Gabbett, T.J. (2007)

Studies have previously considered the incidence of injury amongst senior rugby league players, however information on junior players is somewhat limited. In addition, injury studies which have considered this age group have tended to be performed over a limited time frame (typically one season).

This study aimed to document the incidence of injury in junior rugby league players over four competitive seasons, covering 84 matches. For the purposes of the study, an injury was defined as one that occurred in a match and resulted in the player missing a subsequent match.

The overall incidence of injury was 56.8 per 1000 playing hours. Most of these were sustained to the shoulder (15.6), with sprains being the most common overall injury (24.7). Most injuries occurred when being tackled (19.2) and while tackling (10.1).

While these tendencies did differ over the four seasons, this was not found to be statistically significant. The findings of this study would suggest that the incidence of junior rugby league injuries is similar to those previously reported for senior competitors. A long term collaborative effort to reduce the number of injuries amongst junior league players is therefore warranted.

Journal of Science and Medicine in Sport (2007) Article in Press – Corrected Proof

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Weinhold, P.S., Stewart, J.D.N., Liu, H.Y., Lin, C.F., Garrett, W.E. and Yu, B (2007)

Research has shown that women are at a higher risk of sustaining noncontact anterior cruciate ligament (ACL) injuries in specific sports. This study aimed to determine if this could be due to differences in knee movement, muscle activation and external loading patterns due to gender.

ACL strain was found to be significantly increased for the female loading pattern relative to the male loading pattern when certain forces were applied, which suggests that female motor control strategies used during the stop-jump task may place higher strains on the ACL than male strategies. This may therefore predispose females to a higher risk of sustaining such an injury.

This study may suggest that there could be effectiveness in using training programs to modify motor control strategies, and thus alter the risk of injury.

Injury (2007) 38:8 973-978

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Michell, T.B., Ross, S.E., Blackburn, J.T., Hirth, C. and Guskiewicz, K.M. (2006)

Rehabilitation of ankle injuries is vital following sprains to prevent further injuries and restore function in the injured joint.  Improving postural stability through balance training is thought to be an important aspect in this rehabilitation.  This study suggests that exercise sandals may increase the demands placed on ankle muscles during rehabilitation, which may in turn further develop postural stability.

This study included 16 subjects with functional ankle instability, and 16 subjects with no history of ankle sprains.  The two groups trained three times per week for 8 weeks.  It was found that postural stability improved after following the balance training programs, with and without the exercise sandals.

Training with exercise sandals might not be any more effective in improving postural stability than without, however they did not impair postural stability and might serve as an alternative therapy to improve postural stability.

Journal of Athletic Training (2006) 41:4 393-398

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Croisier, J.L. (2004)

It is widely known that a history of previous injury to a muscle will increase the chances of subsequent injury. Hamstring injuries are particularly common recurring problems which can cause considerable difficulties for athletes and potentially end their career.

This study suggests that extrinsic and intrinsic factors which may predispose an athlete to re-injury are likely present at the initial injury, including the mode of training - particularly warm up and fatigue management; muscle strength abnormalities - particularly agonist/antagonist imbalances; hamstring tightness; scar tissue formation and rehabilitation during healing of previous injuries.

A management model of hamstring strain is proposed by the author, to facilitate not only the return of the athlete to full fitness but also to prevent recurrence of the injury.

Sports Medicine (2004) 34:10 681-695

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Hubbard, T.J. and Denegar, C.R. (2004)

The use of ice or cold water with soft tissue injuries is often advocated, however what research is there to prove that it actually works?

This paper reviewed a large amount of studies around this subject, and was able to conclude that the use of cryotherapy is effective in decreasing pain, however when this is compared with other rehabilitation techniques, the efficacy of cryotherapy has been questioned. The effect of cold therapy on the most common acute soft tissue injuries including strains and bruises has not been fully proven. Further research is required to identify the most appropriate modes, durations and frequencies of cryotherapy use post injury to optimise outcomes post injury.

Journal of Athletic Training (2004) 39:3 278-279

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Warming Up With an Ice Vest: Core Body Temperature Before and After Cross-Country Racing

Hunter, I., Hopkins, J.T. and Casa, D.J. (2006)

Athletes training in hot, humid environments are at a high risk of developing heat illness.  During the 2004 Olympic Games, ice vests were provided to American and Australian athletes to cool their bodies before performance, which appeared to be effective in keeping body temperatures down and improving the performance of the marathon runners.  There was no research to suggest whether this was replicated before an actual competition, and what happened to the body temperatures.

