Neuromuscular training and the risk of leg injuries in female floorball players: cluster randomised controlled study

Objective To investigate whether a neuromuscular training programme is effective in preventing non-contact leg injuries in female floorball players.Design Cluster randomised controlled study.Setting 28 top level female floorball teams in Finland.Participants 457 players (mean age 24 years)—256 (14 teams) in the intervention group and 201 (14 teams) in the control group—followedup for one league season (six months).Intervention A neuromuscular training programme to enhance players’ motor skills and body control, as well as to activate and prepare their neuromuscular system for sports specific manoeuvres.Main outcome measure Acute non-contact injuries of the legs.Results During the season, 72 acute non-contact leg injuries occurred, 20 in the intervention group and 52 in the control group. The injury incidence per 1000 hours playing and practise in the intervention group was 0.65 (95% confidence interval 0.37 to 1.13) and in the control group was 2.08 (1.58 to 2.72). The risk of non-contact leg injury was 66% lower (adjusted incidence rate ratio 0.34, 95% confidence interval 0.20 to 0.57) in the intervention group.Conclusion A neuromuscular training programme was effective in preventing acute non-contact injuries of the legs in female floorball players. Neuromuscular training can be recommended in the weekly training of these athletes.Trial registration Current Controlled Trials ISRCTN26550281.     

Training injuries in rugby league: an evaluation of skill-based conditioning games

This study investigated the site and nature of rugby league training injuries, and identified the training activities that were most likely to result in injury in rugby league players. The incidence of training injuries was prospectively studied in 60 semiprofessional rugby league players over 1 season. Injury data was collected from 72 training sessions, which included all preseason and in-season training sessions. Injuries were described according to site, type, and the training activity performed at the time of injury. The majority of injuries (90.9 per 1000 training hours, 37.5%) were sustained in traditional conditioning activities that involved no skill component (i.e., running without the ball). In contrast, the incidence of injuries sustained while participating in skill-based conditioning games (26.0 per 1000 training hours, 10.7%) was low. These results suggest that skill-based conditioning games offer a safe, effective method of conditioning for rugby league players.     

Incidence and Characteristics of Injuries during the 2010 FELDA/FAM National Futsal League in Malaysia

Objective

In Malaysia, futsal is a popular sport played by individuals across all ages and genders. Despite its popularity, information on futsal related injury in Malaysia is not available. The purpose of this study is to examine the injury incidence and injury patterns among amateur men and women futsal players in Malaysia.

Methods

Players reported injury to the tournament medical team during the FELDA/FAM National Futsal League 2010 were interviewed and assessed by a Sports Medicine registrar. Player''s socio-demographic profiles and information about the injury were documented in the injury report form adapted from medical report form used by FIFA: Medical Assessment and Research Centre (F-Marc).

Results

A total of 86 injuries were reported from 141 matches, equivalent to an incidence of 91.5 injuries per 1000 player hours (95% CI 72.2 to 110.8), or 61.0 injuries per 1000 player matches (95% CI 48.1 to 73.9). Most were minor injuries resulted from contact with another player. Injuries often involved the lower extremity (44%) followed by the trunk (14%) and the upper limb (13%). Ankle (n = 7; 39%) and knee (n = 6; 33%) sprains were the most prevalent diagnoses of time-loss injuries. A significant association between time-loss and type of injury was found χ ² (1,N = 86) = 3.99, p = 0.04. In addition, time-loss injury was significantly associated with playing surface χ ² (1,N = 86) = 10.11, p = 0.018.

Conclusion

The injury rate during the FELDA/FAM National Amateur Futsal Men''s League in Malaysia was lower compared with previous Futsal World Cups competition. Most injuries resulted from contact with another player were minor and did not lead to time-loss from participation. Time-loss injury was significantly associated with type of injury and playing surface.     

Injuries in racket sports among Slovenian players

On the sample of 83 top Slovenian athletes we have studied the frequency of injuries among table tennis, tennis and badminton players, types of injuries and severity of injuries--the latter based on data of players absences from training and/or competition processes. The most liable parts to injuries are shoulder girdle (17.27%), spine (16.55%) and ankle (15.83%), while foot (10.07%) and wrist (12.23%) are slightly less liable to injuries. The most frequent injuries in racket sports pertain to muscle tissues. According to this data, the majority of injuries occur halfway through a training session or a competition event, mostly during a competition season. The injuries primarily pertain to muscle tissues; these are followed by joint and tendon injuries. There are no differences between male and female players. Compared to other racket sports players, table tennis players suffer from fewer injuries.     

