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Sports injury

Concussion in sport: Changing the “Culture”

8 Jun, 16 | by Sheree Bekker

 

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Photo by Scott Beale / Laughing Squid CC BY-NC-ND 2.0

[SB] Concussion remains the current hot topic in sports injury prevention. Injury Prevention has published many an article on the topic, including the recent An examination of concussion education programmes: a scoping review methodology. I have blogged about this here too.

I have invited Dr Johna Register-Mihalik (follow her on Twitter @johnamihalik), an assistant professor in the Department of Exercise and Sport Science at The University of North Carolina at Chapel Hill, to share her thoughts on concussion prevention with us. Dr Register-Mihalik serves as a research scientist at the Injury Prevention Research Centre at UNC-CH. She is on the Brain Injury Association of North Carolina Board and USA Baseball’s Medical and Safety Advisory Committee, and is also an active member of the National Athletic Trainers’ Association (NATA) and the American College of Sports Medicine (ACSM), amongst others.

[JRM] Few injuries receive the attention and the discussion that concussion does, especially those occurring in sports such as football, in both the mainstream and medical communities. Concussion is a complex injury that is the result of forces transmitted through the brain, resulting in a complex neurometabolic cascade leading to a wide array of signs and symptoms. The more we learn about concussion, as well as exposure to head impacts, the more we realize that we don’t know. It is an injury, that – perhaps because it is the brain that is affected – most in the sporting community are hyper aware of, regardless of level of participation.

However, due to this increasing attention and focus, one of the most common discussions and recommendations is to change the “culture” to improve safety concerning concussion and head trauma. However, when we say “change the culture”, what are we actually trying to change? Certainly, we can think of key things we want to see changed universally, such as: recognizing as many injuries as possible, student-athletes disclosing these injuries if they haven’t been identified (when possible), individuals and organizations consistently adhering to  no same day return to play, no student-athlete returning to play without clearance from a medical professional with the training to make the decision, and perhaps more general, a sporting environment that encourages safe practices, not playing through injury, and creates a positive environment for players, coaches, fans, and families alike. I am sure we could continue to add to this list of things we want to change or see as a consistent part of sport. However, most factors or behaviors around the culture of sport are complex and multifaceted.

For one, many aspects of the culture of sport that are at their core good, may progress to risky decisions down the road. Let’s take the concept of persistence and not quitting. While at the core those are good things, these may be the constructs that then drive playing through injuries, especially those like concussions that we cannot always see.  While no studies have directly addressed these relationships, data does highlight not wanting to let teammates or coaches down and not wanting to be pulled from play as primary reasons for not disclosing a concussion (McCrea, 2004, Register-Mihalik, 2013; Kerr, 2016). In addition, there is data to show that even some of the efforts that we direct to improve the culture, may have a negative effect (Kroshus et al, 2015) . This body of work highlights the importance of careful thoughtful messaging and imagery giving in our educational sessions, videos, and programs.

The type of change we talk about around concussion and head trauma is multifaceted. As such, the work to truly improve outcomes, improve behaviors, and create a “safe” environment (both social and physical) must also be multifaceted and affect multiple levels of the socio-ecological framework. It is also work that should be thoughtful, not sensationalized, and rooted in evidence – which can all be difficult things in the face of such heightened attention around a topic, where many have opinions. The work to truly insightful change will continue to require an interdiscplinary and community-based approach to not only develop the interventions and tools for change, but to see them be both successfully implemented and sustainable. I for one am excited about this work ahead and look forward to working with others to continue to see change happen for the better.

Neuromuscular control program prevents lower limb injuries in men’s community Australian Football

23 Mar, 16 | by Angy El-Khatib

Injury researchers commonly study elite athletes because they participate in athletics year-round and thus have an increased chance of sustaining an injury. However, most athletes participate at the recreational or community level. (According to the NCAA, only 1.9% of American, high school, soccer players become professional players!)

Understanding that there is a difference between the physical profile of an elite player and a community player is imperative for making recommendations for injury risk factor management. The latest publication by Finch, et al. focuses on this matter.

