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A-42 Free Communication/Poster - Injury Epidemiology

Medicine & Science in Sports & Exercise: May 2013 - Volume 45 - Issue 5S - p 63–66
doi: 10.1249/

May 29, 2013, 7:30 AM - 12:30 PM

Room: Hall C

290 Board #142 May 29, 11:00 AM - 12:30 PM

Playing Dirty: The Ball as a Fomite for Transmission of Staphylococcus Aureus

Nimesh A. Patel. University of California, Irvine, Irvine, CA.

Supported by N.A. Patel: Intellectual Property; Arthur Kreitenburg.

The emergence of Community-Associated Methicillin Resistant Staphylococcus Aureus (CA-MRSA) has gained national awareness amongst many sport-governing bodies due to its potential for serious infection. Because of their repeated exposure to unclean environments, athletes represent one of the populations most vulnerable to the effects of CA-MSRA.

PURPOSE: To better understand the role of the sports ball in transmission of Staphylococcus aureus between players and the gym environment.

METHODS: Three different trial conditions were employed to measure the transfer of Staph. aureus that occurred between three surfaces - hands, ball, and floor – following play. In each condition, two of the three surfaces were initially sterilized, allowing for a transfer dynamic that was predictably directional via the sports ball. To initiate bacterial transfer to the various surfaces, typical sport play was then simulated within recreational indoor courts. The presence of bacteria was measured before and after play using media selective for Staph. aureus.

RESULTS: The first condition, where hands were not sterilized, resulted in a significant transfer from hands to the ball (hands: 23.5±22.1 to 11.1±20.5 CFU, ball: 0 to 1.5±2.3 CFU) but no transfer to the floor. An unsterilized ball was used in the second condition where there was a small but significant increase in colony counts on the hands following sport play (2.1±1.9 to 5.9±3.1 CFU). During the third condition, an unsterilized gym floor was analyzed. There was a significant amount of transfer from the gym floor to the ball (floor: 38.6±57.8 to 7.9±5.5 CFU, ball: 3.0±9.8 to 44.0±486) and then to the hands (2.3±4.0 to 21.7±11.2 CFU).

CONCLUSIONS: Staph. aureus is effectively transmitted through the sports ball to athletes during typical play. However, further studies are required to more thoroughly explore the factors which impact transmission, such as the duration of exposure. Nevertheless, these findings elucidate the need for prevention strategies aimed at ameliorating the health hazards implicit in sports activities.

291 Board #143 May 29, 11:00 AM - 12:30 PM

Injury Risk and Performance among Soldiers Wearing Minimalist Running Shoes Compared to Traditional Running Shoes

Tyson Grier1, Michelle Canham-Chervak1, Timothy T. Bushman1, Morgan Anderson1, Will North2, Bruce H. Jones, FACSM1. 1United States Army Institute of Public Health, Aberdeen Proving Ground, MD. 2Henry Jackson Foundation, Fort Carson, CO.

(No relationships reported)

Minimalist running shoes (MRS) are lightweight, extremely flexible and have little to no cushioning. It has been thought that MRS will enhance running performance and decrease injury risk.

PURPOSE: To compare physical characteristics, fitness performance, and injury risks associated with Soldiers wearing MRS and those wearing traditional running shoes (TRS).

METHODS: Participants were men in a U.S. Army Brigade Combat Team (n=1332). Physical characteristics and Army Physical Fitness Test (APFT) data were obtained by survey. Fitness performance testing was administered at the brigade and the types of footwear worn were identified by visual inspection. Injuries from the previous 24 months were obtained from the Defense Medical Surveillance System. Shoe types were categorized into 2 groups: TRS (cushioning, stability, motion control) and MRS. A T-test was used to determine mean differences between personal characteristics and fitness performance metrics by shoe type (MRS vs. TRS). Hazard ratios (HR) and 95% confidence intervals (95%CI) were calculated to determine injury risk.

