledge of normal child and adolescent development is essential to providing a developmentally appropriate sports experience for the child, and to providing guidance to parents regarding their child's sport participation. This article reviews neurodevelopment, normal child and adolescent development relevant to sport participation, and developmental readiness to participate in sports. Neurodevelopmental maturation is a complex, continuous process. The sense of social comparison is not achieved until after 6 years of age, and the ability to understand the competitive nature of sports is generally not achieved until 9 years of age. By about 12 years of age, most children are mature enough to comprehend the complex tasks of sports and are physically and cognitively ready to participate in competitive sports with appropriate supervision.

Adolescent↗

A comparison of the sports safety policies and practices of community sports clubs during training and competition in northern Sydney, Australia.

OBJECTIVES: To compare the safety policies and practices reported to be adopted during training and competition by community sports clubs in northern Sydney, Australia. METHODS: This cross sectional study involved face to face interviews, using an 81 item extensively validated questionnaire, with representatives of 163 community netball, rugby league, rugby union, and soccer clubs (response rate 85%). The study was undertaken during the winter sports season of 2000. Two separate 14 item scales were developed to analyse the level of safety policy adoption and safety practice implementation during training and competition. The statistical analysis comprised descriptive and inferential analysis stratified by sport. RESULTS: The reliability of the scales was good: Cronbach's alpha = 0.70 (competition scale) to 0.81 (training scale). Significant differences were found between the safety scores for training and competition for all clubs (mean difference 11.2; 95% confidence interval (CI) 10.0 to 12.5) and for each of the four sports: netball (mean difference 14.9; 95% CI 12.6 to 17.2); rugby league (mean difference 10.3; 95% CI 7.1 to 13.6); rugby union (mean difference 9.4; 95% CI 7.1 to 11.7); and soccer (mean difference 8.4; 95% CI 6.5 to 10.3). CONCLUSIONS: The differences in the mean competition and training safety scores were significant for all sports. This indicates that safety policies were less often adopted and practices less often implemented during training than during competition. As injuries do occur at training, and sports participants often spend considerably more time training than competing, sporting bodies should consider whether the safety policies and practices adopted and implemented at training are adequate.

Athletic Injuries↗

Epidemiology of sports injuries in the Swiss organization "Youth and Sports" 1987-1989. Injuries, exposure and risks of main diagnoses.

In the Swiss organization "Youth and Sports" all acute injuries that are attended to by a physician are registered by the Military Insurance, and data on the number of participants in 32 sports together with the time of exposure are collected by the organization. Per year there are close to 350,000 participants (age 14-20 years) during 13.2 million hours causing more than 5,000 injuries. In a descriptive study the data on the activities in "Youth and Sports" from 1987-1989 have been combined with the injuries which occurred during the same time period. The exposure to risk per 10,000 hours (incidence rate) has been calculated and is presented as a mean of the three years. Icehockey, handball and soccer had the highest incidences in males (8.6, 7.2, and 6.6) followed by wrestling, hiking and basketball (6.3, 3.6, and 3.5). In females the ranking order was handball, soccer and basketball (7.6, 6.7, and 4.9) succeeded by alpine skiing, volleyball and alpinism (3.9, 3.8, and 3.0). A comparison between males and females of the incidence rates in eleven analogous sports showed five significantly higher rates, four in female sports: basketball, alpine skiing, volleyball and apparatus gymnastics, and one in a male sport, hiking. The overall rate was significantly higher in males, but the higher risk was explained by the predominance of male soccer (56% of the injuries in males). After standardization for total exposure the results were even reversed and female sports had a higher overall risk.

Adolescent↗

[Epidemiology of sports injuries--25-year-analysis of sports orthopedic-traumatologic ambulatory care].

