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PubMed1990

Assessment and treatment of TMJ muscles, fascia, ligaments, and associated structures.

The primary goal of temporomandibular joint therapy is to establish normal physiologic tension of the muscles, fascia, ligaments, and associated soft tissue structures. Because of pathologic sprain and strain patterns in the TMJ structures, the patient may exhibit pain and dysfunction due to tissue tightness, disk displacement, and occlusal discrepancies. This article presents an effective clinical technique to assess and relieve the sprain and strain in the TMJ muscles, fascia, ligaments, and associated structures to restore normal physiology.

Fascia↗
PubMedDate not supplied

Epidemiology of women's gymnastics injuries.

Injury information from 98 participants in 2 years of interscholastic women's gymnastics competition in four Seattle area high schools was collected by certified athletic trainers. During the 2nd year of data collection, the study was expanded to include an additional 12-team high school league, 2 college teams, and 3 private clubs. A wide variety of injuries was observed, the total time loss injury rate was 39.8 injuries per 100 participant-seasons. Strains and sprains involving the back, particularly the lumbar region, appeared to occur more frequently than in most other interscholastic athletic activities. Ankle sprains were also common, and a relatively high frequency of thigh and leg strains and overuse problems of the leg were seen. This suggests that there may well be room for improvement in conditioning and other preventive programs in women's gymnastics.

Adolescent↗
PubMed1977

Parameters of injury reporting in skiing.

An injury survey of 505 skiers from the 1971-72 and 5,459 skiers from thh 1972-73 season collected 601 time loss injries for a rate of 9.31000 skier days. Forty percent of these injuries were reported to a ski patrol and almost 60 to physicians. Fractures and lacerations were reported to the patrol more frequently than other injury types, bruises and strains less commonly. Injuries not reported to patrols and physicians were primarily bruises, sprains and strains. Although fractures were almost invariably reported to physicians, one in four was not seen by the ski patrol. Patrol-only or physician only reported injuries thus do not represent the full spectrum of time loss skiing injuries.

Adolescent↗
PubMedDate not supplied

Comparison of diclofenac sodium and aspirin in the treatment of acute sports injuries.

A randomized, double-blind, parallel-group clinical trial compared diclofenac sodium (Voltaren, Ciba-Geigy Summit, NJ) with aspirin for the treatment of acute sprains and/or strains of the knee or ankle. One hundred thirty-nine patients were admitted to the study. Patients received either 150 mg (75 mg twice daily) of diclofenac (N = 69) or 3.6 g (1.2 g three times daily) of aspirin (N = 70) for 3 to 10 days. Forty-seven diclofenac patients and 49 aspirin patients, mean age for both groups 25 years, were evaluated to determine the efficacy of each treatment. Both groups experienced significant (P less than 0.001) improvements for all efficacy variables measured. Treating sprains and strains with diclofenac rather than with aspirin allowed an earlier return to activity. Of those patients who achieved playing fitness, those in the diclofenac group resumed athletic activities in a mean of 4.7 days, compared with a mean of 5.9 days for patients in the aspirin group. Although the overall multivariate F was nonsignificant (P = 0.19), the univariate F for days required to resume playing fitness was significantly (P = 0.025) shorter in the diclofenac group. While the nonsignificant multivariate result suggests that the significance may be due to chance, it is also possible that there was a trend toward earlier resumption of activities with diclofenac treatment compared to aspirin, but an insufficient sample size to demonstrate the trend statistically. Since others have reported such a trend without the greater controls of a multivariate analysis, this area warrants further research.

Acute Disease↗
PubMed1999

Injuries and illnesses among hospital workers in Ohio. A study of workers' compensation claims from 1993 to 1996.

