Collecting health and exposure data in Australian olympic combat sports : Feasibility study utilizing an electronic system
- Authors: Bromley, Sally , Drew, Michael , Talpey, Scott , McIntosh, Andrew , Finch, Caroline
- Date: 2018
- Type: Text , Journal article
- Relation: Journal of Medical Internet Research Vol. 20, no. 10 (2018), p. 1-11
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- Description: Background: Electronic methods are increasingly being used to manage health-related data among sporting populations. Collection of such data permits the analysis of injury and illness trends, improves early detection of injuries and illnesses, collectively referred to as health problems, and provides evidence to inform prevention strategies. The Athlete Management System (AMS) has been employed across a range of sports to monitor health. Australian combat athletes train across the country without dedicated national medical or sports science teams to monitor and advocate for their health. Employing a Web-based system, such as the AMS, May provide an avenue to increase the visibility of health problems experienced by combat athletes and deliver key information to stakeholders detailing where prevention programs May be targeted. Objective: The objectives of this paper are to (1) report on the feasibility of utilizing the AMS to collect longitudinal injury and illness data of combat sports athletes and (2) describe the type, location, severity, and recurrence of injuries and illnesses that the cohort of athletes experience across a 12-week period. Methods: We invited 26 elite and developing athletes from 4 Olympic combat sports (boxing, judo, taekwondo, and wrestling) to participate in this study. Engagement with the AMS was measured, and collected health problems (injuries or illnesses) were coded using the Orchard Sports Injury Classification System (version 10.1) and International Classification of Primary Care (version 2). Results: Despite >160 contacts, athlete engagement with online tools was poor, with only 13% compliance across the 12-week period. No taekwondo or wrestling athletes were compliant. Despite low overall engagement, a large number of injuries or illness were recorded across 11 athletes who entered data—22 unique injuries, 8 unique illnesses, 30 recurrent injuries, and 2 recurrent illnesses. The most frequent injuries were to the knee in boxing (n=41) and thigh in judo (n=9). In this cohort, judo players experienced more severe, but less frequent, injuries than boxers, yet judo players sustained more illnesses than boxers. In 97.0% (126/130) of cases, athletes in this cohort continued to train irrespective of their health problems. Conclusions: Among athletes who reported injuries, many reported multiple conditions, indicating a need for health monitoring in Australian combat sports. A number of factors May have influenced engagement with the AMS, including access to the internet, the design of the system, coach views on the system, previous experiences with the system, and the existing culture within Australian combat sports. To increase engagement, there May be a requirement for sports staff to provide relevant feedback on data entered into the system. Until the Barriers are addressed, it is not feasible to implement the system in its current form across a larger cohort of combat athletes.
Head impact velocities in FIS World Cup snowboarders and freestyle skiers : Do real-life impacts exceed helmet testing standards?
- Authors: Steenstrup, Sophie , Mok, Kam-Ming , McIntosh, Andrew , Bahr, Roald , Krosshaug, Tron
- Date: 2018
- Type: Text , Journal article
- Relation: British Journal of Sports Medicine Vol. 52, no. 1 (2018), p. 32-40
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- Description: Introduction Prior to the 2013-2014 season, the International Ski Federation (FIS) increased the helmet testing speed from a minimum requirement of 5.4 to 6.8 m/s for alpine downhill, super-G and giant slalom and for freestyle ski cross, but not for the other freestyle disciplines or snowboarding. Whether this increased testing speed reflects impact velocities in real head injury situations on snow is unclear. We therefore investigated the injury mechanisms and gross head impact biomechanics in four real head injury situations among World Cup (WC) snowboard and freestyle athletes and compared these with helmet homologation laboratory test requirements. The helmets in the four cases complied with at least European Standards (EN) 1077 (Class B) or American Society for Testing and Materials (ASTM) F2040. Methods We analysed four head injury videos from the FIS Injury Surveillance System throughout eight WC seasons (2006-2014) in detail. We used motion analysis software to digitize the helmet's trajectory and estimated the head's kinematics in two dimensions, including directly preimpact and postimpact. Results All four impacts were to the occiput. In the four cases, the normal-to-slope preimpact velocity ranged from 7.0(±SD 0.2) m/s to 10.5±0.5 m/s and the normalto-slope velocity change ranged from 8.4±0.6 m/s to 11.7±0.7 m/s. The sagittal plane helmet angular velocity estimates indicated a large change in angular velocity (25.0±2.9 rad/s to 49.1±0.3 rad/s). Conclusion The estimated normal-to-slope preimpact velocity was higher than the current strictest helmet testing rule of 6.8 m/s in all four cases. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved.
