Categorising sports injuries in epidemiological studies : the subsequent injury categorisation (SIC) model to address multiple, recurrent and exacerbation of injuries
- Authors: Finch, Caroline , Cook, Jill
- Date: 2014
- Type: Text , Journal article
- Relation: British Journal of Sports Medicine Vol. 48, no.17, p. 1-6
- Relation: http://purl.org/au-research/grants/nhmrc/565900
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- Description: Objective: Sports injuries are often recurrent and there is wide recognition that a subsequent injury (of either the same or a different type) can be strongly influenced by a previous injury. Correctly categorising subsequent injuries (multiple, recurrent, exacerbation or new) requires substantial clinical expertise, but there is also considerable value in combining this expertise with more objective statistical criteria. This paper presents a new model, the subsequent injury categorisation (SIC) model, for categorising subsequent sports injuries that takes into account the need to include both acute and overuse injuries and ten different dependency structures between injury types. Methods: The suitability of the SIC model was demonstrated with date ordered sports injury data from a large injury database from community Australian football players over one playing season. A subsequent injury was defined to have occurred in the subset of players with two or more reported injuries. Results: 282 players sustained 469 subsequent injuries of which 15.6% were coded to categories representing injuries that were directly related to previous index injuries. This demonstrates that players can sustain a number of injuries over one playing season. Many of these will be unrelated to previous injuries but subsequent injuries that are related to previous injury occurrences are not uncommon. Conclusion: The handling of subsequent sports injuries is a substantial challenge for the sports medicine field—both in terms of injury treatment and in epidemiological research to quantify them. Application of the SIC model allows for multiple different injury types and relationships within players, as well as different index injuries.
The long-term impact of overuse injuries on life-long participation in sport and health status
- Authors: Cook, Jill , Finch, Caroline
- Date: 2011
- Type: Text , Book chapter
- Relation: Sport participation: Health benefits, injuries and psychological effects p. 85-104
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- Description: Overuse injuries are common in many sports and it is well known that they can negatively influence ongoing participation in sport, especially during the period when people recover and rehabilitate from these injuries. Much less is recognised about the longer-term impact of these overuse injuries, with most focus in the literature appearing to be on the outcomes of acute, traumatic injuries. This chapter provides an overview of the available evidence that links overuse injuries to restriction of sport participation and other physical activities in both the short term and longer term, as well as the associated health issues that may be associated with this. In particular, residual musculoskeletal deficits that might affect future joint and tendon health and injury risk are reviewed. By drawing on models describing the chronicity of problems such as poor tendon health and osteoarthritis and the recently presenting LOAD (List of All Deficits) injury outcome framework, this chapter presents a new conceptual approach towards understanding the significant impact of overuse injuries that arise during sport on subsequent health and sports participation across the lifespan.
Bridging the gap between content and context : Establishing expert consensus on the content of an exercise training program to prevent lower-limb injuries
- Authors: Donaldson, Alex , Cook, Jill , Gabbe, Belinda , Lloyd, David , Young, Warren , Finch, Caroline
- Date: 2015
- Type: Text , Journal article
- Relation: Clinical Journal of Sport Medicine Vol.25, no.3, p.221-229
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Relation: http://purl.org/au-research/grants/nhmrc/565907
- Full Text: false
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- Description: OBJECTIVE: To achieve expert consensus on the content of an exercise training program (known as FootyFirst) to prevent lower-limb injuries. DESIGN: Three-round online Delphi consultation process. SETTING: Community Australian Football (AF). PARTICIPANTS: Members of the Australian Football Leagues' Medical Officers (n = 94), physiotherapists (n = 50), and Sports Science (n = 19) Associations were invited to participate through e-mail. Five people with more general expertise in sports-related lower-limb injury prevention were also invited to participate. MAIN OUTCOME MEASURES: The primary outcome measure was the level of agreement on the appropriateness of the proposed exercises and progressions for inclusion in FootyFirst. Consensus was reached when ≥75% of experts who responded to each item agreed and strongly agreed, or disagreed and strongly disagreed, that an exercise or its progressions were appropriate to include in FootyFirst. RESULTS: Fifty-five experts