Mild traumatic brain injury in major and Minor League Baseball players.

BACKGROUND: Although mild traumatic brain injury (MTBI) is not as common in professional baseball as in collision sports, it does occur and frequently results in significant loss of time away from the sport. To date, no study has investigated MTBI among an entire cohort of professional baseball players. PURPOSE: To investigate MTBIs in major and minor league baseball players to determine the most common mechanisms of injury, activity at time of injury, position, level of play, and time lost, as well as ultimately inform prevention efforts. A secondary objective was to document the association between MTBI and return to play using several different measures. STUDY DESIGN: Descriptive epidemiologic study. METHODS: Data were captured from a newly implemented league-wide injury surveillance system that records injuries among all professional baseball players as entered by certified athletic trainers and physicians. The MTBIs were identified with respect to level of play, activity, field location, and mechanism of injury. Time loss was assessed by 3 measures of return to play, and MTBI game rates were reported as injuries per 1000 athlete-exposures. Data were combined over the 2011-2012 seasons for analysis, and results were presented separately for minor and major league players. Chi-square tests were used to test the hypothesis of equal proportions between the various categories of MTBI injury characteristics. RESULTS: There were 41 reported MTBIs in the major leagues and 266 in the minor leagues over the 2-year period under study. The overall MTBI game rate across both major and minor league ball clubs was 0.42 per 1000 athlete-exposures. The median time lost was 9 days. Mild traumatic brain injury accounted for 1% of all injuries resulting in time lost from play. For MTBIs that occurred while fielding, catchers were significantly overrepresented. No differences were noted among the 3 measures of time lost. CONCLUSION: Mild traumatic brain injury is an important problem in professional baseball players, especially for catchers. This study provides a foundation for future inquiry to reduce the incidence of MTBI in those positions at greatest risk and to provide a baseline as rules and equipment evolve.

Major and Minor League Baseball Hamstring Injuries: Epidemiologic Findings From the Major League Baseball Injury Surveillance System.

BACKGROUND: Hamstring strains are a recognized cause of disability for athletes in many sports, but no study exists that reports the incidence and circumstances surrounding these injuries in professional baseball. HYPOTHESIS: Professional baseball players have a high incidence of hamstring strains, and these injuries are influenced by multiple factors including history of hamstring injury, time period within the season, and activity of base running. STUDY DESIGN: Descriptive epidemiologic study. METHODS: For the 2011 season, injury data were prospectively collected for every Major League Baseball (MLB) major and minor league team and recorded in the MLB's Injury Surveillance System. Data collected for this study included date of injury, activity in which the player was engaged at the time of injury, and time loss. Injury rates were reported in injuries per athlete-exposure (A-E). Athlete-exposures were defined as the average number of players on a team who were participating in a game multiplied by the number of games. RESULTS: In the major leagues, 50 hamstring strains were reported for an injury rate (IR) of 0.7 per 1000 A-Es and averaged 24 days missed. In the minor leagues, 218 hamstring strains were reported for an IR of 0.7 per 1000 A-Es and averaged 27 days missed. Base running, specifically running to first base, was the top activity for sustaining a hamstring strain in both major and minor leagues, associated with almost two-thirds of hamstring strains. Approximately two-thirds of these injuries in both the major and minor leagues resulted in more than 7 days of time loss. Approximately 25% of these injuries kept the player out for 1 month or longer. History of a previous hamstring strain in the prior year, 2010, was found in 20% of the major league players and 8% of the minor league players. In the major leagues, the month of May had a statistically significant higher frequency of hamstring injuries than any other month in the season (P = .0153). CONCLUSION: Hamstring strains are a considerable cause of disability in professional baseball and are affected by history of hamstring strain, seasonal timing, and running to first base.

Athletes and the arts--the role of sports medicine in the performing arts.