In the current issue of Injury Prevention, Finch, et al. provide more evidence for targeted neuromuscular control exercise programs for decreasing knee injuries and lower limb injuries (LLI). The randomized-controlled trial (RCT) evaluated 18 male, non-elite, community Australian football clubs with data from more than 1,564 people. As profiled in the study, individuals who participated in the neuromuscular control intervention had a reduced rate of LLI as compared to control players.
The intervention was implemented as a “warm-up” prior to training. The program was based on the Preventing Australian Football Injuries through eXercise (PAFIX) study ; the control group participated in a “sham” program that included similar exercises. Although not in the published article, I was curious to know what PAFIX training fully entailed. The PAFIX training manuals include a detailed look at the neuromuscular exercises implemented, including a variety of plyometric training, stability and balance exercises, and change-of-direction drills.

Despite no statistically significant findings, this “analysis indicates that clinically relevant reduced knee injury and LLI rates can be achieved through targeted exercise training programmes in men’s community AF” (Australian Football).

This finding struck me as particularly important because of the vital role of community sport and recreation programs in providing nonelite athletes with the opportunity to gain the physical literacy skills needed to benefit from participation in sport and physical activity.

I look forward to more injury research which could potentially be generalized for nonelite, athletic communities.

Planning the implementation of an injury prevention programme

22 Feb, 16 | by Sheree Bekker

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(Photo: Steve CC BY-NC-ND 2.0)

I have invited Dr Alex Donaldson (follow him on Twitter @AlexDonaldson13), of the Australian Centre for Research into Injury in Sport and its Prevention, to share a little more about their new paper published open access in Injury Prevention: “We have the programme, what next? Planning the implementation of an injury prevention programme“.

The Translating Research into Injury Prevention Practice (TRIPP) framework, developed by Caroline Finch a decade ago, built on van Mechelen and colleagues’ ‘sequence of prevention’ for sports injuries. TRIPP highlighted the fact that only research that can, and will, be adopted by sports participants, their coaches and sporting bodies will prevent sports injuries. Stage 5 of TRIPP (‘Describe intervention context to inform implementation strategies) introduced the (then) novel idea of focusing research attention on understanding how the outcomes of efficacy research (TRIPP Stage 4) could be translated into interventions (policies, programmes, environmental or technical modifications) that could be actually implemented in the real-world context. This included developing an understanding of the best way to target and market evidence-based interventions to sport bodies and their participants.

However, implementing injury prevention programmes in the real-world is challenging and there is precious little information available in the scientific literature about how to transition from having an evidence-based intervention to getting that intervention widely, properly and sustainably implemented. As a consequence, most research remains in the early stages of these models/frameworks (i.e. describing the extent of the problem and identify causes or mechanisms of injury) which limits the potential for injuries to be prevented.

In a soon to be completed study investigating the factors that influence the translation of evidence-based injury prevention interventions into practice in community sport, I (as the project manager) found myself in the situation where my colleagues and I had:

What we then needed was an implementation plan for FootyFirst. The burning question was how can we ensure that the programme we had developed will be used and maintained for as long as it is needed by community-level Australian Football coaches and players?

Luckily for me, I had recently attended a short training course facilitated by Guy Parcel (then Dean Emeritus of the University Texas School of Public Health (Austin) on Intervention Mapping (IM). IM is a framework for health promotion intervention development underpinned by the notion that the impact of a health promotion (or injury prevention) programme is a function of the programme (its efficacy) and its implementation (whether people actually use it properly for sustained periods of time). IM is a six-step tool for planning and developing health promotion programmes. Like other programme planning frameworks, it starts with needs assessment and ends in evaluation. However, unlike other frameworks, it includes a step (Step 5) specifically focused on planning programme adoption, implementation and sustainability. IM Step 5 comprises seven tasks that are operationalised through six core processes (see Figure 1) and can be used independent of the other IM steps.

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The thing I found particularly useful about IM Step 5 was that it helped me to focus my attention on answering some key questions during the FootyFirst implementation planning process including:

  1. Who will decide to use FootyFirst and who will deliver it to the players?
  2. How can we involve the delivers (coaches) and participants (players) in developing the implementation plan for FootyFirst?
  3. What do community-AF coaches actually need to do to adopt and implement FootyFirst?
  4. What is likely to influence whether coaches adopt and implement FootyFirst?
  5. What needs to change for coaches to adopt and implement FootyFirst?
  6. What strategies could be used to help, support or encourage coaches to achieve the identified changes?
  7. Why do we think a particular implementation strategy is likely to work – what is the evidence or theoretical underpinnings for the selected strategy?