Reconstruction of head impacts in FIS World Cup alpine skiing
- Authors: Steenstrup, Sophie , Mok, Kam-Ming , McIntosh, Andrew , Bahr, Roald , Krosshaug, Tron
- Date: 2018
- Type: Text , Journal article
- Relation: British Journal of Sports Medicine Vol. 52, no. 11 (2018), p. 709-715
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- Description: Introduction Prior to the 2013/2014 season, the International Ski Federation (FIS) increased the helmet testing speed from 5.4 to 6.8 m/s for alpine downhill, super-G and giant slalom. Whether this increased testing speed reflects head impact velocities in real head injury situations on snow is unclear. We therefore investigated the injury mechanisms and gross head impact biomechanics in seven real head injury situations among World Cup (WC) alpine skiers. Methods We analysed nine head impacts from seven head injury videos from the FIS Injury Surveillance System, throughout nine WC seasons (2006-2015) in detail. We used commercial video-based motion analysis software to estimate head impact kinematics in two dimensions, including directly preimpact and postimpact, from broadcast video. The sagittal plane angular movement of the head was also measured using angle measurement software. Results In seven of nine head impacts, the estimated normal to slope preimpact velocity was higher than the current FIS helmet rule of 6.8 m/s (mean 8.1 (±SD 0.6) m/s, range 1.9±0.8 to 12.1±0.4 m/s). The nine head impacts had a mean normal to slope velocity change of 9.3±1.0 m/s, range 5.2±1.1 to 13.5±1.3 m/s. There was a large change in sagittal plane angular velocity (mean 43.3±2.9 rad/s (range 21.2±1.5 to 64.2±3.0 rad/s)) during impact. Conclusion The estimated normal to slope preimpact velocity was higher than the current FIS helmet rule of 6.8 m/s in seven of nine head impacts.
What is the definition of sports-related concussion : A systematic review
- Authors: McCrory, Paul , Feddermann-Demont, Nina , Dvorak, Jiri , Cassidy, David , McIntosh, Andrew , Vos, Pieter , Echemendia, Ruben , Meeuwisse, Willem , Tarnutzer, Alexander
- Date: 2017
- Type: Text , Journal article , Review
- Relation: British Journal of Sports Medicine Vol. 51, no. 11 (2017), p. 877-887
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- Description: Objectives: Various definitions for concussion have been proposed, each having its strengths and weaknesses. We reviewed and compared current definitions and identified criteria necessary for an operational definition of sports-related concussion (SRC) in preparation of the 5th Concussion Consensus Conference (Berlin, Germany). We also assessed the role of biomechanical studies in informing an operational definition of SRC. Design: This is a systematic literature review. Data sources: Data sources include MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Clinical Trials and SPORT Discus (accessed 14 September 2016). Eligibility criteria for selecting studies: Eligibility criteria were studies reporting (clinical) criteria for diagnosing SRC and studies containing SRC impact data. Results: Out of 1601 articles screened, 36 studies were included (2.2%), 14 reported on criteria for SRC definitions and 22 on biomechanical aspects of concussions. Six different operational definitions focusing on clinical findings and their dynamics were identified. Biomechanical studies were obtained almost exclusively on American football players. Angular and linear head accelerations linked to clinically confirmed concussions demonstrated considerable individual variation. Summary/conclusions: SRC is a traumatic brain injury that is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces with several common features that help define its nature. Limitations identified include that the current criteria for diagnosing SRC are clinically oriented and that there is no gold/standard to assess their diagnostic properties. A future, more valid definition of SRC would better identify concussed players by demonstrating high predictive positive/negative values. Currently, the use of helmet-based systems to study the biomechanics of SRC is limited to few collision sports. New approaches need to be developed to provide objective markers for SRC. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved.
