Headers and concussions in elite female and male football: a pilot study

Background: Heading is a risk factor for neurogenerative disease in football. However, the exposure to heading in elite football training is understudied. Objectives: The primary purpose of this study was to determine the exposure to headers in elite men’s and women’s football and to describe the effects of the headers on ocular markers. Methods: Exposure to headers was observed over three days of women’s and men’s football. The number of headers at each session was determined through video analysis, and the G-force was determined via an impact tracker. Ocular markers were assessed at the start and end of the three days, and the results were compared to determine if there were any changes. Self-reported exposure to heading was recorded after each session and compared to the number of headers observed through video analysis, to assess the validity of players’ self-reporting. Results: Female players made an average of 11 headers per player per session. Ninety percent of the headers were below 10G, and none were above 80G. Male players made an average of three headers per player per session, with 74% of the headers recording a G-force above 10G and 3% above 80G. No meaningful changes were observed post-session in the ocular markers, and no concussions were observed. Neither cohort was able to accurately self-report exposure to headers. Conclusion: Longitudinal studies should be designed and conducted across different levels of play in both women and men’s football as a prerequisite to develop evidence-based measures to prevent or mitigate the potential risks associated with headers and concussions in elite football

A history of concussions is associated with symptoms of common mental disorders in former male professional athletes across a range of sports

Objective: Recent reports suggest that exposure to repetitive concussions in sports is associated with an increased risk of symptoms of distress, anxiety and depression, sleep disturbance or substance abuse/dependence (typically referred as symptoms of common mental disorders[CMD]) and of later development of neurodegenerative disease, in particular chronic traumatic encephalopathy (CTE). The primary aim of this study was to explore the relationship between sports career-related concussions and the subsequent occurrence of symptoms of CMD among former male professional athletes retired from football (soccer), ice hockey and rugby (union). Methods: Cross-sectional analyses were performed on baseline electronic questionnaires from three prospective cohort studies among former male professional athletes retired from football (soccer), ice hockey and rugby (union). The number of confirmed concussions was examined through a single question, while symptoms of distress, anxiety and depression, sleep disturbance and adverse alcohol use were assessed using validated questionnaires. Results: From 1,957 former professional athletes contacted, a total of 576 (29%) completed the questionnaire. Of these, 23% had not incurred a concussion during their career, 34% had two or three, 18% four or five, and 11% six or more concussions. The number of sports career-related concussions was a predictor for all outcome measures (β = 0.072–0.109; P ≤ 0.040). Specifically, former professional athletes who reported a history of four or five concussions were approximately 1.5 times more likely to report symptoms of CMD, rising to a two- to five-fold increase in those reporting a history of six or more sports career-related concussions. Conclusions: These data demonstrate an association between exposure to sports concussion and subsequent risk of symptoms of CMD in former professional athletes across a range of contact sports. Further work to explore the association between sports concussion and symptoms of CMD is required; in the meanwhile, strategies for effective risk reduction and improved management appear indicated

Preventing injuries among recreational adult volleyball players:Results of a prospective randomised controlled trial

The objective was to evaluate the effectiveness of an exercise-based warm-up programme ("VolleyVeilig") on the one-season occurrence of musculoskeletal injuries among recreational adult volleyball players. A prospective randomised controlled trial was conducted over the 2017-2018 volleyball season. Recreational adult volleyball players were allocated either to an intervention or control group. The Dutch version of the Oslo Sports Trauma Research Centre questionnaire was used to register and monitor acute and overuse injuries. A total of 672 volleyball players were enrolled: 348 in the intervention group (mean age: 30) and 324 in the control group (mean age: 27). The incidence rate of acute injury was 21% lower in the intervention group, namely 8.9 versus 11.3 per 1,000 h in the control group (Cox mixed effects crude model: hazard ratio = 0.82 [95%CI: 0.69-0.98]; Cox mixed effects adjusted model: 0.85 [95%CI: 0.71-1.02]). No significant difference in mean prevalence of overuse injury was found between the intervention (4.8%) and control (4.2%) groups. The severity of injuries was not significantly different between groups, while injury burden was slightly lower in the intervention group. The exercise-based warm-up programme led to a trend in less acute injuries among recreational adult volleyball players