In a 25-years period (1972-1997) 30,603 sportsmen, having a total of 34,742 sports related injuries, were treated in our outpatient-department specialized in sports orthopaedics and traumatology. All cases were systematically recorded and analysed right from the beginning. This is the most extensive clinical statistics currently known. The absolutely highest incidence rate of sports-related injuries is seen in common disciplines like soccer with 10,493 (34.3%), skiing with 3632 (11.9%), handball 2307 (7.5%), tennis 1643 (5.4%) and volleyball 1550 (5.1%). 3/4 were male. The distribution of age shows a significant peak between 20 and 29 years of age, whereas in women we found a wide plateau between 10 and 39 years. Compared to earlier investigations we have an increase of injuries in higher age. In 72.4% the lower extremities are mainly effected, followed by the upper extremities (21.8%) and the spine with 3.0%. With increasing tendency knee injuries take main part (36.6%--12,708 cases) followed by injuries of the ankle (19.9%--6920 cases), shoulder (7.7%), lower leg (7.0%) and fingers (5.8%). Main diagnosis were: distortion (32.6%); ruptures of ligaments and menisci (21.5%); fractures (10.5%) and lesions of muscles and tendons (8.8%). Comparing our 15- and 25-years studies we found an interesting significant increase of injuries in skiing, tennis and physical exercising by 25%, in cycling four times. New disciplines like squash, snowboarding, mountainbiking and inlineskating have been added. All together the number of injuries is distributed to 87 different disciplines. In 1998 26.7 million sportsmen (one third of the German population) were member of the German Sports Association (DSB). The number of annual accidents in sports and sporting spare time activities is estimated at about 1.5-2 million, that's 25-30% of all accidents. The analysis of almost 35,000 treated sports injuries and further evaluation of more than 5000 orthopaedic examinations of top athletes are useful for analysis comparing single disciplines.

Adolescent↗

Trends in sports injuries, 1982-1988: an in-depth study on four types of sport.

In this study, we analyzed the records of both inpatients and outpatients which were treated for acute sports injuries in the Trauma Department of the University of Groningen (The Netherlands) during the years 1982 to 1988. We examined whether there was a trend in sports injuries in this time period. The study comprised four types of sports, i.e., soccer, volleyball, gymnastics, and martial arts. The absolutely highest rates of injuries across the seven years were found in soccer, followed by gymnastics, volleyball, and martial arts. Injuries sustained at participating in soccer, volleyball, and gymnastics involved for the major part the lower extremities, followed by injuries of the upper extremities, whereas the reverse pattern was observed for patients who participated in martial arts. For all four types of sport, the ankle and foot were the most frequently site of injury of the lower extremities. Sprains and strains were the major types of injury. Most injuries were seen at ages between 10 and 30 years. The ratio of male to female patients within age groups did not differ significantly across the seven years. We concluded that, except for martial arts, the increased participation in sports in the last decade was not accompanied with a change in the patterns of sports injuries by the patients' age, sex, and number and nature of the injury. This consistency in results can be used to guide the development of prevention programs aimed at a reduction of injuries in specific sports.

Adolescent↗

Adaptive Sports Exposure Across Physical Medicine and Rehabilitation Residency and Sports Medicine Fellowship Programs: A National Cross-Sectional Website Analysis.

Adaptive sports improve health and quality of life for people with disabilities, yet the extent of adaptive sports exposure in physical medicine and rehabilitation (PM&R) training is unclear. This cross-sectional study reviewed the public websites of 115 accredited physical medicine and rehabilitation residency programs and 26 sports medicine fellowship programs for any mention of adaptive sports, characterizing exposure type, target populations, and associated program characteristics. Adaptive sports were mentioned by 32 residency programs (27.8%) and 8 fellowship programs (30.8%). Mention varied significantly by geographic region in both cohorts (residency, West 64% vs. South 19%, P=.017; fellowship, Midwest 80% vs. South 0%, P=.035) and, among residencies, was associated with larger program size and a greater number of associated subspecialty fellowships. Residency exposure was predominantly volunteer-based, whereas fellowship exposure was exclusively clinical or undisclosed; target populations served were frequently unspecified. Programs have an opportunity to expand structured adaptive sports training and to clearly convey these opportunities to applicants and patients.

Adaptive sports↗

[Doctors belonging to the Senegalese Association of Sport Medicine and doping in sports: survey on knowledge and attitudes].

Doping in sports is as old as sports, but it grew considerably during the 20th century with the arrival in stadiums during the 1990s of amphetamines and anabolic steroids as well as such peptide hormones as erythropoietin. The international fight against doping took a giant step forward in 1999 with the creation of the world antidoping agency (WADA). This study is part of that fight. It follows an earlier survey of retail pharmacists in Senegal and aims to evaluate the knowledge about doping of doctors belonging to the Senegalese Association of Sports Medicine and to assess their attitude towards this phenomenon. Its goal is to determine how best to involve them in preventive actions. We conducted a survey in 2001 and randomly selected and interviewed 60 of the 92 doctors in the association. The questionnaire focused on three areas: their knowledge of doping, their attitudes to it, and the means of prevention that they proposed. The results showed that only 11 of the 60 doctors knew the definition of doping and 15% of doctors could not cite any family of doping products. They were aware mainly of testosterone and other anabolic steroids (84.3%), then amphetamines and other stimulants (64.7%), and finally peptide hormones (58.8%). The subjects mentioned blood doping and pharmacological manipulations as forbidden methods. They considered that the four groups of drugs most often used by athletes for doping were, in descending order, anabolic steroids, stimulants, peptide hormones and corticoids. Eighty per cent of doctors think that Senegalese athletes use doping products and that the sports most involved are football, wrestling, track and field and basketball. They also think that doping is a form of drug addiction and a public health problem. Eleven doctors (18%) said they had been contacted for information on use of doping products. The interviewees consider that the three best methods of prevention include information about side effects, unannounced urine and blood tests, and sanctions. This work shows that Senegalese athletes may use doping; it contains no direct proofs but many indirect indicators. Success against doping requires preventive activities that should be conducted jointly for trainers, sports federations and doctors of the Senegalese Association of Sports Medicine and then by all of them for athletes, who are the primary targets of any prevention campaign.