Programme effects have been shown to be up to three times higher when programmes are well implemented. If your target audience doesn’t know about your programme, use it properly and use it for a sustained period of time, it is unlikely your injury prevention programme will achieve the holy grail of ‘making a difference in the real-world’. For me, using IM Step 5 helped to ensure that our programme implementation planning process was:

  • based on a partnership between health promotion, implementation science, and injury prevention researchers, and community sports administrators and coaches;
  • informed by behaviour change theory, implementation science frameworks and published evidence about effective implementation strategies for safety programmes in community sport; and
  • supplemented with in-depth knowledge of the implementation context and input from the programme end-users.

This in turn enabled us to develop an implementation plan specifically designed to bridge the gap between research (top-down) and community (bottom-up) driven programme implementation processes.

Our experience demonstrates the critical importance of researchers, practitioners and community end-users collaborating early in the implementation planning process underpinned by a mutual respect for the knowledge, skills and experience that these different groups bring to the implementation planning process.

 

 

“The Beautiful Game”… minus headers?: Discussing USSF’s recent announcement to limit headers in youth soccer leagues

23 Nov, 15 | by Angy El-Khatib

In the United States, sports-related traumatic brain injuries (concussions and otherwise) have been a HOT topic. In 2013, approximately 4,500 former NFL players sued the league, claiming that the NFL failed to educate, manage, and protect its players from head injuries. Judges approved a settlement of $765 million that would fund concussion-related compensation, including medical exams and research for ex-players. This past year, Chris Borland, a 24 year-old, highly revered linebacker, decided to retire after playing only one year of professional football. His reasoning was that football was “not worth the risk” to his health.

The NFL is not the only sporting organization looking at concussions among its players; other organizations include the National Hockey League (NHL) and the National Collegiate Athletic Association (NCAA). Most recently, the U.S. Soccer Federation (USSF) announced that it has developed a set of guidelines for its youth leagues in which it recommends a ban on headers for players ages 10 and under and a limit on headers for players between 11 and 13 years of age. The USSF also developed a standard protocol in which medical professionals, as opposed to coaches or referees, make decisions about return-to-play for players who are suspected of sustaining a concussion.

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The USSF developed these guidelines in response to a class-action lawsuit which targeted six of the largest youth soccer groups, including FIFA, U.S. Youth Soccer, and the American Youth Soccer Organization. The lawsuit claims that these organizations have “failed to adopt effective policies to evaluate and manage concussions.”

But will policy changes – “banning headers” – solve the concussion problem among youth soccer players?

Unlikely.

A September 2015 study in JAMA by Comstock, et al. evaluated trends in soccer concussions among youth players. The study found that the most common concussion mechanism was contact with another player (player-player), not a ball – this is consistent with other literature.

The most common mechanism for all concussions was contact with another player, accounting for 68.8% of all concussions among boys and 51.3% among girls. The most common mechanism among heading-related concussions was also contact with another player, accounting for 78.1% of heading-related concussions among boys and 61.9% among girls.

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Among soccer-specific activities, heading was responsible for 30.6% of concussions among boys and 25.3% of concussions among girls.

The study concludes that reducing athlete-athlete contact across all phases of play – not just headers – would be more likely to prevent concussions. It also mentions that, culturally, banning headers may not be a feasible prevention effort. After all, an integral part of the Beautiful Game is headers (Robin Van Persie during the 2014 FIFA World Cup, anyone?). The soccer community, anecdotally, seems exceptionally resistant to the prospect of banning headers. As injury researchers, we know that one of the most important aspects of a successful and effective public health intervention is cultural feasibility.

With this in mind, I don’t think it is likely the USSF’s announcement about banning or limiting headers will significantly affect the epidemiology of concussions in youth soccer.  At most, this sends a strong message to coaches and brings safety management to the forefront. (The new rule which requires a Health Care Professional, [shoutout to Athletic Trainers!] to be present to make decisions regarding concussions instead of coaches or referees could be positive, though!)

