Pediatric and adolescent injury in mountain biking.

Mountain-biking has become a popular competitive and recreational activity but also involves risk of injury. This article provides an overview of what is known about the scope of the injury problem affecting children and adolescent mountain bikers, the risk factors involved and injury prevention strategies. The proportion of injured child and adolescent mountain bikers ranges from 10.6% to 64.0%, but few studies provide separate analysis of youth injuries. Upper extremity injuries appear most common except among adolescents where the risk of head injury and traumatic brain injuries are greater. Concern is raised regarding the reported frequency of spine fractures and spinal cord injuries. Multi-faceted, longitudinal injury research focusing on youth mountain bikers is required to provide a reliable basis for testing risk factors and evaluating preventive measures. Reducing mountain biking-related injuries will require multiple strategies that integrate approaches from education, engineering, and evidence-based safety measures and their enforcement.

The elite young athlete: strategies to ensure physical and emotional health.

This article presents a current review of the risk of physical and psychological injury associated with participation in elite youth sport, and suggests strategies to ensure the physical and emotional health of these young athletes. Although there is lack of epidemiological data, especially with regard to psychological injury, preliminary data suggest that the risk of injury is high in this population. While there is lack of incident and follow-up data, there is also concern regarding burnout, disordered eating, and the long-term consequences of injury. Modifiable injury risk factors identified include postural control, competition anxiety, life events, previous injury, and volume of training. There are presently no studies designed to determine the effectiveness of injury prevention measures in elite youth sports. However, there is adequate evidence arising from injury prevention studies of youth sports participants - including neuromuscular training, protective equipment, mental training to enhance self-esteem, and sport rules modification - to prevent injuries in elite youth sports settings. Although not tested, psychosocial prevention strategies such as adoption of task-oriented coping mechanisms, autonomous support from parents, and a proactive organizational approach also show promise in injury prevention.

The Effects of Proprioceptive Neuromuscular Facilitation Stretching on Post-Exercise Delayed Onset Muscle Soreness in Young Adults.

Until recently, the scientific community believed that post-exercise stretching could reduce delayed onset muscle soreness (DOMS), but recent reviews of studies on the topic have concluded that pre- or post-exercise static stretching has no effect on mitigating DOMS. However, the effect of proprioceptive neuromuscular facilitation (PNF) post-exercise stretching on preventing DOMS has not been adequately studied. The purpose of this study was to determine the effect of post-exercise PNF stretching on DOMS. Young adult participants (N=57) were randomly assigned to a PNF stretching group (n=19), a static stretching group (n=20), and to a no-stretching control group (n=18). All participants completed exercise designed to induce DOMS prior to post-exercise experimental stretching protocols. Participants rated their soreness level on a pain scale 24 and 48 hours post-exercise. A 3 × 2 mixed ANOVA showed there was an effect for time (p<.01). Post hoc testing revealed that DOMS pain significantly decreased (p<.05) from 24 to 48 hours post-exercise for the PNF and control groups, but not for the static stretching group. Other analyses revealed a significant correlation (r=.61, p<.01) between the pre- and post-exercise stretch scores and the 48 hour post-exercise pain score for the PNF group. Consistent with the results of previous research on post-exercise static stretching, these results indicate that post-exercise PNF stretching also does not prevent DOMS. However, the correlation analysis suggests it is possible the pre-stretch muscle contractions of the post-exercise PNF protocol may have placed a load on an already damaged muscle causing more DOMS for some participants.

A prospective study of injury affecting competitive collegiate swimmers.

The purposes of this study were to determine the incidence and distribution of injuries affecting collegiate competitive swimmers and to test possible injury risk factors. A prospective cohort design was used to follow 34 swimmers (16 M, 18 F) from an NCAA Division I Midwest University over one academic year. Exposure-based injury rates were determined for both practice and competition. Risk of injury was assessed relative to gender, years swimming, and history of injury. Twenty of 34 swimmers sustained 31 injuries with overall injury rates of 5.55 injuries per 1000 athlete exposures and 3.04 injuries per 1000 hours exposure. Practice injury rates for female swimmers were higher than for women's practice injury rates in other NCAA sports. The most common injury locations were the shoulder, back, and knee. Risk factors that remained significant in the multivariate analysis were history of injury to the same anatomical location and history of injury at other anatomical sites.

The epidemiology of injury in adventure and extreme sports.

