Groin injuries averted by preseason injury prevention
Study of pro soccer players finds significant reduction in injuries using simple 20-minute warm-up
Professional soccer players who participated in a special preseason groin injury prevention program had fewer groin injuries during that subsequent season than those who were not in the program, according to new research released today at the 2007 Annual Meeting of the American Orthopaedic Society for Sports Medicine at the Telus Convention Center (July 12-15).
The researchers enrolled 315 major league soccer players in a preseason groin injury prevention program to evaluate the effectiveness of the program. The 20-minute program was used as a prepractice warm-up two to three times a week during the preseason period. It included three phases – warm-up, dynamic stretching, and strengthening.
The participating athletes had a groin injury incidence of 0.44 injuries per 1,000 hours, while a control group had a groin injury rate of 0.61 injuries per 1,000 hours.
“Our 28% injury reduction rate is highly significant,” says principal investigator Michael B. Gerhardt, M.D., director of the Center for Athletic Hip and Groin Disorders in Santa Monica, Calif., and team physician for US Soccer and Chivas USA, a major league soccer team. “We were anticipating a 5-10% reduction rate, so we were pleasantly surprised that the injury reduction number was so high.”
Most professional soccer teams in Europe and the United States recognize groin injury as a major problem, according to Dr. Gerhardt. Groin injury accounts for a large amount of lost playing time. They are common in elite soccer players and especially problematic among male soccer players. The term “groin injury” encompasses a wide range of injuries ranging from minor groin strains to chronic groin injuries, such as sports hernias, which often require surgery.
The number of groin surgeries was also evaluated. Although not statistically significant, the athletes in the prevention session had fewer surgeries (0.13/1,000 hours) than the control subjects (0.18/1,000) who did not participate in the program. “While we were able to prevent the total number of groin injuries, we were unable to significantly reduce the number of surgeries,” comments Dr. Gerhardt. “Once an injury reaches the chronic stage it is hard to manage with any treatment regimen, including ours. These players typically go on to require surgery.”
Chronic injuries are defined as lasting a month or longer. Avoiding acute injuries, which the study’s preseason injury prevention program was able to reduce, can hopefully prevent them.
“If a simple 15- to 20-minute program can reduce the number of groin injuries that are occurring in professional athletes, I think it will gain widespread use,” notes Dr. Gerhardt. “We’ve seen this with ACL prevention programs, which have been implemented successfully by a variety of teams around the world. I anticipate that professional soccer teams will want their players to participate in a program if it is simple, cost effective, and, most importantly, proven to reduce groin injury.”
Dr. Gerhardt attributes the success of the prevention program to the multidisciplinary efforts of several expert therapists, trainers, and physicians.
Thursday, July 12, 2007
Neoprene sleeve = knee brace during ACL recovery
Neoprene sleeve equal to knee brace during recovery from ACL surgery
For most patients, wearing a hard knee brace is not necessary for return to sport
Users of functional knee braces and neoprene sleeves have similar recoveries from anterior cruciate ligament (ACL) reconstruction, according to new research presented today at the 2007 Annual Meeting of the American Orthopaedic Society for Sports Medicine at the Telus Convention Center (July 12-15).
“For patients returning to sport after ACL reconstruction, a functional knee brace, which is sturdy, elaborate, and expensive, does not provide advantages over a soft neoprene elastic sleeve,” says principal investigator Trevor Birmingham, Ph.D., P.T., Canada Research Chair in musculoskeletal rehabilitation at the University of Western Ontario and the Fowler Kennedy Sport Medicine Clinic in London, Ontario.
ACL reconstruction surgery is common, particularly in young, athletic individuals. The ACL is an important ligament inside the knee that helps keep it stable. ACL reconstruction involves replacing the torn ACL with a strip of tendon called a graft. Approximately 100,000 ACL reconstructions are performed annually according to the American Academy of Orthopaedic Surgeons.
“It is widely believed that the rigid support provided by a functional knee brace protects the graft and improves knee stability and function when the patient returns to sport after surgery and rehabilitation,” explains Dr. Birmingham. “Others believe that the additional support provided by a brace is not necessary.”