Relationship between running loads and soft-tissue injury in elite team sport athletes

Although the potential link between running loads and soft-tissue injury is appealing, the evidence supporting or refuting this relationship in high-performance team sport athletes is nonexistent, with all published studies using subjective measures (e.g., ratings of perceived exertion) to quantify training loads. The purpose of this study was to investigate the risk of low-intensity (e.g., walking, jogging, total distances) and high-intensity (e.g., high acceleration and velocity efforts, repeated high-intensity exercise bouts) movement activities on lower body soft-tissue injury in elite team sport athletes. Thirty-four elite rugby league players participated in this study. Global positioning system data and the incidence of lower body soft-tissue injuries were monitored in 117 skill training sessions during the preseason and in-season periods. The frailty model (an extension of the Cox proportional regression model for recurrent events) was applied to calculate the relative risk of injury after controlling for all other training data. The risk of injury was 2.7 (95% confidence interval 1.2-6.5) times higher when very high-velocity running (i.e., sprinting) exceeded 9 m per session. Greater distances covered in mild, moderate, and maximum accelerations and low- and very low-intensity movement velocities were associated with a reduced risk of injury. These results demonstrate that greater amounts of very high-velocity running (i.e., sprinting) are associated with an increased risk of lower body soft-tissue injury, whereas distances covered at low and moderate speeds offer a protective effect against soft-tissue injury. From an injury prevention perspective, these findings provide empirical support for restricting the amount of sprinting performed in preparation for elite team sport competition. However, coaches should also consider the consequences of reducing training loads on the development of physical qualities and playing performance.     

Creatine supplementation during college football training does not increase the incidence of cramping or injury

The purpose of this study was to examine the effects of creatine supplementation on the incidence of injury observed during 3-years of NCAA Division IA college football training and competition. In an open label manner, athletes participating in the 1998–2000 football seasons elected to take creatine or non-creatine containing supplements following workouts/practices. Subjects who decided to take creatine were administered 15.75 g of creatine for 5 days followed by ingesting an average of 5 g/day thereafter administered in 5–10 g doses. Creatine intake was monitored and recorded by research assistants throughout the study and ranged between 34–56% of players during the course of the study. Subjects practiced or played in environmental conditions ranging from 8–40°C (mean 24.7 ± 9°C) and 19–98% relative humidity (49.3 ± 17%). Injuries treated by the athletic training staff were recorded and categorized as cramping, heat/dehydration, muscle tightness, muscle strains/pulls, non-contact joint injuries, contact injuries, and illness. The number of missed practices due to injury/illness was also recorded. Data are presented as the total number of treated injuries for creatine users/total injuries observed and percentage occurrence rate of injuries for creatine users for all seasons. The incidence of cramping (37/96, 39%), heat/dehydration (8/28, 36%), muscle tightness (18/42, 43%), muscle pulls/strains (25/51, 49%), non-contact joint injuries (44/132, 33%), contact injuries (39/104, 44%), illness (12/27, 44%), number of missed practices due to injury (19/41, 46%), players lost for the season (3/8, 38%), and total injuries/missed practices (205/529, 39%) were generally lower or proportional to the creatine use rate among players. Creatine supplementation does not appear to increase the incidence of injury or cramping in Division IA college football players.     

The dominant leg is more likely to get injured in soccer players: systematic review and meta-analysis