Either way, one has to commend USSF’s attempt at targeted prevention efforts to bring soccer to its high and honorable state:

 

Joga Bonito!

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P.S. – you’re not allowed to make fun of me for calling it “soccer” instead of “football”! 🙂

Howzat?! An Injury Prevention and Prediction App for Cricket?

8 Nov, 15 | by dbui

As the 1st test is underway between Australia and New Zealand at the Gabba, British Medical Journal Injury Prevention brings you an interview with Dr Naj Soomro, a physician with a passion for Technology and Sports Medicine in Cricket. I met Dr Soomro at the National Conference of Sports Medicine Australia last month where I was representing the University of New South Wales Sports Medicine Society, and his presentation was one of my personal highlights of the conference! He presented on a novel Injury Surveillance, Prevention and Prediction App, “Cricket Predict”.

Dr Soomro kindly agreed to answer a few questions for the blog!

Q1. Tell us about Cricket Predict; what is it and how did you come up with the concept?

I’ve been interested in prediction for a long time now. Today, we use technology and science to predict everything from the weather to cardiovascular risk. This carries into Sport as well: If you have a look at NFL, previous injury is used extensively in determining injury risk; Rugby players are similarly triaged using GPS data and the number of tackles per game. My aim was to develop a similar system for Cricket.

Cricket predict is a mobile app that harnesses technology in the surveillance of injuries, measures risk factors for injury and ultimately, aims to predict (and prevent!) injury. By tracking risk factors for injury in real-time, medical and coaching staff can receive alerts when an individual player’s risk profile is high – and interventions can be implemented. Further, whenever a player is injured, there is an electronic injury form which can be filled out through the app that goes onto a central online database, helping with identification of injuries.

Q2. Cricket predict utilises a number of different risk factors to help predict injury, what is the evidence for using these risk factors specifically?
The risk factors that are used in Cricket Predict are all validated in the literature. They include:
I. Cricket workload, such as number of balls bowled
II. Non-cricket workload e.g. Strength and conditioning sessions, cross-training
III. Psychological status – measured by a modified Profile of Mood States (POMS) questionnaire, usually 76 items but modified to 10 items to be cricket-specific and “player-friendly”.
IV. Sleep, a measure of fatigue and documented risk factor for injury, measured by an accelerometer and analysed by Activ Graph.
V. Previous injury profile
VI. Pre-season strength parameters, including Internal Rotation to External Rotation ratio (predicts injury in Throwing Athletes), Hamstring to Quadriceps ratio (predicts hamstring injury)

Cricket Predict’s algorithm incorporates all of these risk factors and displays to the user a graphical representation of the player’s injury risk. However, exactly how predictive these risk factors are in cricket players is yet to be studied and my research group is running a prospective validation study to do just that.
Q3. What are the implications of the findings of this study for readers?
There are 2 main implications of this research:

One of the biggest implications of my research is the integration of technology into Sports Medicine, which I see as the way forward. Its one of the reasons I developed this mobile app. Developing an electronic injury surveillance system makes data collection very easy, and numerous studies have demonstrated that electronic injury surveillance systems are superior to paper-based systems. Additionally, with the advent of wearable technology, large amounts of quantitative data can be incorporated.

Secondly, if the algorithm in Cricket Predict is validated, this research will revolutionise the way that Sportspeople play the game. Based on what we prove and validate, the coaches are going to change their coaching techniques, they will be able to select the best players for their teams, and develop policies for junior players as well.

Q4. Has this type of research been undertaken in other sports?
There is a recent article by Tim Gabbett which studied an injury prediction model in Australian Rugby League in which he was able to predict approximately 50-80% of soft-tissue non contact injuries over the course of 2 seasons. In the course of a tournament, an injury to a key player can change the balance of a team. Even if an algorithm can predict 10-20% of injuries, for an elite team that is very significant.

