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PubMed2000

An examination of psychosocial variables moderating the relationship between life stress and injury time-loss among athletes of a high standard.

Based on Williams and Andersen's model of stress and athletic injury, six psychosocial variables were assessed as possible moderators of the relationship between life stress and injury among 121 athletes (65 males, 56 females) competing in a variety of sports at state, national or international level. No significant effects of the sex of the participants were evident. Correlational analyses revealed moderator effects of several variables. Specifically, dispositional optimism and hardiness were related to decreased injury time-loss in athletes when positive life change increased, and global self-esteem was associated with decreased injury time-loss when both negative life change and total life change increased. The results indicate that athletes with more optimism, hardiness or global self-esteem may cope more effectively with life change stress, resulting in reduced injury vulnerability and recovery rates.

Adolescent↗
PubMed2006

Recovery from sports concussion in high school and collegiate athletes.

INTRODUCTION: Neuropsychological testing is a valuable tool in concussion diagnosis and management. ImPACT, a computerized neuropsychological testing program, consists of eight cognitive tasks and a 21-item symptom inventory. METHOD: ImPACT was used to examine the cognitive performance of 104 concussed athletes at baseline, 2, 7 and 14 days post-injury. Dependent measures included composite scores from the ImPACT computerized test battery, as well as a total symptom score from the Post-Concussion Symptom Scale. RESULTS: Differences between baseline and day 2 post-injury scores were observed for all ImPACT composites (Verbal memory-VERM, visual memory-VISM, processing speed-PROC and reaction time-RT) as well as in total symptom score (SX). At day 7, concussed athletes continued to perform significantly poorer on VERM, VISM, RT and SX. At day 14, only VERM scores were significantly different from baseline. CONCLUSIONS: Cognitive performance deficits in concussed athletes may persist to 7 and even to 14 days in some cases. In addition to symptom status, the athlete's post-concussion cognitive functioning should be considered when making return-to-play decisions.

Adolescent↗
PubMed1992

Psychosocial antecedents of athletic injury: the effects of life stress and social support on female collegiate gymnasts.

The article presents information from two studies of a research program investigating psychosocial antecedents of athletic injury. Study 1 describes the development of the Life Events Survey for Collegiate Athletes (LESCA). The LESCA demonstrated good content validity and provided a stable measure of life stress. The LESCA's validity and the moderating effects of social support were explored in the second study. The LESCA provided a construct-valid measure of life stress and was a better predictor of athletic injury than the Social and Athletic Readjustment Rating Scale. Social support moderated the stress-injury relationship in such a way that LESCA negative life stress accounted for 11% to 22% of injury variances in low-support conditions; LESCA positive life stress accounted for 14% to 20% of injury variances in high-support conditions. Mechanisms underlying the stress-injury relationship and directions for future research are discussed with respect to the model outlined by M. B. Andersen and J. M. Williams in 1988.

Adolescent↗
PubMed2005

Use of discretionary protective equipment and rate of lower extremity injury in high school athletes.

Use of protective equipment is an important sports injury prevention strategy, yet use of protective equipment by high school athletes has seldom been studied. The authors analyzed data from a 3-year (1996-1999), stratified, two-stage cluster sample of athletes from 12 organized sports in 100 North Carolina high schools (n = 19,728 athlete-seasons). Information on each athlete's use of protective equipment and prior injury was collected during the preseason. Prospective information on injuries and weekly participation in games and practices was collected during the playing season. Use of lower extremity discretionary protective equipment tended to decrease the overall rate of lower extremity injury (rate ratio (RR) = 0.91, 95% confidence interval (CI): 0.72, 1.15). However, this slight protective effect was entirely due to kneepad use (for knee injury, RR = 0.44, 95% CI: 0.27, 0.74). Knee brace use and ankle brace use were associated with increased rates of knee injury (RR = 1.61, 95% CI: 1.08, 2.41) and ankle injury (RR = 1.74, 95% CI: 1.11, 2.72), respectively. This could be due to slippage of the brace during use, increased fatigue due to the energy cost of wearing a brace, or bias in the study. Further investigation into the effects of brace use is warranted.

Adolescent↗
PubMed1998

Monitoring training in athletes with reference to overtraining syndrome.