Performing artists are athletes. Like athletes, performing artists practice and/or perform most days with little off season, play through pain, "compete" in challenging environments, and risk career-threatening injury. Athletes and the Arts is a multiorganizational initiative linking the sport athlete and musician/performing artist communities. Performing artists of all ages and genre are an underserved population related to medical coverage, care, injury prevention, performance enhancement, and wellness. Sports medicine professionals are a valuable resource for filling this gap by applying existing knowledge of treating sport athletes (nutrition, injury prevention) while gaining a better understanding of performers' unique needs (hearing loss, focal dystonia) and environment. These applications can occur in the clinical setting and through developing organizational policies. By better understanding the needs of the performing arts population and applying existing concepts and knowledge, sports medicine professionals can expand their impact to a new patient base that desperately needs support.

Effectiveness of the women's lacrosse protective eyewear mandate in the reduction of eye injuries.

BACKGROUND: In an effort to minimize the risk of catastrophic eye injury, US Lacrosse initiated mandatory use of protective eyewear in women's lacrosse in the 2004-2005 season. PURPOSE: The authors compared eye injury rates in girls' scholastic lacrosse before and after implementation of protective eyewear. They also compared head/face injury rates, concussion rates, and overall injury rates before and after the rule change to assess possible unintended consequences of the change. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: The study group included female scholastic lacrosse players in the 25 public high schools in Fairfax County, Virginia, during the 2004-2009 spring seasons. Injury rates were compared with those from the same data source for the 2000-2003 seasons. Premandate versus postmandate injury rates were adjusted for athlete exposures, or total opportunities for injury throughout the season. RESULTS: The rate of eye injuries was reduced from 0.10 injuries per 1000 athlete exposures (AEs) in 2000 through 2003 before the use of protective eyewear to 0.016 injuries per 1000 AEs in 2004 through 2009 (incident rate ratio [IRR], 0.16; 95% confidence interval [CI], 0.06-0.42). The rate ratio of head/face injuries excluding concussion also decreased (IRR, 0.44; 95% CI, 0.26-0.76). There was no change in the rate ratio of total injuries involving all body parts (IRR, 0.93; 95% CI, 0.82-1.1) after introduction of protective eyewear. However, the rate ratio of concussion increased (IRR, 1.6; 95% CI, 1.1-2.3). CONCLUSION: The use of protective eyewear in women's lacrosse was associated with a reduction in the number of eye injuries. The number of head/face injuries decreased in this study group after introduction of protective eyewear, and there was no change in overall injury rates. The reason for the increase in concussion rate cannot be determined conclusively based on this study, but the authors speculate that this increase resulted largely from increased recognition and diagnosis because overall injury rates do not indicate rougher play with introduction of protective equipment.

A randomized controlled trial to prevent noncontact anterior cruciate ligament injury in female collegiate soccer players.

BACKGROUND: Neuromuscular and proprioceptive training programs can decrease noncontact anterior cruciate ligament injuries; however, they may be difficult to implement within an entire team or the community at large. HYPOTHESIS: A simple on-field alternative warm-up program can reduce noncontact ACL injuries. STUDY DESIGN: Randomized controlled trial (clustered); Level of evidence, 1. METHODS: Participating National Collegiate Athletic Association Division I women's soccer teams were assigned randomly to intervention or control groups. Intervention teams were asked to perform the program 3 times per week during the fall 2002 season. All teams reported athletes' participation in games and practices and any knee injuries. Injury rates were calculated based on athlete exposures, expressed as rate per 1000 athlete exposures. A z statistic was used for rate ratio comparisons. RESULTS: Sixty-one teams with 1435 athletes completed the study (852 control athletes; 583 intervention). The overall anterior cruciate ligament injury rate among intervention athletes was 1.7 times less than in control athletes (0.199 vs 0.340; P = .198; 41% decrease). Noncontact anterior cruciate ligament injury rate among intervention athletes was 3.3 times less than in control athletes (0.057 vs 0.189; P = .066; 70% decrease). No anterior cruciate ligament injuries occurred among intervention athletes during practice versus 6 among control athletes (P = .014). Game-related noncontact anterior cruciate ligament injury rates in intervention athletes were reduced by more than half (0.233 vs 0.564; P = .218). Intervention athletes with a history of anterior cruciate ligament injury were significantly less likely to suffer another anterior cruciate ligament injury compared with control athletes with a similar history (P = .046 for noncontact injuries). CONCLUSION: This program, which focuses on neuromuscular control, appears to reduce the risk of anterior cruciate ligament injuries in collegiate female soccer players, especially those with a history of anterior cruciate ligament injury.

