The sport Injury Rehabilitation Adherence Scale : a reliable scale for use in clinical physiotherapy

Objective
To evaluate, through two studies, the factor structure, inter-rater agreement, and test–retest and inter-rater reliability of the Sport Injury Rehabilitation Adherence Scale (SIRAS).

Design
Repeated measures design in both Study 1 (video evaluation) and Study 2 (clinical evaluation).

Setting
University department (Study 1) and outpatient physiotherapy department (Study 2).

Participants
Sixty physiotherapists and physiotherapy students in Study 1 and 45 patients undergoing physiotherapy treatment for a musculoskeletal injury in Study 2.

Intervention
In Study 1, participants rated the adherence of a simulated videotaped patient demonstrating high, moderate and low adherence during rehabilitation. In Study 2, two physiotherapists rated the adherence of patients at two consecutive rehabilitation sessions.

Main outcome measure
The SIRAS.

Results
In Study 1, principal components analysis confirmed a single factor for the SIRAS, and inter-rater agreement values ranged from 0.87 to 0.93. In Study 2, inter-rater and test–retest reliability coefficients ranged from 0.76 [95% confidence interval (CI) 0.54 to 0.83] to 0.89 (95% CI 0.79 to 0.95), and from 0.63 (95% CI 0.36–0.82) to 0.76 (95% CI 0.55–0.88), respectively.

Conclusion
The SIRAS is a reliable measure with high inter-rater agreement when used to evaluate clinic-based adherence to physiotherapy rehabilitation for musculoskeletal injury.

Volume of physical activity and injury occurrence in young basketball players

Participation in organised, competitive physical activity by young athletes is increasing rapidly. This is concurrent with an increase in sporting injuries in the young population. This pilot study aimed to compare the weekly volume and types of physical activity in young basketball players injured and not injured during the season. Detailed physical activity and injury data were prospectively collected in 46 school-level basketball players aged 14 to 18 years. Participants completed physical activity logs which documented the type of physical activity undertaken, what the activity consisted of (i.e. training, competition) and the level at which it was played on a daily basis. Allied health staff completed a weekly injury form. Results showed that injured and uninjured athletes participated in a similar volume of total weekly physical activity over the season. However, injured athletes (p = 0.04) and athletes who specifically sustained overuse injuries (p = 0.01) participated in a greater amount of basketball refereeing than uninjured athletes. Based on these findings it was concluded that greater participation in running-type physical activity such as refereeing, as an addition to training and competition, may predispose the young basketball player to increased injury risk. Future research using larger sample sizes are required to further investigate the role of participation volume and type on injury occurrence in adolescent athletes.

Translating guidelines for the diagnosis and management of sports-related concussion into practice

Sports injuries are a significant clinical and public
health concern. There is a growing call to improve the translation of available evidence-based and expert- informed sports injury prevention interventions into sustained use in practice by physicians and others (eg, athletic trainers, coaches, and parents) who care for injured athletes. This article provides a brief overview of the current sport injury prevention implementation literature before focusing specifically on the translation of guidelines (including consensus and position statements) developed to assist physicians and others diagnose and manage athletes with sport-related concussion and the associated return-to-play decisions. The outcomes of more than 20 published studies indicate that physician, athletic trainer, coach, parent,
and athlete knowledge, use of, and compliance with sport-related concussion guidelines are limited. More concerted, coordinated, and theory-informed efforts are required to facilitate the widespread dissemination, translation, and implementation of such guidelines. An example is provided of how implementation drivers could be used to inform the development of a comprehensive, multilevel implementation strategy targeting the individual, organizational, and system-level changes necessary to support the translation of available sport-related concussion guidelines in both the clinical and sports settings.

Return to pre-injury health status and function 12 months after hospitalisation for sport and active recreation related orthopaedic injury

Background Hospitalised sport and active recreation injuries can have serious long-term consequences. Despite this, few studies have examined the long-term outcomes of these injuries. The purpose of this study was to establish whether patients hospitalised with orthopaedic sport and active recreation injuries, have returned to their pre-injury levels of health status and function, 12 months post injury and identify factors associated with poor outcomes. The present work was a cohort study with retrospective assessment of pre-injury status and prospective assessment of outcome at 12 months post injury.

