Injuries, Prevention, Treatment
JS Torg, SM Harris, K Rogers, et al (Hahnemann Univ, Philadelphia)
Retrospective Report on the Effectiveness of a Polyurethane Football Helmet Cover on the Repeated Occurrence of Cerebral Concussions.
Am J Orthop 28: 128-132, 1999.
A sample survey of 245 users was made of whom 155 responded (63.3%). Most of them were using it because they had at least one previous concussion. Most of them were high school football players. Respondents were grouped according to the number of concussions experienced before using the helmet.
Findings: In the groups with 1, 2, 3, or at least 4 previous concussions, the reconcussion rates were 2.4%, 7.3%, 15.8% and 33.3% respectively. Thus, the more concussions an athlete had experienced before using the helmet, the more concussions he experienced while using the helmet cover.
Conclusions: The use of a polyurethane helmet may not protect against the concussion.
TM Best, B Loitz-Ramage, DT Corr, et al (Univ of Wisconsin, Madison)
Hyperbaric Oxygen in the Treatment of Acute Muscle Stretch Injuries: Results in an Animal Model.
Am J Sports Med 26:367-372, 1998.
The effect of Hyperbaric Oxygen (HBO) therapy were studied in a rabbit model of acute muscle stretch injury.
Method : A standardised partial stretch injury of tibialis anterior muscle-tendon unit was created in 18 rabbits. The opposite limb was used as control starting 24 hours after the injury, one group of animals received HBO therapy (oxygen levels >95% at 2.5atm, 60 min/day for 5 days). The other group received no treatment. Tissue healing, functional and morphological indicators of recovery were assessed after 7 days.
Results: The functional deficit was significantly reduced in the HBO treated group. The percentage of ankle isometric torque on the injured side was 15% in the treated group versus 48% in the uninjured group. Surgical wound healing was quicker and on histology the HBO treated group showed reduced cellularity and fiber damage.
Conclusion: HBO therapy may help to hasten recovery after muscle stretch injury.
JM Beiner, P Jokl, J Cholewicki, et al (Yale Univ, New Haven, Conn)
The Effect of Anabolic Steroids and Corticosteroids on Healing of Muscle Contusion Injury.
Am J Sports Med 27: 2-9, 1999.
The effects of nandrolone, an anabolic steroid and methylprednisolone acetate (a corticosteroid) on muscle healing were studied in a rat model.
Methods: The muscle was injured using a drop-mass technique. Active contractile tension was measured in each muscle and histologic analysis was performed to determine healing.
Findings: With corticosteroids on day 2, there was significant improvement in the twitch and tetanic strength, but by day 7, this effect was reversed and on day 14, total degeneration was observed in the muscle. There was no significant effect in the anabolic steroid group.
Conclusion: Corticosteroids may be beneficial in the short term but results in irreversible damage in the long term. Anabolic steroids may facilitate healing of muscle contusion injury.
JE Houglum (South Dakota State Univ, Brookings)
Pharmacologic Considerations In the Treatment of Injured Athletes with Non-Steroidal Anti-inflammatory Drugs.
J.Athletic Train 33; 259-263. 1998
A thorough understanding of the pharmacodynamics of NSAIDs is essential to optimise the use of these drugs in the treatment of sports injuries.
The primary mechanism of action is through the inhibition of arachidonic acid metabolism. This has implications for potential adverse effects and drug interactions particularly those associated with clotting pathway, kidney function and gastrointestinal side effects. The extent of injury, drug dosing and duration of therapy and the specific agent used can affect the rate of healing and in relief from pain and inflammation.
It is recommended that only one NSAID should be used. It should be taken with food. It should be stopped as soon as the desired therapeutic effect is obtained. The use of 2 or more NSAIDs provide no increased benefit and may increase toxic effects.
P Holmich, P Uhrskou, l Ulnits, et al (Amarger Univ, Copenhagen; Herlev Univ, Denmark; Glostrup Univ, Denmark; et al )
Effectiveness of Active Physical Training as Treatment for Longstanding Adductor-related Groin Pain in Athletes: Randomised Trial.
Lancet 353: 439-443, 1999
Groin pain is a common problem in athletes and sportsmen and one of its commonest causes is injury to adductor muscle. Previous research has shown that exercises to strengthen a muscle may protect it from injury. An active training program for the adductor muscle was evaluated to determine whether it would reduce pain in athletes with long standing adductor related groin pain.
68 male athletes with sports related groin pain of longstanding were divided into 2 groups (1) with an active training program (2) with no specific treatment at improving strength and co-ordination of muscles that act on the pelvis for a period of 8-12 weeks and evaluated after 4 months.
Results: Significantly more subjects in the AT group had excellent results (23 vs 4) and were able to return to active athletes without groin pain.
Conclusion : An active training program to strengthen and improve co-ordination of the pelvic muscles was effective in the treatment of long standing groin pain (adductor related).
KA Hildebrand, SL-Y Woo, DW Smith, et al (Univ of Pittsburgh, Pa)
The Effects of Platelet-derived Growth Factor-BB on Healing of the Rabbit Medial Collateral Ligament: An In Vivo Study.