participated in at least 1 Delphi round. In round 1, consensus was achieved that the proposed warm-up (run through and dynamic stretches) and the exercises and progressions for hamstring strength and for balance, landing, and changing direction were appropriate to include in FootyFirst. There was also consensus in round 1 that progressions for hip/core strength should be included in FootyFirst. Consensus was reached in round 2 that the revised groin strength and hip strength exercises should be included in FootyFirst. Consensus was reached for the progression of the groin strength exercises in round 3. CONCLUSIONS: The formal consensus development process has resulted in an evidence-informed, researcher-developed, exercise-based sports injury prevention program that is expert endorsed and specific to the context of AF. CLINICAL RELEVANCE: Lower-limb injuries are common in running, kicking, and contact sports like AF. These injuries are often costly to treat, and many have high rates of recurrence, making them challenging to treat clinically. Reducing these injuries is a high priority for players, teams, and medical staff. Exercise programs provide a method for primary prevention of lower-limb injuries, but they have to be evidence based, have currency with sports practitioners/clinicians, and utility for the context in which they are to be used. However, the comprehensive methods and clinical engagement processes used to develop injury prevention exercise programs have not previously been described in detail. This study describes the results of engaging clinicians and sport scientists in the development of a lower-limb sports injury prevention program for community AF, enabling the development of a program that is both evidence informed and considerate of expert clinical opinion.
Sports injury prevention: improving the outcomes
- Authors: Finch, Caroline , Gabbe, Belinda , Lloyd, David , Cook, Jill , Young, Warren , Nicholson, Matthew , Seward, Hugh , Donaldson, Alex , Doyle, Tim , White, Peta
- Date: 2011
- Type: Text , Journal article
- Relation: Sport Health Vol. 29, no. 1 (2011), p. 34-37
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Relation: http://purl.org/au-research/grants/nhmrc/565907
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- Description: In australia, the public health signifi cance of sports injuries has long been recognised with national and state-specifi c injury data collections demonstrating the magnitude of the population burden of such injuries, including their signifi cant impact on health service delivery and their potential to be associated with socio-demographic health inequalities. Moreover, health-related lifelong physical activity participation will only be sustained in the long-term if it is delivered in a safe way to minimise injury risk.
Towards a national sports safety strategy: Addressing facilitators and barriers towards safety guideline uptake
- Authors: Finch, Caroline , Gabbe, Belinda , Lloyd, David , Cook, Jill , Young, Warren , Nicholson, Matthew , Seward, Hugh , Donaldson, Alex , Doyle, Tim
- Date: 2011
- Type: Text , Journal article
- Relation: Injury Prevention Vol. 17, no. 3 (2011), p. 1-10
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Relation: http://purl.org/au-research/grants/nhmrc/565907
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- Description: Background: Limited information exists about how best to conduct intervention implementation studies in community sport settings. Research should be directed towards understanding the context within which evidence-based injury prevention interventions are to be implemented, while continuing to build the evidencebase for the effectiveness of sports injury interventions. Objectives: To identify factors that influence the translation of evidence-based injury prevention interventions into practice in community sport, and to provide specific evidence for the effectiveness of an evidence-based exercise training programme for lower limb injury prevention in community Australian football. Setting: Community-level Australian football clubs, teams and players. Methods: An exercise-based lower limb injury prevention programme will be developed and evaluated in terms of the implementation context, infrastructure and resources needed for its effective translation into community sport. Analysis of the community sports safety policy context will be undertaken to understand the barriers and facilitators to policy development and uptake. A randomised group-clustered ecological study will be conducted to compare the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) of the intervention over 2 years. Outcome Measures: The primary outcome will be evidence-based prevention guidelines that are fully supported by a comprehensively evaluated dissemination plan. The plan will detail the support structures and add-ons necessary to ensure sustainability and subsequent national implementation. Research outcomes will include new knowledge about how sports safety policy is set, how consensus is reached among sports safety experts in the community setting and how evidence-based safety guidelines are best developed, packaged and disseminated to community sport.