Methods Adults with orthopaedic sport and active recreation injuries, captured by the Victorian Orthopaedic Trauma Outcomes Registry were recruited to the study. Pre-injury and 12-month outcomes were assessed using the 36-item Short Form Health Survey (SF-36) and the extended Glasgow Outcome Scale. Differences in pre-injury and post-injury SF-36 scores were examined and demographic, injury, hospital and physical activity variables were assessed for associations with outcome using multivariate linear regression.

Results Of the 324 participants 98% were followed-up at 12 months post injury. At 12 months, participants reported a mean 7.0-point reduction in physical health (95% CI 5.8 to 7.8) and a 2.5-point reduction in mental health (95% CI 1.2 to 3.0), with 58% (95% CI 52.6% to 63.4%) reporting reduced function. Sporting group (p=0.001), Injury Severity Score >15 (p=0.007) and high pre-injury vigorous activity levels (p=0.04), were related to poorer physical health outcomes.

Conclusions At 12 months post injury, most participants reported large reductions in physical health and reduced function. This information is important for furthering our understanding of the burden of sport and active recreation injury and setting priorities for treatment and rehabilitation.

The impact of sport and active recreation injuries on physical activity levels at 12 months post-injury

The aim of this study was to evaluate the impact of serious sport and active recreation injury on 12-month physical activity levels. Adults admitted to hospital with sport and active recreation-related injuries, and captured by the Victorian Orthopaedic Trauma Outcomes Registry were recruited to the study. Changes between preinjury and 12 month post-injury physical activity was assessed using the short International Physical Activity Questionnaire (IPAQ). Independent demographic, injury, and hospital variables were assessed for associations with changes in physical activity levels, using multivariate linear regression. A total of 324 patients were recruited, of which 98% were followed up at 12 months. Mean short IPAQ scores decreased from 7650 METS (95% CI: 7180, 8120) preinjury to 3880 METS; (95% CI: 3530, 4250) post-injury, independent of functional recovery. Education level and occupation group were the only variables independently associated with changes in physical activity levels post-injury. These results highlighted that sport and active recreation injuries lead to significant reductions in physical activity levels. Hence, the prevention of sport and active recreation injuries is important when considering promotion of activity at a population level.

Efficacy of ACL injury risk screening methods in identifying high-risk landing patterns during a sport-specific task

Screening methods sensitive to movement strategies that increase anterior cruciate ligament (ACL) loads are likely to be effective in identifying athletes at-risk of ACL injury. Current ACL injury risk screening methods are yet to be evaluated for their ability to identify athletes' who exhibit high-risk lower limb mechanics during sport-specific maneuvers associated with ACL injury occurrences. The purpose of this study was to examine the efficacy of two ACL injury risk screening methods in identifying high-risk lower limb mechanics during a sport-specific landing task. Thirty-two female athletes were screened using the Landing Error Scoring System (LESS) and Tuck Jump Assessment. Participants' also completed a sport-specific landing task, during which three-dimensional kinematic and kinetic data were collected. One-dimensional statistical parametric mapping was used to examine the relationships between screening method scores, and the three-dimensional hip and knee joint rotation and moment data from the sport-specific landing. Higher LESS scores were associated with reduced knee flexion from 30 to 57 ms after initial contact (P = 0.003) during the sport-specific landing; however, no additional relationships were found. These findings suggest the LESS and Tuck Jump Assessment may have minimal applicability in identifying athletes' who exhibit high-risk landing postures in the sport-specific task examined.

Balancing the risk of injury to gymnasts : how effective are the counter measures?

Background—To minimise injury risk and maximise gymnastics performance, coaches, parents, and health professionals working with young gymnasts need to understand and practise safe gymnastics.

Aims—To (a) identify the various injury counter measures specific to gymnastics, (b) critically review the literature describing each injury prevention measure, and (c) assess, using available risk factor and injury data, the weight of evidence to support each of these counter measures. Specific recommendations for further research and implementation strategies to prevent injury and improve safety are also given.

Methods—The relevant literature was identified through the use of Medline (1966 to May 1998) and SPORT Discus (1975 to May 1998) searches, hand searching of journals and reference lists, and discussions with key Australian gymnastics organisations.