Considerations for the performance requirements and technical specifications of soft-shell padded headgear
- Authors: Patton, Declan , McIntosh, Andrew
- Date: 2016
- Type: Text , Journal article , Review
- Relation: Proceedings of the Institution of Mechanical Engineers, Part P: Journal of Sports Engineering and Technology Vol. 230, no. 1 (2016), p. 29-42
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- Description: Laboratory and epidemiological research in Australian football, rugby league and rugby union has demonstrated that commercially available soft-shell padded headgear is currently ineffective in reducing the risk of concussion. However, modified headgear studies have demonstrated that significant improvements in impact energy attenuation performance are possible with small design changes, such as increases in foam density and thickness. A literature review of the design, performance and use of headgear in Australian football, rugby league and rugby union was conducted. A total of 23 articles were identified using primary and secondary search strategies, which included epidemiological field studies, laboratory impact test studies and studies investigating the behaviours and attitudes of players. The results of the review were synthesised and used to identify injury reduction objectives and appropriate design criteria. The need for a headgear standard was identified and performance requirements were discussed, which drew upon human tolerance and sports-specific head impact exposure data. Usability and behavioural issues, which require consideration during the design process, were also assessed. © IMechE 2015.
Boxing headguard performance in punch machine tests
- Authors: McIntosh, Andrew , Patton, Declan
- Date: 2015
- Type: Text , Journal article
- Relation: British Journal of Sports Medicine Vol. 49, no. 17 (2015), p. 1108-1112
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- Description: Background: The paper presents a novel laboratory method for assessing boxing headguard impact performance. The method is applied to examine the effects of headguards on head impact dynamics and injury risk. Methods: A linear impactor was developed, and a range of impacts was delivered to an instrumented Hybrid III head and neck system both with and without an AIBA (Association Internationale de Boxe Amateur)- approved headguard. Impacts at selected speeds between 4.1 and 8.3 m/s were undertaken. The impactor mass was approximately 4 kg and an interface comprising a semirigid 'fist' with a glove was used. Results: The peak contact forces were in the range 1.9-5.9 kN. Differences in head impact responses between the Top Ten AIBA-approved headguard and bare headform in the lateral and forehead tests were large and/or significant. In the 8.3 m/s fist-glove impacts, the mean peak resultant headform accelerations for bare headform tests was approximately 130 g compared with approximately 85 g in the forehead impacts. In the 6.85 m/s bare headform impacts, mean peak resultant angular head accelerations were in the range of 5200-5600 rad/s
The impact performance of headguards for combat sports
- Authors: McIntosh, Andrew , Patton, Declan
- Date: 2015
- Type: Text , Journal article
- Relation: British Journal of Sports Medicine Vol. 49, no. 17 (2015), p. 1113-1117
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- Description: Background/aim: To assess the impact energy attenuation performance of a range of headguards for combat sports. Methods: Seven headguards worn during combat sport training or competition, including two Association Internationale de Boxe Amateur (AIBA)-approved boxing models, were tested using drop tests. An International Organization for Standardization (ISO) rigid headform was used with a 5.6 kg drop assembly mass. Tests were conducted against a flat rigid anvil both with and without a boxing glove section. The centre forehead and lateral headguard areas were tested. Peak headform acceleration was measured. Tests from a selection of drop heights and repeated tests on the same headguard were conducted. Results: Headguard performance varied by test condition. For the 0.4 m rigid anvil tests, the best model headguard was the thickest producing an average peak headform acceleration over 5 tests of 48 g compared with 456 g for the worst model. The mean peak acceleration for the 0.4, 0.5 and 0.6 frontal and lateral rigid anvil impact tests was between 32% and 40% lower for the Top Ten boxing model compared with the Adidas boxing model. The headguard performance deterioration observed with repeat impact against the flat anvil was reduced for impacts against the glove section. The overall reduction in acceleration for the combination of glove and headguard in comparison to the headguard condition was in the range of 72-93% for 0.6 and 0.8 m drop tests. Conclusions: The impact tests show the benefits of performance testing in identifying differences between headguard models.
What are the most effective risk-reduction strategies in sport concussion?