An epidemiologic comparison of high school and college wrestling injuries.

BACKGROUND: Wrestling holds worldwide popularity, and large numbers of United States high school and college males participate. However, the sport's arduous nature results in high injury rates. HYPOTHESIS: Wrestling injury rates and patterns will differ between high school and college practice and match exposures. STUDY DESIGN: Descriptive epidemiology study. METHODS: Wrestling-related injury data were collected during the 2005-2006 academic year from 74 nationally representative high schools via High School Reporting Information Online (RIO) and from 15 Division I, II, and III colleges via the National Collegiate Athletic Association Injury Surveillance System. RESULTS: Certified athletic trainers reported 387 injuries among participating high school wrestlers during 166,279 athlete-exposures, for an injury rate of 2.33 injuries per 1000 athlete-exposures. Nationally, high school wrestlers sustained an estimated 99,676 injuries and 8741 skin infections during the 2005-2006 season. In college, 258 injuries occurred among participating wrestlers during 35,599 athlete-exposures, for an injury rate of 7.25 injuries per 1000 athlete-exposures. The injury rate per 1000 athlete-exposures was higher in college than high school (rate ratio [RR] = 3.11, 95% confidence interval [CI]: 2.66-3.64) and was higher in matches than in practice in high school (RR = 2.12, 95% CI: 1.73-2.59) and college (RR = 5.07, 95% CI: 3.96-6.50). Diagnoses in greater proportions of college wrestlers included lacerations (injury proportion ratio [IPR] = 5.98, 95% CI: 2.27-15.74) and cartilage injuries (IPR = 2.69, 95% CI: 1.26-5.74). Body parts injured in greater proportions of high school wrestlers included elbow (IPR = 3.90, 95% CI: 1.66-9.14) and hand (IPR = 2.59, 95% CI: 1.21-5.54). Almost half of all injured high school (44.9%) and college (42.6%) wrestlers resumed wrestling within <1 week. Skin infections represented 8.5% and 20.9% of all reported high school and college events, respectively, and frequently affected the head/face/neck (50.0%). CONCLUSIONS: Rates and patterns of wrestling injury differ between high school and college and between practice and matches.

Comparison of the incidence, nature and cause of injuries sustained on grass and new generation artificial turf by male and female football players. Part 1: match injuries.

OBJECTIVE: To compare the incidence, nature, severity and cause of match injuries sustained on grass and new generation artificial turf by male and female footballers. METHODS: The National Collegiate Athletic Association Injury Surveillance System was used for a two-season (August to December) prospective study of American college and university football teams (2005 season: men 52 teams, women 64 teams; 2006 season: men 54 teams, women 72 teams). Injury definitions and recording procedures were compliant with the international consensus statement for epidemiological studies of injuries in football. Athletic trainers recorded details of the playing surface and the location, diagnosis, severity and cause of all match injuries. The number of days lost from training and match play was used to define the severity of an injury. Match exposures (player hours) were recorded on a team basis. RESULTS: The overall incidence of match injuries for men was 25.43 injuries/1000 player hours on artificial turf and 23.92 on grass (incidence ratio 1.06; p = 0.46) and for women was 19.15 injuries/1000 player hours on artificial turf and 21.79 on grass (incidence ratio = 0.88; p = 0.16). For men, the mean severity of non-season ending injuries was 7.1 days (median 5) on artificial turf and 8.4 days (median 5) on grass and, for women, 11.2 days (median 5) on artificial turf and 8.9 days (median 5) on grass. Joint (non-bone)/ligament/cartilage and contusion injuries to the lower limbs were the most common general categories of match injury on artificial turf and grass for both male and female players. Most injuries were acute (men: artificial turf 24.60, grass 22.91; p = 0.40; women: artificial turf 18.29, grass 20.64; p = 0.21) and resulted from player-to-player contact (men: artificial turf 14.73, grass 13.34; p = 0.37; women: artificial turf 10.72; grass 11.68; p = 0.50). CONCLUSIONS: There were no major differences in the incidence, severity, nature or cause of match injuries sustained on new generation artificial turf and grass by either male or female players.

