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1.  The effect of a sports chiropractic manual therapy intervention on the prevention of back pain, hamstring and lower limb injuries in semi-elite Australian Rules footballers: a randomized controlled trial 
Background
Hamstring injuries are the most common injury in Australian Rules football. It was the aims to investigate whether a sports chiropractic manual therapy intervention protocol provided in addition to the current best practice management could prevent the occurrence of and weeks missed due to hamstring and other lower-limb injuries at the semi-elite level of Australian football.
Methods
Sixty male subjects were assessed for eligibility with 59 meeting entry requirements and randomly allocated to an intervention (n = 29) or control group (n = 30), being matched for age and hamstring injury history. Twenty-eight intervention and 29 control group participants completed the trial. Both groups received the current best practice medical and sports science management, which acted as the control. Additionally, the intervention group received a sports chiropractic intervention. Treatment for the intervention group was individually determined and could involve manipulation/mobilization and/or soft tissue therapies to the spine and extremity. Minimum scheduling was: 1 treatment per week for 6 weeks, 1 treatment per fortnight for 3 months, 1 treatment per month for the remainder of the season (3 months). The main outcome measure was an injury surveillance with a missed match injury definition.
Results
After 24 matches there was no statistical significant difference between the groups for the incidence of hamstring injury (OR:0.116, 95% CI:0.013-1.019, p = 0.051) and primary non-contact knee injury (OR:0.116, 95% CI:0.013-1.019, p = 0.051). The difference for primary lower-limb muscle strains was significant (OR:0.097, 95%CI:0.011-0.839, p = 0.025). There was no significant difference for weeks missed due to hamstring injury (4 v14, χ2:1.12, p = 0.29) and lower-limb muscle strains (4 v 21, χ2:2.66, p = 0.10). A significant difference in weeks missed due to non-contact knee injury was noted (1 v 24, χ2:6.70, p = 0.01).
Conclusions
This study demonstrated a trend towards lower limb injury prevention with a significant reduction in primary lower limb muscle strains and weeks missed due to non-contact knee injuries through the addition of a sports chiropractic intervention to the current best practice management.
Trial registration
The study was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12608000533392).
doi:10.1186/1471-2474-11-64
PMCID: PMC2858097  PMID: 20374662
2.  A survey of referee participation, training and injury in elite gaelic games referees 
Background
Referees in Gaelic games are exposed to injury risk in match-play and training. Little is currently know about the degree of exposure or the prevalence of injury in this group. The aim of this study was to determine the time commitment to refereeing and training in elite-level Gaelic referees and to establish, for the first time, point and period (past 12 months) prevalence of Gaelic games injury in these officials.
Methods
A retrospective survey was posted to the complete list of 111 male referees who officiated in elite-level competition in Gaelic football and hurling at the end of the 2005 competition season. Data were summarised using percentages with 95% Confidence Intervals.
Results
The response rate was 80% (n = 89). Mean age was 42 ± 6 years, ranging from 28–55 years. Forty eight percent were football referees, 25% were hurling referees and 27% refereed both football and hurling. Most referees (69%) officiated at 3–4 games weekly (range 1–6) and most (62%) trained 2–3 times per week (range 1–7). Fourteen percent (n = 12) were currently injured (95% CI 9–21%). Annual injury prevalence was 58% (95% CI 46 to 70%) for football, 50% (95% CI 33 to 67%) for hurling and 42% (95% CI 27 to 58%) for dual referee groups. Sixty percent of injuries were sustained while refereeing match play. The majority (83%, n = 40) were to the lower limb and the predominant (56%, n = 27) injury mechanism was running or sprinting. The most prevalent injuries were hamstring strain (n = 12, 25% of injuries) and calf strain (n = 9, 19% of injuries). Injury causing time off from refereeing was reported by 31% of all referees (95% CI 24 to 40%, n = 28), for a median duration of 3 weeks.
Conclusion
Participation in official duties and training is high in elite Gaelic games referees, despite the amateur status of the sports. Gaelic games injury is common in the referee cohort, with lower limb injury predominating. These injuries have implications for both the referee and for organisation of the games.
doi:10.1186/1471-2474-10-74
PMCID: PMC2713203  PMID: 19545401
3.  Musculoskeletal problems in soccer players: current concepts 
Summary
Soccer is the most popular sport worldwide, with about 200 million players, both professionals and amateurs. Because of its popularity, it has been often proposed to be able to prevent or cure health problems around the world. Although participation in football leads to significant physical benefits such as improving well-being, extending life expectancy and reducing the likelihood of several major non-communicable diseases, the possibility to incur in soccer injuries must be considered. On average, an elite football player suffers from 1.5–7.6 injuries each 1,000 hours of training and 12–35 injuries each 1000 hours of match. Several risk factors for soccer injuries have been described. The most important of them are the level of play (the risk appears to be higher in professional than amateur players); the exercise load; and the standard of training. The injury prevention program “The 11”, developed with the support of the Federation Internationale de Football Association (FIFA), aims to reduce the impact of intrinsic injury risk factors in soccer, and it has been validated in that sport. A successive modified version of “The 11” (“The 11+”) has been also shown to be effective in preventing injuries in young female soccer players. The FIFA 11+ provided more than 40% of reduction of the risk of injury. Several factors can be related to the risk of injury during sport. Therefore different exercises or factors might have been responsible for efficacy of the FIFA 11+ to prevent injuries. Several improvements have been surely achieved in the last ten years, but further investigation is needed to improve the benefits of playing soccer on human health.
