Psychological predictors of injury in elite athletes

The Queensland Academy of Sport (QAS) supports over 600 high-level athletes across 20 sports. Given the high cost of injuries (e.g., time out of sport and consequent detraining, expense of rehabilitation, adverse social and economic effects), comprehensive injury management and prevention has become a priority for the QAS. Considering the potential for developing cost-effective, preventative programs, knowledge gained by examination of psychological screening predictors of injury may also prove beneficial for the broader sports medicine community. Aims were to: Objectively summarise existing injury characteristics, including the creation of population-specific norms for scholarship holders at the QAS. Assess relationships between injuries, specific medical factors (e.g., asthma, back pain) and psychological risk factors including life stress, mood, previous psychological diagnoses and disordered eating behaviour over a three-year period. Evaluate the effectiveness of the psychological component of the QAS Health Screening Questionnaire.

Shoulder pain in overhead athletes : a systematic review of orthopaedic causes

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Neuromuscular adaptations in football athletes with prior history of hamstring strain injury

Background: Hamstring strain injuries (HSI) are one of the most common injuries in a wide variety of running-sports, resulting in a considerable loss of competition and training time. One of the most problematic consequences regarding HSI is the recurrence rate and its non-decrease over the past decades, despite increasing evidence. Recent studies also found several maladaptations post-HSI probably due to neuromuscular inhibition and it has been proposed that these adaptations post-injury may contribute as risk factors for the injury-reinjury cycle and high recurrence rates. Furthermore it has been recently proposed not to disregard the inter-relationship between these adaptations and risk-factors post-injury in order to better understand the mechanisms of this complex injury. Objective: To determine, analyze and correlate neuromuscular adaptations in amateur football players with prior history of HSI per comparison to uninjured athletes in similar conditions. Methodology: Every participant was subjected to isokinetic concentric (60 and 240deg.sec) and eccentric (30 and 120deg.sec¯¹) testing, and peak torque, angle of peak torque and hamstrings to quadriceps (H:Q) conventional ratios were measured, myoelectrical activity of Bicep Femoris (BF) and Medial Hamstrings (MH) were also measured during isokinetic eccentric testing at both velocities and muscle activation percentages were calculated at 30, 50 and 100ms after onset of contraction. Furthermore active and passive knee extension, knee joint position sense (JPS) test, triple-hop distance (THD) test and core stability (flexors and extensors endurance, right and left side bridge test) were used and correlated. Results: Seventeen players have participated in this study: 10 athletes with prior history of HSI, composing the Hamstring injury group (HG) and 7 athletes without prior severe injuries as control group (CG). We found statistical significant differences between HG injured and uninjured sides in the BF myoelectrical activity at almost all times in both velocities and between HG injured and CG non-dominant sides at 100ms in eccentric 120deg.sec¯¹ velocity (p<.05). We found no differences in MH activity. Regarding proprioception we found differences between the HG injured and uninjured sides (p=.027). We found no differences in the rest of used tests. However, significant correlation between myoelectrical activation at 100ms in 120deg.sec¯¹ testing and JPS with initial position at 90º (r-.372; p=0.031) was found, as well as between isokinetic H:Q ratio at 240deg.sec and THD score (r=-.345; p=.045). Conclusion: We found significant differences that support previous research regarding neuromuscular adaptations and BF inhibition post-HSI. Moreover, to our knowledge, this was the first study that found correlation between these adaptations, and may open a door to new perspectives and future studies.

The role of neuromuscular inhibition in hamstring strain injury recurrence

Hamstring strain injuries are amongst the most common and problematic injuries in a wide range of sports that involve high speed running. The comparatively high rate of hamstring injury recurrence is arguably the most concerning aspect of these injuries. A number of modifiable and nonmodifiable risk factors are proposed to predispose athletes to hamstring strains. Potentially, the persistence of risk factors and the development of maladaptations following injury may explain injury recurrence. Here, the role of neuromuscular inhibition following injury is discussed as a potential mechanism for several maladaptations associated with hamstring re-injury. These maladaptations include eccentric hamstring weakness, selective hamstring atrophy and shifts in the knee flexor torque-joint angle relationship. Current evidence indicates that athletes return to competition after hamstring injury having developed maladaptations that predispose them to further injury. When rehabilitating athletes to return to competition following hamstring strain injury, the role of neuromuscular inhibition in re-injury should be considered.