Results—The key gymnastics injury counter measures identified in this review include coaching (physical preparation, education, spotting, and performance technique), equipment, and the health support system (medical screening, treatment, and rehabilitation). Categorisation of the type of evidence for the effectiveness of each of these counter measures in preventing injury showed that most of it is based on informal opinion/anecdotal evidence, uncontrolled data based studies, and several prospective epidemiological studies. There is no evidence from formally controlled trials or specific evaluation studies of counter measures for gymnastics.

Conclusions—Although gymnastics is a sport associated with young participants and frequent high volume, high impact training, there is a paucity of information on injury risk factors and the effectiveness of injury practices. Further controlled trials are needed to examine the extent to which injury prevention counter measures can prevent or reduce the occurrence of injury and re-injury. Particular attention should be devoted to improving training facilities, the design and testing of apparatus and personal equipment used by gymnasts, and coaching and the role of spotting in preventing injury.

Sport safety policies and practices in two rural Victorian communities

Australian football and netball are the predominant sports played in rural Victoria, Australia. This exploratory study is the first to report the sport safety policies and practices adopted by junior Australian football and netball clubs in small rural communities. Eleven informants from four clubs completed a semi-structured interview and survey. Whilst the clubs performed a range of injury prevention activiities, they did not have formal sports safety policies. Generally, netball informants reported fewer safety practices than football informants. Crucial factors influencing safety policies and practices were the reliance on volunteers and a lack of senior players. Barriers towards the adoption of safety policies and practices appeared to be related to rural population declines, a lack of qualified people and attitudes to injury in rural areas. Future research needs to identify how widespread this lack of sport safety policies and practices is across rural Australia and to identify strategies to overcome barriers to implementing them.

Teaching landing skills in elite junior Australian football: evaluation of an injury prevention strategy

Objective: To evaluate the effectiveness of a preseason physical training programme that taught landing and falling skills in improving landing skills technique and preventing injury in junior elite Australian football players.

Methods: 723 male players who participated in an under 18 elite competition were studied prospectively in a non-randomised controlled trial over two consecutive football seasons. There were 114 players in the intervention group and 609 control players. The eight session intervention programme taught players six landing, falling, and recovery skills, which were considered fundamental for safe landing in Australian football. Landing skills taught in these sessions were rated for competence by independent and blinded assessors at baseline and mid-season.

Results: Evaluation of landing skills found no significant differences between the groups at baseline. Evaluation after the intervention revealed overall improvement in landing skills, but significantly greater improvement in the intervention group (z = –7.92, p = 0.001). Players in the intervention group were significantly less likely (relative rate 0.72, 95% confidence interval 0.52 to 0.98) to sustain an injury during the season than the control group. In particular, the time to sustaining a landing injury was significantly less for the intervention group (relative rate 0.40, 95% confidence interval 0.17 to 0.92) compared with the control group.

Conclusions: Landing and falling ability can be taught to junior elite Australian football players. Players in the intervention group were protected against injury, particularly injuries related to landing and falls.

Injury prevention during physical activity in the Australian Defence Force

Introduction:
Injuries sustained by Australian Defence Force (ADF) personnel during non-combat military training and sports activity are associated with increasing costs due to work days lost, medical treatment, compensation, and early retirement. In 2001, the ADF commissioned a systematic review of the evidence-base for reducing injuries associated with physical activity, while at the same time improving physical activity participation rates to sustain a trained, fit and deployable workforce.

Method:
Literature from on-line library databases, relevant unclassified military reports, and material from previously published sport-specific injury countermeasure reviews were systematically and critically analysed to address the study aims.

Results:
Modification of intensity, frequency and duration of basic military training activities and improved equipment is likely to reduce injury occurrence. Sports injury countermeasures used for the civilian population have merit for the ADF physical activity program. Injury countermeasures should be designed to minimise any possible deterrent effect on the motivation to participate in regular physical activity. Increasing the participation of ADF personnel in physical activity in the presence of evidence-based injury prevention strategies has the potential to increase health, fitness and deployability with minimal impact on injury frequency.