PMCID: PMC3476519  PMID: 23087721
soccer; football; injuries; anterior cruciate ligament; muscle injuries; platelet rich plasma; players
4.  Low back pain in junior Australian Rules football: a cross-sectional survey of elite juniors, non-elite juniors and non-football playing controls 
Background
Low back pain in junior Australian Rules footballers has not been investigated despite findings that back pain is more prevalent, severe and frequent in senior footballers than non-athletic controls and findings that adolescent back pain is a strong predictor for adult back pain. The aim of this study was to determine the prevalence, intensity, quality and frequency of low back pain in junior Australian Rules footballers and a control group and to compare this data between groups.
Methods
A cross-sectional survey of male non-elite junior (n = 60) and elite junior players (n = 102) was conducted along with a convenience sample of non-footballers (school children) (n = 100). Subjects completed a self-reported questionnaire on low back pain incorporating the Quadruple Visual Analogue Scale and McGill Pain Questionnaire (short form), along with additional questions adapted from an Australian epidemiological study. Linear Mixed Model (Residual Maximum Likelihood) methods were used to compare differences between groups. Log-linear models were used in the analysis of contingency tables.
Results
For current, average and best low back pain levels, elite junior players had higher pain levels (p < 0.001), with no difference noted between non-elite juniors and controls for average and best low back pain. For low back pain at worst, there were significant differences in the mean pain scores. The difference between elite juniors and non-elite juniors (p = 0.040) and between elite juniors and controls (p < 0.001) was significant, but not between non-elite juniors and controls. The chance of suffering low back pain increases from 45% for controls, through 55% for non-elite juniors to 66.7% for elite juniors. The chance that a pain sufferer experiences chronic pain is 16% for controls and 41% for non-elite junior and elite junior players. Elite junior players experienced low back pain more frequently (p = 0.002), with no difference in frequency noted between non-elite juniors and controls. Over 25% of elite junior and non-elite junior players reported that back pain impacted their performance some of the time or greater.
Conclusions
This study demonstrated that when compared with non-elite junior players and non-footballers of a similar age, elite junior players experience back pain more severely and frequently and have higher prevalence and chronicity rates.
doi:10.1186/1471-2474-11-241
PMCID: PMC2967511  PMID: 20958973
5.  Analysis of the Three Most Prevalent Injuries in Australian Football Demonstrates a Season to Season Association Between Groin/Hip/Osteitis Pubis Injuries With ACL Knee Injuries 
Background:
Injuries are common in contact sports like Australian football. The Australian Football League (AFL) has developed an extensive injury surveillance database that can be used for epidemiological studies.
Objectives:
The purpose of this study is to identify any association between the three most prevalent injuries in the AFL.
Patients and Methods:
From the AFL injury surveillance data 1997-2012 the injury incidence (new injuries per club per season) and the injury prevalence data (missed games per club per season) were analysed to detect the three most common injuries that would cause a player to miss a match in the AFL. The three most prevalent injuries in the AFL are hamstring strains, groin/hip/osteitis pubis injuries and Anterior Cruciate Ligament (ACL) knee injuries. Following this, further study was undertaken to detect the presence of any statistical relationship between injury incidences of the three most prevalent injuries over this sixteen year study period.
Results:
Statistical analysis demonstrates for any given year that there was an association between having a groin/hip/osteitis pubis injuriy and having a knee ACL injury (P < 0.05) over the entire sixteen years. In other words if the number of groin/hip/osteitis pubis injuries in any given season were higher than average (alternatively lower) then the number of knee ACL injuries were also higher than average (alternatively lower) for that same season. Hamstring injuries had the highest variance of incidence of the three most prevalent injuries.
Conclusions:
Analysis of the AFL injury data demonstrates an association between incidence of groin/hip/osteitis pubis injuries and incidence of knee ACL injuries for any given playing season. This finding is difficult to explain with further research being required.
doi:10.5812/asjsm.23072
PMCID: PMC4267488  PMID: 25520768
Groin; Hip; Anterior Cruciate Ligament; Football; Groin; Muscles; Hip
6.  Clinical risk factors for hamstring muscle strain injury: a prospective study with correlation of injury by magnetic resonance imaging 
Objective—To prospectively establish risk factors for hamstring muscle strain injury using magnetic resonance imaging (MRI) to define the diagnosis of posterior thigh injury.
Method—In a prospective cohort study using two elite Australian Rules football clubs, the anthropometric characteristics and past clinical history of 114 athletes were recorded. Players were followed throughout the subsequent season, with posterior thigh injuries being documented. Hamstring intramuscular hyperintensity on T2 weighted MRI was required to meet our criteria for a definite hamstring injury. Statistical associations were sought between anthropometric and previous clinical characteristics and hamstring muscle injury.
Results—MRI in 32 players showed either hamstring injury (n = 26) or normal scans (n = 6). An association existed between a hamstring injury and each of the following: increasing age, being aboriginal, past history of an injury to the posterior thigh or knee or osteitis pubis (all p<0.05). These factors were still significant when players with a past history of posterior thigh injury (n = 26) were excluded. Previous back injury was associated with a posterior thigh injury that looked normal on MRI scan, but not with an MRI detected hamstring injury.