Injuries leading to hospitalisation in the first year of life : analysis by trimester of age using coded data and textual description

Objective: To describe unintentional injuries to children aged less than one year, using coded and textual information, in three-month age bands to reflect their development over the year. Methods: Data from the Queensland Injury Surveillance Unit was used. The Unit collects demographic, clinical and circumstantial details about injured persons presenting to selected emergency departments across the State. Only injuries coded as unintentional in children admitted to hospital were included for this analysis. Results: After editing, 1,082 children remained for analysis, 24 with transport-related injuries. Falls were the most common injury, but becoming proportionately less over the year, whereas burns and scalds and foreign body injuries increased. The proportion of injuries due to contact with persons or objects varied little, but poisonings were relatively more common in the first and fourth three-month periods. Descriptions indicated that family members were somehow causally involved in 16% of injuries. Our findings are in qualitative agreement with comparable previous studies. Conclusion: The pattern of injuries varies over the first year of life and is clearly linked to the child's increasing mobility. Implications: Injury patterns in the first year of life should be reported over shorter intervals. Preventive measures for young children need to be designed with their rapidly changing developmental stage in mind, using a variety of strategies, one of which could be opportunistic developmentally specific education of parents. Injuries in young children are of abiding concern given their immediate health and emotional effects, and potential for long-term adverse sequelae. In Australia, in the financial year 2006/07, 2,869 children less than 12 months of age were admitted to hospital for an unintentional injury, a rate of 10.6 per 1,000, representing a considerable economic and social burden. Given that many of these injuries are preventable, this is particularly concerning. Most epidemiologic studies analyse data in five-year age bands, so children less than five years of age are examined as a group. This study includes only those children younger than one year of age to identify injury detail lost in analyses of the larger group, as we hypothesised that the injury pattern varied with the developmental stage of the child. The authors of several North American studies have commented that in dealing with injuries in pre-school children, broad age groupings are inadequate to do justice to the rapid developmental changes in infancy and early childhood, and have in consequence analysed injuries in shorter intervals. To our knowledge, no similar analysis of Australian infant injuries has been published to date. This paper describes injury in children less than 12 months of age using data from the Queensland Injury Surveillance Unit (QISU).

Patellar tendon ultrasonography in asymptomatic active athletes reveals hypoechoic regions : a study of 320 tendons

OBJECTIVE: To compare patellar tendon sonographic findings in active, currently asymptomatic, elite athletes with those in nonathletic controls. DESIGN: Cross-sectional cohort study with convenience control sample. SETTING: The Victorian Institute of Sport Tendon Study Group, an institutional elite athlete study group in Australia. PATIENTS AND PARTICIPANTS: Two hundred elite male and female athletes from the sports of basketball, cricket, netball, and Australian rules football. Forty athletes who had current symptoms of jumper's knee were excluded from analysis, leaving 320 subject tendons in athletes who were currently asymptomatic. Twenty-seven nonathletic individuals served as controls. MAIN OUTCOME MEASURE: Sonographic patellar tendon appearance. We measured the dimensions of subject tendons and noted the presence or absence of hypoechoic regions and tendon calcification. Dimensions of hypoechoic regions were measured, and approximate cross-sectional areas were calculated. Chi-squared analysis was used to test the prevalence of hypoechoic regions in subjects and controls and men and women. RESULTS: In currently asymptomatic subjects, hypoechoic regions were more prevalent in athlete tendons (22%) than in controls (4%), in male subject tendons (30%) than in female subjects (14%), and in basketball players (32%) than in other athletes (9%) (all p < 0.01). Bilateral tendon abnormalities were equally prevalent in men and women but more prevalent in basketball players (15%) than in other athletes (3%) (p < 0.05). Sonographic hypoechoic regions were present in 35 of 250 (14%) patellar tendons in athletes who had never had anterior knee pain. CONCLUSIONS: Patellar tendon sonographic hypoechoic areas were present in asymptomatic patellar tendons of a proportion of elite athletes but rarely present in controls. This has implications for clinicians managing athletes with anterior knee pain.