RESULTS: A majority of the Soldiers wore cushioning shoes (57%), followed by stability shoes (24%), MRS (17%), and motion control shoes (2%). Soldiers wearing MRS were younger than those wearing TRS (24.3±5.4 years vs. 25.3±4.8 years, p<0.01), performed more push-ups (69.1±13.5 vs. 64.2±13.4, p<0.01), more sit-ups (71.6±11 vs. 68.3±12.1, p<0.01), ran faster during the 2 mile run (14.5±1.5 vs. 14.8±1.6, p=0.01), excelled on the vertical jump test (23.5±4.2 vs.22.6±4.4, p<0.01), performed more pull-ups (7.7±5.2 vs.6.2±4.4, p<0.01), completed the 300 yard shuttle run faster (70.1±8.1 vs.71.8±9.1, p=0.03), and scored higher on the Functional Movement Screening test (17±2.2 vs. 16.3±2.5, p<0.01). When controlling for personal characteristics, physical fitness, and a history of prior injury, there was no difference in injury risk in the previous 12 months between Soldiers wearing MRS compared to Soldiers wearing TRS (HR (MRS vs.TRS) 95%CI): 1.03 (0.80-1.33, p=0.82).

CONCLUSIONS: Soldiers who chose to wear MRS were younger and had higher physical performance scores compared to Soldiers wearing TRS. Controlling for these differences, use of MRS does not appear to be associated with higher or lower injury risk in this population.

292 Board #144 May 29, 11:00 AM - 12:30 PM

Definitions Used To Refer To A Running-related Musculoskeletal Injury: A Systematic Review

Tiê P. Yamato1, Bruno T. Saragiotto1, Luiz Carlos Hespanhol Junior1, Simon Yeung2, Alexandre D. Lopes1. 1Universidade Cidade de São Paulo, São Paulo, Brazil. 2Hong Kong Polytechnic University, Hong Kong, China.

(No relationships reported)

Running is one of the most popular kinds of physical activity in the world. Despite the well-known health benefits of running the number of running-related musculoskeletal injuries is high varying between 19% and 92%. The definitions of running-related musculoskeletal injury are based on different structures and criteria. This lack of standardization for the definition of RRMI hinders comparisons between the different rates of prevalence and incidence reported in the literature.

PURPOSE:To review the definitions of running-related musculoskeletal injury.

METHODS: The searches were conducted on EMBASE (1981 to May 2012), MEDLINE (1973 to May 2012), SPORTDiscus (1977 to May 2012), LILACS (1986 to May 2012) and SCIELO (1998 to May 2012) database. We included only articles that gave a definition of musculoskeletal injury applied to the runner population. Three independent reviewers analysed the title, abstract and full text of the articles and if they did not reach a consensus, a fourth reviewer decided whether or not the article should be included. The articles’ risk of bias was assessed by four criteria based and adapted of previous studies. To analyse the structure of the definitions for RRMI in each study, the definitions were divided on three main characteristics with subdivisions (between brackets): 1) presence of physical complaint (symptom, involvement, region); 2) need to interrupt training and/or competition (race condition, consequence, factor, interruption, restriction of the time of injury); and 3) seeking medical assistance (medical assistance/medication).

RESULTS: The search results identified 1934 studies in which 42 studies were included in this review. The risk of bias assessment showed that most of the articles met at least three of the four criteria, which represents a low risk of bias for the majority of the studies. We found that the definitions contained similar structures regards to the three main characteristics analysed. The subdivisions that had the greatest number of terms used to describe them were symptom, consequence and factor.

CONCLUSIONS: The different definitions of running-related musculoskeletal injuries found in this systematic review are based on informing the presence of physical complaint and/or the need for a minimum period of interruption to training or racing.

293 Board #145 May 29, 11:00 AM - 12:30 PM

Common Injuries in Judo: A Descriptive Study

Juan C. Galloza, Gualberto Oquendo, William Micheo, FACSM, Roxanna Amill, Juan C. Perez. University of Puerto Rico-Medical Sciences Campus, San Juan, PR.

(No relationships reported)

PURPOSE: To investigate the most common types of injuries present in judo athletes and how these may affect training and competition.