Occupational illnesses and injuries are common problems facing workers and employers. The purpose of this study was to determine the nature and extent of illnesses and injuries among hospital workers in Ohio. All workers' compensation claims for 22 hospitals in Ohio during the period 1993-1996 were reviewed. The majority of the claims were for sprain and strain injuries. Most of the claims were approved. Back injury was the leading cause of injury in both genders, and females reported a significantly higher percentage of back injuries. The incidence rates for injuries and illnesses were lower than national rates for other industries. Generally, there was a downward trend in the number of claims during the study period. A negative linear trend in injury rates by hospital size was detected. Our findings suggest the need for safety programs, especially in smaller hospitals, with the goal of preventing sprain and strain injuries.

Adult↗
PubMed2001

Influence of rugby injuries on players' subsequent health and lifestyle: beginning a long term follow up.

OBJECTIVES: To describe the current rugby playing status of a cohort of 1,169 men who had previously participated in an epidemiological survey of rugby injuries during the 1993-1994 season, and assess the consequences of rugby injuries sustained. METHODS: In May 1998, 911 (78%) men completed a questionnaire reporting their current involvement in rugby and the influence that the 324 (71%) injuries they had sustained four years earlier had since had on their health and wellbeing. RESULTS: The most common reasons given by the 390 (43%) ex-players for ceasing to play rugby were family (10%), employment (25%), and an injury sustained while playing rugby (26%), 80% of which were dislocations, strains, and sprains, mainly to the knee (35%), back (14%), and shoulder (9%). A significantly (chi2 test 21.7, df = 1, p<0.001) higher proportion of current players (90%) undertook (non-rugby) sporting activities compared with ex-players (78%). Few ex-players undertook coaching (12%) and refereeing (2%). Only 22 (9%) men reported significant negative effects to employment, family life, and health up to mid-1998 from injuries that occurred during the 1993-1994 season, although the impact on their lifestyle had been substantial in some cases. CONCLUSIONS: With the recent increase in the incidence of dislocation, strain, and sprain injuries in rugby football, the findings of this follow up could have a great impact on the game in the future. Although this survey has shown that, so far, only a small proportion of players suffer significant effects of rugby injuries, four years is not long enough to assess the long term effects. This cohort of rugby players need to be followed up for at least a further 20 years to determine whether there is a higher incidence of subsequent degenerative joint disease or other long term sequelae to injuries sustained while playing rugby.

Chi-Square Distribution↗
PubMed2000

Heavy drinking, alcohol dependence, and injuries at work among young workers in the United States labor force.

BACKGROUND: To determine whether heavily drinking and alcohol-dependent workers are at higher risk of occupational injury, we analyzed the nationally representative cohort of people enrolled in the National Longitudinal Survey of Youth since 1979. METHODS: This analysis was restricted to the 8569 respondents in the 1989 annual interview (age 24-32) who were employed during the 6 months before the interview. We studied occupational injuries (excluding sprains or strains) reported within 6 months of the interview in 1989 (cross-sectional analysis) and 1990 (prospective analysis). RESULTS: Among current drinkers, significant two-fold increases in the odds of injury for one or more episodes of heavy drinking were reduced to an odds ratio (OR) of 1.2 (95% confidence interval [CI] = 0.7, 2.1) in the cross-sectional analysis and an OR of 1.6 (CI 1.0, 2.8) in the prospective analysis after adjustment for confounding. No dose-response relationship with the frequency of heavy drinking was found. Alcohol-dependent respondents were not at higher risk of injury in the cross-sectional (OR = 1.1, CI 0.7, 1.8) or prospective (OR = 1.3,CI 0.8, 2.2) analyses after adjustment for confounding. CONCLUSIONS: For young U.S. workers, common occupational injuries (excluding sprains and strains) may not be strongly associated with alcohol dependence. Confounding by other risk factors may explain much of the association between being a heavy drinker and occupational injuries in this population.

Accidents, Occupational↗
PubMed2000

Injury toll following the 1997 Maccabiah Games bridge collapse: implications of major disasters for sports medicine teams.