Headers and concussions in elite female and male football

BACKGROUND : Heading is a risk factor for neurogenerative disease in football. However, the exposure to heading in elite football training is understudied. OBJECTIVES : The primary purpose of this study was to determine the exposure to headers in elite men’s and women’s football and to describe the effects of the headers on ocular markers. METHODS : Exposure to headers was observed over three days of women’s and men’s football. The number of headers at each session was determined through video analysis, and the G-force was determined via an impact tracker. Ocular markers were assessed at the start and end of the three days, and the results were compared to determine if there were any changes. Self-reported exposure to heading was recorded after each session and compared to the number of headers observed through video analysis, to assess the validity of players’ self-reporting. RESULTS : Female players made an average of 11 headers per player per session. Ninety percent of the headers were below 10G, and none were above 80G. Male players made an average of three headers per player per session, with 74% of the headers recording a G-force above 10G and 3% above 80G. No meaningful changes were observed post-session in the ocular markers, and no concussions were observed. Neither cohort was able to accurately self-report exposure to headers. CONCLUSION : Longitudinal studies should be designed and conducted across different levels of play in both women and men’s football as a prerequisite to develop evidence-based measures to prevent or mitigate the potential risks associated with headers and concussions in elite football.http://sajsm.org.za/index.php/sajsmam2024Sports MedicineNon

The effectiveness of an online intervention in stimulating injury-preventive behaviour in adult novice runners. Results of a randomised controlled trial

BACKGROUND: The online intervention Runfitcheck was developed to stimulate injury-preventive behaviour among adult novice runners. OBJECTIVES: This study evaluated the effectiveness of Runfitcheck on injury-preventive behaviour among adult novice runners. METHODS: A randomised controlled trial was conducted among adult novice runners. The intervention group had access to the Runfitcheck intervention, the control group performed their running activities as usual. One, three, and five months after enrolment, participants reported retrospectively what they had done regarding injury-preventive behaviour (operationalised as (i) using a (personalised) training schedule; (ii) performing strength and technique exercises; and (iii) performing a warm-up routine prior to running). Relative Risks (RR) and 95% Confidence Interval (95%CI) were used to analyse behavioural change. RESULTS: The intervention group (n=715) searched more often for information about a warm-up routine (RR 1.211; 95%CI 1.080- 1.357), and added more often strength exercises to their warm-up routine (RR 1.228; 95%CI 1.092-1.380). The intervention group performed more often running technique exercises compared to the control group (n=696) (RR 1.134; 95%CI 1.015-1.267), but less often strength exercises (RR 0.865 (95%CI 0.752-0.995). Within the group of runners that did not perform any warm-up routine at enrolment (n=272), the intervention group started to perform a regular warm-up routine more often than the control group (RR 1.461; 95%CI 1.084-1.968). No significant results were found for using a training schedule. CONCLUSION: The online intervention Runfitcheck was effective in stimulating aspects of injury-preventive behaviour in adult novice runners, mostly related to a warm-up routine.Netherlands Organization for Health Research and Development.http://sajsm.org.za/index.php/sajsmSports Medicin

We know a lot about little and little about a lot: A contextualized scoping review on injury prevention in alpine ski racing

