Musculoskeletal Injury Risk Screening: Difference between revisions
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== Why Screen for Injury Risk? == | == Why Screen for Injury Risk? == | ||
Injury rates in sports are increasing | Injury rates in sports are increasing despite the increased professionalism of sports science and sports medicine support teams. Although participation in sport is encouraged as part of a healthy lifestyle, the sport-related injury burden is high.<ref>Emery CA, Pasanen K. [https://delfamdoc.org/wp-content/uploads/2019/11/current-trends-sports-injury-prevention.pdf Current trends in sport injury prevention.] Best Practice & Research Clinical Rheumatology. 2019 Feb 1;33(1):3-15.</ref> | ||
Consequences of | === Consequences of Injuries in Sport === | ||
Financial implications for the club | * Financial implications for the club | ||
** The cost of player injuries on sports leagues and organisations mainly fall into two categories: the direct medical costs and the opportunity cost of time loss injuries and shortened careers. This has led to professional teams offering players contracts contingent upon medical evaluations and players with high injury risk being offered short-term contracts.<ref>Walia B, Boudreaux CJ. The cost of players’ injuries to professional sports leagues and other sports organizations. Managerial Finance. 2020 Jul 31.</ref> | |||
* Team performance | |||
** A significant relationship of injury rates and time loss with performance in elite team sports is reported.<ref>Hägglund M, Waldén M, Magnusson H, Kristenson K, Bengtsson H, Ekstrand J. [https://www.researchgate.net/publication/236639717_Injuries_affect_team_performance_negatively_in_professional_football_An_11-year_follow-up_of_the_UEFA_Champions_League_injury_study Injuries affect team performance negatively in professional football: an 11-year follow-up of the UEFA Champions League injury study]. British journal of sports medicine. 2013 Aug 1;47(12):738-42.</ref> | |||
* Financial implications for the healthcare system | |||
** Finch et al <ref name=":0">Finch CF, Kemp JL, Clapperton AJ. [https://www.sciencedirect.com/science/article/pii/S1063458415002095 The incidence and burden of hospital-treated sports-related injury in people aged 15+ years in Victoria, Australia, 2004–2010: a future epidemic of osteoarthritis?]. Osteoarthritis and cartilage. 2015 Jul 1;23(7):1138-43.</ref> investigated the trends and burdens of hospital-treated sports injuries in Australia and estimated the direct cost of sport-related injury over 7 years to be $265 million Australian dollars.<ref name=":0" /> | |||
* Financial costs for the individual | |||
** The inability to perform has significant impact on an athlete’s earnings. Secrist et al<ref>Secrist ES, Bhat SB, Dodson CC. [https://journals.sagepub.com/doi/full/10.1177/2325967116663921 The financial and professional impact of anterior cruciate ligament injuries in National Football League athletes.] Orthopaedic journal of sports medicine. 2016 Aug 30;4(8):2325967116663921.</ref> showed that players in the National Football League with an ACL injury earned on average $2,070,521 less than salary-matched controls over the 4 years after the injury. | |||
* Implications for long term health | |||
** It has been shown that knee injuries such as ACL or meniscal injury increases the odds of subsequent knee OA development<ref>Poulsen E, Goncalves GH, Bricca A, Roos EM, Thorlund JB, Juhl CB. Knee osteoarthritis risk is increased 4-6 fold after knee injury–a systematic review and meta-analysis. British journal of sports medicine. 2019 Dec 1;53(23):1454-63.</ref> | |||
* Career progression in sports | |||
** Larukain et al<ref name=":1">Larruskain J, Lekue JA, Martin-Garetxana I, Barrio I, McCall A, Gil SM. Injuries are negatively associated with player progression in an elite football academy. Science and Medicine in Football. 2021 Jun 16(just-accepted)</ref> demonstrated a negative association between injuries and player progression in an elite football academy with players that progressed to the next level having a lower injury burden and higher match availability compared to players that did not progress.<ref name=":1" /> | |||
Career progression in sports | |||
Larukain et al | |||
Injury Prediction | Injury Prediction |
Revision as of 14:04, 25 August 2021
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Introduction[edit | edit source]
Reasons for the Periodic Medical Assessment of Athletes[edit | edit source]
The main reason for the periodic medical assessment of athletes is to safeguard sports participation, but there are many more beneficial reasons as well. Some of the reasons include[1]:
- Identification of medical conditions that contraindicate sports participation
- Assessment of known injuries and illnesses
- Review of current medications and supplements
- Athlete education