Conclusions—Hamstring injuries are common in Australian football, and previous posterior thigh injury is a significant risk factor. Other factors, such as increasing age, being of aboriginal descent, or having a past history of knee injury or osteitis pubis, increase the risk of hamstring strain independently of previous posterior thigh injury. However, as the numbers in this study are small, further research is needed before definitive statements can be made.
Key Words: hamstring muscle strain; thigh injury; magnetic resonance imaging; risk factors
doi:10.1136/bjsm.35.6.435
PMCID: PMC1724419  PMID: 11726483
7.  Injuries in female football players in top‐level international tournaments 
British Journal of Sports Medicine  2007;41(Suppl 1):i3-i7.
Background
Despite the growing popularity of women's football and the increasing number of female players, there has been little research on injuries sustained by female football players.
Purpose
Analysis of the incidence, characteristics and circumstances of injury in elite female football players in top‐level international tournaments.
Study design
Prospective survey.
Methods
Injuries incurred in seven international football tournaments were analysed using an established injury report system. Doctors of all participating teams reported all injuries after each match on a standardised injury reporting form. The mean response rate was 95%.
Results
387 injuries were reported from 174 matches, equivalent to an incidence of 67.4 injuries/1000 player hours (95% CI 60.7 to 74.1) or 2.2 injuries/match (95% CI 2.0 to 2.4). Most injuries (84%; 317/378) were caused by contact with another player. The injuries most commonly involved the lower extremity (n = 248; 65%), followed by injuries of the head and neck (n = 67, 18%), trunk (n = 33, 9%) and upper extremity (n = 32, 8%). Contusions (n = 166; 45%) were the most frequent type of injury, followed by sprains or ligament rupture (n = 96; 26%) and strains or muscle fibre ruptures (n = 31; 8%). The most common diagnosis was an ankle sprain. There were 7 ligament ruptures and 15 sprains of the knee. On average 1 injury/match (95% CI 0.8 to 1.2) was expected to result in absence from a match or training.
Conclusion
The injury rate in women's top‐level tournaments was within the range reported previously for match injuries in elite male and female players. However, the diagnoses and mechanisms of injury among the female players differed substantially from those previously reported in male football players.
doi:10.1136/bjsm.2007.036020
PMCID: PMC2465250  PMID: 17646248
8.  The Preventing Australian Football Injuries with Exercise (PAFIX) Study: a group randomised controlled trial 
Injury Prevention  2009;15(3):e1.
Background:
Knee injuries are a major injury concern for Australian Football players and participants of many other sports worldwide. There is increasing evidence from laboratory and biomechanically focused studies about the likely benefit of targeted exercise programmes to prevent knee injuries. However, there have been few international studies that have evaluated the effectiveness of such programmes in the real-world context of community sport that have combined epidemiological, behavioural and biomechanical approaches.
Objective:
To implement a fully piloted and tested exercise training intervention to reduce the number of football-related knee injuries. In so doing, to evaluate the intervention’s effectiveness in the real-world context of community football and to determine if the underlying neural and biomechanical training adaptations are associated with decreased risk of injury.
Setting:
Adult players from community-level Australian Football clubs in two Australian states over the 2007–08 playing seasons.
Methods:
A group-clustered randomised controlled trial with teams of players randomly allocated to either a coach-delivered targeted exercise programme or usual behaviour (control). Epidemiological component: field-based injury surveillance and monitoring of training/game exposures. Behavioural component: evaluation of player and coach attitudes, knowledge, behaviours and compliance, both before and after the intervention is implemented. Biomechanical component: biomechanical, game mobility and neuromuscular parameters assessed to determine the fundamental effect of training on these factors and injury risk.
Outcome measures:
The rate and severity of injury in the intervention group compared with the control group. Changes, if any, in behavioural components. Process evaluation: coach delivery factors and likely sustainability.
doi:10.1136/ip.2008.021279
PMCID: PMC2684655  PMID: 19494090
9.  Injuries in youth amateur soccer and rugby players—comparison of incidence and characteristics 
Objectives: In reviewing the literature on sports injuries, few studies could be found in which exposure related incidences of injury in different types of sport were compared. These studies indicated that ice hockey, handball, basketball, soccer, and rugby are popular team sports with a relatively high risk of injury. The aim of the study was to compare the characteristics and incidence of injuries in male youth amateur soccer and rugby players.
Methods: This prospective cohort study comprised an initial baseline examination to ascertain the characteristics of the players and their level of performance, and a one season observation period during which a physician visited the team weekly and documented all occurring injuries. Twelve soccer and 10 rugby school teams with male amateur players aged 14–18 years were selected for the study. 145 soccer and 123 rugby players could be followed up over one season.
Results: Comparison of the incidence of soccer and rugby injuries indicated that rugby union football was associated with a significantly higher rate of injury than soccer. The differences were pronounced for contact injuries, injuries of the head, neck, shoulder, and upper extremity, as well as for concussion, fractures, dislocations, and strains. Rugby players incurred 1.5 times more overuse and training injuries in relation to exposure time, and 2.7 times more match injuries than soccer players. Three rugby players but no soccer players had to stop their participation in sport because of severe injury.