The objective of this article is to provide an overview of the current knowledge related to the epidemiology of injury in selected adventure and extreme sports. PubMed and Google Scholar were searched using the terms 'epidemiology', 'injury,' 'adventure sports' and 'extreme sports'. Publications from the past 10 years were largely selected, but commonly referenced or highly regarded older publications were also included. References lists of articles identified in the search strategy were also searched and articles selected that were judged to be relevant. Important aspects of the epidemiology of injury related to adventure and extreme sports are discussed including occurrence of injury, who is affected by injury, where and when injury occurs, injury outcome, risk factors, inciting events, prevention and further research. Given the life-changing impact injury can have in sports (personal, social, financial, psychological, political, and medical), the current paucity of well-designed descriptive and particularly analytical epidemiological studies in some adventure and extreme sports is disturbing. The importance of denominator-based and longitudinal data collection in obtaining an accurate picture of injury risk and severity and as a basis for testing risk factors and evaluating preventive measures is emphasized.

A comprehensive review of the effectiveness of different exercise programs for patients with osteoarthritis.

Exercise is recommended as a first-line conservative intervention approach for osteoarthritis (OA). A wide range of exercise programs are available and scientific evidence is necessary for choosing the optimal strategy of treatment for each patient. The purpose of this review is to discuss the effectiveness of different types of exercise programs for OA based on trials, systematic reviews, and meta-analyses in the literature. Publications from January 1997 to July 2012 were searched in 4 electronic databases using the terms osteoarthritis, exercise, exercise program, effectiveness, and treatment outcome. Strong evidence supports that aerobic and strengthening exercise programs, both land- and water-based, are beneficial for improving pain and physical function in adults with mild-to-moderate knee and hip OA. Areas that require further research include examination of the long-term effects of exercise programs for OA, balance training for OA, exercise programs for severe OA, the effect of exercise programs on progression of OA, the effectiveness of exercise for joint sites other than the knee or hip, and the effectiveness of exercise for OA by such factors as age, sex, and obesity. Efforts to improve adherence to evidence-based exercise programs for OA and to promote the dissemination and implementation of these programs are crucial.

Resistance training vs. static stretching: effects on flexibility and strength.

Morton, SK, Whitehead, JR, Brinkert, RH, and Caine, DJ. Resistance training vs. static stretching: Effects on flexibility and strength. J Strength Cond Res 25(12): 3391-3398, 2011-The purpose of this study was to determine how full-range resistance training (RT) affected flexibility and strength compared to static stretching (SS) of the same muscle-joint complexes in untrained adults. Volunteers (n = 25) were randomized to an RT or SS training group. A group of inactive volunteers (n = 12) served as a convenience control group (CON). After pretesting hamstring extension, hip flexion and extension, shoulder extension flexibility, and peak torque of quadriceps and hamstring muscles, subjects completed 5-week SS or RT treatments in which the aim was to stretch or to strength train the same muscle-joint complexes over similar movements and ranges. Posttests of flexibility and strength were then conducted. There was no difference in hamstring flexibility, hip flexion, and hip extension improvement between RT and SS, but both were superior to CON values. There were no differences between groups on shoulder extension flexibility. The RT group was superior to the CON in knee extension peak torque, but there were no differences between groups on knee flexion peak torque. The results of this preliminary study suggest that carefully constructed full-range RT regimens can improve flexibility as well as the typical SS regimens employed in conditioning programs. Because of the potential practical significance of these results to strength and conditioning programs, further studies using true experimental designs, larger sample sizes, and longer training durations should be conducted with the aim of confirming or disproving these results.

Survey of injuries in Seattle area levels 4 to 10 female club gymnasts.