METHODS: 93 judo athletes (ages 15 +) were recruited from 8 different judo clubs in Puerto Rico (all athletes were members of the National Judo Federation). Participants completed questionnaires to assess body area affected by injury, type of injury, mechanism of injury, time off from judo practice due to injury, and whether injury was sustained during practice or competition. Gender and experience level associations were made using Pearsons Chi-Square correlation.

RESULTS: Average age was 26 years. Most (67%) of athletes had participated more than 5 years in judo. Experience levels (Belts) ranged from white-orange (29%), green-brown (37%) and Black (33%). Competition categories ranged from 48kg to >78kg (females) and >100kg (males). Average weekly practice time was 9 hours.

83% of all athletes reported injuries. The 4 most common body areas affected by injury were ankle/foot (20%), Fingers (15%), Shoulder (13%) and knee (12%). The 5 most common types of injury were ligament injury (excluding ankle sprain) (25%), ankle sprain (23%), contusion/hematoma (14%), fracture (11%). Most injuries occurred while fighting Tachiwaza (Standing) (96%) vs. Newaza (Floor) (4%). Of all injuries, 28% did not require time off from practice. Of the remaining 72% that did required time off from practice, the average time was 51 days. Most injuries occurred during practice (72%) vs. competition (28%). No association was found (P=0.511) between males or females and the rate of injury. An association was found (P<0.05) between less experience level and a lower rate of injury.

CONCLUSIONS: In this initial report of our ongoing study our data shows that injuries among judo athletes are common. Injuries occurred more commonly during practice than during competition. The majority of injuries occurred while fighting Tachiwaza. There is no difference between male and female athletes and the rates of injury. Judoka’s with less experience level had lower rates of injury. This finding may be explained by lower level of competition or less years practicing the sport. Further scientific study is needed to understand injury patterns, risk factors and injury mechanisms for the different groups studied.

294 Board #146 May 29, 11:00 AM - 12:30 PM

Profile of Health Service Utilization During the XVI Pan American Games: Delegation of Puerto Rico

Gerardo E. Miranda, Luis Baerga. University of Puerto Rico School of Medicine, San Juan, PR. (Sponsor: William Micheo, FACSM)

(No relationships reported)

PURPOSE: The aim of the study is to describe the health care service utilization and pathology patterns of the Puerto Rican delegation during the XVI Pan American Games in Guadalajara 2011. We want to use our findings to prepare for future events and implement preventive measures.

METHODS: The medical records of each intervention in the Puerto Rico Delegation medical clinic in the Pan American village were evaluated. Services included primary care and musculoskeletal medicine, physical therapy, and psychology. The information included the date of the intervention, the name, gender, age, sport, and role in the delegation of the patient. The duration of symptoms, diagnosis, and therapeutic intervention were recorded for each intervention.

RESULTS: The Puerto Rican delegation was composed of 406 members. A total of 355 interventions were made in the Pan American village medical clinic. The primary care clinic evaluated 112 patients in 134 interventions. The most common complaints were respiratory (45%), gastrointestinal (11%), and dermatologic (10%). Meanwhile in the musculoskeletal injury clinic 160 patients were evaluated for a total of 223 interventions. The most common diagnoses were tendinopathies (22.4%), strains (13%), and sprains (13%). The knee (17%), the shoulder (13.5%), and the lumbar spine (12.6%) were the most often involved anatomic areas. Sonography was used in 56 interventions (25% of all interventions) to aid in the diagnosis, therapeutic decisions, and procedures. The physical therapy service made a total of 908 interventions in the clinic and on-field. In the clinic area most interventions involved physical modalities, such as, electrical stimulation (18%), superficial heat (17%), cryotherapy (17%), and therapeutic ultrasound (15%). On-field interventions mostly included cryotherapy (41%), massage (22%), stretching (19%), and athletic taping (16%). The psychology service made a total of 224 interventions including individual and group therapy sessions.

CONCLUSIONS: Musculoskeletal injuries involved most health services interventions, but a primary care, physical therapy, and psychology services play a major role in international competition medical coverage. The use of technology such as sonography assists in diagnostic, therapeutic, and participation decisions.