Conclusion: The incidence of injury in New Zealand school teams playing soccer or rugby union is high, probably in part because of the low ratio of hours spent in training relative to hours spent playing matches. The development and implementation of preventive interventions to reduce the rate and severity of injury is recommended.
doi:10.1136/bjsm.2002.003020
PMCID: PMC1724792  PMID: 15039253
10.  Safety attitudes and beliefs of junior Australian football players 
Injury Prevention  2002;8(2):151-154.
Objectives: To describe the safety attitudes and beliefs of junior (aged 16–18 years) Australian football players.
Setting: Six Victorian Football League Under 18 (VFL U18) clubs in Victoria, Australia.
Methods: Cross sectional survey. Altogether 103 players completed a self report questionnaire about their safety beliefs and perceptions of support when injured, across three contexts in which they played: VFL U18 club, local club, and school.
Results: Although only 6% believed it was safe to play with injuries, 58% were willing to risk doing so. This increased to almost 80% when players perceived that their chances of being selected to play for a senior elite team would be adversely affected if they did not play. There were significant differences in the perceived level of support for injured players and in the ranking of safety as a high priority across the three settings. In general, the VFL U18 clubs were perceived as providing good support for injured players and giving a high priority to safety issues, but local clubs and particularly schools were perceived to address these issues less well.
Conclusions: Junior Australian football players have certain beliefs and perceptions in relation to injury risk that have the potential to increase injuries. These negative beliefs need to be addressed in any comprehensive injury prevention strategy aimed at these players.
doi:10.1136/ip.8.2.151
PMCID: PMC1730842  PMID: 12120836
11.  Shoulder Injuries Among United States High School Athletes During the 2005–2006 and 2006–2007 School Years 
Journal of Athletic Training  2009;44(1):76-83.
Context:
The shoulder is one of the most commonly injured body sites among athletes. Little previous research describes shoulder injury patterns in high school athletes.
Objective:
To describe and compare shoulder injury rates and patterns among high school athletes in 9 sports (football, soccer, basketball, baseball, and wrestling for boys and soccer, volleyball, basketball, and softball for girls).
Design:
Prospective injury surveillance study.
Setting:
Injury data were collected from 100 nationally representative US high schools via High School Reporting Information Online.
Patients or Other Participants:
Athletes from participating high schools injured while involved in a school-sanctioned practice or competition in 1 of the above sports during the 2005–2006 and 2006–2007 school years.
Main Outcome Measure(s):
Shoulder injury rates, diagnoses, severity, and mechanisms.
Results:
During the 2005–2006 and 2006–2007 school years, athletes in this study sustained 805 shoulder injuries during 3 550 141 athlete-exposures (AEs), for an injury rate of 2.27 shoulder injuries per 10 000 AEs. This corresponds to an estimated 232 258 shoulder injuries occurring nationwide during this time. Shoulder injuries were more likely to occur during competition than practice (rate ratio  =  3.01, 95% confidence interval  =  2.62, 3.46). Shoulder injury rates per 10 000 AEs were highest in football (5.09), wrestling (4.34), and baseball (1.90). Common shoulder injury diagnoses included sprains/strains (39.6%), dislocations/separations (23.7%), contusions (11.5%), and fractures (6.6%). Although 44.8% of athletes sustaining a shoulder injury returned to play in less than 1 week, 22.9% were out of play for more than 3 weeks, and 6.2% of shoulder injuries required surgery. Common mechanisms of shoulder injury included player-to-player contact (57.6%) and contact with the playing surface (22.8%).
Conclusions:
High school shoulder injury rates and patterns varied by sport. Continued surveillance is warranted to understand trends and patterns over time and to develop and evaluate evidence-based preventive interventions.
PMCID: PMC2629044  PMID: 19180222
epidemiology; injury surveillance
12.  Epidemiology of time-loss injuries in English community-level rugby union 
BMJ Open  2013;3(11):e003998.
Objectives
Using a prospective cohort study design, to establish the incidence and nature of time-loss injuries in English community rugby and to assess the differences between different playing levels.
Setting
English community rugby clubs.
Participants
Injury information for 4635 matches was collected during seasons 2009/2010 (46 clubs), 2010/2011(67 clubs) and 2011/2012 (76 clubs). Clubs were subdivided into groups A (semiprofessional), B (amateur) and C (recreational) for analysis.
Primary and secondary outcome measures
Any injury resulting in 8 days or greater absence from match play was reported by injury management staff at the clubs. The primary outcome measure was injury incidence (per 1000 player match-hours) and the secondary outcome measure was severity (ie, days absence).
Results
Overall match injury incidence was 16.9 injuries per 1000 player match-hours. Incidence was higher for group A (21.7; 95% CI 19.8 to 23.6) compared with group B (16.6; 95% CI 15.2 to 17.9) and C (14.2; 95% CI 13.0 to 15.5, both p<0.001). The mean time-loss was 7.6 weeks absence, with knee and shoulder injuries the most severe with mean absences of 11.6 and 9.3 weeks, respectively. Half of all injuries occurred to the lower limb, with knee and ankle joint/ligament injuries the most common diagnoses. Shoulder joint/ligament injuries were the most common and severe upper limb injuries. Contact events accounted for 80% of all injuries and tackles accounted for 50%. Running was the most common non-contact injury event, of which 56% were hamstring injuries.