In soccer (football), dominant limb kicking produces higher ball velocity and is used with greater frequency than the non-dominant limb. It is unclear whether limb dominance has an effect on injury incidence. The purpose of this systematic review with meta-analysis is to examine the relationship between limb dominance and soccer injuries. Studies were identified from four online databases according to PRISMA guidelines to identify studies of soccer players that reported lower extremity injuries by limb dominance. Relevant studies were assessed for inclusion and retained. Data from retained studies underwent meta-analyses to determine relative risk of dominant versus non-dominant limb injuries using random-effects models. Seventy-four studies were included, with 36 of them eligible for meta-analysis. For prospective lower extremity injury studies, soccer players demonstrated a 1.6 times greater risk of injury to the dominant limb (95% CI [1.3–1.8]). Grouped by injury location, hamstring (RR 1.3 [95% CI 1.1–1.4]) and hip/groin (RR 1.9 [95% CI 1.3–2.7]) injuries were more likely to occur to the dominant limb. Greater risk of injury was present in the dominant limb across playing levels (amateurs RR 2.6 [95% CI 2.1–3.2]; youths RR 1.5 [95% CI 1.26–1.67]; professionals RR 1.3 [95% CI 1.14–1.46]). Both males (RR 1.5 [95% CI 1.33–1.68)] and females (RR 1.5 [95% CI 1.14–1.89]) were more likely to sustain injuries to the dominant limb. Future studies investigating soccer injury should adjust for this confounding factor by using consistent methods for assigning limb dominance and tracking use of the dominant versus non-dominant limb.     

Technical and tactical analysis of youth taekwondo performance

This study aimed to analyze the technical and tactical aspects of young athletes during official taekwondo competitions. Fifty-nine youth taekwondo athletes (43 boys and 16 girls; age range: 10-12 years; weight category range: <24 to >59 kg) with at least 2 years of taekwondo training consisting of three 90-minute training sessions for 3 d·wk?1 participated in this study. Thirty-seven matches (three 1-minute rounds, with 1-minute rest in between) were analyzed to verify the differences (p ≤ 0.05) in offensive and defensive actions in relation to gender (male, female), match outcome (winners, nonwinners), kicking leg (front, rear), and round (first, second, third). No difference emerged for gender and match outcome. With respect to defensive actions (8.4 ± 12.0%), youth athletes engaged more frequently (p < 0.0001) in offensive actions (91.6 ± 12.0%), which showed a significant decrease (p < 0.016) from the first round (42.3 ± 21.8%) to the second (33.1 ± 14.8%) and third (24.5 ± 16.0%) ones. Kicks performed with the rear leg (94.4 ± 7.8%) occurred more frequently (p < 0.0001) than those performed with the front leg (5.6 ± 7.8%). In considering that a high level of coordination is required to perform front-leg kicks and defensive actions necessitate a high level of tactical skills, these findings might indicate a not-yet complete attainment of fundamental coordinative capabilities in 10- to 12-year-old athletes, independently of match outcome. To enhance coordination capabilities in youth athletes, coaches are recommended to structure their training including skill-ability and sport-ability drills.     

Urinary epinephrine and norepinephrine levels in women athletes during training and competition.

Training and competitive epinephrine and norepinephrine levels and proportions were compared in two groups of women athletes to determine whether changes in catecholamine excretion reflect the added mental stress of athletic competition on physical effort. An intercollegiate basketball team and a group of track and field athletes volunteered as subjects. Competitive epinephrine urinary levels were significantly (P less than 0.01) higher than training levels. A concomitant rise in the norepinephrine with an increase in physical effort was observed in both groups of athletes following training sessions as well as after athletic competition. Track and field athletes trying to qualify for an international team exhibited significantly ( less than 0.01) higher epinephrine levels than the team members; thus suggesting that anticipation of competition imposes a mental stress on an athlete. Constant changes in the catecholamine pattern as against a normal work load have yet to be established.     

Exercises to prevent lower limb injuries in youth sports: cluster randomised controlled trial

Objective To investigate the effect of a structured warm-up programme designed to reduce the incidence of knee and ankle injuries in young people participating in sports.Design Cluster randomised controlled trial with clubs as the unit of randomisation.Setting 120 team handball clubs from central and eastern Norway (61 clubs in the intervention group, 59 in the control group) followed for one league season (eight months).Participants 1837 players aged 15-17 years; 958 players (808 female and 150 male) in the intervention group; 879 players (778 female and 101 male) in the control group.Intervention A structured warm-up programme to improve running, cutting, and landing technique as well as neuromuscular control, balance, and strength.Main outcome measure The rate of acute injuries to the knee or ankle.Results During the season, 129 acute knee or ankle injuries occurred, 81 injuries in the control group (0.9 (SE 0.09) injuries per 1000 player hours; 0.3 (SE 0.17) in training v 5.3 (SE 0.06) during matches) and 48 injuries in the intervention group (0.5 (SE 0.11) injuries per 1000 player hours; 0.2 (SE 0.18) in training v 2.5 (SE 0.06) during matches). Fewer injured players were in the intervention group than in the control group (46 (4.8%) v (76 (8.6%); relative risk intervention group v control group 0.53, 95% confidence interval 0.35 to 0.81).Conclusion A structured programme of warm-up exercises can prevent knee and ankle injuries in young people playing sports. Preventive training should therefore be introduced as an integral part of youth sports programmes.     