295 Board #147 May 29, 11:00 AM - 12:30 PM

Epidemiology of Musculoskeletal Injuries in a Sports Specialized School

Alexandra Rivera-Vega, Rafael Acevedo, Gerardo E. Miranda. University of Puerto Rico, San Juan, Puerto Rico. (Sponsor: William Micheo, FACSM)

(No relationships reported)

PURPOSE: The primary aim of this study is to describe the epidemiology of musculoskeletal injuries in a sports specialized middle and high school. We want to evaluate injury frequency and patterns by gender, grade level, and sport specific issues in order to establish injury prevention protocols.

METHODS: The medical records from the Center of Sports Medicine and Exercise Sciences in the Olympic Training Facility medical clinic were review. We collected data from patients that were part of the Sports-Specialized Community School located in the Olympic Training Facility during the previous five school years. Injury was defined as any event that occurred during participation of sport requiring medical attention from physician at our clinic resulting in restriction or modification of participation for ≥1 days beyond the day of injury. Subject information included gender, grade level, and sport. Each injury was classified according to anatomic region, diagnosis, type, and severity.

RESULTS: A total of 337 subjects from nineteen sport disciplines (74 boys and 263 girls) were included, of which 149 were in middle school and 188 were in high school. A total of 496 musculoskeletal injuries were evaluated. Track and field athletes were the most commonly injured (24%), and there was no difference in the number of injured individuals between contact and non-contact sports. The most commonly involved anatomic region were the lower extremities (58%), especially the knee (21%) and the ankle (15%), followed by the upper extremities (22%) and the spine (16%). Muscle strain and ligament sprain were the most common diagnosis (23% each), followed by contusions (15%) and tendinopathies (13%). Acute injuries (67%) occurred more often than overuse injuries (33%). Additionally, mild injuries were more predominant (66%) than moderate or severe injuries (22% and 11%, respectively).

CONCLUSION: A sports-specialized school exposes young athletes to high levels of training load and intensity that may lead to increased number of injuries; therefore, the understanding and early injury recognition is important in treating these patients, and providing preventive recommendations.

296 Board #148 May 29, 11:00 AM - 12:30 PM

The Use of Ankle Injury Prevention Programs in High School Basketball Settings

Timothy A. McGuine, M. Alison Brooks, Scott Hetzel, Anthony Pennuto. University of Wisconsin, Madison, WI.

(No relationships reported)

Ankle injuries are the most common injury in high school basketball. Sports medicine providers cite the efficacy of Ankle Injury Prevention Programs (AIPP) to reduce the incidence of ankle injuries in basketball players. However, little is known regarding: 1) the extent AIPP are utilized in high school settings, 2) perceived barriers for the implementation of AIPP and 3) specific formats and components coaches prefer to implement AIPP.

PURPOSE: Determine high school basketball coaches’ attitudes and behaviors regarding the use of AIPP to reduce ankle injuries

METHODS: An electronic survey was sent to all (N = 868) basketball coaches at 412 Wisconsin high schools during the 2011-2012 season. Fischer’s Exact Tests were used to determine if years coaching, school enrollment or team gender (male vs female) were associated with the use of AIPP. Response frequencies were reported for barriers faced by coaches and program formats.

RESULTS: A total of 480 (55.2%) coaches from 299 high schools completed the survey. Fifty one percent coached female teams while 49% coached male teams. Respondents were primarily head coaches at the varsity (n = 407, 86%) junior varsity (n = 43, 9%) freshmen (n = 30, 5%) level. Fifty percent (n = 242) of the coaches indicated they do not utilize an AIPP. There was no difference in utilization of AIPP based on years coaching (p = 0.78), school enrollment (p = 0.47) or team gender (p = 0.41). Coaches who did not utilize AIPP indicated they did not have time (54%), expertise (50%) or awareness (47%) to implement them. Coaches indicated they would prefer an AIPP that combined injury prevention and performance enhancement components (85%), lasted 15 minutes or less (81%), was performed 2 to 3 days per week (78%) and specific to basketball (67%).