Conclusions
More time-loss injuries occur at higher levels of community rugby. Injury prevention strategies should focus on good technique in the tackle and conditioning exercises for the knee, ankle, hamstrings and shoulder.
doi:10.1136/bmjopen-2013-003998
PMCID: PMC3831106  PMID: 24240143
EPIDEMIOLOGY; SPORTS MEDICINE; Sports Injury
13.  Injury Incidence in a Spanish Sub-Elite Professional Football Team: A Prospective Study During Four Consecutive Seasons 
The aim of this study was to investigate the injury incidence and injury characteristics of a Spanish sub-elite professional football team during four consecutive seasons. A team was followed prospectively from the season 2003-2004 to 2006-2007 and individual player exposure and time loss injuries were recorded during all club training sessions and matches. A total of 313 time-loss injuries were recorded. The mean injury incidence was 10.9 injuries/1000 hours (5.2 injuries/1000 training hours and 44.1 injuries/1000 match hours). The injury incidence during competitive matches was higher (p < 0.001) than in friendly matches (55.8 vs. 22.6 injuries/1000 hours). The incidence of major injuries (>28 days absence) was 0.4 injuries/1000 hours. The thigh was the most commonly (35%) injured region and caused 29% of all competitive match absence. Muscle injuries in the four main groups of the lower limbs (hamstrings, adductors, quadriceps and calf muscles) caused 43% of competitive match unavailability. The results of this study show that the risk to sustain a major injury in the course of the season was low for sub- elite footballers in comparison to elite players. Thigh strains were the first cause of absence in competition due to injury.
Key pointsThe incidence of major injuries (absence greater than 4 weeks) was lower in a Spanish sub-elite football team than in elite European teams.The risk of sustaining an injury was 2.5 fold higher (p < 0.001) in official than in friendly matches.Lower limb muscular (hamstrings, quadriceps, hip adductors and calf muscles) and joint (knee and ankle) injuries were the main causes of match unavailability.
PMCID: PMC3761521  PMID: 24149566
Soccer; epidemiology; hamstrings; match play
14.  Epidemiology of injuries in hurling: a prospective study 2007–2011 
BMJ Open  2014;4(6):e005059.
Objectives
Hurling is a stick handling game which, although native to Ireland, has international reach and presence. The aim of this study was to report incidence and type of injuries incurred by elite male hurling players over five consecutive playing seasons.
Design
Prospective cohort study.
Setting
Male intercounty elite sports teams participating in the National GAA Injury Database, 2007–2011.
Participants
A total of 856 players in 25 county teams were enrolled.
Primary and secondary outcomes
Incidence, nature and mechanism of injury were recorded by team physicians or physiotherapists to a secure online data collection portal. Time-loss injury rates per 1000 training and match play hours were calculated and injury proportions were expressed.
Results
In total 1030 injuries were registered, giving a rate of 1.2 injuries per player. These were sustained by 71% (n=608) of players. Injury incidence rate was 2.99 (95% CI 2.68 to 3.30) per 1000 training hours and 61.75 (56.75 to 66.75) per 1000 match hours. Direct player-to-player contact was recorded in 38.6% injuries, with sprinting (24.5%) and landing (13.7%) the next most commonly reported injury mechanisms. Median duration of time absent from training or games, where the player was able to return in the same season, was 12 days (range 2–127 days). The majority (68.3%) of injuries occurred in the lower limbs, with 18.6% in the upper limbs. The trunk and head/neck regions accounted for 8.6% and 4.1% injuries, respectively. The distribution of injury type was significantly different (p<0.001) between upper and lower extremities: fractures (upper 36.1%, lower 1.5%), muscle strain (upper 5.2%, lower 45.8%).
Conclusions
These data provide stable, multiannual data on injury patterns in hurling, identifying the most common injury problems. This is the first step in applying a systematic, theory-driven injury prevention model in the sport.
doi:10.1136/bmjopen-2014-005059
PMCID: PMC4067887  PMID: 24948748
Athletic Injuries; Sports Medicine; Epidemiology; Incidence
15.  The Relative Age Effect in Youth Soccer Players from Spain 
The purpose of this study was to identify the existence of Relative Age Effect (RAE) at youth level in both elite and amateur Spanish soccer clubs, and also to carry out an analysis providing with information on how this effect has evolved in recent years. We have obtained information on the youth teams of the 20 clubs belonging to the Spanish Professional Football League (LFP) in two separate seasons (2005-2006 and 2008-2009) as well as data on five youth academies belonging to amateur clubs. The collected data revealed an over- representation of players born in the first months of the selection year in all groups of analysis (Elite 2005-2006, Elite 2008-2009 and Amateurs), although only the Elite groups showed significant variations in birth-date distribution in relation to the Spanish population. The results showed a reduction in RAE from the 2005-2006 season to the 2008-2009 season. The following variables - playing position, the number of years each player has spent in their specific age group and the category of the team at each club were shown not to have influence on the extent of RAE.
Key pointsThere was RAE in all groups analyzed, although only the Elite groups showed significant variations in birth-date distribution in relation to the general population.RAE is more evident in the Elite groups than in the Amateur probably because of the detection process, which is more thorough in the Elite groups.Playing position, number of years in their specific age group and category of the team did not have any influence on the extent of RAE.Any attempts to prevent RAE should be based on a stable sport policy and the implication of all the stakeholders in the system. All of them should think in the development of a player as a long-term project.