A major disaster was encountered at the 1997 Maccabiah Games in Israel. As the Australian team was about to enter the main stadium for the opening ceremony, a pedestrian bridge they were crossing collapsed, killing 4 athletes and injuring many others. The aim of this paper is to establish the rates, types and anatomical locations of musculoskeletal injuries incurred by members of the Australian Maccabiah Games team, with particular reference to the impact of the bridge collapse. In total, the 410 members of the team (360 athletes and coaches and 50 team officials) reported 166 injuries from their participation in sport and 30 musculoskeletal injuries associated with the collapse of the bridge. The most common sports-related injuries were sprains and strains to the hip/thigh, lumbar spine and ankle/foot regions, while the bridge collapse resulted in, most commonly, sprains and contusions to the hip/thigh, knee, lower leg and ankle/foot regions. In addition, team members incurred many medical and psychological conditions. This paper makes several recommendations for sports medicine staff based on the experience of this significant sport disaster.

Accidents↗
PubMed2004

Does Cryotherapy Improve Outcomes With Soft Tissue Injury?

REFERENCE: Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. Am J Sport Med. 2004; 32:251-261. CLINICAL QUESTION: What is the clinical evidence base for cryotherapy use? DATA SOURCES: Studies were identified by using a computer-based literature search on a total of 8 databases: MEDLINE, Proquest, ISI Web of Science, Cumulative Index to Nursing and Allied Health (CINAHL) on Ovid, Allied and Complementary Medicine Database (AMED) on Ovid, Cochrane Database of Systematic Reviews, Cochrane Database of Abstracts of Reviews of Effectiveness, and Cochrane Controlled Trials Register (Central). This was supplemented with citation tracking of relevant primary and review articles. Search terms included surgery,orthopaedics,sports injury,soft tissue injury,sprains and strains,contusions,athletic injury,acute,compression, cryotherapy,ice,RICE, andcold. STUDY SELECTION: To be included in the review, each study had to fulfill the following conditions: be a randomized, controlled trial of human subjects; be published in English as a full paper; include patients recovering from acute soft tissue or orthopaedic surgical interventions who received cryotherapy in inpatient, outpatient, or home-based treatment, in isolation or in combination with placebo or other therapies; provide comparisons with no treatment, placebo, a different mode or protocol of cryotherapy, or other physiotherapeutic interventions; and have outcome measures that included function (subjective or objective), pain, swelling, or range of motion. DATA EXTRACTION: The study population, interventions, outcomes, follow-up, and reported results of the assessed trials were extracted and tabulated. The primary outcome measures were pain, swelling, and range of motion. Only 2 groups reported adequate data for return to normal function. All eligible articles were rated for methodologic quality using the PEDro scale. The PEDro scale is a checklist that examines the believability (internal validity) and the interpretability of trial quality. The 11-item checklist yields a maximum score of 10 if all criteria are satisfied. The intraclass correlation coefficient and kappa values are similar to those reported for 3 other frequently used quality scales (Chalmers Scale, Jadad Scale, and Maastricht List). Two reviewers graded the articles, a method that has been reported to be more reliable than one evaluator. MAIN RESULTS: Specific search criteria identified 55 articles for review, of which 22 were eligible randomized, controlled clinical trials. The articles' scores on the PEDro scale were low, ranging from 1 to 5, with an average score of 3.4. Five studies provided adequate information on the subjects' baseline data, and only 3 studies concealed allocation during subject recruitment. No studies blinded their therapist's administration of therapy, and just 1 study blinded subjects. Only 1 study included an intention-to-treat analysis. The average number of subjects in the studies was 66.7; however, only 1 group undertook a power analysis. The types of injuries varied widely (eg, acute or surgical). No authors investigated subjects with muscle contusions or strains, and only 5 groups studied subjects with acute ligament sprains. The remaining 17 groups examined patients recovering from operative procedures (anterior cruciate ligament repair, knee arthroscopy, lateral retinacular release, total knee and hip arthroplasties, and carpal tunnel release). Additionally, the mode of cryotherapy varied widely, as did the duration and frequency of cryotherapy application. The time period when cryotherapy was applied after injury ranged from immediately after injury to 1 to 3 days postinjury. Adequate information on the actual surface temperature of the cooling device was not provided in the selected studies. Most authors recorded outcome variables over short periods (1 week), with the longest reporting follow-ups of pain, swelling, and range of motion recorded at 4 weeks postinjury. Data in that study were insufficient to calculate effect size. Nine studies did not provide data of the key outcome measures, so individual study effect estimates could not be calculated. A total of 12 treatment comparisons were made. Ice submersion with simultaneous exercises was significantly more effective than heat and contrast therapy plus simultaneous exercises at reducing swelling. Ice was reported to be no different from ice and low-frequency or high-frequency electric stimulation in effect on swelling, pain, and range of motion. Ice alone seemed to be more effective than applying no form of cryotherapy after minor knee surgery in terms of pain, but no differences were reported for range of motion and girth. Continuous cryotherapy was associated with a significantly greater decrease in pain and wrist circumference after surgery than intermittent cryotherapy. Evidence was marginal that a single simultaneous treatment with ice and compression is no more effective than no cryotherapy after an ankle sprain. The authors reported ice to be no more effective than rehabilitation only with regard to pain, swelling, and range of motion. Ice and compression seemed to be significantly more effective than ice alone in terms of decreasing pain. Additionally, ice, compression, and a placebo injection reduced pain more than a placebo injection alone. Lastly, in 8 studies, there seemed to be little difference in the effectiveness of ice and compression compared with compression alone. Only 2 of the 8 groups reported significant differences in favor of ice and compression. CONCLUSIONS: Based on the available evidence, cryotherapy seems to be effective in decreasing pain. In comparison with other rehabilitation techniques, the efficacy of cryotherapy has been questioned. The exact effect of cryotherapy on more frequently treated acute injuries (eg, muscle strains and contusions) has not been fully elucidated. Additionally, the low methodologic quality of the available evidence is of concern. Many more high-quality studies are required to create evidence-based guidelines on the use of cryotherapy. These must focus on developing modes, durations, and frequencies of ice application that will optimize outcomes after injury.