CONCLUSIONS: Half of coaches surveyed did not utilize an AIPP, stating a lack of awareness, time and expertise. Use of an AIPP was not associated with coaching experience, school enrollment or team gender. Coaches indicated strong preferences for a brief, sport-specific, combined injury prevention and performance enhancement program not performed on a daily basis. Sports medicine providers need to work directly with coaches to emphasize the efficacy of AIPP and to develop strategies for overcoming barriers to use in high school settings.

297 Board #149 May 29, 11:00 AM - 12:30 PM

Descriptive Epidemiology of Musculoskeletal Injuries in Naval Special Warfare Personnel

Mita Lovalekar, John P. Abt, Timothy C. Sell, Karen Keenan, Anthony Zimmer, Scott M. Lephart, FACSM. University of Pittsburgh, Pittsburgh, PA.

(No relationships reported)

Injury prevention is of utmost importance in the Naval Special Warfare (NSW) population. The first step in the Public Health Model as applied to injury prevention is measuring the burden of injuries in the population of interest. Previous studies examining musculoskeletal injuries in NSW personnel have utilized either medical chart review (MCR) or self-report (SR), but not both. MCRs yield only those injuries for which medical care was sought. SR injuries are prone to issues with lack of recall, especially as time since injury increases. Using both methods provides further detail of the injury burden.

PURPOSE: To describe both MCR and SR musculoskeletal injuries in the NSW population.

METHODS: Two hundred thirty five NSW personnel volunteered (age 28.3 ± 5.8 years, height 1.8 ± 0.1 meters, weight 85.7 ± 9.4 kilograms). MCR and SR injuries were obtained by certified athletic trainers, and musculoskeletal injuries sustained during the calendar year prior to the year of survey were described. Injury description included anatomic location, activity when injury occurred, and injury type.

RESULTS: MCR were reviewed for 108 subjects and SR were obtained for 226 subjects. For both MSR and SR data, the average numbers of injuries recorded during one year were 0.32 per subject. Anatomic distribution for MCR injuries was - upper extremity (UE): 45.7%, lower extremity (LE): 34.3%, spine: 17.1% and torso: 2.9%. Anatomic distribution for SR injuries was - LE: 47.2%, UE: 37.5%, spine: 8.3%, torso: 4.2% and head/face: 2.8%. The most common anatomic sub-location was the shoulder (28.6%) for MCR injuries, and the ankle and shoulder (16.7% each) for SR injuries. Subjects were engaged in training for 40.0% of MCR and 56.9% of SR injuries. Subjects were engaged in recreational activity/ sports for 8.6% of MCR and 20.8% of SR injuries. Common MCR injury types were strains (25.7%), pain/spasm/ache (20.0%), and fracture (11.4%). Common SR injury types were fracture (26.4%), sprain (13.9%), and strain (12.5%).

CONCLUSION: The analysis shows that musculoskeletal injuries are common in the NSW population. Many of these injuries are potentially preventable by an injury prevention and performance optimization program.

Supported by the Office of Naval Research #N00014-11-1-0929

298 Board #150 May 29, 11:00 AM - 12:30 PM

Extremity Cooling Reduces Exertional Heat Injury Severity During Military Training

David DeGroot, FACSM1, Robert W. Kenefick, FACSM2, Michael N. Sawka, FACSM2. 1US Army Public Health Command, Aderbeen, MD. 2US Army Research Institute of Environmental Medicine, Natick, MA.

(No relationships reported)

A number of studies have reported the effects of extremity immersion in cool water for accelerating the rate of body cooling after an event or during rest intervals. We have developed an Arm Immersion Cooling System (AICS) as to means to provide cooling in a military training environment; however the effects of systematic application of the AICS on exertional heat injury (EHI) severity are unknown.

PURPOSE: The purpose of this retrospective study was to determine the efficacy of the AICS for reducing the severity of EHI in a military training environment.