PMCID: PMC3761747  PMID: 24149685
Relative age effect; season-of-birth bias; selection processes; talent identification; youth soccer
16.  Trends in reporting of mechanisms and incidence of hip injuries in males playing minor ice hockey in Canada: a cross-sectional study 
Background
There has been a noted increase in the diagnosis and reporting of sporting hip injuries and conditions in the medical literature but reporting at the minor hockey level is unknown. The purpose of this study is to investigate the trend of reporting hip injuries in amateur ice hockey players in Canada with a focus on injury type and mechanism.
Methods
A retrospective review of the Hockey Canada insurance database was performed and data on ice hockey hip injuries reported between January 2005 and June 2011 were collected. The study population included all male hockey players from Peewee (aged 11–12 years) to Senior (aged 20+ years) participating in amateur level competition sanctioned by Hockey Canada. Reported cases of ice hockey hip injuries were analyzed according to age, mechanism of injury, and injury subtype. Annual injury reporting rates were determined and using a linear regression analysis trended to determine the change in ice hockey hip injury reporting rate over time.
Results
One hundred and six cases of ice hockey-related hip injuries were reported in total. The majority of injuries (75.5%) occurred in players aged 15–20 years playing at the Junior level. Most injuries were caused by a noncontact mechanism (40.6%) and strains were the most common subtype (50.0%). From 2005 to 2010, the number of reported hip injuries increased by 5.31 cases per year and the rate of reported hip injury per 1,000 registered players increased by 0.02 cases annually.
Conclusion
Reporting of hip injuries in amateur ice hockey players is increasing. A more accurate injury reporting system is critical for future epidemiologic studies to accurately document the rate and mechanism of hip injury in amateur ice hockey players.
doi:10.2147/OAJSM.S58985
PMCID: PMC4069148  PMID: 24966705
amateur ice hockey; hip injury; pelvic injury; mechanism
17.  Incidence and pattern of injuries among adolescent basketball players in Nigeria 
Background
Basketball is the second most popular sport in Nigeria after football and is commonly played by adolescents. Prospective studies on adolescent basketball players in Nigeria are lacking. Such studies will help to develop injury counter-measures. Hence, this study aimed at determining the incidence and pattern of injuries among adolescent basketball players in Nigeria.
Methods
A prospective observational study involving 141 adolescent basketball players (75 boys and 66 girls; with age range 15 – 18 years) who participated in the 2010 National Finals of the Nigeria Nestlé Milo Basketball Competition. Basketball-related injury data were collected by an assessor during the competition using a standardized basketball injury report form. Data were analyzed using descriptive and inferential statistics.
Results
A total of 32 injuries were recorded with an incidence of 22.7 injuries per 100 participants same for boys and girls. This is equivalent to 1.1 injury per match for boys and 0.9 injuries per match for girls. Jumping/landing was the most common cause of injury (28.1%, N = 9). Most of the injuries were at the lower extremities (75%, N = 24); with majority at the knee joint (40.6%, N = 13). Ligament sprain was the most common types of injury. The pattern of injuries among boys did not significantly differ from that of girls (P > 0.05). Most injuries (N = 13, 41%) occurred in the offensive half of the court and cryotherapy was the most frequently used treatment modality.
Conclusion
The overall incidence of match injury among adolescent amateur basketball players during a national competition in Nigeria was 22.7 injuries per 100 participants; equivalence of 1.0 injury per match. The pattern of injuries was similar in both genders and consistent with what has been previously reported in literature for adolescent basketball players. Exercise-based injury prevention programmes aimed at improving core strength and neuromuscular control at the lower limbs may help reduce the incidence of injuries.
doi:10.1186/1758-2555-4-15
PMCID: PMC3444312  PMID: 22559878
18.  Retrospective study of concussive convulsions in elite Australian rules and rugby league footballers: phenomenology, aetiology, and outcome. 
BMJ : British Medical Journal  1997;314(7075):171-174.
OBJECTIVES: To study the ictal phenomenology, aetiology, and outcome of convulsions occurring within seconds of impact in violent collision sport. DESIGN: Retrospective identification of convulsions associated with concussive brain injury from case records from medical officers of football clubs over a 15 year period. SUBJECTS: Elite Australian rules and rugby league footballers. MAIN OUTCOME MEASURES: Neuroimaging studies, electroencephalography, neuropsychological test data, and statistics on performance in matches to determine presence of structural or functional brain injury. Clinical follow up and electroencephalography for evidence of epilepsy. RESULTS: Twenty two cases of concussive convulsions were identified with four events documented on television videotape. Convulsions began within 2 seconds of impact and comprised an initial period of tonic stiffening followed by myoclonic jerks of all limbs lasting up to 150 seconds. Some asymmetry in the convulsive manifestations was common, and recovery of consciousness was rapid. No structural or permanent brain injury was present on clinical assessment, neuropsychological testing, or neuroimaging studies. All players returned to elite competition within two weeks of the incident. Epilepsy did not develop in any player over a mean (range) follow up of 3.5 (1-13) years. CONCLUSIONS: These concussive or impact convulsions are probably a non-epileptic phenomenon, somewhat akin to convulsive syncope. The mechanism may be a transient traumatic functional decerebration. In concussive convulsions the outcome is universally good, antiepileptic treatment is not indicated, and prolonged absence from sport is unwarranted.
PMCID: PMC2125700  PMID: 9022428
19.  Mechanisms of Team-Sport-Related Brain Injuries in Children 5 to 19 Years Old: Opportunities for Prevention 
PLoS ONE  2013;8(3):e58868.