Retrospective injury epidemiology of one hundred one competitive Oceania power lifters: the effects of age, body mass, competitive standard, and gender

The injury epidemiology of competitive power lifters was investigated to provide a basis for injury prevention initiatives in power lifting. Self-reported retrospective injury data for 1 year and selected biographical and training information were obtained via a 4-page injury survey from 82 men and 19 women of varying ages (Open and Masters), body masses (lightweight and heavyweight), and competitive standards (national and international). Injury was defined as any physical damage to the body that caused the lifter to miss or modify one or more training sessions or miss a competition. A total of 118 injuries, which equated to 1.2 +/- 1.1 injuries per lifter per year and 4.4 +/- 4.8 injuries per 1,000 hours of training, were reported. The most commonly injured body regions were the shoulder (36%), lower back (24%), elbow (11%), and knee (9%). More injuries appeared to be of a sudden (acute) (59%) rather than gradual (chronic) nature (41%). National competitors had a significantly greater rate of injury (5.8 +/- 4.9 per 1,000 hours) than international competitors (3.6 +/- 3.6 per 1,000 hours). The relative proportion of injuries at some body regions varied significantly as a function of competitive standard and gender. No significant differences in injury profile were seen between Open and Masters or between lightweight and heavyweight lifters. Power lifting appears to have a moderately low risk of injury, regardless of the lifter's age, body mass, competitive standard, or gender, compared with other sports. Future research should utilize a prospective cohort or case-controlled design to examine the effect of a range of other intrinsic and extrinsic factors on injury epidemiology and to assess the effects of various intervention strategies.     

Factors Associated with Fatal Occupational Accidents among Mexican Workers: A National Analysis

Objective

To identify the factors associated with fatal occupational injuries in Mexico in 2012 among workers affiliated with the Mexican Social Security Institute.

Methods

Analysis of secondary data using information from the National Occupational Risk Information System, with the consequence of the occupational injury (fatal versus non-fatal) as the response variable. The analysis included 406,222 non-fatal and 1,140 fatal injuries from 2012. The factors associated with the lethality of the injury were identified using a logistic regression model with the Firth approach.

Results

Being male (OR=5.86; CI95%: 4.22-8.14), age (OR=1.04; CI95%: 1.03-1.06), employed in the position for 1 to 10 years (versus less than 1 year) (OR=1.37; CI95%: 1.15-1.63), working as a facilities or machine operator or assembler (OR: 3.28; CI95%: 2.12- 5.07) and being a worker without qualifications (OR=1.96; CI95%: 1.18-3.24) (versus an office worker) were associated with fatality in the event of an injury. Additionally, companies classified as maximum risk (OR=1.90; CI 95%: 1.38-2.62), workplace conditions (OR=7.15; CI95%: 3.63-14.10) and factors related to the work environment (OR=9.18; CI95%:4.36-19.33) were identified as risk factors for fatality in the event of an occupational injury.

Conclusions

Fatality in the event of an occupational injury is associated with factors related to sociodemographics (age, sex and occupation), the work environment and workplace conditions. Worker protection policies should be created for groups with a higher risk of fatal occupational injuries in Mexico.     