To address this uncertainty, Dr. Birmingham and colleagues studied 150 athletes preparing to return to sport following ACL reconstruction. Seventy-six patients were randomized to receive a functional knee brace and 74 to receive a neoprene sleeve. The patients were instructed to wear the orthosis during all physical activities. The researchers found no significant differences between the groups at the one- and two-year follow-up visits.
“Based on our clinical experience, we were not completely surprised by the results,” Dr. Birmingham comments. “These findings provide strong evidence that the average patient does not require a functional knee brace when returning to sport after ACL reconstruction. There may be some patients who will benefit from a brace, and identifying these individuals requires further research. Until then, these decisions are left to the surgeon’s discretion.”
ACL functional knee braces are made by several different companies and have a variety of looks and fitting instructions. They are intended to limit abnormal movement of the knee and prevent excessive strain on the ACL or new graft. They generally provide a rigid support to restrain the knee, although they may also improve neuromuscular control of the knee. Most laboratory studies suggest that different types of functional knee braces perform similarly.
Neoprene sleeves are also made by several different companies and have different looks. Rather than providing rigid support, they are only intended to gently compress the area around the knee and improve neuromuscular control.
The study was large enough and had enough statistical power to detect even slight differences between the functional knee brace and sleeve groups. “We can be confident that even if small but true differences between these groups exist, these differences are not large enough to be clinically important,” concludes Dr. Birmingham. He notes that the study was not designed to test whether using a neoprene sleeve was better than using nothing at all.
For most patients, wearing a hard knee brace is not necessary for return to sport
Users of functional knee braces and neoprene sleeves have similar recoveries from anterior cruciate ligament (ACL) reconstruction, according to new research presented today at the 2007 Annual Meeting of the American Orthopaedic Society for Sports Medicine at the Telus Convention Center (July 12-15).
“For patients returning to sport after ACL reconstruction, a functional knee brace, which is sturdy, elaborate, and expensive, does not provide advantages over a soft neoprene elastic sleeve,” says principal investigator Trevor Birmingham, Ph.D., P.T., Canada Research Chair in musculoskeletal rehabilitation at the University of Western Ontario and the Fowler Kennedy Sport Medicine Clinic in London, Ontario.
ACL reconstruction surgery is common, particularly in young, athletic individuals. The ACL is an important ligament inside the knee that helps keep it stable. ACL reconstruction involves replacing the torn ACL with a strip of tendon called a graft. Approximately 100,000 ACL reconstructions are performed annually according to the American Academy of Orthopaedic Surgeons.
“It is widely believed that the rigid support provided by a functional knee brace protects the graft and improves knee stability and function when the patient returns to sport after surgery and rehabilitation,” explains Dr. Birmingham. “Others believe that the additional support provided by a brace is not necessary.”
To address this uncertainty, Dr. Birmingham and colleagues studied 150 athletes preparing to return to sport following ACL reconstruction. Seventy-six patients were randomized to receive a functional knee brace and 74 to receive a neoprene sleeve. The patients were instructed to wear the orthosis during all physical activities. The researchers found no significant differences between the groups at the one- and two-year follow-up visits.
“Based on our clinical experience, we were not completely surprised by the results,” Dr. Birmingham comments. “These findings provide strong evidence that the average patient does not require a functional knee brace when returning to sport after ACL reconstruction. There may be some patients who will benefit from a brace, and identifying these individuals requires further research. Until then, these decisions are left to the surgeon’s discretion.”
ACL functional knee braces are made by several different companies and have a variety of looks and fitting instructions. They are intended to limit abnormal movement of the knee and prevent excessive strain on the ACL or new graft. They generally provide a rigid support to restrain the knee, although they may also improve neuromuscular control of the knee. Most laboratory studies suggest that different types of functional knee braces perform similarly.
Neoprene sleeves are also made by several different companies and have different looks. Rather than providing rigid support, they are only intended to gently compress the area around the knee and improve neuromuscular control.
The study was large enough and had enough statistical power to detect even slight differences between the functional knee brace and sleeve groups. “We can be confident that even if small but true differences between these groups exist, these differences are not large enough to be clinically important,” concludes Dr. Birmingham. He notes that the study was not designed to test whether using a neoprene sleeve was better than using nothing at all.
Study on soccer headgear
From small scrapes to hospital emergencies, playing soccer can be painful, and even dangerous. To avoid head injuries and concussions the only effective solution is wearing soft protective headgear, as shown by Dr. Scott Delaney, Research Director of Emergency Medicine at the MUHC, in a new study published in the July issue of the British Journal of Sports Medicine.