Background
There is a gap in knowledge about the mechanisms of sports-related brain injuries. The objective of this study was to determine the mechanisms of brain injuries among children and youth participating in team sports.
Methods
We conducted a retrospective case series of brain injuries suffered by children participating in team sports. The Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) database was searched for brain injury cases among 5–19 year-olds playing ice hockey, soccer, American football (football), basketball, baseball, or rugby between 1990 and 2009. Mechanisms of injury were classified as “struck by player,” “struck by object,” “struck by sport implement,” “struck surface,” and “other.” A descriptive analysis was performed.
Results
There were 12,799 brain injuries related to six team sports (16.2% of all brain injuries registered in CHIRPP). Males represented 81% of injuries and the mean age was 13.2 years. Ice hockey accounted for the greatest number of brain injuries (44.3%), followed by soccer (19.0%) and football (12.9%). In ice hockey, rugby, and basketball, striking another player was the most common injury mechanism. Football, basketball, and soccer also demonstrated high proportions of injuries due to contact with an object (e.g., post) among younger players. In baseball, a common mechanism in the 5–9 year-old group was being hit with a bat as a result of standing too close to the batter (26.1% males, 28.3% females).
Interpretation
Many sports-related brain injury mechanisms are preventable. The results suggest that further efforts aimed at universal rule changes, safer playing environments, and the education of coaches, players, and parents should be targeted in maximizing prevention of sport-related brain injury using a multifaceted approach.
doi:10.1371/journal.pone.0058868
PMCID: PMC3610710  PMID: 23555602
20.  The Football Association Medical Research Programme: an audit of injuries in professional football—analysis of hamstring injuries 
Objective: To conduct a detailed analysis of hamstring injuries sustained in English professional football over two competitive seasons.
Methods: Club medical staff at 91 professional football clubs annotated player injuries over two seasons. A specific injury audit questionnaire was used together with a weekly form that documented each clubs' current injury status.
Results: Completed injury records for the two competitive seasons were obtained from 87% and 76% of the participating clubs respectively. Hamstring strains accounted for 12% of the total injuries over the two seasons with nearly half (53%) involving the biceps femoris. An average of five hamstring strains per club per season was observed. A total of 13 116 days and 2029 matches were missed because of hamstring strains, giving an average of 90 days and 15 matches missed per club per season. In 57% of cases, the injury occurred during running. Hamstring strains were most often observed during matches (62%) with an increase at the end of each half (p<0.01). Groups of players sustaining higher than expected rates of hamstring injury were Premiership (p<0.01) and outfield players (p<0.01), players of black ethnic origin (p<0.05), and players in the older age groups (p<0.01). Only 5% of hamstring strains underwent some form of diagnostic investigation. The reinjury rate for hamstring injury was 12%.
Conclusion: Hamstring strains are common in football. In trying to reduce the number of initial and recurrent hamstring strains in football, prevention of initial injury is paramount. If injury does occur, the importance of differential diagnosis followed by the management of all causes of posterior thigh pain is emphasised. Clinical reasoning with treatment based on best available evidence is recommended.
doi:10.1136/bjsm.2002.002352
PMCID: PMC1724733  PMID: 14751943
21.  Epidemiology of injuries in the Australian Football League, seasons 1997–2000 
Objective: To describe the epidemiology of injuries in the Australian Football League (AFL) over four seasons.
Methods: An injury was defined as "any physical or medical condition that caused a player to miss a match in the regular season." The rationale for this definition was to eliminate a previously noted tendency of team recorders to interpret injury definitions subjectively. Administrative records of injury payments to players who did not play matches determined the occurrence of an injury.
Results: The seasonal incidence of new injuries was 39 per club (of 40 players) per season (of 22 matches). The match injury incidence for AFL games was 25.7 injuries per 1000 player hours. The injury prevalence (percentage of players missing through injury in an average week) was 16%. The recurrence rate of injuries was 17%. The most common and prevalent injury was hamstring strain (six injuries per club per season, resulting in 21 missed matches per club per season), followed in prevalence by anterior cruciate ligament and groin injuries.
Conclusions: The injury definition of this study does not produce incidence rates that are complete for all minor injuries. However, the determination of an injury is made by a single entity in exactly the same manner for all teams, which overcomes a significant methodological flaw present in other multiteam injury surveillance systems.
doi:10.1136/bjsm.36.1.39
PMCID: PMC1724448  PMID: 11867491
22.  Alcohol consumption and sport: a cross-sectional study of alcohol management practices associated with at-risk alcohol consumption at community football clubs 
BMC Public Health  2013;13:762.
Background
Excessive alcohol consumption is responsible for considerable harm from chronic disease and injury. Within most developed countries, members of sporting clubs participate in at-risk alcohol consumption at levels above that of communities generally. There has been limited research investigating the predictors of at-risk alcohol consumption in sporting settings, particularly at the non-elite level. The purpose of this study was to examine the association between the alcohol management practices and characteristics of community football clubs and at-risk alcohol consumption by club members.
Methods
A cross sectional survey of community football club management representatives and members was conducted. Logistic regression analysis (adjusting for clustering by club) was used to determine the association between the alcohol management practices (including alcohol management policy, alcohol-related sponsorship, availability of low- and non-alcoholic drinks, and alcohol-related promotions, awards and prizes) and characteristics (football code, size and location) of sporting clubs and at-risk alcohol consumption by club members.