Comparison of the incidence, nature and cause of injuries sustained on grass and new generation artificial turf by male and female football players. Part 2: training injuries.

OBJECTIVE: To compare the incidence, nature, severity and cause of training injuries sustained on new generation artificial turf and grass by male and female footballers. METHODS: The National Collegiate Athletic Association Injury Surveillance System was used for a two-season (August to December) prospective study involving American college and university football teams (2005 season: men 52 teams, women 64 teams; 2006 season: men 54 teams, women 72 teams). Injury definitions and recording procedures were compliant with the international consensus statement for epidemiological studies of injuries in football. Athletic trainers recorded details of the playing surface and the location, diagnosis, severity and cause of all training injuries. The number of days lost from training and match play was used to define the severity of an injury. Training exposures (player hours) were recorded on a team basis. RESULTS: The overall incidence of training injuries for men was 3.34 injuries/1000 player hours on artificial turf and 3.01 on grass (incidence ratio 1.11; p = 0.21) and for women it was 2.60 injuries/1000 player hours on artificial turf and 2.79 on grass (incidence ratio 0.93; p = 0.46). For men, the mean severity of injuries that were not season ending injuries was 9.4 days (median 5) on artificial turf and 7.8 days (median 4) on grass and, for women, 10.5 days (median 4) on artificial turf and 10.0 days (median 5) on grass. Joint (non-bone)/ligament/cartilage and muscle/tendon injuries to the lower limbs were the most common general categories of injury on artificial turf and grass for both male and female players. Most training injuries were acute (men: artificial turf 2.92, grass 2.63, p = 0.24; women: artificial turf 1.94, grass 2.23, p = 0.21) and resulted from player-to-player contact (men: artificial turf 1.08, grass 0.85, p = 0.10; women: artificial turf 0.47, grass 0.56; p = 0.45). CONCLUSIONS: There were no major differences between the incidence, severity, nature or cause of training injuries sustained on new generation artificial turf and on grass by either men or women.

A framework for recording recurrences, reinjuries, and exacerbations in injury surveillance.

A previous injury can increase the risk of sustaining a similar injury by up to an order of magnitude. To understand the role of previous injury as a risk factor, it is necessary to consider, among other issues, the clinical status of the first (index) injury at the time of the subsequent (recurrent) injury: currently, the inconsistent use of descriptive terms for recurrent injuries makes this extremely difficult. Although recent consensus statements on injury definitions based on return-to-play criteria have provided a consistent methodology for recording and reporting index and recurrent injuries, these statements do not differentiate between the types of recurrent injuries that can occur. This paper presents a recording and reporting framework that subcategorizes recurrent injuries into reinjuries and exacerbations on the basis of whether a player was fully recovered from the preceding index injury, with the state of fully recovered determined by medical opinion. A reinjury is a repeat episode of a fully recovered index injury and an exacerbation is a worsening in the state of a nonrecovered index injury. With this more detailed framework, researchers will be able to investigate risk factors for reinjuries and exacerbations separately, and they will be able to investigate how well players have been rehabilitated before returning to full training and match play.

Epidemiology of high school and collegiate football injuries in the United States, 2005-2006.