Psychological screening and injury among elite athletes

The purpose of the present investigation was to evaluate the effectiveness of the psychological component of the Queensland Academy of Sport (QAS) Health Screening Questionnaire in screening for injury/illness characteristics among elite athletes. In total, 793 scholarship athletes (409 females and 384 males) ranging in age from 11 to 41 years (M = 19, SD = 4.4) across 20 sports at the QAS in Brisbane, Australia, completed the QAS Health Screening Questionnaire. Psychological risk factors examined were life stress and mood, as measured by the Perceived Stress Scale - 10 (PSS-10) and the Brunel Mood Scale (BRUMS) respectively, in addition to disordered eating behaviours and history of diagnosed psychological disorders. Medical risk factors examined included asthma and back pain. Single-factor MANOVAs showed multivaritate effects for injury, second injury, back pain, asthma, anxiety disorder diagnosis, and fasting. Discriminant function analyses demonstrated that life stress and mood scores had significant utility in correctly classifying injury and second injury status, asthma, back pain, anxiety, and eating disorder diagnosis, in addition to the use of fasting and vomiting as weight control methods. The present findings suggest that the psychology component of the QAS Health Screening Questionnaire demonstrates significant utility as a screening tool regarding injury/illness characteristics among elite athletes.

Prospects for studying how high-intensity compression waves cause damage in human blast injuries

Since World War I, explosions have accounted for over 70% of all injuries in conflict. With the development of improved personnel protection of the torso, improved medical care and faster aeromedical evacuation, casualties are surviving with more severe injuries to the extremities. Understanding the processes involved in the transfer of blast-induced shock waves through biological tissues is essential for supporting efforts aimed at mitigating and treating blast injury. Given the inherent heterogeneities in the human body, we argue that studying these processes demands a highly integrated approach requiring expertise in shock physics, biomechanics and fundamental biological processes. This multidisciplinary systems approach enables one to develop the experimental framework for investigating the material properties of human tissues that are subjected to high compression waves in blast conditions and the fundamental cellular processes altered by this type of stimuli. Ultimately, we hope to use the information gained from these studies in translational research aimed at developing improved protection for those at risk and improved clinical outcomes for those who have been injured from a blast wave.

How useful are x-rays in severe paediatric cervical spinal injuries?

INTRODUCTION Radiological evaluation of the paediatric cervical spine can be a challenge due to the normal anatomic variants and injuries that are unique to children. We aimed to identify the usefulness of plain X-rays in comparison with CT and MRI in diagnosing Paediatric cervical spinal injuries. METHODS Retrospective review of imaging studies of children diagnosed with paediatric cervical spine injuries who had presented to two tertiary hospitals in Queensland. RESULTS There were 38 patients with 18 male and 20 female .The mean age was 8.6 years. Plain Cervical Spine X-rays (3views, AP lateral and open mouth views) were done in 34 patients. The remaining 8 children had a suspected head injury and hence had CT scans of their neck done at the time of CT head scan. Of these images taken, X-rays were diagnostic in 28 (82%) patients. CONCLUSION X- Rays still have a role to play in the diagnosis of pediatric cervical spinal injuries and should be considered as the first line in fully conscious patients and their usefulness should not be overlooked in light of the newer imaging modalities.