Results
Members of clubs that served alcohol to intoxicated people [OR: 2.23 (95% CI: 1.26-3.93)], conducted ‘happy hour’ promotions [OR: 2.84 (95% CI: 1.84-4.38)] or provided alcohol-only awards and prizes [OR: 1.80 (95% CI: 1.16-2.80)] were at significantly greater odds of consuming alcohol at risky levels than members of clubs that did not have such alcohol management practices. At-risk alcohol consumption was also more likely among members of clubs with less than 150 players compared with larger clubs [OR:1.45 (95% CI: 1.02-2.05)] and amongst members of particular football codes.
Conclusions
The findings of this study suggest a need and opportunity for the implementation of alcohol harm reduction strategies targeting specific alcohol management practices at community football clubs.
doi:10.1186/1471-2458-13-762
PMCID: PMC3751764  PMID: 23947601
Alcohol drinking; Sports; Public health
23.  Teaching landing skills in elite junior Australian football: evaluation of an injury prevention strategy 
British Journal of Sports Medicine  2006;40(10):834-838.
Objective
To evaluate the effectiveness of a preseason physical training programme that taught landing and falling skills in improving landing skills technique and preventing injury in junior elite Australian football players.
Methods
723 male players who participated in an under 18 elite competition were studied prospectively in a non‐randomised controlled trial over two consecutive football seasons. There were 114 players in the intervention group and 609 control players. The eight session intervention programme taught players six landing, falling, and recovery skills, which were considered fundamental for safe landing in Australian football. Landing skills taught in these sessions were rated for competence by independent and blinded assessors at baseline and mid‐season.
Results
Evaluation of landing skills found no significant differences between the groups at baseline. Evaluation after the intervention revealed overall improvement in landing skills, but significantly greater improvement in the intervention group (z  =  −7.92, p  =  0.001). Players in the intervention group were significantly less likely (relative rate 0.72, 95% confidence interval 0.52 to 0.98) to sustain an injury during the season than the control group. In particular, the time to sustaining a landing injury was significantly less for the intervention group (relative rate 0.40, 95% confidence interval 0.17 to 0.92) compared with the control group.
Conclusions
Landing and falling ability can be taught to junior elite Australian football players. Players in the intervention group were protected against injury, particularly injuries related to landing and falls.
doi:10.1136/bjsm.2006.025692
PMCID: PMC2465083  PMID: 16920776
injury; Australian football; prevention; intervention; landing
24.  Injury surveillance in the World Football Tournaments 1998–2012 
British Journal of Sports Medicine  2012;47(12):782-788.
Background
International sports bodies should protect the health of their athletes, and injury surveillance is an important pre-requisite for injury prevention. The Fédération International de Football Association (FIFA) has systematically surveyed all football injuries in their tournaments since 1998.
Aims
Analysis of the incidence, characteristics and changes of football injury during international top-level tournaments 1998–2012.
Methods
All newly incurred football injuries during the FIFA tournaments and the Olympic Games were reported by the team physicians on a standardised injury report form after each match. The average response rate was 92%.
Results
A total of 3944 injuries were reported from 1546 matches, equivalent to 2.6 injuries per match. The majority of injuries (80%) was caused by contact with another player, compared with 47% of contact injuries by foul play. The most frequently injured body parts were the ankle (19%), lower leg (16%) and head/neck (15%). Contusions (55%) were the most common type of injury, followed by sprains (17%) and strains (10%). On average, 1.1 injuries per match were expected to result in absence from a match or training. The incidence of time-loss injuries was highest in the FIFA World Cups and lowest in the FIFA U17 Women's World Cups. The injury rates in the various types of FIFA World Cups had different trends over the past 14 years.
Conclusions
Changes in the incidence of injuries in top-level tournaments might be influenced by the playing style, refereeing, extent and intensity of match play. Strict application of the Laws of the Games is an important means of injury prevention.
doi:10.1136/bjsports-2013-092205
PMCID: PMC3717759  PMID: 23632746
Soccer; Epidemiology; Sporting injuries; Injury Prevention
25.  Risk factors for hamstring injuries in community level Australian football 
Objectives: To identify risk factors for hamstring injury at the community level of Australian football.
Methods: A total of 126 community level Australian football players participated in this prospective cohort study. To provide baseline measurements, they completed a questionnaire and had a musculoskeletal screen during the 2000 preseason. All were monitored over the season. Injury surveillance and exposure data were collected for the full season. Survival analysis was used to identify independent predictors of hamstring injury.
Results: A hamstring injury was the first injury of the season in 20 players (16%). After adjustment for exposure, increasing age and decreased quadriceps flexibility were identified as significant independent predictors of the time to sustaining a hamstring injury. Older age (⩾23 years) was associated with an increased risk of hamstring injury (RR 3.8; 95% confidence interval (CI) 1.1 to 14.0; p = 0.044). Players with increased quadriceps flexibility (as measured by the modified Thomas test) were less likely to sustain a hamstring injury (RR 0.3; 95% CI 0.1 to 0.8; p = 0.022).
Conclusions: The findings of this study can be used in the development of hamstring injury prevention strategies and to identify Australian football players at increased risk of hamstring injury.
doi:10.1136/bjsm.2003.011197
PMCID: PMC1725127  PMID: 15665208

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