METHODS: An Army training school has been using 25 AICS units since August 2010, during the initial high-intensity training phase of the course. Additionally, beginning in 2007 this training school has maintained a database of EHI casualties, which includes data on whether a suspected EHI casualty was transported to the hospital and if so, whether the casualty was hospitalized or not. A case was defined as an individual who was seen by a medic or physician assistant and diagnosed with any form of EHI. As the database only contains de-identified data, medical records were unavailable and hospitalization status was used as a proxy indicator of injury severity.

RESULTS: During the pre-AICS (control) study period, there were 87 EHI cases. Of those, 77 (89%) were evacuated to the hospital and 47 (54% of the total) were hospitalized. In contrast, during the post-AICS implementation (experimental) period, there were 46 EHI cases, 52% of whom were evacuated to the hospital; 15 of these cases (24% of the total) were hospitalized.

CONCLUSIONS: The reduction in hospitalized cases, from 52% to 24% of total EHI cases, strongly suggests a reduction in injury severity due to AICS implementation during military training.

299 Board #151 May 29, 11:00 AM - 12:30 PM

Assessing Performance-Related Shoulder Pain In The Musical Athlete - Are Typical Shoulder Examinations Enough?

Bronwen J. Ackermann, Tim Driscoll. University of Sydney, Sydney, Australia. (Sponsor: Randall Dick, FACSM)

(No relationships reported)

PURPOSE:To compare self-reports of playing-related shoulder pain and physical examination data between two groups of professional orchestral musicians with contrasting task demands. The trombone requires sustained left shoulder instrument support while the right arm moves the slide back and forth. For the cello, the right bowing arm moves continually back and forth into shoulder elevation ranges in excess of 90 degrees.

METHODS: From 8 national orchestras, the self-report data from 16 trombonists (15 males, 1 female) and 46 cellists (23 males, 23 females) was analysed and compared to typical shoulder physical examination data (shoulder internal/external rotation and abduction isometric strength, Apleys scratch tests, Kibler’s scapula slide test and the Hawkins-Kennedy test) gathered by physical therapists. Age and professional experience of both musician groups did not significantly differ.

RESULTS:Trombonists (T) reported significantly more left shoulder performance-related pain than cellists (C) (50% vs 20%, p=0.02), while pain in the right shoulder was greater in cellists than trombonists (46% vs 19%, p=0.04). No gender differences in reports of playing-related pain were found. Common reported causes of playing-related pain included sudden increases in playing (82% T, 69% C), muscle tension (67% T, 82% C) and muscle fatigue (73% T, 70% C). Significant differences existed in flexibility with females more flexible than males and in all strength measures males were significantly stronger than females. For example, in cellists mean shoulder internal rotation (IR) strength (in Newtons) measured 16 for males and 11 for females in both shoulders (p<.0001). Male cellist and trombonist shoulder physical examination data was compared to self-report findings. No significant left or right-sided differences were detected in the mean values of any of the shoulder physical examination tests between male cellists and trombonists despite the significant shoulder pain difference between sides.

CONCLUSIONS: Typical shoulder physical examination tests are insufficient alone to detect physical causes of shoulder pain in elite musical performers. As in the sports domain, analysis of instrument-specific music performance demands is likely to be necessary to adequately assess an injured professional musician.

300 Board #152 May 29, 11:00 AM - 12:30 PM

Characteristics of Injury in a Professional Soccer Club of Dubai

Mourad Ghrairi1, Maher Khelifa2, Ridha Sallawi3, Yacine Zerguini4. 1Dubai Sport Council, Dubai, United Arab Emirates. 2Zayed University, Dubai, United Arab Emirates. 3Issep, Sfax, Tunisia. 4Fifa Medical Center of Excellence, Algiers, Algeria.

(No relationships reported)

An extensive body of research exists on Soccer injuries worldwide. However, injury data on soccer players from the Arabian Peninsula is scant if not inexistent.

This prospective study was conducted in the United Arab Emirates (UAE) on Alshabab Football Club Dubai, one of 12 professional teams participating in the UAE Professional Soccer League.