- Authors: Benson, Brian , McIntosh, Andrew , Maddocks, David , Herring, Stanley , Raftery, Martin , Dvorak, Jiri
- Date: 2013
- Type: Text , Journal article
- Relation: British Journal of Sports Medicine Vol. 47, no. 5 (2013), p. 321-326
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- Description: Aim To critically review the evidence to determine the efficacy and effectiveness of protective equipment, rule changes, neck strength and legislation in reducing sport concussion risk. Methods Electronic databases, grey literature and bibliographies were used to search the evidence using Medical Subject Headings and text words. Inclusion/ exclusion criteria were used to select articles for the clinical equipment studies. The quality of evidence was assessed using epidemiological criteria regarding internal/external validity (eg, strength of design, sample size/power, bias and confounding). Results No new valid, conclusive evidence was provided to suggest the use of headgear in rugby, or mouth guards in American football, significantly reduced players' risk of concussion. No evidence was provided to suggest an association between neck strength increases and concussion risk reduction. There was evidence in ice hockey to suggest fair-play rules and eliminating body checking among 11-years-olds to 12-years-olds were effective injury prevention strategies. Evidence is lacking on the effects of legislation on concussion prevention. Equipment self-selection bias was a common limitation, as was the lack of measurement and control for potential confounding variables. Lastly, helmets need to be able to protect from impacts resulting in a head change in velocities of up to 10 and 7 m/s in professional American and Australian football, respectively, as well as reduce head resultant linear and angular acceleration to below 50 g and 1500 rad/s2, respectively, to optimise their effectiveness. Conclusions A multifactorial approach is needed for concussion prevention. Future well-designed and sportspecific prospective analytical studies of sufficient power are warranted.
Compliance with return-to-play regulations following concussion in Australian schoolboy and community rugby union players
- Authors: Hollis, Stephanie , Stevenson, Mark , McIntosh, Andrew , Shores, E Arthur , Finch, Caroline
- Date: 2012
- Type: Text , Journal article
- Relation: British Journal of Sports Medicine Vol. 46, no. 10 (2012), p. 735-740
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- Description: Background: There is a risk of concussion when playing rugby union. Appropriate management of concussion includes compliance with the return-to-play regulations of the sports body for reducing the likelihood of premature return-to-play by injured players. Purpose: To describe the proportion of rugby union players who comply with the sports body's regulations on returning to play postconcussion. Study design: Prospective cohort study. Methods: 1958 community rugby union players (aged 15–48 years) in Sydney (Australia) were recruited from schoolboy, grade and suburban competitions and followed over ≥1 playing seasons. Club doctors/physiotherapists/coaches or trained injury recorders who attended the game reported players who sustained a concussion. Concussed players were followed up over a 3-month period and the dates when they returned to play (including either a game or training session) were recorded, as well as any return-to-play advice they received. Results: 187 players sustained ≥1 concussion throughout the follow-up. The median number of days before players returned to play (competition game play or training) following concussion was 3 (range 1–84). Most players (78%) did not receive return-to-play advice postconcussion, and of those who received correct advice, all failed to comply with the 3-week stand-down regulation. Conclusions: The paucity of return-to-play advice received by community rugby union players postconcussion and the high level of non-compliance with return-to-play regulations highlight the need for better dissemination and implementation of the return-to-play regulations and improved understanding of the underlying causes of why players do not adhere to return-to-play practices.
Mild traumatic brain injury among a cohort of rugby union players: predictors of time to injury
- Authors: Hollis, Stephanie , Stevenson, Mark , McIntosh, Andrew , Li, Ling , Heritier, Stephane , Shores, E Arthur , Collins, Michael , Finch, Caroline
- Date: 2011
- Type: Text , Journal article
- Relation: British Journal of Sports Medicine Vol. 45, no. 12 (2011), p. 997-999
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- Description: This study reports the time to sustain a mild traumatic brain injury (mTBI) among a cohort of community rugby union players. Demographic and player characteristics were collected and players followed up for between one and three playing seasons. 7% of the cohort sustained an mTBI within 10 h of game time, increasing twofold to 14% within 20 h. The mean time to first mTBI was 8 h with an SD of 6.2 (median 6.8 h; IQR: 2.9–11.7 h). Players reporting a recent history of concussion were 20% more likely to sustain an mTBI after 20 h of game time compared with those with no recent history of concussion. Players were likely to sustain an mTBI in shorter time if they trained for <3 h/week (HR=1.48, p=0.03) or had a body mass index <27 (HR=1.77, p=0.007). The findings highlight modifiable characteristics to reduce the likelihood of shortened time to mTBI.