OBJECTIVE: To evaluate incidence, distribution, and contributing factors of injury in club gymnastics. DESIGN: Cross-sectional survey. SETTING: Five randomly selected gymnastics clubs near Seattle, WA. PARTICIPANTS: Ninety-six club gymnasts from competitive levels 4 to 10. INTERVENTIONS: The participants completed a questionnaire regarding demographics, injuries and contributing factors, and exposure time in the last competitive season. MAIN OUTCOME MEASURES: Acute and overuse injury incidence rates stratified by practice and competition, age categories, and level using relative risks and 95% confidence intervals (CIs). Chi-square testing was used to compare demographic-specific and gymnastic-specific variables between injured and uninjured. Multivariate regression modeling was used to assess independent risk factors for risk of acute and overuse injuries. RESULTS: Acute injury rate was 1.3 per 1000 hours and in univariate, but not multivariate analysis, it was 3.6-fold greater (95% CI, 1.6-9.1) among 10 to 12 year olds and 3.1-fold greater (95% CI, 1.3-8.0) among 13 to 17 year olds compared with 7 to 9 year olds. The most common acutely injured body parts were foot (21.0%), ankle (19.3%), knee (14.0%), and wrist (8.8%). The majority of injuries occurred in practice, but the meet injury rate was higher. Most injuries occurred on floor exercise (32.1%), beam (20.7%), and bars (17.0). Injury was most common during landing. The overuse injury rate was 1.8 per 1000 hours. During their gymnastics careers, concussions occurred in 30.2% and stress fractures affecting mostly low back and foot occurred in 16.7% of the gymnasts. CONCLUSIONS: Gymnasts are at similar risk of acute and overuse injuries, and acute injury rates were greater among older gymnasts. However, this predictor did not remain significant in multivariate analysis. Concussions and stress fractures are common. Gymnastics injury prevention studies should focus on older gymnasts, concussion education, and landing after a skill.

Osteoarthritis as an outcome of paediatric sport: an epidemiological perspective.

Recent data suggest that the risk of paediatric sport injury is high and constitutes a significant public health burden. A concern regarding long-term consequences of youth sports injury is the risk of developing osteoarthritis (OA) at a young age. Based on the available evidence, a link between youth sports injuries, particularly acute injury of the knee and ankle, and OA, is likely. Early OA development and intense participation in high-impact, high-stress elite sports at an early age also may be associated, but follow-up of elite athletes into the early adult years is needed to examine this relationship. Given that some antecedents of early adult-onset OA may be traced to child and adolescent sports injury and related surgery, and perhaps intense training regimens, it follows that efforts to prevent sports-related joint injury should begin during the childhood years. Based on the results of recent research evidence, programmes addressing prevention of youth sports injuries may provide the rewarding results of OA prevention.

Wrist pain, distal radial physeal injury, and ulnar variance in the young gymnast.

In gymnastics, the wrist joint is subjected to repetitive loading in a weightbearing fashion. In this setting, chronic wrist pain is quite common. Because gymnasts ordinarily enter the sport at very young ages and train for several years before skeletal maturity is attained, the growth plates of the wrist are at risk for injury. In addition, imaging studies have identified evidence of injury to the distal radial physis and the development of positive ulnar variance. Recent studies provide more information on the relationships between these findings, as well as factors that may predispose some gymnasts to wrist pain. This article provides a comprehensive review of these issues and offers suggestions for management, preventive measures, and future research.

Gymnastics injuries.

OBJECTIVE: The purpose of this chapter is to review the distribution and determinants of injury rates as reported in the pediatric gymnastics injury literature, and to suggest measures for the prevention of injury and directions for further research. DATA SOURCES: An extensive search of Pubmed was conducted using the Text and MeSH words "gymnastics" and "injury" and limited to the pediatric population (0-18 years). The review focused on studies using denominator-based designs and on those published in the English language. Additional references were obtained from hand searches of the reference lists. Unpublished injury data from the USA Gymnastics National Women's Artistic Gymnastics Championships during 2002-04 were also analyzed. MAIN RESULTS: Comparison of study results was compromised due to the diversity of study populations, variability of injury definition across studies, and changes in rules and equipment across years. Notwithstanding, this review of the literature reveals a reasonably consistent picture of pediatric gymnastics injuries. The incidence and severity of injuries is relatively high, particularly among advanced level female gymnasts. Body parts particularly affected by injury vary by gender and include the ankle, knee, wrist, elbow, lower back, and shoulder. Ankle sprains are a particular concern. Overuse and nonspecific pain conditions, particularly the wrist and low back, occur frequently among advanced-level female gymnasts. Factors associated with an increased injury risk among female gymnasts include greater body size and body fat, periods of rapid growth, and increased life stress. CONCLUSIONS: Above all, this overview of the gymnastics injury literature underscores the need to establish large-scale injury surveillance systems designed to provide current and reliable data on injury trends in both boys and girls gymnastics, and to be used as a basis for analyzing injury risk factors and identifying dependable injury preventive measures.