PURPOSE: Overtraining is primarily related to sustained high load training, often coupled with other stressors. Studies in animal models have suggested that unremittingly heavy training (monotonous training) may increase the likelihood of developing overtraining syndrome. The purpose of this study was to extend our preliminary observations by relating the incidence of illnesses and minor injuries to various indices of training. METHODS: We report observations of the relationship of banal illnesses (a frequently cited marker of overtraining syndrome) to training load and training monotony in experienced athletes (N = 25). Athletes recorded their training using a method that integrates the exercise session RPE and the duration of the training session. Illnesses were noted and correlated with indices of training load (rolling 6 wk average), monotony (daily mean/standard deviation), and strain (load x monotony). RESULTS: It was observed that a high percentage of illnesses could be accounted for when individual athletes exceeded individually identifiable training thresholds, mostly related to the strain of training. CONCLUSIONS: These suggest that simple methods of monitoring the characteristics of training may allow the athlete to achieve the goals of training while minimizing undesired training outcomes.

Adult↗
PubMed1999

Forefoot problems in athletes.

Athletes who participate in high-impact sports involving running, jumping, or contact are at risk for forefoot injury. These injuries occur as a result of acute trauma or chronic overuse. Some athletes may be predisposed to injury because of preexisting foot deformity, such as cavus, hallux valgus, or Achilles contracture. This article reviews the common causes of forefoot pain in the athlete. The most common causes of forefoot pain in the athlete are metatarsal stress fracture, interdigital neuroma, sesamoid pathology, metatarsalgia, hallux rigidus, hallux valgus, and turf toe. The pathophysiology, clinical presentation, and treatment of these conditions are discussed.

Athletic Injuries↗
PubMed1987

Professional personnel in health care among secondary school athletics in Alabama.

To ascertain the use of professional personnel in health care among secondary school athletics in Alabama, a survey was sent to all high schools in the state. Smaller schools (classified 1A) are located an average of 10.8 miles from the nearest medical facility, while for larger schools (classified 4A) the average is 3.2 miles. Overall, 55% have a team physician; primary care physicians represent 65.8% and orthopedists 13%. Only 40% of the team physicians conduct preseason physical examinations for the boys and 25% for the girls. Also, 65% of all the schools reported that a physician was not readily available for practice and games for boys' or girls' teams. Almost 90% of the 4A schools reported that a physician lives in the community, compared to 30% for the 1A schools. On this survey, a physician or athletic trainer outranked a medical facility or training room as being most important to their athletic program, suggesting that the greatest need in health care among high schools in Alabama is the presence of personnel trained in athletic injuries.

Adolescent↗
PubMed2002

Athletic activity after spine surgery in children and adolescents: results of a survey.

STUDY DESIGN: Questionnaire-based survey. OBJECTIVES: To poll the members of the Scoliosis Research Society regarding their opinions and experience with athletic activity after spine surgery performed on children and adolescents. SUMMARY OF BACKGROUND DATA: Athletic activity is increasingly important in society. Patients are very concerned about returning to sports and exercise after spinal surgery. There are no generally accepted guidelines for surgeons regarding either appropriate sports or the appropriate time to resume sports after spinal surgery. METHODS: A survey was designed by the authors and reviewed by a statistical consultant. The form was mailed to the 721 individuals on the Scoliosis Research Society mailing list. Returned surveys were hand scored and entered into an Excel spreadsheet. RESULTS: Of the 316 forms returned, 278 indicated that the respondent performed spinal fusion on children and adolescents. Two hundred sixty-one completed forms, representing approximately 45% of the society's estimated active clinicians, were reviewed. Formal physical therapy was unlikely to be recommended by members of the society regardless of procedure, although postoperative home exercise was used by many after spondylolisthesis fusion. The majority of patients were returned to gym class between 6 months and 1 year (range, immediate to never) after surgery. Most respondents returned patients to noncontact sports between 6 months and 1 year postoperatively. Contact sports were generally withheld until 1 year after surgery. Close to 20% of respondents required, and 35% suggested, that patients never return to collision sports. Twenty percent of respondents for scoliosis and 5% for spondylolisthesis reported having notable adverse outcomes attributed to athletic activity. CONCLUSION: These survey results show the varying approaches taken by members of the Scoliosis Research Society to postoperative athletic activity, and they provide a starting point for investigations regarding alternative approaches.