Q5. This research is heavily reliant on Technology, where do you see Technology and Medicine, or Technology and Injury Prevention going forward?
A lot of data that we get these days is subjective data from players, and I think the best way to quantify data and validate data is to get data electronically from the use of sensors. Sensor-based technology and imaging technology is going to go very far in terms of performance analysis and the usage of physical characteristics of players. I see the usage of wearable technology being really big in sports. What I mean by this is the use of accelerometers or gyroscopes to look at movement patterns, similar sensors to look at medical data such as the amount of perspiration, and the amount of stress hormones such as Cortisol that can be measured in saliva and also in sweat. We can also look at blood sugar levels, heart rate, oxygen saturations – all of these things can be measured using wearable technology which can send wireless information to the medical and coaching staff. One of the most important things coaches can get out of this is the amount of fatigue of their players. If we can use technology to quantify this fatigue, that is going to revolutionise sport.

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If you’d like to keep this conversation going, or be involved with Cricket Predict in the future, please get in touch with Dr Najeeb Soomro via email cricdoctor@gmail.com or Twitter @CricDoctor. Specifically, if you are a cricket club, sports scientist or health professional interested in doing injury surveillance or helping to validate the app, Dr Soomro is happy to share the app with you! 
Let us know what you think @BMJ_IP too!

David Bui is a final year medical student at the University of New South Wales and outgoing President of the University of New South Wales Sports Medicine Society. He has an interest in Orthopaedics, Sports Medicine and Injury – in all forms! @David_Bui_

Snow safety in Australia: Perceptions from a well-travelled snow sport injury researcher

12 Aug, 15 | by Sheree Bekker

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This week I have the pleasure of sharing the views of one of my colleagues here at the Australian Centre for Research into Injury in Sport and its Prevention (follow us on Twitter @ACRISPFedUni). Matthew Shumack (follow him on Twitter @snowboardPhD) is researching snow sports injury prevention (cue: research envy).

A cursory keyword search in Injury Prevention shows that snow sports injury prevention research in this journal is largely focused on head injuries and attitudes towards helmet use. Matt paints a picture below of a different, yet common-sense and just as important, consideration for snow sports safety.

I (MS) have spent the majority of my adult life chasing winter, the search for fresh snow and deep pow will continue. I am not the only one that chases the snow, Dickson even conducted a study to find out how many Australians travel for skiing and snowboarding. However, when you arrive in places like the U.S.A, Canada, or Japan the question is always asked…

“You get snow in Australia?”

Well we do, we get a lot of it. This year alone we have seen multiple evacuations from different places in Tasmania of people being snowed in. Snowboarders trapped in their car, and even a group of 10 people who needed to be airlifted out of a national park. Considering that winter is nowhere near over, awareness of the possibility of injury and even death needs to be articulated, not only our community, but to the international community as well. Last year (2014) we saw some tragic events occur over our winter, whether it was avalanche deaths, or injury and death occurring in organised ski areas.

These are not the first, and will not be the last, but the numbers may be limited with better injury prevention awareness campaigns. There is never going to be a seatbelt for skiing and snowboarding, but ensuring adequate health promotion of the risks of injury and death are needed on a wider scale.

As an interesting parallel to this, I (SB), have some Canadian friends living here in Australia (shout out to Wagga Wagga) who have told me that they never felt the cold as much in Canada as they do here. In fact, they would agree that Australian houses are just glorified tents in winter (read the interesting research linked in the article which shows that the poor quality of housing is behind many preventable deaths from exposure to cold in Australia). 

 

Concern for prehospital care/ambulance services

10 Aug, 15 | by jmagoola

I spent last week travelling in Adjumani district (located in Northern Uganda) as part of an exercise in improving the quality of immunization data through support supervision and mentor-ship. This required us as a team to visit as many of the health facilities in the district as possible. Due to the limited sources of our country, we had to make do with one of the hospital ambulances as a means of transport. In between ferrying us from one health facility to another, the driver would get calls to go pick up emergency cases that required urgent transportation to hospital.