PURPOSE: To analyze the incidence, characteristics and specificities of soccer injuries in a UAE professional soccer club

METHODS: A total of 22 professional players were observed systematically during the entire 2010-2011 season. Injury characteristics were recorded and categorized by the team physician during games and training sessions using the FIFA Medical Assessment and Research Center’s (FMARC) recording system.

RESULTS: The total exposure time during the season was 5940 playing hours (5115 hours of training and 825 hours of competition). Fifty-three injuries were recorded during the season with a total injury incidence of 8,92 injuries /1000h. Injury incidence was higher during games (44,48/1000h) than during training (3,12/1000h), P < 0,001. Muscle injuries were most common with an incidence of 3,87/1000 hours of play. Muscle cramps especially occurred at the end of games played under hot and humid weather conditions (over 30 C and 60% humidity).

CONCLUSIONS: Recorded data suggest a possible strong association between heat, humidity and muscle cramps often necessitating player substitution. Knowing that the FIFA World Cup 2022 will be played under similar weather conditions this relationship deserves further research and scholarly attention.

301 Board #153 May 29, 11:00 AM - 12:30 PM

Ankle Sprain Severity Affects the Probability of Return-To-Play in High School Athletes

Jennifer M. Medina McKeon1, Sarah G. Adkins1, Heather M. Bush1, R. Dawn Comstock2. 1University of Kentucky, Lexington, KY. 2Research Institute at Nationwide Children’s Hospital, Columbus, OH.

(No relationships reported)

For lateral ankle sprains (LAS), ligament healing times may not be a strong prognostic indicator for when an athlete will return-to-play (RTP). Although athletes are routinely RTP prior to complete tissue healing, the extent of tissue damage may still contribute to RTP timelines.

PURPOSE: To generate RTP probabilities stratified by severity for new LAS.

METHODS: New LAS that were documented into the High School RIO™ database were analyzed. LAS were graded based on the number of lateral ligaments (anterior talofibular, calcaneofibular, posterior talofibular) that were documented as damaged: 1 ligament damaged was classified as a 1° sprain; 2 ligaments = 2° sprain; 3 ligaments = 3° sprain. Kaplan-Meier estimators [censored data] were stratified by injury grade to determine probability of time until RTP (T-RTP) after new LAS. Cases for which the athlete did not RTP (medical disqualification or season ended before the athlete was released to play) were considered censored. For the estimators, each LAS was classified based on RTP status (return, no return) at specified time frame intervals (1-2 day return, 3-6 days, 7-9 days, 10-21 days, > 22-days, no return[censored]).

RESULTS: A total of 2285 new LAS were considered for analysis (1° = 1421 sprains [42 censored], 2° = 701 sprains [32 censored], 3° = 163 sprains [22 censored]). A significant difference existed between median T-RTP for 1° and 2° LAS (p<.0001), but not between 2° and 3° LAS (p=.8). The median T-RTP for 1° = 3 days (IQR=3,10); 2° = 7 days (IQR=3,10), and 3° = 10 days (IQR=7,22). Selected results are presented as the probability of T-RTP [exact 95% confidence intervals]: The probability of a 1-2 day return for a 1° = 17.0% [15.2, 19.1]; 2° = 9.6% [7.6, 12.0]; 3° LAS = 2.5% [0.9, 6.4]. The probability of a 7-9-day return for a 1° = 52.5% [49.9, 55.1]; 2° = 37.6% [34.1, 41.3]; 3° = 20.3% [14.8, 27.3].

CONCLUSIONS: The extent of tissue damage was reflective of RTP probabilities. However, even for 3° LAS, median T-RTP was much shorter than typical ligament healing times. Accordingly, the proportion of censored cases was higher for 3° sprains compared to 1° or 2° sprains. RTP probabilities can assist clinicians with providing accurate prognoses for athletes. Further, the combination of timeframe-based and clinical-based indicators of RTP provide objective and more accurate prognoses.