BACKGROUND: Football, one of the most popular sports among male high school students in the United States, is a leading cause of sports-related injuries, with an injury rate almost twice that of basketball, the second most popular sport. HYPOTHESIS: Injury patterns will vary between competition and practice exposures and between levels of play (ie, high school vs. National Collegiate Athletic Association [NCAA]). STUDY DESIGN: Descriptive epidemiology study. METHODS: Football-related injury data were collected over the 2005-2006 school year from 100 nationally representative high schools via High School RIO (Reporting Information Online) and from 55 Division I, II, and III colleges via the NCAA Injury Surveillance System. RESULTS: Nationally, an estimated 517,726 high school football-related injuries (1881 unweighted injuries) occurred during the 2005-2006 season. The rate of injury per 1000 athlete-exposures was greater during high school competitions (12.04) than during practices (2.56). The rate of injury per 1000 athlete-exposures was also greater during collegiate competitions (40.23) than during practices (5.77). While the overall rate of injury per 1000 athlete-exposures was greater in the NCAA (8.61) than in high school (4.36), high school football players sustained a greater proportion of fractures and concussions. Running plays were the leading cause of injury, with running backs and linebackers being the positions most commonly injured. CONCLUSION: Patterns of football injuries vary, especially by type of exposure and level of play. Future studies should continue to compare differences in injury patterns in high school and collegiate football, with particular emphasis placed on high-risk plays (running plays) and positions (running backs and linebackers).

Head, face, and eye injuries in scholastic and collegiate lacrosse: a 4-year prospective study.

BACKGROUND: Risks and mechanisms of head, face, and eye injuries in high school and college lacrosse are not well documented. PURPOSE: To identify (1) primary mechanisms of head, face, and eye injuries in lacrosse and (2) differences in injury risk between the men's and women's game and between high school and collegiate levels. STUDY DESIGN: Descriptive epidemiological study. METHODS: The authors gathered data on 507,000 girls' and boys' high school and 649,573 women's and men's college lacrosse athletic exposures using sport-specific injury surveillance systems over 4 seasons. They identified the most common scenarios for head, face, and eye injuries. RESULTS: The high school girls' head, face, and eye injury rate (0.54 per 1000 athletic exposures) was significantly higher (incident rate ratio, 1.42; 95% confidence interval, 1.09-1.86) than that for boys (0.38 per 1000 athletic exposures); college women (0.77 per 1000 athletic exposures) sustained a higher rate of injuries (incident rate ratio, 1.76; 95% confidence interval, 1.42-2.19) than did men (0.44 per 1000 athletic exposures). Concussions constituted a higher percentage of injuries among boys (73%) and men (85%) than among girls (40%) and women (41%). Men sustained few facial injuries, whereas a substantial proportion of women's injuries involved the face and orbital area. CONCLUSION: Although permitting only incidental contact, women's lacrosse had higher rates of head, face, and eye injuries at both the high school and collegiate levels. Concussion was the most common injury. For men, the primary injury mechanism was player-to-player contact; women's injuries primarily resulted from stick or ball contact. High school injury rates were lower than were college rates, but the nature of injuries, body parts affected, and mechanisms were similar.

Concussions among United States high school and collegiate athletes.

CONTEXT: An estimated 300,000 sport-related traumatic brain injuries, predominantly concussions, occur annually in the United States. Sports are second only to motor vehicle crashes as the leading cause of traumatic brain injury among people aged 15 to 24 years. OBJECTIVE: To investigate the epidemiology of concussions in a nationally representative sample of high school athletes and to compare rates of concussion among high school and collegiate athletes. DESIGN: Descriptive epidemiologic study. SETTING: 100 United States high schools and 180 US colleges. PATIENTS OR OTHER PARTICIPANTS: United States high school and collegiate athletes. MAIN OUTCOME MEASURE(S): Data from 2 injury surveillance systems, High School Reporting Information Online (RIO) and the National Collegiate Athletic Association Injury Surveillance System, were analyzed to calculate rates, describe patterns, and evaluate potential risk factors for sport-related concussion. RESULTS: Concussions represented 8.9% (n = 396) of all high school athletic injuries and 5.8% (n = 482) of all collegiate athletic injuries. Among both groups, rates of concussions were highest in the sports of football and soccer. In high school sports played by both sexes, girls sustained a higher rate of concussions, and concussions represented a greater proportion of total injuries than in boys. In all sports, collegiate athletes had higher rates of concussion than high school athletes, but concussions represented a greater proportion of all injuries among high school athletes. CONCLUSIONS: Sport-related injury surveillance systems can provide scientific data to drive targeted injury-prevention projects. Developing effective sport-related concussion preventive measures depends upon increasing our knowledge of concussion rates, patterns, and risk factors.