An effective, economic way of monitoring menstrual cycle hormones in at risk female athletes

PURPOSE: Female athletes, in response to intensive training, competition stress and a lean, athletic physique, are at increased risk of altered hypothalamic-pituitary ovarian (HPO) axis function associated with menstrual cycle disturbance and reduced secretion of the ovarian hormones estrogen and progesterone. Because there is evidence suggesting possible detrimental effects on skeletal health associated with deficiencies in these hormones, a suitable means to asses ovarian hormone concentrations in at risk athletes is needed. The aim of this study was to evaluate a simple, economical means to monitor the ovarian hormone production in athletes, in the setting of intensive training. METHODS: Subjects comprised 14 adolescent rowers, 12 lightweight rowers, and two groups of 10 matched control subjects. Ovarian function was monitored during the competition season by estimation of urinary excretion of estrone glucuronide (E1G) and pregnanediol glucuronide (PdG), enabling the menstrual cycles to be classified as ovulatory or anovulatory. RESULTS: Results indicated 35% and 75% of schoolgirl and lightweight rowers had anovulatory menstrual cycles, respectively. These findings were highlighted by significantly lower excretion of E1G and PdG during phases of intensive training in both the lightweight and schoolgirl rowers, compared with the control subjects. CONCLUSION: It was concluded that the urinary E1G and PdG assays were an effective means to assess the influence of intense training on ovarian hormone concentrations in at risk athletes. It is recommended that this technique be applied more widely as a means of early detection of athletes with low estrogen and progesterone levels, in an attempt to avoid detrimental influences on skeletal health.

Ballistic Trauma in Finland : An Epidemiologic and Clinical Study of Firearm and Explosion Injuries

The occurrence and nature of civilian firearm- and explosion-injuries in Finland, and the nature of severe gunshot injuries of the extremities were described in seven original articles. The main data sources used were the National Hospital Discharge Register, the Cause-of-Death Register, and the Archive of Death Certificates at Statistics Finland. The present study was population based. Epidemiologic methods were used in six and clinical analyses in five papers. In these clinical studies, every original hospital record and death certificate was critically analyzed. The trend of hospitalized firearm injuries has slightly declined in Finland from the late 1980s to the early 2000s. The occurrence decreased from 5.1 per 100 000 person-years in 1990 to 2.6 in 2003. The decline was found in the unintentional firearm injuries. A high incidence of unintentional injuries by firearms was characteristic of the country, while violence and homicides by firearms represented a minor problem. The incidence of fatal non-suicidal firearm injuries has been stable, 1.8 cases per 100 000 person-years. Suicides using firearms were eight times more common during the period studied. This is contrary to corresponding reports from many other countries. However, the use of alcohol and illegal drugs or substances was detected in as many as one-third of the injuries studied. The median length of hospitalization was three days and it was significantly associated (p<0.001) with the type of injury. The mean length of hospital stay has decreased from the 1980s to the early 2000s. In this study, there was a special interest in gunshot injuries of the extremities. From a clinical point of view, the nature of severe extremital gunshot wounds, as well as the primary operative approach in their management, varied. The patients with severe injuries of this kind were managed at university and central hospital emergency departments, by general surgeons in smaller hospitals and by cardiothoracic or vascular surgeons in larger hospitals. Injuries were rarities and as such challenges for surgeons on call. Some noteworthy aspects of the management were noticed and these should be focused on in the future. On the other hand, the small population density and the relatively large geographic area of Finland do not favor high volume, centralized trauma management systems. However, experimental war surgery has been increasingly taught in the country from the 1990s, and excellent results could be expected during the present decade. Epidemiologically, explosion injuries can be considered a minor problem in Finland at present, but their significance should not be underestimated. Fatal explosion injuries showed up sporadically. An increase occurred from 2002 to 2004 for no obvius reason. However, in view of the historical facts, a possibility for another rare major explosion involving several people might become likely within the next decade. The national control system of firearms is mainly based on the new legislations from 1998 and 2002. However, as shown in this study, there is no reason to assume that the national hospitalization policies, or the political climate, or the legislation might have changed over the study period and influenced the declining development, at least not directly. Indeed, the reason for the decline to appear in the incidence of unintentional injuries only remains unclear. It may derive from many practical steps, e.g. locked firearm cases, or from the stability of the community itself. For effective reduction of firearm-related injuries, preventive measures, such as education and counseling, should be targeted at recreational firearm users. To sum up, this study showed that the often reported increasing trend in firearm as well as explosion-related injuries has not manifested in Finland. Consequently, it can be recognized that, overall, the Finnish legislation together with the various strategies have succeeded in preventing firearm- and explosion-related injuries in the country.