In the first attempt to rely on results from the field instead of the lab, this innovative study was carried out just after the 2006 soccer season and included 268 adolescents, aged 12 to 17 years, from the Oakville Soccer Club. Although only 52 of them wore headgear during this period, the results are significant: the risk of concussion was 2.65 times higher for players who were not protected. In fact, 52.8% of the adolescents who did not wear headgear reported being injured compared to only 26.9% of those who did. These results are indeed noteworthy, particularly since approximately 80% of sports-related injuries are not recognized or reported. Prevention is therefore an essential means of protection.
Interestingly, though headgear protects the areas of the head that are covered, there were no differences in the number of cuts and bruises on the areas of the head and face not covered by it. “This was important to examine as many people fear that the use of soccer headgear may make players more aggressive and more prone to other injuries. At least for these injuries, it may show that wearing headgear does not encourage people to play more aggressively,” stated Dr. Delaney.
Unfortunately, adolescents who regularly wear headgear are not the rule and do not represent the majority of young athletes: most of them are young girls or adolescents who have already been injured. “Girls, in general, are more prone to concussions in soccer and they may be more aware of the possible benefits of wearing headgear,” remarked Dr. Delaney, who also practices at the McGill Sports Medicine Clinic. Since 2002, the Fédération Internationale de Football Association (FIFA) has authorized soft headgear during official matches but has not made it mandatory. “This study may help convince parents and players that soft protective soccer headgear can be an effective part of a comprehensive plan to reduce the number of head injuries and concussions in soccer,” confirmed Dr. Delaney.
In the first attempt to rely on results from the field instead of the lab, this innovative study was carried out just after the 2006 soccer season and included 268 adolescents, aged 12 to 17 years, from the Oakville Soccer Club. Although only 52 of them wore headgear during this period, the results are significant: the risk of concussion was 2.65 times higher for players who were not protected. In fact, 52.8% of the adolescents who did not wear headgear reported being injured compared to only 26.9% of those who did. These results are indeed noteworthy, particularly since approximately 80% of sports-related injuries are not recognized or reported. Prevention is therefore an essential means of protection.
Interestingly, though headgear protects the areas of the head that are covered, there were no differences in the number of cuts and bruises on the areas of the head and face not covered by it. “This was important to examine as many people fear that the use of soccer headgear may make players more aggressive and more prone to other injuries. At least for these injuries, it may show that wearing headgear does not encourage people to play more aggressively,” stated Dr. Delaney.
Unfortunately, adolescents who regularly wear headgear are not the rule and do not represent the majority of young athletes: most of them are young girls or adolescents who have already been injured. “Girls, in general, are more prone to concussions in soccer and they may be more aware of the possible benefits of wearing headgear,” remarked Dr. Delaney, who also practices at the McGill Sports Medicine Clinic. Since 2002, the Fédération Internationale de Football Association (FIFA) has authorized soft headgear during official matches but has not made it mandatory. “This study may help convince parents and players that soft protective soccer headgear can be an effective part of a comprehensive plan to reduce the number of head injuries and concussions in soccer,” confirmed Dr. Delaney.
Wednesday, July 11, 2007
Average major league baseball career 5.6 years
The average career of a Major League Baseball player is 5.6 years, according to a new study by a University of Colorado at Boulder research team. The study also revealed that one in five position players will have only a single-year career, and that at every point of a player's career, the player's chance of ending his career is at least 11 percent.
Results of the study, "Major League Baseball Career Length in the 20th Century," will be published in the August issue of Population Research and Policy Review. The study was conducted by former CU-Boulder graduate student William Witnauer, sociology Professor Richard Rogers and doctoral student Jarron Saint Onge. Rogers also directs the Population Program in the CU-Boulder Institute of Behavioral Science.
"Population research can provide rich insight into important and popular social issues, including baseball," Rogers said.
The study examined the career statistics of baseball players who started their careers between 1902 and 1993. Pitchers were excluded because of their unique positions, career volatility and propensity for injuries.
Between 1902 and 1993, 5,989 position players started their careers and played 33,272 person years of Major League Baseball. Using voluminous baseball statistics, the authors then developed a table of average career lengths for the players.