Am J Sports Med 26: 549-554, 1998.
In a previous in-vitro study the authors have shown that platelet derived growth factor-BB promoted fibroblast proliferation and that transforming growth factor B1 promoted matrix synthesis. These factors were now used in-vivo studies.
Methods: 37 rabbits were divided into 5 groups. 2 groups were given high or low dose growth factor-BB, 2 groups were given in addition a high or low dose of growth factor B1 and one group was given fibrin sealant only (used as a delivery system). The rabbits were sacrificed at 6 weeks and biomechanical and histologic analysis of healing was performed.
Results: The values for ultimate load, energy absorbed to failure and ultimate elongation were 1.6, 2.4 and 1.6 times higher in higher doses of growth factor BB. The addition of growth factor-B1 did not increase the structural properties of the complex.
KA Karlson (Univ of Michigan, Ann Arbor)
Rib Stress Fractures in Elite Rowers: A Case Series and Proposed Mechanism.
Am J Sports Med 26: 516-519, 1998.
Ten elite rowers with 14 stress fractures were interviewed (3 males, 7 females). Sex, date of injury, side rowed, weight class, fracture location, training phase and method of diagnosis evaluated.
Results : Fractures occurred on the anterior to posterolateral aspect of ribs 5-9. 11 were diagnosed by bone scan, 2 by plain radiographs and 1 by clinical observation. The onset was slow with several days or weeks of discomfort followed by sharp pain that worsened at the end of the arm pull through phase.
Conclusion: Rib stress fractures appear to be the result of the pull of the serratus anterior and external oblique muscles on the rib which causes repetitive bending of the rib. Therefore, the incidence can be reduced by decreasing the force of pull on the rib by the serratus anterior and the external oblique muscle or both.
BP Boden, DT Kirkendall, Jr Garrett WE (Duke Univ, Durham,NC)
Concussion Incidence in Elite College Soccer Players
Am J Sports Med 26: 238-241, 1998.
The potential for head injuries among soccer players and its relation to neuropsychological deficits have long been debated. The incidence of concussion in elite college soccer players has been assessed.
Methods: Seven men’s and 8 women’s soccer teams were studied for 2 seasons, and results documented.
Findings: 29 concussions were diagnosed in 26 athletes (17men and 12 women). Concussions occurred from contact with :
1) an opponent’s head in 28%
2) an elbow in 14%
3) a knee in 3%
4) a foot in 3%
5) a ball in 24%
6) ground in 10%
7) concrete side lines 3%
8) goal post in 3%
9) combination in 10%
69% occurred during games. None of them occurred during intentional heading of the ball 72% of concussions were grade 1 and 28% were grade 2.
Conclusions: Concussion occurs more commonly in soccer than has been believed. Such injuries may result in long term neuropsychological changes.
JT Matser, AGH Kessels, BD Jordan, et al (St Anna Hosp Geldrop, The Netherlands; Univ of Maastricht, The Netherlands; Charles R Drew Univ of Medicine & Science, Los Angeles; et al)
Chronic Traumatic Brain Injury in Professional Soccer Players.
Neurology 51: 791-796, 1998.
Repeated concussive and subconcussive blows to the head may result in chronic brain injury. Such injuries are common in soccer.
Methods: 53 active professional soccer players were studied along with 27 elite atheletes from non contact sports and they were examined neuropsychologically.
Findings: Compared with the controls, the soccer players had impaired performances in memory, planning, performances were correlated inversely with the number of concussions and with the frequency of “heading”. This also depended on field position with higher incidence amongst the forwards and defenders.
BC Barnes, L Cooper, DT Kirkendall, et al (Duke Univ, Durham, NC; Univ of Los Angeles)
Concussion History in Elite Male and Female Soccer Players
Am J Sports Med 26: 433-438, 1998.
Neurophysiologic and neuropsychologic changes have been reported in active and retired soccer players and “heading” has often been cited as the cause. There is concern about the cumulative effects of “heading”. The information available in the context is conflicting.
Methods: All male and female soccer players who completed in the 1993 Olympic Sports Festival were interviewed. There were 137 players with a mean age of 20.5 years. The mechanisms of injuries, frequency of injuries and the outcomes were determined.
Results: In males there were 74 concussions in 39 players (50 injuries were Grade I by the Colorado Medical Society guidelines). In females, there were 28 concussions in 23 players (19 injuries were Grade I). In males 48 of 74 concussions and in females 20 of 28 concussions occurred as a result of collision with another player. The most common symptoms were headache, a dazed feeling and dizziness. On the basis of the study, the odds that a soccer player would sustain a concussion within a 10 year period were 50% for males and 22% for females.
JE Sturmi, C Smith, JA Lombardo (Ohio State Univ, Columbus)
Mild Brain Trauma in Sports: Diagnosis and Treatment Guidelines.
Sports Med 25:351-358, 1998.
Inspite of numerous guidelines for diagnosis and management of mild brain trauma in sports, much confusion remains. The pathophysiology, diagnosis and management of head injury in athletes are reviewed.