入伍新训中膝关节损伤的特点与防治研究

目的：通过对某部新入伍官兵训练中膝关节损伤发生原因、特点进行流行性病学调查和分析,为合理训练,预防损伤发生和 治疗相关伤病提供指导依据。方法：对某部2013 年度450 名新入伍官兵的训练伤发病情况进行统计分析,重点分析膝关节损伤 发生率、伤病类型和致伤原因,并对其严重者进行关节镜治疗,观察和分析术后随访效果。结果：某部新兵的训练伤发生率为 20.0%。以关节急性扭伤最为多见,占81.1%。其中膝关节损伤共发生32 例,占训练伤发病率为7.1%,占训练伤发病率43.8%,其 中膝关节周围肌肉损伤20 例、交叉韧带损伤1 例、半月板损伤9 例、侧副韧带损伤2 例。致伤率最高的前3 位科目是5000 米负 重跑、跨越障碍训练、格斗训练,共27 例,占膝关节训练伤总数的84.4%。所有受伤患者中,12 例行手术治疗,20 例给予石膏、支具 固定、休息等保守治疗。经随访所有患者均得到较好的功能恢复。结论：对于新兵膝关节训练伤预防工作非常重要,避免致残;关 节镜手术技术的进步对于膝关节军事训练伤治疗有良好的效果。     

Neuromuscular performance of Bandal Chagui: Comparison of subelite and elite taekwondo athletes

With the aim of comparing kinematic and neuromuscular parameters of Bandal Chagui kicks between 7 elite and 7 subelite taekwondo athletes, nine Bandal Chaguis were performed at maximal effort in a selective reaction time design, simulating the frequency of kicks observed in taekwondo competitions. Linear and angular leg velocities were recorded through 3D motion capture system. Ground reaction forces (GRF) were evaluated by a force platform, and surface electromyographic (sEMG) signals were evaluated in the vastus lateralis, biceps femoris, rectus femoris, tensor fasciae lata, adductor magnus, gluteus maximus, gluteus medius, and gastrocnemius lateralis muscles of the kicking leg. sEMG data were processed to obtain the cocontraction indices (CI) of antagonist vs. overall (agonist and antagonist) muscle activity. CI was measured for the hip and knee, in flexion and extension, and for hip abduction. Premotor, reaction (kinetic and kinematic), and kicking times were evaluated. Timing parameters, except kinetic reaction time, were faster in elite athletes. Furthermore, CI and angular velocity during knee extension, foot and knee linear velocity, and horizontal GRF were significantly higher in elite than in subelite athletes. In conclusion, selected biomechanical parameters of Bandal Chagui appear to be useful in controlling the training status of the kick and in orienting the training goal of black belt competitors.     

Retrospective case evaluation of gender differences in sports injuries in a Japanese sports medicine clinic

Background: Although both gender- and sports-specific injuries exist among athletes, gender differences in the types of injuries caused by sports activities, except for anterior cruciate ligament (ACL) injury and anterior knee pain, are not well established.Objective: An observational study with a retrospective case-series design was conducted to investigate gender-specific differences in the types of injuries sustained while engaging in sports activities common to both males and females.Methods: We analyzed injuries sustained during sports activities including basketball, volleyball, tennis, skiing, track and field, and swimming, using data on age, sex, sports activities, activity levels, and sports injuries that had been computerized at our sports medicine (orthopedics) clinic. Inclusion criteria were sports activities that had a record of >100 injuries in total and athletes aged <50 years who were engaging in only 1 sports activity. We determined the absolute number of patients in each category and their percentage (proportion) of our cohort. The proportions of common injuries caused by sports activities were investigated, and gender-specific differences in the types of common injuries caused by sports activities were clarified. The Fisher exact test was used to determine the significance (P < 0.01) of the gender-specific differences in the types of sports injuries.Results: According to our database, during the 14-year period between October 1992 and December 2006, a total of 2989 athletes (1624 males and 1365 females) aged <50 years who engaged in 1 of the 6 sports activities described consulted our sports medicine clinic. The most common sports injuries were ACL injury (14.3%) and knee pain (13.7%), followed by ankle sprain (9.4%), lumbar disc disease (7.0%), meniscus injury (5.1%), stress fracture (2.9%), low back pain (2.5%), patellar tendinitis (2.1%), injury of the medial collateral ligament of the knee (2.0%), lumbar spondylolysis (1.7%), and muscle strain (1.5%). Among these 11 types of sports injuries, a significantly higher proportion of females who engaged in basketball (24.4% vs 10.5%), volleyball (20.5% vs 4.5%), or skiing (41.4% vs 26.5%) presented with an ACL injury, compared with their male counterparts (all, P < 0.001). There was also a significantly higher proportion of females than of males among the track and field athletes who presented with stress fractures (18.7% vs 3.9%; P < 0.001).Conclusion: The findings of this retrospective study suggest that there are gender-specific differences in the types of injuries sustained during sports activities.     