Priorities for investment in injury prevention in community Australian football
- Authors: Finch, Caroline , Gabbe, Belinda , White, Peta , Lloyd, David , Twomey, Dara , Donaldson, Alex , Elliott, Bruce , Cook, Jill
- Date: 2013
- Type: Text , Journal article
- Relation: Clinical journal of sport medicine Vol. 23, no. 6 (November 2013 2013), p. 430-438
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Relation: http://purl.org/au-research/grants/nhmrc/565907
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- Description: Objective:High-quality sport-specific information about the nature, type, cause, and frequency of injuries is needed to set injury prevention priorities. This article describes the type, nature, and mechanism of injuries in community Australian Football (community AF) players, as collected through field-based monitoring of injury in teams of players.Data Sources:Compilation of published prospectively collected injury data from 3 studies in junior community AF (1202 injuries in 1950+ players) and 3 studies in adult community AF (1765 injuries in 2265 players). This was supplemented with previously unpublished data from the most recent adult community AF injury cohort study conducted in 2007 to 2008. Injuries were ranked according to most common body regions, nature of injury, and mechanism.Main Results:In all players, lower limb injuries were the most frequent injury in community AF and were generally muscle strains, joint sprains, and superficial injuries. These injuries most commonly resulted from incidental contact with other players, or from overexertion. Upper limb injuries were less common but included fractures, strains, and sprains that were generally caused by incidental contact between players and the result of players falling to the ground.Conclusions:Lower limb injuries are common in community AF and could have an adverse impact on sustained participation in the game. Based on what is known about their mechanisms, it is likely that a high proportion of lower limb injuries could be prevented and they should therefore be a priority for injury prevention in community AF.
Injuries in community-level Australian football : Results from a club-based injury surveillance system
- Authors: Ekegren, Christina , Gabbe, Belinda , Donaldson, Alex , Cook, Jill , Lloyd, David , Finch, Caroline
- Date: 2014
- Type: Text , Journal article
- Relation: Journal of Science and Medicine in Sport Vol. 18, no. 6 (2014), p.651-655
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Relation: http://purl.org/au-research/grants/nhmrc/1058737
- Relation: http://purl.org/au-research/grants/nhmrc/565907
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- Description: Objectives: Far fewer injury surveillance systems exist within community sport than elite sport. As a result, most epidemiological data on sports injuries have limited relevance to community-level sporting populations. There is potential for data from community club-based injury surveillance systems to provide a better understanding of community sports injuries. This study aimed to describe the incidence and profile of community-level Australian football injuries reported using a club-based injury surveillance system. Design: Prospective, epidemiological study. Methods: Sports trainers from five community-level Australian football leagues recorded injury data during two football seasons using the club-based system. An online surveillance tool developed by Sports Medicine Australia ('Sports Injury Tracker') was used for data collection. The injury incidence, profile and match injury rate were reported. Results: Injury data for 1205 players were recorded in season one and for 823 players in season two. There was significant variability in injury incidence across clubs. However, aggregated data were consistent across football seasons, with an average of 0.7 injuries per player per season and 38-39 match injuries per 1000. h match exposure. A large proportion of injuries occurred during matches, involved the lower limb and resulted from contact. Conclusions: Data from the club-based system provided a profile of injuries consistent with previous studies in community-level Australian football. Moreover, injury incidence was consistent with other studies using similar personnel to record data. However, injury incidence was lower than that reported in studies using player self-report or healthcare professionals and may be an underestimate of true values.