- Baseline testing
- Development of athlete rapport
- Specific Screening
- Cardiac screening
- Screening for unknown illnesses
- Screening for risk factors for future injury
Why Screen for Injury Risk?[edit | edit source]
Injury rates in sports are increasing despite the increased professionalism of sports science and sports medicine support teams. Although participation in sport is encouraged as part of a healthy lifestyle, the sport-related injury burden is high.[2]
Consequences of Injuries in Sport[edit | edit source]
- Financial implications for the club
- The cost of player injuries on sports leagues and organisations mainly fall into two categories: the direct medical costs and the opportunity cost of time loss injuries and shortened careers. This has led to professional teams offering players contracts contingent upon medical evaluations and players with high injury risk being offered short-term contracts.[3]
- Team performance
- A significant relationship of injury rates and time loss with performance in elite team sports is reported.[4]
- Financial implications for the healthcare system
- Financial costs for the individual
- The inability to perform has significant impact on an athlete’s earnings. Secrist et al[6] showed that players in the National Football League with an ACL injury earned on average $2,070,521 less than salary-matched controls over the 4 years after the injury.
- Implications for long term health
- It has been shown that knee injuries such as ACL or meniscal injury increases the odds of subsequent knee OA development[7]
- Career progression in sports
Injury Prediction
Can we predict injuries?
Association vs prediction articles
Factors involved in the development of injuries
There are various factors that play a role in the risk of injury occurrence, and these factors can interact with each other.
Training-related factors
Training volume, load, intensity
Type of training
Training and competition schedule
Rest
Motor control factors
Posture
Movement patterns
Muscle tone
Technique
Sport specific movements
Psychological factors
Beliefs
Fears
Coping strategies
Self-efficacy
Catastrophising
Emotional status (stress, depression, anxiety)
Health-related factors
Diet
Medication
General health
Fatigue
Sleep patterns
Non-modifiable factors
Gender
Age
Maturation stage
Body type
Genetics
Previous injuries
Environmental factors
Training/competition surface
Equipment
Clothing
Weather
Coaching
Conditioning factors
Strength
Endurance
Muscle length
Joint range of motion
Chronic capacity
Additional demands
Home
Work
Family
Social
Leadership
Media
Sponsors
Other factors
Sport specific skill level
Ranking and status
Goals of athlete – short and long term
When considering injury screening it is important to consider this myriad of factors that can influence injury occurrence. Furthermore, it is unlikely that these can be reduced to a single factor that may lead to injury occurrence. Factors that are commonly screened for in musculoskeletal injury risk screening are: strength and conditioning; movement quality and stability/alignment. From the map by Bolling et al it is evident that these factors are just a few of numerous factors that can be involved in injury occurrence. – download Bolling image and edit and upload
Predispose vs Predict
Instead of trying to predict injury occurrence, it may be more appropriate to identify athletes who are predisposed and where possible modify the predisposition.
Non-modifiable predispositions
Anatomy
Genetics
Previous injury
Environmental factors
Modifiable predispositions
Long-term
Strength
Movement
Skill
Flexibility
Short term
State of the athlete
How does the athlete feel?
Tired?
Stressed?
This flow diagram illustrates how predispositions and exposure to load can lead to vulnerability in an athlete and in combination with an inciting event this can lead to injury mechanisms and occurrences
Exposure = load applied through training, match-time
Vulnerability = predisposed athlete exposed through load applied eg playing a game
Add image of flow diagram
Considerations in identifying predisposed athletes
Understand the nature of the sport and the injuries occurring
Common injuries vs Catastrophic injuries (for example hamstring injuries vs ACL injuries soccer)
Identify which injury needs to be targeted as this will determine what types of screening tests will be used
Do these specific injuries have modifiable factors?
Are there clearly definable physical qualities related to the injury? ? Can these modifiable factors be clearly defined in terms of certain physical qualities?
Can these physical qualities be identified with reliable screening tests?
Can these physical qualities be influenced ie modified and changed? (Example – blue eyes are predisposing to a certain type of injury: one can easily and reliably screen for it, but eye colour can not be changed, modified or influenced.)