Adolescent↗
PubMed2001

Common athletic injuries in adolescent girls.

Teenaged girls constitute the fastest growing segment of children and adolescents participating in organized athletics. Adolescent girls appear to have similar injury rates as boys in comparable activities but different injury patterns. To properly diagnose and manage athletic injuries in adolescent girls, pediatric health care providers must be aware of these differences, especially as the literature and their knowledge base may be skewed to the traditional predominance of males in sport. This review identifies athletic injuries that are unique to or especially common in adolescent girls, including apophyseal injuries; breast and pelvic injuries; scoliosis and spondylolysis; multidirectional shoulder instability and "gymnast's wrist"; anterior cruciate ligament injuries and patellofemoral pain syndrome; chronic exertional lower-leg compartment syndrome, ankle sprains, and reflex sympathetic dystrophy; and stress fractures. It also briefly discusses possible risk factors for these injuries, emphasizing the female athlete triad.

Adolescent↗
PubMed1995

Suprascapular neuropathy in athletes: case reports.

Shoulder pain and dysfunction is a common problem among athletes, and a great deal of attention is being given to scapular stability and rotator cuff pathology. Two athletes who were first seen with posterolateral shoulder pain and weakness were found to have isolated entrapment of the suprascapular nerve, causing their impairment. Both athletes responded well to conservative treatment, but this entity occasionally requires operative decompression. This article reviews the most common presentation, etiologies, and treatments of suprascapular neuropathy and how it can affect athletic performance.

Adolescent↗
PubMed1998

Seasonal variations of injury and overtraining in elite athletes.

OBJECTIVE: To assess reported injuries and cases of overtraining in relation to training and competition cycles, aerobic versus anaerobic sport, and gender. METHODS: A total of 163 elite male and 94 elite female athletes from eight different sports volunteered. They reported 212 musculoskeletal injuries and 38 cases of the overtraining syndrome. These injuries and cases of overtraining were then arranged according to the training or competition cycle in which they occurred, whether the sufferers were male or female athletes, and the metabolic characteristics of the sports in which the injuries and overtraining occurred. RESULTS: The preparation (October to February), precompetition (March to May), and competition (June to August) cycles were associated with 9%, 19%, and 32% of the injuries reported by the men, respectively, and with 8%, 10%, and 22% of the injuries reported by the women, respectively. For the same cycles, cases of overtraining were found to be 15%, 24%, and 35% for the men, respectively, and 4%, 7%, and 15% for the women, respectively. For both men and women, the competition cycle produced significantly more injuries and incidents of overtraining than the preparation and precompetition cycles (p < 0.05 vs p < 0.005). Similarly, precompetition revealed significantly more injuries (p < 0.05) in men, but not in women, compared with the preparation cycle. Also, male athletes reported a significantly higher number of injuries during the precompetition (p < 0.05) and competition (p < 0.01) cycles, and more cases of overtraining during the competition cycle (p < 0.01) than did their female counterparts. No differences were found when the data were arranged according to dominant metabolic characteristics of the sports in which the injuries and overtraining occurred. CONCLUSIONS: Elite athletes are more likely to become injured or overtrained during the precompetition and, especially, competition cycles than in the preparation cycle. Parallel seasonal variations were also found when data were analyzed for aerobic versus anaerobic sport and gender.

Adult↗
PubMed2006

Low back pain in pediatric athletes with unilateral tracer uptake at the pars interarticularis on single photon emission computed tomography.