Journal Article↗
PubMed1989

Splinting tips.

Both plaster of Paris and fiberglass can be used for temporary or definitive treatment of acute extremity fractures, sprains, and strains. Longitudinal slab splints are appropriate for immobilizing inflamed tendons or joints of the wrist, elbow, and knee. "Sugar-tong" splints work well for humerus, forearm, and ankle fractures or sprains.

Arm Injuries↗
PubMed1992

Soft tissue "rheumatism" in sports.

Pain and stiffness of the injured region after prolonged periods of inactivity is commonly encountered following soft tissue injuries in sports. The injury in most of these instances is due to stress failure although occasionally an acute injury with a protracted course in recovery may develop similar symptoms. The most common of these condition are the enthesopathies, that include tendonitis and fasciitis, sprains and strains, bursitis, tenovaginitis and the fibrositis syndrome.

Athletic Injuries↗
PubMed1996

Low back pain and its relationship to back strength and physical activity in children.

OBJECTIVE: The objective of the study was to determine the occurrence of low back pain and its relationship to back strength and physical activity in children. METHODS AND MATERIALS: The study included 53 boys and 43 girls aged 10 to 19 years from a group of 116 children who had undergone isometric strength testing 4 years previously. No intervention was performed. Each child was asked five questions concerning low back pain. A questionnaire to quantify participation in athletic activities and manual labor was used as the basis for calculation of each child's activity level. Isometric back flexor and extensor strength were measured with the same method used 4 years previously. Statistical analyses were performed with appropriate correction for confounding factors. RESULTS: The frequency of low back pain and the relationship between low back pain and age, between low back pain and back strength, and between low back pain and physical activity were determined. There was a history of low back pain in 51%, and the frequency of low back pain in the past year was 35%. Eight percent of the children had been limited by low back pain, and 7% had seen a doctor for the pain. The first incident of low back pain occurred at a mean age of 12.3 years. The frequencies of a history of low back pain and of low back pain in the past year increased significantly with age (p = 0.02 and 0.01 respectively). Increased physical activity was significantly associated with a history of low back pain (p = 0.03), and increased back flexor strength was significantly associated with a history of low back pain and of low back pain in the past year (p = 0.03 and 0.008, respectively). The rate of low back flexor or strength over 4 years had a significantly positive association with the occurrence of low back pain in the past year (p = 0.008). CONCLUSIONS AND RELEVANCE: Low back pain is common in children, and, in contrast to adults, low back pain in these children was more common with increased physical activity and stronger back flexors. We believe the main causes of low back pain in children are musculotendinous strains and ligamentous sprains.

