Management of Elbow Dislocations in the National Football League.

Background: Although much literature exists regarding the treatment and management of elbow dislocations in the general population, little information is available regarding management in the athletic population. Furthermore, no literature is available regarding the postinjury treatment and timing of return to play in the contact or professional athlete. Purpose: To review the clinical course of elbow dislocations in professional football players and determine the timing of return to full participation. Study Design: Case series; Level of evidence, 4. Methods: All National Football League (NFL) athletes with elbow dislocations from 2000 through 2011 who returned to play during the season were identified from the NFL Injury Surveillance System (NFL ISS). Roster position, player activity, use of external bracing, and clinical course were reviewed. Mean number of days lost until full return to play was determined for players with elbow dislocations who returned in the same season. Results: From 2000 to 2011, a total of 62 elbow dislocations out of 35,324 injuries were recorded (0.17%); 40 (64.5%) dislocations occurred in defensive players, 12 (19.4%) were in offensive players; and 10 (16.1%) were during special teams play. Over half of the injuries (33/62, 53.2%) were sustained while tackling, and 4 (6.5%) patients required surgery. A total of 47 (75.8%) players who sustained this injury were able to return in the same season. For this group, the mean number of days lost in players treated conservatively (45/47) was 25.1 days (median, 23.0 days; range, 0.0-118 days), while that for players treated operatively (2/47) was 46.5 days (median, 46.5 days; range, 29-64 days). Mean return to play based on player position was 25.8 days for defensive players (n = 28; median, 21.5 days; range, 3.0-118 days), 24.1 days for offensive players (n = 11; median, 19 days; range, 2.0-59 days), and 25.6 days for special teams players (n = 8; median, 25.5 days; range, 0-44 days). Conclusion: Elbow dislocations comprise less than a half of a percent of all injuries sustained in the NFL. Most injuries occur during the act of tackling, with the majority of injured athletes playing a defensive position. Players treated nonoperatively missed a mean of 25.1 days, whereas those managed operatively missed a mean of 46.5 days

The effects of a mindfulness-based program on the incidence of injuries in young male soccer players

We tested the effectiveness of a mindfulness-based program in reducing sport injury incidence. 168 young male elite soccer players were randomly assigned to mindfulness (MG) and control (CG) groups. The MG consisted of 7 sessions based on the Mindfulness-Acceptance-Commitment approach while the CG consisted of 7 presentations on sport injury psychology. Athlete-exposure and injury data were recorded during one season. State and trait mindfulness, sport anxiety, stress, and attention control of participants were assessed. Number of injuries, average of injuries per team, and days lost to injury in the MG weresignificantly lower than in the CG. Mindfulness and attention control werelower and sport anxiety and stress were higher in injured players than innon-injured players. Psychological variables were associated with injury. Mindfulness training may reduce the injury risk of young soccer players due to improved mindfulness and attention control and reduced sport anxiety

The effects of level and duration of play on cognition, mood and behavior among former football players

Thesis (M.A.)--Boston UniversityInterest in the short and long-term effects of concussions has drastically increased due to the recent high-profile deaths of former National Football League (NFL) players. However, research on this subject, especially at the youth level, has moved at a much slower rate. Second Impact Syndrome (SIS), Postconcussive Syndrome (PCS) and Chronic Traumatic Encephalopathy (CTE) are three major consequences that have the potential to negatively affect athletes participating in contact sports immediately or years after their athletic careers are over. The goal of this study is to examine whether the level of first exposure and/or duration of exposure has an effect on a player’s cognition, mood and behavior years after his football career is complete. I hypothesized that the age of onset of exposure to football would have a significant effect on cognition, mood and behavior later in life, and that those who started playing football prior to high school would self-report more problems in all three domains compared to those who started playing in high school when matched for the total number of years played. In order to test my hypotheses, analysis was completed on n=154 cases, all of whom played football at some level. Results showed that age of onset of exposure to football did have a significant effect on the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) assessment, specifically the Global Executive Composite (GEC) (p = .018), Behavioral Regulation Index (BRI) (p = .014) scores and three of the nine clinical subscales (Inhibit [p = .025], Shift [p = .015] and Self-Monitor [p = .048]). Age of onset of exposure to football was also found significant for the mood and behavior assessment scores, the Apathy Evaluation Scale (AES) (p = .024) and Center for Epidemiological Studies Depression Scale CES-D (p = .011). No significant difference in assessment scores was found for level of onset of exposure when matched by number of years of football played. BRIEF-A GEC, BRI and MI raw scores were significantly different than published normative data for each age group, except the 70-79 and 80-90 year olds, both of which had very small sample sizes. Significant differences in all BRIEF-A index scores and all nine clinical subscores were found for the 40-49, 50-59 and 60-69 age groups. Finding significant differences in these age groups is somewhat unsurprising, given that CTE symptoms tend to begin decades after the end of exposure. Also consistent with this idea, the 30-39 years old age group showed a significant difference with the normative data in six of the nine clinical subscales, while the 18-29 years old age group showed a significant difference in three of the nine subscales. Longitudinal studies will need to be conducted to validate these findings and further understand the relationship between level of onset of play and long-term deleterious effects as a result of repetitive brain trauma (RBT)