The IOC Centres of Excellence bring prevention to Sports Medicine
- Authors: Engebretsen, Lars , Bahr, Roald , Cook, Jill , Derman, Wayne , Emery, Carolyn , Finch, Caroline , Meeuwisse, Willem , Schwellnus, Martin , Steffen, Kathrin
- Date: 2014
- Type: Text , Journal article
- Relation: British Journal of Sports Medicine Vol. 48, no. 17 (2014), p. 1270-1275
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- Description: The protection of an athlete's health and preventing injuries and illnesses in sport are top priorities for the IOC and its Medical Commission. The IOC therefore partners with selected research centres around the world and supports research in the field of sports medicine. This has enabled the IOC to develop an international network of expert scientists and clinicians in sports injury and disease prevention research. The IOC wants to promote injury and disease prevention and the improvement of physical health of the athlete by: (1) establishing long-term research programmes on injury and disease prevention (including studies on basic epidemiology, risk factors, injury mechanisms and intervention), (2) fostering collaborative relationships with individuals, institutions and organisations to improve athletes' health, (3) implementing and collaborating with applied, ongoing and novel research and development within the framework and long-term strategy of the IOC and (4) setting up knowledge translation mechanisms to share scientific research results with the field throughout the Olympic Movement and sports community and converting these results into concrete actions to protect the health of the athletes. In 2009, the IOC also identified four research centres that had an established track record in research, educational and clinical activities to achieve these ambitions: (1) the Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Australia; (2) the Sport Injury Prevention Research Centre (SIPRC), Canada; (3) the Clinical Sport and Exercise Medicine Research (CSEM), South Africa and (4) the Oslo Sports Trauma Research Center (OSTRC), Norway. This paper highlights the work carried out by these four IOC Centres of Excellence over the past 6 years and their contribution to the world of sports medicine.
Could targeted exercise programmes prevent lower limb injury in community Australian football?
- Authors: Andrew, Nadine , Gabbe, Belinda , Cook, Jill , Lloyd, David , Donnelly, Cyril , Nash, Clare , Finch, Caroline
- Date: 2013
- Type: Text , Journal article
- Relation: Sports Medicine Vol. 43, no. 8 (2013), p. 751-763
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Relation: http://purl.org/au-research/grants/nhmrc/565907
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- Description: Background: Australian football is a popular sport in Australia, at both the community and elite levels. It is a high-speed contact sport with a higher incidence of medically treated injuries when compared with most other organized sports. Hamstring injuries, ligament injuries to the knee or ankle, hip/groin injuries and tendinopathies are particularly common and often result in considerable time lost from sport. Consequently, the prevention of lower limb injuries is a priority for both community and elite Australian football organizations. There is considerable literature available on exercise programmes aimed at reducing lower limb injuries in Australian football and other running-related sports. The quality and outcomes of these studies have varied considerably, but indicate that exercise protocols may be an effective means of preventing lower limb injuries. Despite this, there has been limited high-quality and systematic evaluation of these data. Objective: The aim of this literature review is to systematically evaluate the evidence about the benefits of lower limb injury prevention exercise protocols aimed at reducing the most common severe lower limb injuries in Australian football. Methods: The Cochrane Central Register of Controlled Trials, the Cochrane Bone Joint and Muscle Trauma Group Specialized Register, MEDLINE and other electronic databases were searched, from January 1990 to December 2010. Papers reporting the results of randomized controlled trials (RCTs), quasi-RCTs, cohort and case-control studies were extracted. Primary outcomes were injury reduction or risk factor identification and/or modification. Secondary outcomes were adherence to any trialled interventions, injury severity and adverse effects such as secondary injuries and muscle soreness. The methodological quality of extracted manuscripts was assessed and results were collated. Results: Forty-seven papers were identified and reviewed of which 18 related to hamstring injury, eight related to knee or ankle ligament injury, five related to tendon injury and four were hip or groin injury related. Another 12 papers targeted general lower limb injuries. Most (n = 27 [57 %]) were observational studies, investigating injury risk factors. Twenty reported the results of intervention trials. Of these, 15 were efficacy trials reporting the effects of an intervention in reducing injury rates, four were biomechanical interventions in which the impact of the intervention on a known injury risk factor was assessed and one reported changes in injury risk factors as well as injury rates. The strength of the evidence base for exercise programmes for lower limb injury prevention was found to be limited, primarily due to the research methods employed, low adherence to interventions by the study participants and a lack of statistical power. Limited evidence obtained from a small number of RCTs suggests that balance and control exercises might be efficacious in preventing ankle ligament injuries and a programme involving a combination of balance and control exercises, eccentric hamstring, plyometrics and strength exercises could be efficacious in preventing all lower limb injuries. Conclusions: Overall, the evidence for exercise programmes as an efficacious lower limb injury prevention strategy is predominantly restricted to studies addressing injury aetiology and mechanisms. The findings of this review highlight the need to develop and test interventions in well designed population-based trials with an emphasis on promoting intervention uptake and adherence and, hence, intervention effectiveness. The results of this review can inform the development of the components of a future lower limb injury prevention exercise protocol for community-level Australian football. © 2013 Springer International Publishing Switzerland. Funded by the NHMRC.