Understanding and preventing noncontact anterior cruciate ligament injuries: a review of the Hunt Valley II meeting, January 2005.

The incidence of noncontact anterior cruciate ligament injuries in young to middle-aged athletes remains high. Despite early diagnosis and appropriate operative and nonoperative treatments, posttraumatic degenerative arthritis may develop. In a meeting in Atlanta, Georgia (January 2005), sponsored by the American Orthopaedic Society for Sports Medicine, a group of physicians, physical therapists, athletic trainers, biomechanists, epidemiologists, and other scientists interested in this area of research met to review current knowledge on risk factors associated with noncontact anterior cruciate ligament injuries, anterior cruciate ligament injury biomechanics, and existing anterior cruciate ligament prevention programs. This article reports on the presentations, discussions, and recommendations of this group.

NCAA rule change improves weight loss among national championship wrestlers.

PURPOSE: The present investigation was initiated to examine the weight management practices among wrestlers participating in the NCAA Division I, II, and III wrestling tournaments. Part 1 examined the efficacy of body composition assessment between preseason (PRE) and postseason (POST). Part 2 examined rapid weight loss (RWL) during the 20 h preceding the weigh-in and the rapid weight gained (RWG) during the first day's competition. METHODS: Subjects include 811 competitors from Divisions I, II, and III participating in the NCAA national championship tournaments between 1999 and 2004. Measurements included relative body fatness (% BF) and weight (WT) on the day preceding the tournament and the evening of the first day. Minimal weight (MW) was computed with 5% BF. Retrospectively, MW, % BF, and WT from the previous fall were obtained for comparisons from NCAA records. RESULTS: Part 1: WT and % BF decreased significantly PRE (WT 74.0 +/- 11.1 kg; % BF 12.3 +/- 3.4%) to POST (WT 71.5 +/- 10.4 kg; % BF 9.5 +/- 1.8%), but MW (PRE MW 68.0 +/- 9.2 kg, POST MW 67.9 +/- 9.1 kg) remained unchanged. Heavier wrestlers and Division I and II wrestlers showed the greatest changes in WT and % BF. Part 2: RWL averaged (+/- SD) 1.2 +/- 0.9 kg and relative to weight 1.7 +/- 1.2%. Division I and lighter wrestlers showed the greatest change. RWG averaged 0.9 +/- 0.8 kg, or 1.3 +/- 1.2%. RWG was greater among lighter and Division I and II wrestlers. CONCLUSIONS: Minimal weight estimates PRE appear valid compared with POST. RWL and RWG are reduced significantly over previous investigations with only mat-side weigh-ins. The NCAA weight management program appears effective in reducing unhealthy weight cutting behaviors and promoting competitive equity. Efforts to institute similar programs among younger wrestlers seem warranted.

An ecologic study of protective equipment and injury in two contact sports.

BACKGROUND: Contact sports have high rates of injury. Protective equipment regulations are widely used as an intervention to reduce injury risk. The purpose of this study was to investigate the injury prevention effect of regulations governing protective equipment in two full-body contact sports. METHODS: Injury rates in US collegiate football were compared to New Zealand club Rugby Union. Both sports involve significant body contact and have a high incidence of injury. Extensive body padding and hard-shell helmets are mandated in collegiate football but prohibited in Rugby Union. RESULTS: The injury rate in football was approximately one-third the rugby rate (rate ratio [RR] = 0.35; 95% CI: 0.31-0.40). The head was the body site with the greatest differential in injury incidence (RR = 0.11; 95% CI: 0.08-0.16). Rugby players suffered numerous lacerations, abrasions, and contusions to the head region, but the incidence of these injuries in football was almost zero (RR = 0.01; 95% CI: 0.01-0.03). Injury rates were more similar for the knee (RR = 0.61; 95% CI: 0.43-0.87) and ankle (RR = 0.72; 95% CI: 0.46-1.13), two joints largely unprotected in both sports. CONCLUSIONS: The observed differences are consistent with the hypothesis that regulations mandating protective equipment reduce the incidence of injury, although important potential biases in exposure assessment cannot be excluded. Further research is needed into head protection for rugby players.