In this scenario, all the ambulance is manned by only a driver (no paramedic, no nurse) whose role is to pick you up and drop you at the nearest health facility. One of 2 ambulanes currently used by the district to transport patients during emergencies.No triage, no first aid, no prehospital care until arrival. This could contribute to the trauma mortality rates, which are already higher in rural areas before victims reach the hospital. It is known that travel time is a predictor of the outcome of an injury and as such many fatal injuries or their severity may be reduced by adequate prehospital trauma care. A previous study in Uganda found that fewer than 5% of injured patients are transported by ambulance to hospital  most of which ambulances are privately run and expensive. In neighboring Tanzania, a study evaluating access to prehospital care found there was no prehospital care in the region.

The interior of the ambulance, lacking paramedic supplies for first aid.

The interior of the ambulance, lacking paramedic supplies for first aid.

This highlights a major need to prioritize the development of prehospital trauma care if we are to address the issue of injuries. In addition, while the presence of an ambulance will reduce the travel time to hospital and thus increase the chance of survival, the ambulances themselves should be equipped with materials to offer some basic first aid during the course of transportation. They key policy and clinical practice questions we should ask ourselves should include; how equipped are the ambulances?; what should be the minimum standards a vehicle should attain before it is designated as an ambulance?

 

BokSmart: 5 questions with Dr James Brown

15 Jul, 15 | by Sheree Bekker

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A study in the June 2015, Volume 21, Issue 3 of Injury Prevention, The BokSmart intervention programme is associated with improvements in injury prevention behaviours of rugby union players: an ecological cross-sectional study comes to us from researchers based in South Africa. This research assessed whether player behaviour improved since the launch of the BokSmart nationwide injury prevention programme for rugby union.

One of the authors on this paper, Dr James Brown, kindly agreed to answer a few questions on this work for this blog post. James is a Post-Doctoral Fellow for BokSmart and the Chris Burger Petro Jackson Players’ Fund at the Division of Exercise Science and Sports Medicine, University of Cape Town.

1) Tell us about BokSmart. What is it and why is it important?

BokSmart is a nationwide injury prevention program for rugby in South Africa. It is based on the successful New Zealand program, RugbySmart, and is a joint initiative of the national rugby federation of South Africa – the South African Rugby Union (SARU) – and the Chris Burger Petro Jackson Players’ Fund. Mainly through extensive coach and referee education, the program attempts to reduce all injuries, but specifically catastrophic (permanently disabling) injuries in players. Preventing injuries is particularly important in rugby as it is a collision sport with a higher risk of injury than most other sports and because it is particularly popular in South Africa with an estimated 400-500,000 players.

2) I know that you are active on Twitter (follow James @jamesbrown06), so what is the main message of this research in 140 characters or less?

Injury-preventing behaviours of rugby players have improved since the launch of the @BokSmart nationwide injury prevention program in South Africa in 2008

3) What are the implications of the findings of this study for readers of Injury Prevention?

The success of any intervention is reliant, in part, on the intervention’s ability to influence the behaviour of the intervention target. Thus, it was important to the BokSmart implementers to assess if there was a change in player injury-preventing behaviour. While we could not exclude other potential influences on these players’ behaviour in this ecological study, it is a positive sign that most of the behaviours improved in this five year period, particularly the behaviours that were targeted by the intervention’s implementers.

4) This research focuses on player behaviour, why is this an important component of an injury prevention programme?

Besides what is mentioned above, this study was also an important comparison to New Zealand’s evaluation of RugbySmart, as BokSmart used a very similar questionnaire to assess their players’ behaviours.

5) Tell us more about Rugby Science 

Starting the RugbyScientists.com website was an attempt to deliver some of the plethora of useful, practical scientific research that exists in rugby to the end-user. A colleague, Dr Sharief Hendricks, and I were involved in rugby at both a research and practical level as coaches/players a couple of years ago. We both had experiences a number of coaches, parents and players who asked us questions that had already been answered in the form of scientific publications. From research that Dr Hendricks had conducted, it was obvious that it would be unlikely that coaches would read any scientific publication, so we hoped this might bridge that gap.

James and I would be happy to keep this conversation going either on the comments of this blog, or over on Twitter. Feel free to contact him directly via these Rugby Science contact details.

Thank you for your insight James!

Management of sports-related concussion: is research making a difference yet?