Adolescent↗
PubMed2004

The Football Association medical research programme: an audit of injuries in academy youth football.

OBJECTIVES: To undertake a prospective epidemiological study of the injuries sustained in English youth academy football over two competitive seasons. METHODS: Player injuries were annotated by medical staff at 38 English football club youth academies. A specific injury audit questionnaire was used together with a weekly return form that documented each club's current injury status. RESULTS: A total of 3805 injuries were reported over two complete seasons (June to May) with an average injury rate of 0.40 per player per season. The mean (SD) number of days absent for each injury was 21.9 (33.63), with an average of 2.31 (3.66) games missed per injury. The total amount of time absent through injury equated to about 6% of the player's development time. Players in the higher age groups (17-19 years) were more likely to receive an injury than those in the younger age groups (9-16 years). Injury incidence varied throughout the season, with training injuries peaking in January (p<0.05) and competition injuries peaking in October (p<0.05). Competition injuries accounted for 50.4% of the total, with 36% of these occurring in the last third of each half. Strains (31%) and sprains (20%) were the main injury types, predominantly affecting the lower limb, with a similar proportion of injuries affecting the thigh (19%), ankle (19%), and knee (18%). Growth related conditions, including Sever's disease and Osgood-Schlatter's disease, accounted for 5% of total injuries, peaking in the under 13 age group for Osgood-Schlatter's disease and the under 11 age group for Sever's disease. The rate of re-injury of exactly the same anatomical structure was 3%. CONCLUSIONS: Footballers are at high risk of injury and there is a need to investigate ways of reducing this risk. Injury incidence at academy level is approximately half that of the professional game. Academy players probably have much less exposure to injury than their full time counterparts. Areas that warrant further attention include the link between musculoskeletal development and the onset of youth related conditions such as Sever's disease and Osgood-Schlatter's disease, the significant number of non-contact injuries that occur in academy football, and the increased rates of injury during preseason training and after the mid season break. This study has highlighted the nature and severity of injuries that occur at academy level, and the third part of the audit process now needs to be undertaken: the implementation of strategies to reduce the number of injuries encountered at this level.

Adolescent↗
PubMed2005

Track and field injuries.

OBJECTIVE: A review of the existing literature on injuries to youth (< or =18 years old) in track and field or athletics. DATA SOURCES: Searches of the Medline and SPORT Discus databases for English language articles through the end of 2003, using the search terms (adolescent or youth) and (track or field or running) and injuries. MAIN RESULTS: Only nine prospective or retrospective studies were found dealing with track and field injuries in children and that stated injury rates or provided enough information to allow the estimation of injury rates. Differences in study design and inconsistencies in the definition of a reportable injury provided major hindrances to making comparisons or combining data across studies. Among the few conclusions that can be drawn are that the lower extremities account for the majority of injuries, and muscle strains and ligament sprains are the predominant types of injury. While a majority of injuries may occur during training, since there is much more exposure during training than during competitions, the risk of injury is about four times higher during competitions. CONCLUSIONS: Informed decisions with regard to preventing injuries in youth track and field are dependent upon the quality of the basic epidemiological data available, and at this time such data are, for the most part, nonexistent. Because of the large numbers of participants and the large number and variety of activities involved in track and field, adequately designed epidemiological research is difficult, but opportunities for research in this sport are available for anyone willing to take on the challenge.