Oxidative stress biomarker monitoring in elite women volleyball athletes during a 6-week training period

The objectives of this study were to determine (a) if reactive oxygen metabolites (ROMs) are a reliable parameter for monitoring oxidative stress in athletes alone or in association with other parameters of oxidative stress and depending on whether antioxidant supplements are taken or not; (b) the level of oxidative stress in athletes before the competition season; and (c) if oxidative status could be improved in volleyball athletes. Sixteen women athletes (supplemented group) received an antioxidant cocktail containing vitamin E, vitamin C, zinc gluconate, and selenium as a dietary supplement during a 6-week training period, whereas 12 of them (control group) received no dietary supplement. Blood samples were taken before and after the training period. The following parameters were measured: ROMs, superoxide anion (O2??), malondialdehyde (MDA), advanced oxidation protein products (AOPP), lipid hydroperoxide (LOOH), biological antioxidative potential (BAP), paraoxonase activity toward paraoxon (POase) and diazoxon (DZOase), superoxide dismutase(SOD), total sulfydryl group concentration (SH groups), and lipid status. Reactive oxygen metabolites were taken as the dependent variable and MDA, O2??, AOPP, and LOOH as independent variables. In the group of athletes who have received supplementation, linear regression analysis revealed that the implemented model had a lower influence on dROMs (70.4 vs. 27.9%) after the training period. The general linear model showed significant differences between parameters before and after training/supplementation (Wilks' lambda = 0.074, F = 11.76, p < 0.01). At the partial level, significant increases in ROM levels (p <0.05, 95% confidence interval [CI]: 286-337), SOD activity (CI: 113-144), and BAP (CI: 2,388-2,580) (p < 0.01) were observed. The association between ROMs and other parameters of oxidative stress was reduced in athletes who received supplements. During the precompetition training period, treatment with dietary supplements prevented the depletion of antioxidative defense in volleyball athletes.     

Injuries and Post-Traumatic Stress following Historic Tornados: Alabama,April 2011

Objectives

We analyzed tornado-related injuries seen at hospitals and risk factors for tornado injury, and screened for post-traumatic stress following a statewide tornado-emergency in Alabama in April 2011.

Methods

We conducted a chart abstraction of 1,398 patients at 39 hospitals, mapped injured cases, and conducted a case-control telephone survey of 98 injured cases along with 200 uninjured controls.

Results

Most (n = 1,111, 79.5%) injuries treated were non-life threatening (Injury Severity Score ≤15). Severe injuries often affected head (72.9%) and chest regions (86.4%). Mobile home residents showed the highest odds of injury (OR, 6.98; 95% CI: 2.10–23.20). No severe injuries occurred in tornado shelters. Within permanent homes, the odds of injury were decreased for basements (OR, 0.13; 95% CI: 0.04–0.40), bathrooms (OR, 0.22; 95% CI: 0.06–0.78), hallways (OR, 0.31; 95% CI: 0.11–0.90) and closets (OR, 0.25; 95% CI: 0.07–0.80). Exposure to warnings via the Internet (aOR, 0.20; 95% CI: 0.09–0.49), television (aOR, 0.45; 95% CI: 0.24–0.83), and sirens (aOR, 0.50; 95% CI: 0.30–0.85) decreased the odds of injury, and residents frequently exposed to tornado sirens had lower odds of injury. The prevalence of PTSD in respondents was 22.1% and screening positive for PTSD symptoms was associated with tornado-related loss events.

Conclusions

Primary prevention, particularly improved shelter access, and media warnings, seem essential to prevent severe tornado-injury. Small rooms such as bathrooms may provide some protection within permanent homes when no underground shelter is available.     