STUDY DESIGN: Retrospective clinical study with radiographic and medical chart review. OBJECTIVE: To study the clinical characteristics and outcome of pediatric athletes with low back pain and unilateral tracer uptake on single photon emission computed tomography (SPECT) at the pars interarticularis but no defect on radiographs. SUMMARY OF BACKGROUND DATA: Some pediatric athletes with low back pain have no findings on plain radiographs but a unilateral SPECT uptake at the pars interarticularis. However, little is known about these patients. METHODS: Twenty-two pediatric athletes who had low back pain with increased tracer uptake on SPECT unilaterally at the pars interarticularis but no defect on plain radiograph were evaluated. The following criteria were used for evaluation: age, male-to-female ratio, duration of symptoms, vertebral level, and presence of spina bifida occulta or scoliosis. RESULTS: The average age was 12.3 +/- 2.5 years. The male-to-female ratio was 1.2:1. The average duration of symptoms was 21 +/- 23 weeks. Nineteen (86%) had increased uptake at L5. Six (27%) had spina bifida occulta and 8 (36%) had scoliosis. Eighteen (82%) patients showed an excellent outcome. The patients who presented with a longer history of symptoms or a concomitant spina bifida occulta had an increased risk of having occasional aching with vigorous activity when compared with the patients who did not (P < 0.05). CONCLUSIONS: Athletes who have low back pain and increased tracer uptake unilaterally at the pars interarticularis on SPECT are younger than those previously reported patients with spondylolysis proven by a defect on radiographs. Some of these lesions do progress to "frank" spondylolysis seen on radiographs, but favorable clinical outcomes from nonoperative treatment can be expected. Patients with a longer pain history or concomitant spina bifida occulta may need careful follow-up because they are at increased risk of having occasional low back pain.

Adolescent↗
PubMed2005

Field-side and prehospital management of the spine-injured athlete.

Rapid on-field diagnosis and early stabilization can help to optimize the outcomes of spinal injury, which can have devastating consequences. Several basic principles will guide the rescuer through this process. Preinjury planning should include appointing a team leader, assessing the athletes' equipment, acquiring appropriate equipment to facilitate stabilization, and establishing lines of communication to emergency medical services (EMS). When an athlete is down, the team leader should proceed to quickly assess airway, breathing, circulation, level of consciousness, and activation of EMS. This should be followed by stabilization of the head and neck, a coordinated log roll, and ultimately complete spinal immobilization for transport. Specific techniques for stabilizing the cervical spine, removing the facemask, log rolling the athlete, and lifting the athlete, will improve outcome. The helmet and shoulder pads should remain in place during transport unless specific indications require their removal, in which case a specific protocol should be strictly followed.

Athletic Injuries↗
PubMed2005

Pancreatic injury in the athlete.

Pancreatic injuries in the athlete are seldom reported in the literature. These injuries can result from atraumatic etiologies and blunt abdominal trauma. Atraumatic pancreatic injuries in the athlete are diagnosed and treated in a similar manner to the nonathletic patient. Fluid replacement, analgesic support, metabolic stabilization, and minimization of gastric stimulation are the primary management methods for this type of pancreatic injury. Athletically related traumatic pancreatic injury is associated with a high morbidity and mortality. The consequences of a delayed diagnosis make this type of injury an important diagnostic consideration in an athlete with abdominal pain. Initial clinical, radiologic, and laboratory findings of direct injury to the pancreas are often equivocal, and require clinical suspicion and further investigation. Current evidence suggests that pancreatic duct injury is the primary cause of the morbidity and mortality associated with the direct trauma. A conservative or surgical management plan should be based on a combination of serial clinical examinations, pancreatic enzyme levels, and either magnetic resonance retrograde choleopancreatogram or endoscopic retrograde chloangiopancreatography investigations to rule out ductal injury. The prevention of pancreatic and other intra-abdominal injuries is an evolving area of sports medicine research. Sports specific epidemiologic data collection and analysis are important elements in the development of evidence-based interventions.

Abdominal Injuries↗
PubMed2006

Ehlers-Danlos syndrome in athletes.

Ehlers-Danlos syndrome (EDS) should be considered in the evaluation of the hypermobile athlete. EDS is a group of inheritable connective tissue disorders affecting collagen and is characterized by articular hypermobility, skin extensibility, and tissue fragility. The most common findings in the active athlete are joint pain or instability, tissue fragility, or joint dislocations. Other common findings include "cigarette paper" scarring over bony prominences, pes planus, mitral valve prolapse, hyperelastic thin skin, and internal organ involvement. The vascular type has an increased risk of sudden death secondary to catastrophic events such as aortic or visceral rupture. Although there are some genetic laboratory tests currently available, a careful history and physical examination are most helpful in diagnosing athletes with this disorder. Previous classification systems were confusing, but the 1997 revised nosology simplified the classification of EDS into six types (three major, three minor). Preparticipation cardiothoracic and orthopedic screening is highly recommended for athletes with EDS, and appropriate cardiovascular, orthopedic, gastrointestinal, neurologic, and dermatologic management can often allow patients with EDS to remain active.