- Description: 2003011215
Rehabilitation will increase the 'capacity' of your.... -insert musculoskeletal tissue here..... Defining 'tissue capacity': A core concept for clinicians
- Authors: Cook, Jill , Docking, Sean
- Date: 2015
- Type: Text , Journal article , Editorial
- Relation: British Journal of Sports Medicine Vol. 49, no. 23 (2015), p. 1484-1485
- Full Text: false
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- Description: Capacity is a helpful term in clinical practice to indicate to clients that they (and more importantly their musculoskeletal tissues) are either able or unable to complete a task or participate in physical activity. In the context of injury—having exceeded the capacity of the tissue—the term has immediacy for muscle and ligament: a musculotendinous or ligament strain is an acute injury due to a loading event beyond the tissue's capacity. The tissue response in tendon is usually more gradual—acute traumatic injury of normal tendon is rare, whereas the pathological tendon can fail catastrophically (rupture).
The prevalence of Achilles and patellar tendon injuries in Australian football players beyond a time-loss definition
- Authors: Docking, Sean , Rio, Ebonie , Cook, Jill , Orchard, John , Fortington, Lauren
- Date: 2018
- Type: Text , Journal article
- Relation: Scandinavian Journal of Medicine and Science in Sports Vol. 28, no. 9 (2018), p. 2016-2022
- Full Text: false
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- Description: Little is known about the prevalence and associated of morbidity of tendon problems. With only severe cases of tendon problems missing games, players that have their training and performance impacted are not captured by traditional injury surveillance. The aim of this study was to report the prevalence of Achilles and patellar tendon problems in elite male Australian football players using the Oslo Sports Trauma Research Centre (OSTRC) overuse questionnaire, compared to a time-loss definition. Male athletes from 12 professional Australian football teams were invited to complete a monthly questionnaire over a 9-month period in the 2016 pre- and competitive season. The OSTRC overuse injury questionnaire was used to measure the prevalence and severity of Achilles and patellar tendon symptoms and was compared to traditional match-loss statistics. A total of 441 participants were included. Of all participants, 21.5% (95% CI: 17.9-25.6) and 25.2% (95% CI 21.3-29.4) reported Achilles or patellar tendon problems during the season, respectively. Based on the traditional match-loss definition, a combined 4.1% of participants missed games due to either Achilles or patellar tendon injury. A greater average monthly prevalence was observed during the pre-season compared to the competitive season. Achilles and patellar tendon problems are prevalent in elite male Australian football players. These injuries are not adequately captured using a traditional match-loss definition. Prevention of these injuries may be best targeted during the off- and pre-season due to higher prevalence of symptoms during the pre-season compared to during the competitive season.