Transport-related fatalities and injuries leading to hospitalisation in pre-school children

Pre-school children grow and develop rapidly with age and their changing capabilities are reflected in the ways in which they are injured. Using coded and textual descriptions of transport-related injuries in children under five years of age from the Queensland Injury Surveillance Unit (QISU) this paper profiles the modes of such injuries by single year of age. The QISU collects information on all injury presentations to emergency department in hospitals throughout Queensland using both coded information and textual description. Almost all transport-related injuries in children under one year are due to motor vehicle crashes but these become proportionately less common thereafter, while injuries while cycling become proportionately more common with age. Slow-speed vehicle runovers peak at age one year but occur at all ages in the range. Bicycle-related fatalities are rare in this age group. If bicycle-related injuries are excluded, the profiles of fatal and non-fatal injuries are broadly similar. Comparison with a Queensland hospital series suggests that these results are broadly representative.

LA Size in Former Elite Athletes

A recent meta-analysis by Iskandar et al. (1) nicely showed that endurance athletes have larger left atrial (LA) diameters compared with control subjects. Yet only 9 of 54 studies included in their analysis reported LA volume values corrected for body surface area (BSA). In fact, few studies have determined LA volume in young athletes, and, to the best of our knowledge, no study has reported this variable in older athletes. This is an important question given the growing debate about the potential deleterious effects of long-term strenuous endurance exercise on the human heart, notably the higher risk of atrial fibrillation (AF), a condition for which both atrial dilation and the normal aging process are thought to be potential causative mechanisms (2). Thus, we aimed to assess the long-term consequences of endurance exercise on LA volume in athletes who were highly competitive at younger ages and are still active. To this end, we compared BSA-corrected LA volumes determined with late gadolinium enhancement magnetic resonance imaging (LGE-MRI) in former elite endurance athletes and sedentary control subjects.

Effects on permanent teeth after luxation injuries to the primary predecessors: a study in children assisted at an emergency service

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

The venomous toadfish Thalassophryne nattereri (niquim or miquim): report of 43 injuries provoked in fishermen of Salinópolis (Pará State) and Aracaju (Sergipe State), Brazil

Os peixes da família Batrachoididae causam um grande número de acidentes em pescadores das regiões Norte e Nordeste do Brasil. O gênero Thalassophryne apresenta várias espécies no Brasil e a espécie Thalassophryne nattereri é a mais comum, todas apresentando veneno. O veneno é inoculado por duas espículas ocas na nadadeira dorsal e duas nas regiões pré-operculares, ligadas a uma glândula de veneno na base. Os envenenamentos causaram dor intensa, edema e eritema iniciais em 43 pescadores observados em Salinópolis (Pará) e Aracaju (Sergipe). em todos os casos, não ocorreram fenômenos sistêmicos dignos de nota, mas ocorreu necrose local em oito pacientes e infecção bacteriana em dez. As circunstâncias dos acidentes são comentadas, assim como aspectos terapêuticos. Nossa conclusão foi que o envenenamento por Thalassophryne é importante e freqüente e deve ser considerado de média gravidade, em função de não haverem fenômenos sistêmicos, como observado nos acidentes por peixes-escorpião (Scorpaena) ou arraias marinhas e fluviais.