Mechanism of head injury : In any given year 20% of American high school football players experience a sports related concussion. Other sports causing concussion are boxing, ice hockey, rugby, motor racing, equestrian sports, martial arts, wrestling, gymnastics, cycling, alpine skiing and diving. Given the brain’s protective anatomy, direct blows are tolerated with little injury; the exception being the association of a fracture or haematoma. The acceleration or deceleration injuries are more serious. Additionally, a sharp blow to the athlete’s torso or pelvis can cause a concussion. Protective gear and strong muscles can dissipate the forces and lessen the severity of the injury. Fortunately, most injuries are mild. Nonetheless, all athletes who sustain a head injury, should be properly evaluated irrespective of their state of consciousness.
Diagnosis is based on a high index of suspicion. Particular attention is paid to confusion, dizziness, headache, memory loss, fatigue or nausea. Visual and other neurologic abnormalities should be identified. The tendency of the athlete to downplay his symptoms should be kept in mind. Finally repetitive examination and testing may be required.
Management: The athlete should be rested at once. If warranted he should be hospitalised and properly evaluated. All symptoms must have completely resolved before the athlete is allowed to return to play.
JA Gastel, MA Palumbo, MJ Hulstyn, et al (Brown Univ, Providence, Rl)
Emergency Removal of Football Equipment: A Cadaveric Cervical Spine Injury Model.
Ann Emerg Med 32: 411-417, 1998.
Purpose: The proper early management of suspected cervical spine injuries in football players is critical. EMT’s are trained to remove the helmet to avoid hyperflexion of the neck but sports medicine experts recommend against this practice. A cadaver study was conducted to analyse the effects of a football helmet or shoulder pads on alignment of the unstable cervical spine.
Methods: The study included 8 cadavers of average age 73 years. A simulated bilateral facet dislocation was created at C5-C6 motion segment. Lateral x-rays were taken before and after injury with cadaver wearing (1) no equipment (2) a helmet only (3) shoulder pads only and (4) a helmet and shoulder pads. The effect of the alignment of the cervical spine was studied.
Results: Lordosis was decreased by 9.6 degrees with helmet only and increased 13.6 degrees with shoulder pads only.
After destabilisation of the cervical spine, C5-C6 forward angulation was increased by 16.5 degrees with helmet only and the posterior disc space height was increased by 3.8mm and dorsal element distraction by 8.3 mm. In the other 3 indications there were no significant differences.
Conclusions: The results suggest that the helmet and shoulder pads should be left in place until the patient reaches a hospital unless CPR is required.
WF Donaldson III, WC Lauerman, B Heil, et al (Univ of Pittsburgh, Pa)
Helmet and Shoulder Pad Removal From a Player With Suspected Cervical Spine Injury: A Cadaveric Model.
Spine 23: 1729-1733, 1998.
Objective: Cervical spine injuries can result in quadriplegia. The problem of removing the helmet and shoulder pads of an injured football player has been debated. A cadaver model was used to study how much motion occurs with 2 types of injuries when a helmet and shoulder pads are removed.
Methods: Transoral osteotomy at waist of odontoid process was done to render C1-C2 unstable in 3 cadavers and in another 3 cadavers, the interspinous ligaments, the facet capsules, posterior longitudinal ligaments and posterior one third of the disc were sectioned at C5-C6. Under fluoroscopic visualization, 4 people removed the helmets by first removing the facemask, then the chinstrap and then the ear-pieces. The shoulder pads were then removed. Maximum displacements were recorded and analysed.
Results: Instability at C2 resulted in a change in angulation of 5.47 degrees distraction of 2.98 mm and a change in space available for the cord by 3.91 mm when the helmet was removed. With removal of shoulder pads, the change in angulation was 2.9 degrees distraction 1.76mm and the change in the space available for the cord 2.64 mm.
Conclusions: A significant amount of movement can occur in an unstable cervical spine when the helmet and shoulder pads are removed. Therefore, it would be unwise to try to remove the helmet and shoulder pads before transportation to hospital.
MJ Wetzler, T Akpata, W Laughlin, et al (American Orthopaedic Rugby Football Assoc, Washington Crossing, Pa; South Jersey Orthopedic Associates, Voorhees, NJ: Rugby Magazine, New York; et al )
Occurrence of Cervical Spine Injuries During the Rugby Scrum
Am J Sports Med 26: 177-180, 1998.
Objective: The scrum is responsible for 60% of cervical spine injuries in rugby. The cause and reduction of cervical spine injuries during the rugby scrum were studied retrospectively.
Methods: Data on 62 injured players were compiled from oral and written reports and from medical records.
Results: Between 1970 and 1996, 36 (58%) of players sustaining a cervical spine injury were injured during a scrum with 23(64%) occurring during the engagement and 13 (36%) during the collapse of the scrum.
Players injured during the engagement were hookers (22%), props (11%) and a second row player (3%). There were 21 (58%) senior level players and 15(42%) junior level players. Nine (25%) occurred as a result of a mismatch inexperience.
Conclusion: Cervical spine injuries to rugby players occur more frequently during the engagement phase of the scrum, to hookers, and to lower level players.