Neurological consequences of traumatic brain injuries in sports.

Traumatic brain injury (TBI) is common in boxing and other contact sports. The long term irreversible and progressive aftermath of TBI in boxers depicted as punch drunk syndrome was described almost a century ago and is now widely referred as chronic traumatic encephalopathy (CTE). The short term sequelae of acute brain injury including subdural haematoma and catastrophic brain injury may lead to death, whereas mild TBI, or concussion, causes functional disturbance and axonal injury rather than gross structural brain damage. Following concussion, symptoms such as dizziness, nausea, reduced attention, amnesia and headache tend to develop acutely but usually resolve within a week or two. Severe concussion can also lead to loss of consciousness. Despite the transient nature of the clinical symptoms, functional neuroimaging, electrophysiological, neuropsychological and neurochemical assessments indicate that the disturbance of concussion takes over a month to return to baseline and neuropathological evaluation shows that concussion-induced axonopathy may persist for years. The developing brains in children and adolescents are more susceptible to concussion than adult brain. The mechanism by which acute TBI may lead to the neurodegenerative process of CTE associated with tau hyperphosphorylation and the development of neurofibrillary tangles (NFTs) remains speculative. Focal tau-positive NFTs and neurites in close proximity to focal axonal injury and foci of microhaemorrhage and the predilection of CTE-tau pathology for perivascular and subcortical regions suggest that acute TBI-related axonal injury, loss of microvascular integrity, breach of the blood brain barrier, resulting inflammatory cascade and microglia and astrocyte activation are likely to be the basis of the mechanistic link of TBI and CTE. This article provides an overview of the acute and long-term neurological consequences of TBI in sports. Clinical, neuropathological and the possible pathophysiological mechanisms are discussed. This article is part of a Special Issue entitled 'Traumatic Brain Injury'

Static loads on the lower back for two modalities of the isometric smith squat

Introduction: The squat is one of the most effective exercises in athletic training. However, there is a scarcity of research that reports the muscular and joint loads in the lumbar region incurred when performing the high bar and the low bar isometric squat modalities in a Smith machine. Therefore, this study aims to determine the muscle force of the lower back extensors, and the compressive (Rc) and shear (Rs) forces at the lumbosacral joint for the one repetition maximum (1RM) high bar and low bar isometric parallel-depth Smith squats. Methods: Eight healthy male well-trained 400-m sprinters participated in the study. The athletes performed the two modalities of the isometric squat on a 7° backward-inclined Smith machine using a mean ± SD 1RM external resistance of 100.3 ± 7.2 kg. During the squat, the participants paused for 2-3 s at the bottom of the squat, corresponding to a position in which the thighs are parallel to the ground. This was, therefore, considered a static position for the calculation of isometric muscle forces and joint loads using static mechanical analysis. Moment arms, and joint and segmental angles were calculated from video images of the squatting performance. Internal forces were computed using a geometrical model of the trunk and lower limb. Results: Spinal extensor muscular forces and lumbo-sacral joint forces were higher when using the low bar technique; with the exception of Rs which was approximately equal. The mean Rc were 10.2 body weights (BW) or 8,014 N (high bar) and 11.1 BW or 8,729 N (low bar). Discussion: The low bar technique yields higher Rc and may therefore be avoided in the rehabilitation of spinal injuries. Increased bone mineral density and well-developed trunk musculature due to long term squat training can provide protection against passive spinal tissue failure. Therefore, the Rc found for the 1RM isometric parallel-depth Smith squat do not appear excessive for healthy well-trained athletes. The presence of Rs at the lumbo-sacral joint in both squat modalities suggests potential for damage to the intervertebral disc. The findings provide an in-depth understanding of the two squat modalities in isometric conditions for the prevention of lower back injury and the design of rehabilitation programs