BACKGROUND Our goal was to summarize and contextualize the available literature on alpine ski racing injury epidemiology, injury etiology, injury prevention measures, injury prevention context, and implementation issues. MATERIALS AND METHODS We searched four electronic databases using predetermined search terms. We included original studies that assessed injury, injury risk factors, and injury mechanisms, and assessed and reported the effect of an injury prevention measure in alpine ski racing. Two authors independently conducted title-abstract screening, and one performed the full-text review. For data synthesis and categorization, we used the Translating Research into the Injury Prevention Practice framework and a modified and adapted version of the Haddon matrix. RESULTS Of the 157 included studies, most corresponded to injury epidemiology and etiology, whereas few studies encompassed injury prevention measure development, implementation and evaluation. Preventive interventions targeting equipment, rules and regulations, course design and snow preparation were the most prevalent in the literature. Furthermore, various contextual factors in the current literature have been found, including gender, competition level, countries and federations, and time periods within a season. CONCLUSIONS We provided an in-depth and comprehensive overview of the current state-of-the-art in the alpine ski racing context. We know a lot about little and little about a lot across all the areas associated with injury prevention in such context. The limitations in the literature yield a road map for designing future injury prevention studies to address the key gaps identified. A more comprehensive context-driven approach throughout all stages of injury prevention would benefit the ultimate implementation of effective preventive strategies

Anxiety and depression in athletes assessed using the 12-item General Health Questionnaire (GHQ-12) - a systematic scoping review

Introduction: Poor mental health of athletes is major concern in sport. Typically, incidence/prevalence of mental health symptoms in athletes is studied using symptom-specific questionnaires. For symptoms of depression/anxiety, one such self-reporting questionnaire is the 12-item General Health Questionnaire (GHQ-12). Objective: The aim of this review was to synthesise and compare studies using the GHQ-12 in athletes to inform future research by identifying trends and gaps in the literature. Methods: A systematic search of five electronic databases (Google Scholar, PubMed, PsychINFO, Scopus and Web of Science) was conducted on all published studies up to 1 January 2019. 1) participants were able-bodied athletes; 2) studies measured anxiety/depression using the GHQ-12; 3) studies were full original articles from peer-reviewed journals; 4) studies were published in English. Results: 32 studies were included in the review. Prevalence and incidence of symptoms of anxiety/depression ranged from 21-48% and 17-57% respectively. The majority of studies screening anxiety/depression using the GHQ-12 were cross-sectional. Almost 70% of studies used the traditional scoring method. The majority of study populations sampled all-male cohorts comprising football (soccer) players. Conclusion: The traditional scoring of 0-0-1-1 should be used with the cut-off set at ≥3. Also, the mean GHQ-12 score should be reported. Potential risk factors for symptoms of anxiety/depression (i.e. recent adverse life events, injury and illness, social support, pressure to perform and career transitioning) and a lack of prospective studies were identified. Future research should also broaden the spectrum of athlete populations used and try to improve response rates

Can running-related injuries be prevented through an online behavioural intervention in adult novice runners? Results of a randomised controlled trial

OBJECTIVE : To evaluate the effectiveness of the Runfitcheck on time until the onset of a new running-related injury (RRI) among adult novice runners. METHODS : A three-arm randomised controlled trial was conducted over 7 months. Adult novice runners completed a baseline online questionnaire on their characteristics, running activity, RRIs and injury preventive behaviour. Runners were randomly allocated to one of two intervention groups or the control group (n=238). One intervention group obtained access to the Runfitcheck (n=252), an online intervention to encourage injury preventive behaviour, and was fortnightly promoted to use Runfitcheck; the other intervention group (n=251) was directed towards the Runfitcheck once. Runners were followed for 4 months, not all starting at the same time over 7 months. The main outcome measure was time to a new RRI using the Oslo Sports Trauma Research Centre Overuse Injury Questionnaire, and was analysed with survival analysis Cox regression. Generalised estimating equations (GEE) were used to gain insight into the effectiveness of the Runfitcheck. RESULTS : The time to the occurrence of the first RRI did not differ between the study groups (Wald χ2=0.893). GEE analysis showed no difference in the risk of a new RRI in the group that was referred to the Runfitcheck once (OR 1.22, 95% CI 0.86 to 1.74) nor in the active approach group (OR 1.01, 95% CI 0.71 to 1.45) compared with the control group. Furthermore, the onset of the new RRIs did not change over time (OR 0.96, 95% CI 0.91 to 1.01). CONCLUSIONS : The online intervention Runfitcheck was ineffective in reducing the instantaneous risk of new RRIs in adult novice runners. More research is needed to determine how injuries in novice runners can be prevented. TRIAL REGISTRATION NUMBER: Dutch Trial Registry (ID: NL7823).https://bmjopensem.bmj.comhj2023Sports Medicin