Adolescent↗
PubMedDate not supplied

Injuries in the 1987 national amateur volleyball tournament.

In a prospective study of injuries in the 1987 United States Volleyball Association's national tournament, we found 154 injuries in 1520 participants during 7812 hours of play. The injury rate in this study was 1.97/100 hours of play. Before the tournament, the participants' history was taken, and during the week of participation, records were kept of every player who presented with an injury. Players ranged in age from 17 to 60 and competed in five age/gender groups. Females had an injury rate of 2.3 and males had an injury rate of 1.7. The highest injury rate was seen in the men's open division, ages 17 to 35 (2.7), and the lowest rate was seen in the men's Golden Masters, ages 46 and up (1.5). Seventy-nine percent of the injuries occurred during the tournament and 21% were considered to be chronic injuries with an acute exacerbation. The upper extremities accounted for 20% of the injuries. The ankle (17.6%), low back (14.2%), and knee (11%) were the most common injury sites. Strains (36%) and sprains (28%) were the most frequent types of injury. Only eight (5.2%) injuries resulted in more than 5 days of time loss. Two of these injuries involved the knee and two others required surgery. It is likely that in studies relying upon retrospective methods, fewer of the less severe injuries are found, thereby leading to an overestimation of the percentages of knee and ankle injuries and the proportion of severe injuries. The clinician contemplating providing care for a high-level tournament should expect a preponderance of minor injuries occurring in a variety of anatomical locations.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Musculoskeletal disorders in children: a study in Dutch general practice.

OBJECTIVE: This study focuses on the occurrence of musculoskeletal disorders in children presented in general practice. Known epidemiological studies addressing musculoskeletal diseases in childhood are scarce and based on a low number of episodes. DESIGN AND SETTING: Prospective study of all patient contacts in general practice. A total number of 161 general practitioners participated, divided into four groups, registering during four consecutive three-month periods. PATIENTS: All children younger than 15 years of age who visited their GP during the registration period. All diagnoses and working hypotheses concerning musculoskeletal disorders were selected. RESULTS: The total number of children in the study was 64,198. Disorders of the musculoskeletal system accounted for 3,699 (7.5%) of all 49,309 contacts and for 3,046 (7.5%) of all 40,340 episodes. Of the 3,046 episodes registered for ICPC-chapter L (musculoskeletal), 2,562 (84%) were new episodes, i.e. not presented to the GP before. Fifty-four percent of all new episodes were acute injuries. In 22% of the new episodes the general practitioner made a symptom diagnosis. Differences by age and sex were found for a limited number of diagnosis categories. CONCLUSION: Children present disorders of the musculoskeletal system less often than adults; they also present different disorders to their general practitioners. The majority of disorders presented by children are acute injuries, mostly sprains and strains.

Adolescent↗
PubMed1983

Soccer injuries and their mechanisms: a prospective study.

In order to study the incidence and mechanisms of injury in soccer and to recommend prophylactic measures, 180 players in a senior male soccer division were followed prospectively for 1 yr. Attendance records for games and practice sessions were kept, and all injuries were examined and treated by the same orthopaedic surgeon. One hundred twenty-four players incurred 256 injuries, mostly sprains and strains of the lower extremities. Of these, 62% were considered minor with ankle sprains being the most common (17%), while 11% were considered major with knee ligament sprains being the most frequent (32%). Overuse injuries were most frequent in the preseason training period. Traumatic leg injuries involved players with inadequate or no shin guards. Of the traumatic knee injuries, 11 of 18 (61%) occurred during a collision; non-contact knee injuries were frequently seen in those players with a history of knee injury and existing instability. Study of injury sequence disclosed that a minor injury was often followed within two months by a major one. In addition, with severe injuries incurred during fouls, the individual causing the penalty was injured. This prospective study suggested that those with knee instability and those allowed to resume play with poorly rehabilitated or clinically unhealed injuries are more apt to sustain further injury. Some injuries can be avoided by using better equipment and by observance of the rules.

Adult↗