302 Board #154 May 29, 11:00 AM - 12:30 PM

Injuries Prevention In Children’s Wushu Training: 6-12 Years Old

Wei Wang1, Hui Tang2. 1Jiangsu Normal University, Xuzhou, China. 2Lakehead University, Thunder Bay, ON, Canada. (Sponsor: Weimo Zhu, FACSM)

(No relationships reported)

PURPOSE:Wushu, the Chinese martial arts, is popular with children in China. However, Wushu’s high requirements for physical conditioning produce risks of injury. The purpose of this study was to examine the locations and causes of the children’s injuries that happened in Wushu training and to prevent them in the future.

METHODS:20 Chinese children (6-12 years old) who suffered injuries in Wushu training participated in this study. A semi-structured interview with children and their coaches was employed.

RESULTS:Of the sample, the injuries were divided into 7 categories. Ankle and knee sprains (30%), upper limb fractures (25%) and leg strains (15%) ranked top three. Among them, difficult movements led to 5 ankle and knee sprains and 4 upper limb fractures; all 3 leg strains were due to flexibility exercise; basic skill exercise caused an ankle and knee sprain and an upper limb fracture. Head/face injuries and waist injuries each accounted for 10%, among which difficult movements and basic skill exercise caused one injury respectively. Only 1 shoulder strain and 1 lower limb injury were reported. The former was resulted from flexibility exercise and the latter from difficult movements.The major reasons for the injuries included poor physical quality, low training ability, less warm-up, improper training and no discipline of children.

CONCLUSIONS:Ankle and knee sprains, upper limb fractures and leg strains are top three injuries in children’s Wushu training and most of the injuries are preventable. Measures like enhancing proactive training to easily hurt locations, improving flexibility of muscles and joints in legs and shoulders, plus rational training load based on children’s growth traits, should be taken to reduce the injuries.

303 Board #155 May 29, 11:00 AM - 12:30 PM

Peak Aerobic Capacity to Establish Normative Fitness Values in the Untrained Spinal Cord Injury Population

Jochen Kressler, Okeefe L. Simmons, Mark S. Nash, FACSM. University of Miami, Miami, FL.

(No relationships reported)

Normative values for cardiorespiratory (CR) fitness have not been determined for the general, untrained SCI population.

PURPOSE: Establish normative values of cardiorespiratory (CR) fitness applicable to the general, untrained SCI population.

METHODS: Subject data were extracted from prior studies conducted at the Miami Project to Cure Paralysis. Data from a total of 202 subjects (173 males, 29 females) with chronic SCI were included in this study. All participants were untrained for at least one month, and able to complete a progressive resistance exercise test to volitional exhaustion to determine peak aerobic capacity (VO2peak). Percentile ranking for physical fitness parameters was used to classify subjects (poor<20%, limited 20-40%, average 40-60%, good 60-80%, excellent 80-100%). Regression analysis was used to identify determinants of aerobic capacity.

RESULTS: Normative values for CR fitness based on functional classification as paraplegic (PP) or tetraplegic (TP) were established (PP: median=15.89ml/kg/min, range= 1.4-35.2ml/kg/min, and TP: median = 8.7ml/kg/min, range=1.5-21.5ml/kg/min) for untrained men and women. For men there was a significant difference in VO2peak between PP and TP (16.6±6.2 vs. 9.4±4.8ml/kg/min, p<.001), but differences for women did not reach significance (12.6±4.1 vs. 10.4±5.9 ml/kg/min, p=.199). Regression analysis revealed that motor level of injury (LOI) was associated with 23.1% of the variability in VO2peak (p<.001), and an additional 8.5% was associated with BMI (p<.001). No other measure accounted for additional significant variability.

CONCLUSION:Normative fitness values established in this study will allow investigators and clinicians to stratify relative fitness of subjects/patients from the general, untrained SCI population. In addition, when trying to determine CR fitness particular attention should be paid to motor LOI and functional classification as primary determinants of CR fitness. Body habitus should be noted secondarily. These data should assist in the design and delivery of interventions/treatments targeted to maintain or improve levels of CR fitness.

© 2013 American College of Sports Medicine