This study aimed to determine whether wearing an Ice Vest decreased core temperature before and during athletic performance in warm (26-27 °C),  humid conditions.

It was determined that wearing an ice vest before cross-country performance in warm, humid conditions allowed athletes to start and finish the competition with a lower core temperature than those who were not wearing a vest.  This could have important implications with prevention of heat illness amongst athletes.

Journal of Athletic Training (2006) 41:4 371-374

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A study in Sweden looked at the injuries sustained by 12 elite Swedish male football teams during the 2001 and 2002 seasons. The results were recorded and analyzed to establish any correlation between injuries in concurrent seasons.

Results showed those with hamstring, groin, and knee joint injuries were two to three times more likely to sustain injury in the second season. However players did not show a predisposition to ankle sprain injury if they had sustained the injury the previous season. Age was not associated with an increased injury risk and the overall incidences of injury among players were similar between seasons.
The study concluded previous injury can be considered to be an important risk factor in football players sustaining the same injury again the following season.

Details: Published Online First: 19 July 2006. doi:10.1136/bjsm.2006.026609
Previous injury as a risk factor for injury in elite football: a prospective study over two consecutive seasons M Hägglund, M Waldén and J Ekstrand Department of Health and Society, Linköping University, Linköping, Sweden

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A small study of 20 NCAA (National Collegiate Athletic Association) athletes suggests that due to biomechanical differences between male and female athletes when landing jumps, females may have higher risks of injuring Anterior Cruciate Ligament (ACL) when fatigued. The study suggests that when muscles are fatigued, they are less able to control joint movements, which may increase the chance of sustaining non-contact ACL injuries.

The study determined that female athletes tended to land with a more flexed ankle, with the foot rolling outwards, and had more knee abduction and internal rotation than their male counterparts. This was significantly increased by fatigue, hence putting more stress through the stabilising structures of joints such as the knee.

According to the NCAA, female athletes are more than twice as likely to suffer such an ACL injury than males, and may in some cases be up to eight times more likely. This could be due to biomechanical differences in the lower limbs of the female athlete related to the different shapes of the pelvis, however this study would suggest that fatigue ­ by reducing the stabilising effect of the muscles on the joints ­ may exacerbate this and predispose the athlete to injury.

Details: McLean, S.G., Felin, R.E., Suedekum, N., Calabrese, G., Passerallo, A. & Joy, S. (2007) Impact of Fatigue on Gender-Based High-Risk Landing Strategies. Medicine & Science in Sports & Exercise. 39(3):502-514

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In a study by Emery & colleagues, 920 basketball players from Calgary, Canada were studied in two groups. Both groups were taught basic warm up techniques, but the second group were also taught an additional warm up component and given a home based balance training programme involving the use of a wobble board.
The study found that the addition of a balance training programme did have a positive effect on protecting the athlete from all types of injuries, lower limb injuries and ankle sprains however this was not found to be statistically significant.
There was also a self-reported poor compliance to the home exercise programme, with only 60% compliance. Consideration should be made as to how compliance can be improved, however this study does suggest that coaches should consider such a preventative training strategy for their players in order to reduce injuries.

Details: Emery, C. A., Rose, M.S., McAllister, J. R ., & Meeuwisse, W. H. (2007) A Prevention Strategy to Reduce the Incidence of Injury in High School Basketball: A Cluster Randomized Controlled Trial. Clinical Journal of Sport Medicine. 17(1):17-24

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The use of cryotherapy (ice packs) in the management of acute injuries is largely anecdotal, however there is some evidence to suggest that intermittent application is more effective at reducing tissue temperature to optimal levels.

This study compared 44 sportsmen and 45 members of the public with mild to moderate ankle sprains who were randomly assigned into two groups.

The first group simply applied ice for 20 minutes every two hours as per the standard recommended protocol.

The second group applied ice for 10 minutes, then removed the pack and rested at room temperature for 10 minutes, after which the ice pack was re-applied for another 10 minutes.

This was also repeated every two hours. Both groups used this intervention for the first 72 hours following injury.

Significant improvements were demonstrated over time with regards to pain, function and swelling, however the group using the intermittent application protocol had significantly less pain during everyday activity in week 1 of the study.

This study would suggest that the application of ice has several positive benefits in the acute stage of injury, however there may be some further improvements in pain during the early stages if an intermittent icing protocol is used.

Details: Bleakley, C.M., McDonough, S.M. & MacAuley D.C. (2006) Cryotherapy for acute ankle sprains: a randomised controlled study of two different icing protocols. British Journal of Sports Medicine; 40:700-705

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