8 Jul, 15 | by Sheree Bekker

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Sports-related concussion is currently, arguably, the most heated topic in sports injury prevention. Sensationalist media headlines and stories about the toll of concussive hits, particularly in contact sports, are all-too-common. Recently, during the FIFA Women’s World Cup, we saw this head-knock between Alexandra Popp and Morgan Brian, which once again called into question protocols around the handling of suspected concussion in sports settings.

Concussion is known to be an important issue, and its prevention is of utmost importance for the health and safety of all those who play sport. A recent study monitored the number of people treated in hospital for sport-related concussion over a period of nine years in Victoria, Australia. It showed that more people are being hospitalised for sports-related concussion than in the past, but we don’t know why. We think that better healthcare, more people knowing about concussion and the importance of being monitored for symptoms, as well as changes in the way that sport is played could all have contributed to the increase.

Concussion recognition tools and management guidelines are available freely online: the Sideline Concussion Assessment Tool (SCAT3) and the Child SCAT3  are based on this International Conference on Concussion in Sport consensus statement.

The SCAT3 clearly states:

Any athlete with a suspected concussion should be removed from play, medically assessed, monitored for deterioration (i.e., should not be left alone) and should not drive a motor vehicle until cleared to do so by a medical professional. No athlete diagnosed with concussion should be returned to sports participation on the day of injury.

Yet, as is shown in the media and on our sports fields, more often than not this advice is not followed. It is true that general knowledge about concussion symptoms is good (and most people now understand that you do not need to be knocked ‘out cold’ to experience concussion), but knowledge about concussion management in sport settings is lagging.

A recent article published in Injury Prevention, An examination of concussion education programmes: a scoping review methodology showed that concussion guidelines effected:

short-term improvements in knowledge, attitudes and behaviours; however, the long-term benefits of concussion education programmes were less clear

It has been found that coaches and sports trainers tasked with concussion management do not yet know how to fully use concussion guidelines, even if they are aware of them being available. They need more education and hands-on practical experience. Asking a player if they want to play on after a head-knock is about as useful as a chocolate teapot. Whilst it may appear a common sense question at first, we just do not know enough about how potentially concussive head-knocks affect individuals, and as such cannot rely on the athlete with potential concussion to make such a call. It is vitally important that concussion management is addressed by sports governing bodies, put into operation by clubs, and handled correctly and ethically by team doctors, coaches, and sports trainers  – for the ultimate welfare of athletes.

Research into the management of sports-related concussion can, and should, do more to effect change. Guidelines are necessary but insufficient. Conceiving injury prevention interventions differently by recognising the unique and nuanced challenges of sports culture – such as the win-at-all-costs attitude, and the celebration of hero-athletes returning to play – within complex sports settings is vital.

*Thanks Reidar Lystad for suggesting the chocolate teapot metaphor on twitter last night.

Minimising dance injury through changing dance floors

25 Jun, 15 | by Bridie Scott-Parker

As someone who has appreciated many dance performances (primarily as I have absolutely NO dancing ability or talent in any single speck of my body!), and as an injury prevention researcher and advocate, my interest was piqued by an article authored by Hopper, Alderson, Elliott, & Ackland recently published in the Journal of Science and Medicine in Sport. Having been made for martial arts instead of dancing, I can still recall as a teen the difference flooring can make when you ‘land hard’ – bouts on a tatami were much preferred to bouts in a gymnasium with wood floors (too hard) or with gymnastic mats (too soft). Shin splints already irritated by running hurdles and leaping triple jump were further aggravated by both types of floors. Similarly, Hopper and colleagues note that dance floors have the capacity to contribute to – or prevent – ankle injuries such as ankle tendinopathies and sprains. In their examination of ankle joint mechanics, 14 dancers performed drop landings on five different floors. They note that “Considering the large mechanical demand required to stabilize the ankle joint during landings, floor properties that can absorb landing energy have the potential to reduce ankle joint loads.” Given that nearly 30 years later my shin splints can be aggravated simply by playing a game of basketball with my husband and children (I have decided that it is not simply due to ageing!), it is important to prevent injury wherever possible. Minimising injury is the next best step, although I really don’t think I can blame my shin splints for my non-dancing career path. Thankfully my career does not depend on my lower legs!

Latest from Injury Prevention

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