"Everyone knows that Major League Baseball is highly competitive," Witnauer said. "But as Americans enjoy this year's All-Star game, they now have a definitive answer on the average length of a baseball career."
Results of the study, "Major League Baseball Career Length in the 20th Century," will be published in the August issue of Population Research and Policy Review. The study was conducted by former CU-Boulder graduate student William Witnauer, sociology Professor Richard Rogers and doctoral student Jarron Saint Onge. Rogers also directs the Population Program in the CU-Boulder Institute of Behavioral Science.
"Population research can provide rich insight into important and popular social issues, including baseball," Rogers said.
The study examined the career statistics of baseball players who started their careers between 1902 and 1993. Pitchers were excluded because of their unique positions, career volatility and propensity for injuries.
Between 1902 and 1993, 5,989 position players started their careers and played 33,272 person years of Major League Baseball. Using voluminous baseball statistics, the authors then developed a table of average career lengths for the players.
"Everyone knows that Major League Baseball is highly competitive," Witnauer said. "But as Americans enjoy this year's All-Star game, they now have a definitive answer on the average length of a baseball career."
Wednesday, May 2, 2007
Does Amateur Boxing or Heading Cause Brain Damage?
Blows to the head in amateur boxing appear to cause brain damage, according to research that will be presented at the American Academy of Neurology’s 59th Annual Meeting in Boston, April 28 – May 5, 2007.
“Despite the high prevalence of brain damage as a result of professional boxing, until now there has been little information on the possible risks for brain injury in amateur boxing,” said study author Max Hietala, MD, PhD, with Sahlgrenska University Hospital, Goteborg, Sweden.
For the study, researchers used lumbar puncture to determine if there were elevated levels of biochemical markers for brain injury in the cerebrospinal fluid (CSF) of 14 amateur boxers. Boxers were tested after a fight and then again three months after rest from boxing. The study also included 10 healthy men who were not athletes.
The study found high CSF levels of neuronal and glial markers suggestive of brain damage after a fight. A particular marker for neuronal damage, neurofilament light (NFL), was four times higher in boxers within 10 days of the fight as compared with healthy non-athletes. These increased levels returned to normal after three months rest from boxing.
In addition, the increased levels after a fight were significantly higher among amateur boxers who had received more than 15 high impact hits to the head compared with boxers who reported fewer hits. The boxers who had received more than 15 high impact hits to the head had seven to eight times higher NFL-levels post fight compared to their levels following a three-months rest.
“Repeated hits to the head are potentially damaging to the central nervous system, and our results suggest CSF-analysis could be used for medical counseling of athletes after boxing or head injury,” said Hietala.
The study was extended to soccer players heading the ball repeatedly from long and high goal kicks. No increased levels of biochemical markers for brain damage in cerebrospinal fluid were found. “This data shows headings in soccer is not associated with any neurochemical evidence of brain damage,” said Hietala.
“Despite the high prevalence of brain damage as a result of professional boxing, until now there has been little information on the possible risks for brain injury in amateur boxing,” said study author Max Hietala, MD, PhD, with Sahlgrenska University Hospital, Goteborg, Sweden.
For the study, researchers used lumbar puncture to determine if there were elevated levels of biochemical markers for brain injury in the cerebrospinal fluid (CSF) of 14 amateur boxers. Boxers were tested after a fight and then again three months after rest from boxing. The study also included 10 healthy men who were not athletes.
The study found high CSF levels of neuronal and glial markers suggestive of brain damage after a fight. A particular marker for neuronal damage, neurofilament light (NFL), was four times higher in boxers within 10 days of the fight as compared with healthy non-athletes. These increased levels returned to normal after three months rest from boxing.
In addition, the increased levels after a fight were significantly higher among amateur boxers who had received more than 15 high impact hits to the head compared with boxers who reported fewer hits. The boxers who had received more than 15 high impact hits to the head had seven to eight times higher NFL-levels post fight compared to their levels following a three-months rest.
“Repeated hits to the head are potentially damaging to the central nervous system, and our results suggest CSF-analysis could be used for medical counseling of athletes after boxing or head injury,” said Hietala.
The study was extended to soccer players heading the ball repeatedly from long and high goal kicks. No increased levels of biochemical markers for brain damage in cerebrospinal fluid were found. “This data shows headings in soccer is not associated with any neurochemical evidence of brain damage,” said Hietala.