Traumatic injuries in the sport – how influenceable are traumatic injuries through screening and training?
Screening for Neuromuscular Control of Movement
Neuromuscular control is the ability to perform a movement in the best possible way to minimise loading stress or maximise the distribution of loading stresses on the tissue involved. (Herrington book chapter). An important part of “movement screening” is to identify the high-risk movement tasks and can these tasks be broken down into closed skills. A closed skill is undertaken in a controlled environment where the athlete only focuses on that specific skill (e.g single leg squat or single-leg landing). An open skill is undertaken in a very chaotic and random environment (e.g. single-leg landing in the middle of a sporting environment such as competition or match). The context in which these movements take pace will have an influence on performance as well as the risk for injury. For example, an athlete may pass a closed skill test/task such as single-leg landing at the pre-season screening, but still get injured (i.e. ACL injury) as a result of a single-leg landing in a sporting environment such as a competition.
Factors to consider when selecting a task/screening test
Nature of activities undertaken in the specific sport
Nature of the major injuries in the specific sport (are these linked to specific movements or activities?)
Athlete’s injury history (can the previous injuries be linked to specific movements or activities?)
Factors influencing neuromuscular control of movement
Strength
Joint range of motion
Muscle length – flexibility
Proprioception – joint position sense
Movement dissociation
Sport specific skill
Building a Paradigm for Injury Risk Screening
Consider Predisposition vs Prediction
Screening tests can’t predict if an athlete will get injured, but we can screen and look for predisposed athletes. Remember that being predisposed to a certain injury does not mean that the athlete will get injured. Also, if an athlete does not have a predisposition to an injury, this is not a guarantee that the athlete won’t be injured. Athletes become vulnerable to injury when they are exposed to load and inciting events. (see flow diagram)
Identify if force generation, force absorption or movement skill is an issue in predisposition
Identify the predisposing movement task/s
Break down the identified movement task into close skills that can be measured reliably
If the athlete fails the test/task, identify the reasons for failure
Build ways to improve the skill in a controlled environment but then also in training and competition
Sub Heading 3[edit | edit source]
Resources[edit | edit source]
- bulleted list
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or
- numbered list
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References[edit | edit source]
- ↑ Targett S, Clarsen B. Periodic medical assessment of athletes. In: Brukner P, Clarsen B, Cook J, Cools A, Crossley K, Hutchinson M, McCroy P, Bahr R, Khan K. Brukner and Khan's Clinical Sports Medicine: Injuries, Volume 1, 5e. Sydney: McGraw Hill Education. 2017
- ↑ Emery CA, Pasanen K. Current trends in sport injury prevention. Best Practice & Research Clinical Rheumatology. 2019 Feb 1;33(1):3-15.
- ↑ Walia B, Boudreaux CJ. The cost of players’ injuries to professional sports leagues and other sports organizations. Managerial Finance. 2020 Jul 31.
- ↑ Hägglund M, Waldén M, Magnusson H, Kristenson K, Bengtsson H, Ekstrand J. Injuries affect team performance negatively in professional football: an 11-year follow-up of the UEFA Champions League injury study. British journal of sports medicine. 2013 Aug 1;47(12):738-42.
- ↑ 5.0 5.1 Finch CF, Kemp JL, Clapperton AJ. The incidence and burden of hospital-treated sports-related injury in people aged 15+ years in Victoria, Australia, 2004–2010: a future epidemic of osteoarthritis?. Osteoarthritis and cartilage. 2015 Jul 1;23(7):1138-43.
- ↑ Secrist ES, Bhat SB, Dodson CC. The financial and professional impact of anterior cruciate ligament injuries in National Football League athletes. Orthopaedic journal of sports medicine. 2016 Aug 30;4(8):2325967116663921.
- ↑ Poulsen E, Goncalves GH, Bricca A, Roos EM, Thorlund JB, Juhl CB. Knee osteoarthritis risk is increased 4-6 fold after knee injury–a systematic review and meta-analysis. British journal of sports medicine. 2019 Dec 1;53(23):1454-63.
- ↑ 8.0 8.1 Larruskain J, Lekue JA, Martin-Garetxana I, Barrio I, McCall A, Gil SM. Injuries are negatively associated with player progression in an elite football academy. Science and Medicine in Football. 2021 Jun 16(just-accepted)