The prevention of injuries among youth basketballers according to the “sequence of prevention’’ : a systematic review

BACKGROUND : Basketball is played by the youth worldwide, and various injuries occur in youth basketball. There is currently no overview of the incidence, the risk factors and preventive measures of musculoskeletal injuries among youth basketball players. OBJECTIVE : This systematic review describes the most common injuries among youth basketball players. The most common risk factors and various preventive measures and interventions have also been reported and discussed. METHODS : Search strategies were built based on groups of keywords, namely ‘injury’, ‘youth basketball’, and ‘cohort’. Search strategies were entered into Medline and SPORTDiscus. Titles, abstracts and full text articles were screened by two researchers. Data from the included articles were extracted by one researcher and checked by another researcher. RESULTS : Twenty-seven studies showed that the overall injury rate ranged from 2.64 to 3.83 per 1 000 hours of exposure. Ankle- (22%-37%) and knee injuries (5%-41%) were the most common injuries. Risk factors for knee injuries included ankle dorsiflexion with a range less than 36.5 degrees and female athletes with greater hip abduction strength. High variations of postural sway corresponded to occurrences of ankle injuries (p=0.01, OR =1.22; p<0.001, OR =1.22). A core intervention (rate = 4.99/1 000 athlete exposure (AEs)) focused on the trunk and lower extremity led to a reduction in injuries compared to a sham intervention (rate =7.72/1 000 AEs) (p=0.02). Wearing a McDavid Ultralight 195 brace reduced ankle injuries compared to the controls (HR 0.30; 95 % CI 0.17 0.90; p=0.03). CONCLUSION : Ankle and knee injuries are the most common injuries among youth basketball players. Poor postural control, reduced ankle dorsiflexion and high hip abduction strength are the main risk factors. A neuromuscular warm-up, in combination with strength and stability exercises, seems to be the best training method to prevent injuries. Ankle injuries can be reduced by wearing a lace-up ankle brace.http://sajsm.org.za/index.php/sdm2022Sports Medicin

Osteoarthritic changes in the knees of recently retired male professional footballers: a pilot study

Background: Knee osteoarthritis (OA) is common amongst retired male professional footballers. There is limited understanding with respect to the interplay between imaging findings, clinical presentation and patient-reported outcome measures (PROMs) in retired professional footballers with knee OA. Objectives: This pilot study aimed to evaluate the extent of radiological and clinical knee OA in a cohort of retired male professional footballers, and to explore the relationship between these findings and knee-related PROMs. Methods: Fifteen retired male professional footballers underwent knee radiographs and were surveyed on their history of clinical OA, severe knee injury and previous knee surgery. The Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS) and the Patient-Reported Outcomes Measurement Information System Global Health (PROMIS-GH) were used to assess health outcomes, such as level of function and pain. Results: Radiological knee OA was diagnosed in six out of 15 participants. Seven of the participants had a clinical diagnosis of knee OA. Evidence of clinical and radiological OA was present amongst four participants. Radiological knee OA and clinical OA was significantly associated with a history of severe knee injury and previous knee surgery. Low correlations (ρ&lt;-0.40) were found between knee OA severity and knee-related PROMs. Moderate correlation (ρ=-0.65) was found between clinical knee OA and KOOS-SP. Conclusion: Clinical knee OA correlates with PROMs amongst retired professional footballers but radiological OA does not. Further studies are required to understand the relationship between imaging findings, clinical presentation and PROMs amongst retired professional footballers with knee OA.