Adrenal Cortex Hormones↗

Impact of social standing on sports injury prevention in a WHO safe community: intervention outcome by household employment contract and type of sport.

OBJECTIVES: As physical activity is promoted as part of a healthy lifestyle, sports injuries are becoming an important public health concern in many countries. The objective of this study is to investigate rates of sports injuries before and after implementation of a WHO Safe Community program. METHODS: Sports injury data were collected pre- and post-implementation from all individuals below 65 years of age during 1 year in the targeted municipality (population 41,000) and in a control municipality (population 26,000). A quasi-experimental design was used and individuals were divided into three categories based on household relationship to the labour market. RESULTS: There were no differences between socio-economic categories regarding pre-intervention injury rates. No statistically significant post-intervention changes in injury rate were observed in the control area or among any females in either area. In the intervention area, a statistically significant (p = 0.011) decrease in injury rate was observed among male members of households in which the vocationally important member was employed. A statistically significant decrease was observed in injuries sustained in team sports among male members of households in which the vocationally important member was employed (p = 0.001) and among members of households in which the vocationally important member was self employed (p<0.05). CONCLUSIONS: The study indicates areas for improvement in the civic network based WHO Safe Community model. The results show that females, participants in individual sports, and members of non-vocationally active households were less affected by the interventions. These facts have to be addressed in planning future community based sports injury prevention programmes and their evaluations.

Adolescent↗

Association of prelesion sports participation and involvement in wheelchair sports following spinal cord injury.

116 individuals with spinal cord injury were surveyed to investigate the relationship between prelesion sports participation and involvement in wheelchair sports following injury. While 89 reported they had been involved in sport prior to their injury, only 38 (43%) of these were involved since injury. 27 respondents said that they had not participated in sport preinjury; however, 13 (48%) of these reported that they had become involved since injury. Analysis by chi 2 showed that, for this sample at least, the tendency for an individual with spinal cord injury to be involved in wheelchair sports was not related to preinjury history of sports involvement.

Adolescent↗

[The bill of rights for children in sport: a tool to promote the health and protect the child in sport].

The Bill of rights for children in sport was developed in response to the need for prevention and protection of children practicing sport. It is the result of an interdisciplinary approach and is used with young sportsmen, sport clubs and in the education of the professionals involved with children's sport. It is an excellent tool to sensitize people to children's vulnerabilities and to establish the bases for prevention and protection. In complete accordance with the UN Convention on the Rights of the Child, this Bill gives an example of a concrete application in the field of Sports. Used on a regular basis in the field, it contributes to change the adult's vision of children's sport and the approach to coaching;

Athletic Injuries↗

Do we pay too dearly for our sport and leisure activities? An investigation into fatalities as a result of sporting and leisure activities in England and Wales, 1982-1988.

Analysis of deaths from sports and leisure activities in England and Wales during 1982-88 found that horse riding (98 deaths), air sports (92 deaths), motor sports (86 deaths) and mountaineering (74 deaths) were the most hazardous activities. The most hazardous activity for children was horse riding (19 deaths). The commonest activities resulting in drowning in adults were swimming (128 deaths) and fishing (82 deaths). The main drowning deaths in children followed swimming (24 deaths). When exposure was taken into account, mountaineering, motor sports and horseriding were found to be the most hazardous activities. Mountaineering was one hundred times more dangerous than ball games or water sports. We can expect an increase in sport and leisure accidents in the next few years. Strict control, sensible safety precautions and adequate training are paramount if we are to see any improvement.

Adolescent↗

Report on the survey of National Sport Governing Bodies' Sport Science needs.

This study identifies areas of current and anticipated future utilization of Sport Science Specialists by National Sport Governing Bodies in National level Sport Programs. The results of the survey are discussed in terms of financial and time commitments for sport administrators and sport scientists, respectively.

Canada↗