Friday, April 6, 2007
Officiating bias, influence by crowds=home field advantage
Officiating bias, influenced by crowds, affects home field advantage
Study finds that individual referees vary in response to environmental factors
The roar of the crowd may subconsciously influence some referees to give an advantage to the home team, according to a study that examines the results of over 5,000 soccer matches in the English Premier League. The matches were played between 1992 and 2006, and involved 50 different referees, each of whom had officiated at least 25 games within that time period.
Ryan Boyko, a research assistant in the Department of Psychology in the Faculty of Arts and Sciences at Harvard University, led the study, which will be published in an upcoming edition of the Journal of Sports Sciences.
"Individual referees and the size of the crowd present are variables that affect the home field advantage. In order to ensure that all games are equally fair, ideally, all referees should be equally unaffected by the spectators," says Boyko.
Boyko studied the number of goals scored by a team at home versus those scored while away, and found that teams scored 1.5 home goals on average, and 1.1 while away. Crowd size also had an impact on the number of goals scored by the home team, and for every additional 10,000 people in the crowd, the advantage for the home team increased by about 0.1 goals.
In addition to affecting the number of goals scored, the away team received more penalties, implying that referees are making calls in favor of the home team, possibly as a result of the influence of the crowd. Some individual referees are more susceptible to these influences than others. In fact, more experienced referees are less biased by the impact of a large audience, which suggests that they may develop a resistance to effects of the crowd.
Match results within the English Premier League were chosen for study because the games are heavily attended and the teams are located within the same time zone, eliminating long-distance travel as a factor involved with home field advantage. Information about the results of English Premier League games is also widely available online.
While previous research has studied the home advantage with regard to the influence of the crowd, player performance, and referees' decision-making processes, little work has been done on the variation of partiality from referee to referee. While understood to be present in sports that are both judged and scored, earlier studies had also shown that the home field advantage is more pronounced in sports that are subjectively judged, such as figure skating, as opposed to those that are objectively decided, such as speed skating, indicating a relationship between the judging process and the home field advantage.
The findings could suggest ways to increase the fairness of matches by identifying referee susceptibility to the external factors that are present at most sporting events.
"Referee training could include conditioning towards certain external factors, including crowd response," Boyko says. "Leagues should be proactive about eliminating referee bias. The potential is there for a game to be altered because of factors that subconsciously affect the referee."
Study finds that individual referees vary in response to environmental factors
The roar of the crowd may subconsciously influence some referees to give an advantage to the home team, according to a study that examines the results of over 5,000 soccer matches in the English Premier League. The matches were played between 1992 and 2006, and involved 50 different referees, each of whom had officiated at least 25 games within that time period.
Ryan Boyko, a research assistant in the Department of Psychology in the Faculty of Arts and Sciences at Harvard University, led the study, which will be published in an upcoming edition of the Journal of Sports Sciences.
"Individual referees and the size of the crowd present are variables that affect the home field advantage. In order to ensure that all games are equally fair, ideally, all referees should be equally unaffected by the spectators," says Boyko.
Boyko studied the number of goals scored by a team at home versus those scored while away, and found that teams scored 1.5 home goals on average, and 1.1 while away. Crowd size also had an impact on the number of goals scored by the home team, and for every additional 10,000 people in the crowd, the advantage for the home team increased by about 0.1 goals.
In addition to affecting the number of goals scored, the away team received more penalties, implying that referees are making calls in favor of the home team, possibly as a result of the influence of the crowd. Some individual referees are more susceptible to these influences than others. In fact, more experienced referees are less biased by the impact of a large audience, which suggests that they may develop a resistance to effects of the crowd.
Match results within the English Premier League were chosen for study because the games are heavily attended and the teams are located within the same time zone, eliminating long-distance travel as a factor involved with home field advantage. Information about the results of English Premier League games is also widely available online.
While previous research has studied the home advantage with regard to the influence of the crowd, player performance, and referees' decision-making processes, little work has been done on the variation of partiality from referee to referee. While understood to be present in sports that are both judged and scored, earlier studies had also shown that the home field advantage is more pronounced in sports that are subjectively judged, such as figure skating, as opposed to those that are objectively decided, such as speed skating, indicating a relationship between the judging process and the home field advantage.