Conclusion:
Recommendations arising from the review include injury intervention trials in basic military training and sports. These and other interventions should be supported by refinement to ADF injury surveillance systems. Research should focus on interventions with the greatest gain for fitness, deployability, and cost effectiveness.

Managing sport in drought-new stakeholders and new governance issues : a case study

Globally, almost every nation is facing some form of water crisis (World Commission on Water 2000). In Australia, the sport and recreation industry is one of the highest consumers of water. Other high water consuming industries (such as agriculture and farming) have been forced to adhere to strict managerial and governance reform due to the water crisis, yet in the sport and recreation industry, such changes are yet to be implemented and fully realised across the sector.

This research examines the impacts of drought and sustainable water management for sport and recreation. Specifically, it provides a case study of sport and recreation provision in a municipality that has already undergone considerable reform due to long-term drought. Sport and recreation use water for purposes such as irrigation of playing fields/pitches, filling swimming pools, stadium amenities and facilities, kitchens, maintenance and cleaning, and clubhouse amenities.

For sports that are heavy users of water for the maintenance of playing fields (such as soccer, Australian Rules football, rugby league, rugby union, grass and clay tennis courts to name a few) the impacts of drought and water restrictions have been severe. Some sports have reported an increase in the risk of injury to participants because of the condition of un-watered playing fields (Sport and Recreation Victoria 2007). Others have been forced to delay or shorten their seasons (Sleeman 2007), or worse still, cancel training and organised competition completely (Connolly and Bell 2007). While the impact of water restrictions has been profound on most sports, there are some sports that are not heavy water users and the impact of drought and water restrictions has been minimal. This problem creates issues and apparent inequities raising the need to further examine water consumption in sport and recreation. The potential outcome that arises is that the future of those sports that cannot conduct their competitions may be disadvantaged, while other sports that do not have such problems may be able to flourish.

Water, and those who control the supply of it, then defines which sports are able to flourish and sustain sport development pathways, compared to those whose survival may be in jeopardy. This research explores the stakeholder management and governance issues that have resulted for sport and recreation in the City of Greater Geelong (CoGG) located in Victoria, Australia--a region in long-term water crisis. The supply of sport and recreation facilities in the CoGG (like most municipalities in Australia) is largely the responsibility of the municipal council. The corporation responsible for the supply of water to the municipality is Barwon Water.

Although other sport and recreation facilities exist in the CoGG, the municipal council of CoGG owns and maintains over 120 sporting ovals (including the stadium used by its professional Australian Football League (AFL) team, the Cats), six swimming pools, and three golf courses. The CoGG host their professional AFL team, a range of local, national and international sport events, and provide a wide range of sport and recreation facilities for the community residents.

Eight interviews were conducted in total. Interviews were conducted with representatives from CoGG municipal council (who are responsible for the delivery of sport and recreation services and facilities in Geelong), and representatives from Barwon Water (who are responsible for the ongoing provision and maintenance of sport and recreation services and facilities) through the provision of water. Results show that the ten highest users of water in the municipality are sport and recreation facilitieswhich between them use almost one-third of the city's total water consumption (City of Greater Geelong 2006).

The municipal council is under considerable pressure to find ways to continue to provide sport and recreation opportunities for community members, as well as professional athletes and teams who use these facilities despite water restrictions. After all, these facilities provide benefit to spectators and participants, as well as businesses that rely on visitors to Geelong for sport and recreation events.

Due to such pressures, from 2007, the CoGG and Barwon Water agreed to provide the sport and recreation sector with water allocations rather than to be denied of all water under the water restriction regimes in place in the municipality. During 2007 summer sport season, this allowed the CoGG to keep 16 of its 120 sporting ovals open for participation through allocating all available water to these fields in order to keep them safe and playable. However, CoGG and Barwon Water were required to devise a rating scale to determine which sports (and sport facilities) were to share the allocated water, and which were not. These decisions also had knock on effects through sports. In order to ensure the safety of the playing surfaces, the CoGG and Barwon Water also restricted use of fields to competition only, therefore sport participants were forced to train on local beaches and other parkland areas-transferring issues of safety and public liability to other locations and facilities in the community. Further, it was reported that scheduling of competition seasons and individual matches; as well as the allocation of "home ground" gate receipts and concessions profits were required to be governed by the CoGG and Barwon Water as the competing sports were unable to agree. Perhaps more importantly, the rating scale developed for water allocation also resulted in some sports being rated as ineligible for water and as a result were unable to stage their entire competitions.