The role of neuromuscular inhibition in hamstring strain injury recurrence

Hamstring strain injuries are amongst the most common and problematic injuries in a wide range of sports that involve high speed running. The comparatively high rate of hamstring injury recurrence is arguably the most concerning aspect of these injuries. A number of modifiable and nonmodifiable risk factors are proposed to predispose athletes to hamstring strains. Potentially, the persistence of risk factors and the development of maladaptations following injury may explain injury recurrence. Here, the role of neuromuscular inhibition following injury is discussed as a potential mechanism for several maladaptations associated with hamstring re-injury. These maladaptations include eccentric hamstring weakness, selective hamstring atrophy and shifts in the knee flexor torque-joint angle relationship. Current evidence indicates that athletes return to competition after hamstring injury having developed maladaptations that predispose them to further injury. When rehabilitating athletes to return to competition following hamstring strain injury, the role of neuromuscular inhibition in re-injury should be considered.     

Obesity and Occupational Injury: A Prospective Cohort Study of 69,515 Public Sector Employees

Background

Obesity and overweight are suggested to increase the risk of occupational injury but longitudinal evidence to confirm this is rare. We sought to evaluate obesity and overweight as risk factors for occupational injuries.

Methodology/Principal Findings

A total of 69,515 public sector employees (80% women) responded to a survey in 2000–2002, 2004 or 2008. Body mass index (kg/m²) was derived from self-reported height and weight and was linked to records of subsequent occupational injuries obtained from national registers. Different injury types, locations and events or exposures (the manner in which the injury was produced or inflicted) were analyzed by body mass index category adjusting for baseline socio-demographic characteristics, work characteristics, health-risk behaviors, physical and mental health, insomnia symptoms, and sleep duration. During the mean follow-up of 7.8 years (SD = 3.2), 18% of the employees (N = 12,204) recorded at least one occupational injury. Obesity was associated with a higher overall risk of occupational injury; multivariable adjusted hazard ratio (HR) 1.21 (95% CI 1.14–1.27). A relationship was observed for bone fractures (HR = 1.37; 95% CI: 1.10–1.70), dislocations, sprains and strains (HR = 1.36; 95% CI: 1.25–1.49), concussions and internal injuries (HR = 1.26; 95% CI: 1.11–1.44), injuries to lower extremities (HR = 1.62; 95%: 1.46–1.79) and injuries to whole body or multiple sites (HR = 1.37; 95%: 1.10–1.70). Furthermore, obesity was associated with a higher risk of injuries caused by slipping, tripping, stumbling and falling (HR = 1.55; 95% CI: 1.40–1.73), sudden body movement with or without physical stress (HR = 1.24; 95% CI: 1.10–1.41) and shock, fright, violence, aggression, threat or unexpected presence (HR = 1.33; 95% CI: 1.03–1.72). The magnitude of the associations between overweight and injuries was smaller, but the associations were generally in the same direction as those of obesity.

Conclusions/Significance

Obese employees record more occupational injuries than those with recommended healthy weight.     

Bodychecking Rules and Concussion in Elite Hockey

Athletes participating in contact sports such as ice hockey are exposed to a high risk of suffering a concussion. We determined whether recent rule changes regulating contact to the head introduced in 2010–11 and 2011–12 have been effective in reducing the incidence of concussion in the National Hockey League (NHL). A league with a longstanding ban on hits contacting the head, the Ontario Hockey League (OHL), was also studied. A retrospective study of NHL and OHL games for the 2009–10 to 2011–12 seasons was performed using official game records and team injury reports in addition to other media sources. Concussion incidence over the 3 seasons analyzed was 5.23 per 100 NHL regular season games and 5.05 per 100 OHL regular season games (IRR 1.04; 95% CI 1.01, 1.50). When injuries described as concussion-like or suspicious of concussion were included, incidences rose to 8.8 and 7.1 per 100 games respectively (IRR 1.23; 95% CI 0.81, 1.32). The number of NHL concussions or suspected concussions was lower in 2009–10 than in 2010–11 (IRR 0.61; 95% CI 0.45, 0.83), but did not increase from 2010–11 to 2011–12 (IRR 1.05; 95% CI 0.80, 1.38). 64.2% of NHL concussions were caused by bodychecking, and only 28.4% of concussions and 36.8% of suspected concussions were caused by illegal incidents. We conclude that rules regulating bodychecking to the head did not reduce the number of players suffering concussions during NHL regular season play and that further changes or stricter enforcement of existing rules may be required to minimize the risk of players suffering these injuries.