The findings could suggest ways to increase the fairness of matches by identifying referee susceptibility to the external factors that are present at most sporting events.
"Referee training could include conditioning towards certain external factors, including crowd response," Boyko says. "Leagues should be proactive about eliminating referee bias. The potential is there for a game to be altered because of factors that subconsciously affect the referee."
Thursday, April 5, 2007
Which Catcher’s Mask Works Better?
As Baseball Season Begins, Which Catcher’s Mask Works Better? Kettering University Students Test Traditional and Hockey Style Masks During Research Project
FInspired by professional baseball catcher Mike Matheny’s forced early retirement from major league play, four Kettering University seniors tested the protective properties of catcher’s masks. Their findings support one for foul tips and the other for batter backswings.
Using high speed video, a crash test dummy and a skeet throwing machine, they propelled a baseball at about 100 mph at the dummy wearing both styles of catcher’s mask. Both masks that the group tested were manufactured for professional use by All-Star, a division of Ampac Enterprises.
Crash dummies are instrumented with accelerometers that indicate possible brain or closed-head injuries in humans. The group measured the G-forces exerted on the head in two different types of tests; frontal impact test, simulating a foul-tip, and side impact test, simulating a batter’s backswing striking the side of a catcher’s head.
The traditional style mask performed better on frontal impact. Peak G-force of the traditional mask at this location was 3.763, while peak G-force for the hockey-style mask was 9.814.
The hockey style mask performed better on side impact with a G-force of 13.57 in comparison to the traditional mask recording a value of 32.02.
Their conclusion, the traditional style catcher’s mask is better against a foul-tip, and a hockey-style catcher’s mask is better against a hitter’s backswing. The front impact location was where the foul-tip that ended Mike Matheny’s career struck on the hockey-style catcher’s mask.
The old style is a two-piece design with a metal cage with padding across the forehead and over the cheekbones and chin areas, with no padding on the sides of the head and a helmet with no padding.
The hockey-style looks like a goalie mask, a plastic outer shell over a metal frame and padding underneath with protective coverage back to the ear area and over the top of the head in front.
The research team was Morris “Mo” Roth of Commack, N.Y.; Scott Barel of Sterling Heights, Mich.; Jeff Schulze of Bay Port, Mich.; and Josh Maag of Leipsic, Ohio.
To see photos from the student project, visit www.kettering.edu and click on: “Foul tip trauma.”
FInspired by professional baseball catcher Mike Matheny’s forced early retirement from major league play, four Kettering University seniors tested the protective properties of catcher’s masks. Their findings support one for foul tips and the other for batter backswings.
Using high speed video, a crash test dummy and a skeet throwing machine, they propelled a baseball at about 100 mph at the dummy wearing both styles of catcher’s mask. Both masks that the group tested were manufactured for professional use by All-Star, a division of Ampac Enterprises.
Crash dummies are instrumented with accelerometers that indicate possible brain or closed-head injuries in humans. The group measured the G-forces exerted on the head in two different types of tests; frontal impact test, simulating a foul-tip, and side impact test, simulating a batter’s backswing striking the side of a catcher’s head.
The traditional style mask performed better on frontal impact. Peak G-force of the traditional mask at this location was 3.763, while peak G-force for the hockey-style mask was 9.814.
The hockey style mask performed better on side impact with a G-force of 13.57 in comparison to the traditional mask recording a value of 32.02.
Their conclusion, the traditional style catcher’s mask is better against a foul-tip, and a hockey-style catcher’s mask is better against a hitter’s backswing. The front impact location was where the foul-tip that ended Mike Matheny’s career struck on the hockey-style catcher’s mask.
The old style is a two-piece design with a metal cage with padding across the forehead and over the cheekbones and chin areas, with no padding on the sides of the head and a helmet with no padding.
The hockey-style looks like a goalie mask, a plastic outer shell over a metal frame and padding underneath with protective coverage back to the ear area and over the top of the head in front.
The research team was Morris “Mo” Roth of Commack, N.Y.; Scott Barel of Sterling Heights, Mich.; Jeff Schulze of Bay Port, Mich.; and Josh Maag of Leipsic, Ohio.
To see photos from the student project, visit www.kettering.edu and click on: “Foul tip trauma.”
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