Activities of Daily Living↗
PubMed2006

Evaluation and treatment of medial ulnar collateral ligament injuries in the throwing athlete.

Medial ulnar collateral ligament (UCL) injuries are common and are seen most frequently in baseball pitchers. Appropriate recognition, treatment, and rehabilitation are necessary to ensure the best chance for return to preinjury levels of participation. Participation in competitive sports may be disrupted for 6 months to 1 year when treated optimally. Abstinence from play may be prolonged when treatment is delayed or if conservative treatment fails; this delay carries significant consequences to the professional, collegiate, and high school athlete. The orthopedic literature is replete with recommendations for the care of these athletes. These recommendations are generally based on retrospective reviews. The purposes of this paper are 3-fold: to provide background knowledge on this injury, to synthesize the current knowledge on the diagnosis, treatment, and rehabilitation of athletes with medial UCL injuries, and lastly, to provide a treatment algorithm for athletes with UCL injuries.

Arm Injuries↗
PubMed2006

Sports injuries in high school athletes: a review of injury-risk and injury-prevention research.

OBJECTIVE: The objective of this review is to identify the available research regarding the risk factors and prevention of injuries in high school athletes (ages 14 to 18 years). DATA SOURCES: Relevant manuscripts were identified by searching six electronic databases with a combination of key words and medical subject headings (high school, adolescent, athletic injury, sports injury, risk factors, prevention, and prospective). STUDY SELECTION: Original research that reported prospective data on high school athletes (ages 14 to 18), reported injury and exposure data, and used data collected throughout the entire sport season or school year. DATA EXTRACTION: Twenty-nine studies that identified injury risk factors or injury prevention strategies were reviewed and summarized. Data extracted from the studies included a) sport(s) or injuries studied, b) year of publication, c) lead author, d) description of the subjects, e) sample-size calculation, f) variables studied (baseline demographic or performance variables), g) whether multivariate analyses were used, h) data reported (injury rates, risk ratios, and 95% CI), and i) results. Studies that introduced an intervention were characterized by the same data as well as the type of intervention employed and randomization procedures used. DATA SYNTHESIS: The quality of each injury-risk and injury-prevention study was assessed, and the results were summarized. CONCLUSIONS: The risk factors for injury in several specific sports such as soccer, American football, and basketball have been documented. Other sports are less well represented in the current literature. The risk factors for injuries to the ankle, head, and knee have been identified, to a limited degree. Upper-extremity injury risk factors are less well known. There is a need for high-quality prospective studies to further identify injury risk factors and injury-prevention strategies for high school athletes.

Adolescent↗
PubMed2004

Identifying athletes at risk of hamstring strains and how to protect them.

1. One common soft-tissue injury in sports involving sprinting and kicking a ball is the hamstring strain. Strain injuries often occur while the contracting muscle is lengthened, an eccentric contraction. We have proposed that the microscopic damage to muscle fibres that routinely occurs after a period of unaccustomed eccentric exercise can lead to a more severe strain injury. 2. An indicator of susceptibility for the damage from eccentric exercise is the optimum angle for torque. When this is at a short muscle length, the muscle is more prone to eccentric damage. It is known that subjects most at risk of a hamstring strain have a previous history of hamstring strains. By means of isokinetic dynamometry, we have measured the optimum angle for torque for nine athletes with a history of unilateral hamstring strains. We also measured optimum angles for 18 athletes with no previous history of strain injuries. It was found that mean optimum angle in the previously injured muscles was at a significantly shorter length than for the uninjured muscles of the other leg and for muscles of both legs in the uninjured group. This result suggests that previously injured muscles are more prone to eccentric damage and, therefore, according to our hypothesis, more prone to strain injuries than uninjured muscles. 3. After a period of unaccustomed eccentric exercise, if the exercise is repeated 1 week later, there is much less evidence of damage because the muscle has undergone an adaptation process that protects it against further damage. We propose that for athletes considered at risk of a hamstring strain, as indicated by the optimum angle for torque, a regular programme of mild eccentric exercise should be undertaken. This approach seems to work because evidence from a group of athletes who have implemented such a programme shows a significant reduction in the incidence of hamstring strains.

Athletic Injuries↗