Eccentric Resistance Training in Youth: Perspectives for Long-Term Athletic Development

The purpose of this narrative review is to discuss the role of eccentric resistance training in youth and how this training modality can be utilized within long-term physical development. Current literature on responses to eccentric exercise in youth has demonstrated that potential concerns, such as fatigue and muscle damage, compared to adults are not supported. Considering the importance of resistance training for youth athletes and the benefits of eccentric training in enhancing strength, power, speed, and resistance to injury, its inclusion throughout youth may be warranted. In this review we provide a brief overview of the physiological responses to exercise in youth with specific reference to the different responses to eccentric resistance training between children, adolescents, and adults. Thereafter, we discuss the importance of ensuring that force absorption qualities are trained throughout youth and how these may be influenced by growth and maturation. In particular, we propose practical methods on how eccentric resistance training methods can be implemented in youth via the inclusion of efficient landing mechanics, eccentric hamstrings strengthening and flywheel inertia training. This article proposes that the use of eccentric resistance training in youth should be considered a necessity to help develop both physical qualities that underpin sporting performance, as well as reducing injury risk. However, as with any other training modality implemented within youth, careful consideration should be given in accordance with an individual's maturity status, training history and technical competency as well as being underpinned by current long-term physical development guidelines

Understanding sports hernia (athletic pubalgia) - The anatomic and pathophysiologic basis for abdominal and groin pain in athletes

Recent publicity and some scientific reports suggest increasing success in treating an entity called “sports hernia” - more accurately named athletic pubalgia. The primary purpose of this article is to portray what we believe to be the key concept for understanding this wide variety of abdominal and groin injuries that afflict high performance athletes. These injuries have been plaguing athletes for a long time, and past treatments, based on concepts of occult hernia or simple strains, have generally failed. The former concepts do not take into account the likely mechanisms of injury or various patterns of pain that these athletes exhibit. The authors believe that the concept of a pubic joint or pubic dynamic complex is fundamental to understanding the anatomy and pertinent pathophysiology in these patients. Many injuries can now be treated successfully. Some of the injuries require surgery and others do not. In most cases, decisions regarding treatment and timing for return to full play require proper identification of the problems and consideration of a wide variety of medical, social, and business factors

Training load and injury incidence over one season in adolescent Arab table tennis players : a pilot study

Background: It has been established that injury incidence data and training load in table tennis is somewhat limited. Objectives: The purpose of this study was to analyze and report training load and injury incidence. This was established over a full season in highly trained youth table tennis athletes. We further aimed to establish what variables related to training load have a statistically significant effect on injury in youth table tennis. Methods: Data was collected from eight male adolescent table tennis players of Arabic origin. Training and game time were monitored continuously throughout each training session and match. Heart rate was measured throughout and then subsequently analyzed to quantify internal training load. Results: Players were subjected to an average of 1901 h 33 min ± 44 h 30 min of training time and 140 h 0 min ± 11 h 29 min of game time over the season. Overall injury incidence was 8.3 (95% CI: 4.6 - 12.0), time-loss injuries 4.4 (95% CI: 1.9 - 6.9) and growth conditions 2.0 (95% CI: 0.6 - 3.3) per 1000 hours. Internal training loads quantified via the Edwards training impulse equation were significantly different between training weeks (P = 0.001), with lowest values around competition periods (P < 0.05). For every extra auxiliary unit of relative training load per minute during training, a significant increase (P = 0.014) in injury occurrence was present. Conclusions: Most of the injuries occurred during the first quarter of the year (65%), when training loads were highest. In conclusion, the results of this preliminary study showed that training loads increase during a season until competition period, with relative training load per minute being linked to the likelihood of injuries. The rate of overuse injuries and growth-related conditions were higher than previously reported in adolescents in other racket sports