Clearly, the water allocation rating scale, and approach taken in this municipality to the continued delivery of sport and recreation has provided a workable solution. However, this study also signals that new stakeholders have entered the arena for the governance of sport. Governance structures in sport and recreation are being impacted as a result of the water crisis.

Those making decisions about which sport and recreation activities and/or facilities will be assisted with water resources are being made by local councils and water corporations. Sport managers are being required to understand existing areas of knowledge (such as turf management) in different ways, to gain knowledge in new areas (such as sustainable water management), and to lobby new stakeholder groups (such as water corporations) in order to secure their futures. The continued existence of some sports is no longer in the hands of governing bodies, but in the hands of local councils, and water corporations.

Clearly, any of the solutions implemented as discussed above, require multiple stakeholders to interact, and to reach agreement in order to assist in sustainable management of water in sport and recreation. In this sense, the management of water in sport (and all other industries) is more than a rational decision about policy, legislation, restrictions and resource allocations. It is a social and political process requiring scholarly attention for practical solutions.

Imagery in sport

Ch. 1. Introduction : the power of imagination -- Ch. 2. Definitions : what is imagery? -- Ch. 3. Theories : how does imagery work? -- Ch. 4. Imagery-ability and imagery-use assessment -- Ch. 5. Imagery research -- Ch. 6. Imagery perspectives -- Ch. 7. Psychophysiological research on imagery -- Ch. 8. Strategies for applying imagery -- Ch. 9. Uses for imagery -- Ch. 10. Technical aids to imagery -- Ch. 11. Injury rehabilitation and imagery -- Ch. 12. Exercise and imagery -- Ch. 13. Future directions in research and practice

Neuromuscular adaptations to training, injury and passive interventions: implications for running economy

Performance in endurance sports such as running, cycling and triathlon has long been investigated from a physiological perspective. A strong relationship between running economy and distance running performance is well established in the literature. From this established base, improvements in running economy have traditionally been achieved through endurance training. More recently, research has demonstrated short-term resistance and plyometric training has resulted in enhanced running economy. This improvement in running economy has been hypothesized to be a result of enhanced neuromuscular characteristics such as improved muscle power development and more efficient use of stored elastic energy during running. Changes in indirect measures of neuromuscular control (i.e. stance phase contact times, maximal forward jumps) have been used to support this hypothesis. These results suggest that neuromuscular adaptations in response to training (i.e. neuromuscular learning effects) are an important contributor to enhancements in running economy. However, there is no direct evidence to suggest that these adaptations translate into more efficient muscle recruitment patterns during running. Optimization of training and run performance may be facilitated through direct investigation of muscle recruitment patterns before and after training interventions.

There is emerging evidence that demonstrates neuromuscular adaptations during running and cycling vary with training status. Highly trained runners and cyclists display more refined patterns of muscle recruitment than their novice counterparts. In contrast, interference with motor learning and neuromuscular adaptation may occur as a result of ongoing multidiscipline training (e.g. triathlon). In the sport of triathlon, impairments in running economy are frequently observed after cycling. This impairment is related mainly to physiological stress, but an alteration in lower limb muscle coordination during running after cycling has also been observed. Muscle activity during running after cycling has yet to be fully investigated, and to date, the effect of alterations in muscle coordination on running economy is largely unknown. Stretching, which is another mode of training, may induce acute neuromuscular effects but does not appear to alter running economy.

There are also factors other than training structure that may influence running economy and neuromuscular adaptations. For example, passive interventions such as shoes and in-shoe orthoses, as well as the presence of musculoskeletal injury, may be considered important modulators of neuromuscular control and run performance. Alterations in muscle activity and running economy have been reported with different shoes and in-shoe orthoses; however, these changes appear to be subject-specific and nonsystematic. Musculoskeletal injury has been associated with modifications in lower limb neuromuscular control, which may persist well after an athlete has returned to activity. The influence of changes in neuromuscular control as a result of injury on running economy has yet to be examined thoroughly, and should be considered in future experimental design and training analysis.