A 2-year prospective study of injury epidemiology in elite Australian rugby sevens : Exploration of incidence rates, severity, injury type, and subsequent injury in men and women
- Authors: Toohey, Liam , Drew, Michael , Finch, Caroline , Cook, Jill , Fortington, Lauren
- Date: 2019
- Type: Text , Journal article
- Relation: American Journal of Sports Medicine Vol. 47, no. 6 (2019), p. 1302-1311
- Full Text: false
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- Description: Background: Injuries are common in rugby sevens, but studies to date have been limited to short, noncontinuous periods and reporting of match injuries only. Purpose: To report the injury incidence rate (IIR), severity, and burden of injuries sustained by men and women in the Australian rugby sevens program and to provide the first longitudinal investigation of subsequent injury occurrence in rugby sevens looking beyond tournament injuries only. Study Design: Descriptive epidemiology study. Methods: Ninety international rugby sevens players (55 men and 35 women) were prospectively followed over 2 consecutive seasons (2015-2016 and 2016-2017). All medical attention injuries were reported irrespective of time loss. Individual exposure in terms of minutes, distance, and high-speed distance was captured for each player for matches and on-field training, with the use of global positioning system devices. The IIR and injury burden (IIR × days lost to injury) were calculated per 1000 player-hours, and descriptive analyses were performed. Results: Seventy-three players (81.1%) sustained 365 injuries at an IIR of 43.2 per 1000 player-hours (95% CI, 43.0-43.3). As compared with male players, female players experienced a lower IIR (incidence rate ratio, 0.91; 95% CI, 0.90-0.91). Female players also sustained a higher proportion of injuries to the trunk region (relative risk, 1.75; 95% CI, 1.28-2.40) but a lower number to the head/neck region (relative risk, 0.58; 95% CI, 0.37-0.93; P =.011). The majority (80.7%) of subsequent injuries were of a different site and nature than previous injuries. A trend toward a reduced number of days, participation time, distance, and high-speed distance completed before the next injury was observed after successive injury occurrence. Conclusion: Female players have a lower IIR than male players, with variation of injury profiles observed between sexes. With a surveillance period of 2 years, subsequent injuries account for the majority of injuries sustained in rugby sevens, and they are typically different from previous types of sustained injuries. After each successive injury, the risk profile for future injury occurrence appears to be altered, which warrants further investigation to inform injury prevention strategies in rugby sevens.
An updated subsequent injury categorisation model (SIC-2.0) : Data-driven categorisation of subsequent injuries in sport
- Authors: Toohey, Liam , Drew, Michael , Fortington, Lauren , Finch, Caroline , Cook, Jill
- Date: 2018
- Type: Text , Journal article
- Relation: Sports Medicine Vol. 48, no. 9 (2018), p. 2199-2210
- Full Text: false
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- Description: Background: Accounting for subsequent injuries is critical for sports injury epidemiology. The subsequent injury categorisation (SIC-1.0) model was developed to create a framework for accurate categorisation of subsequent injuries but its operationalisation has been challenging. Objectives: The objective of this study was to update the subsequent injury categorisation (SIC-1.0 to SIC-2.0) model to improve its utility and application to sports injury datasets, and to test its applicability to a sports injury dataset. Methods: The SIC-1.0 model was expanded to include two levels of categorisation describing how previous injuries relate to subsequent events. A data-driven classification level was established containing eight discrete injury categories identifiable without clinical input. A sequential classification level that sub-categorised the data-driven categories according to their level of clinical relatedness has 16 distinct subsequent injury types. Manual and automated SIC-2.0 model categorisation were applied to a prospective injury dataset collected for elite rugby sevens players over a 2-year period. Absolute agreement between the two coding methods was assessed. Results: An automated script for automatic data-driven categorisation and a flowchart for manual coding were developed for the SIC-2.0 model. The SIC-2.0 model was applied to 246 injuries sustained by 55 players (median four injuries, range 1–12), 46 (83.6%) of whom experienced more than one injury. The majority of subsequent injuries (78.7%) were sustained to a different site and were of a different nature. Absolute agreement between the manual coding and automated statistical script category allocation was 100%. Conclusions: The updated SIC-2.0 model provides a simple flowchart and automated electronic script to allow both an accurate and efficient method of categorising subsequent injury data in sport.
The continuum of tendon pathology : Current view and clinical implications
- Authors: Cook, Jill , Rio, Ebonie , Purdam, Craig , Girdwood, Michael , Ortega-Cebrian, Silvia , Docking, Sean
- Date: 2017
- Type: Text , Journal article
- Relation: Apunts Medicina de l'Esport Vol. 52, no. 194 (2017), p. 61-69
- Full Text: false
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- Description: Cook and Purdam first proposed the Continuum model in 2009, with the aim of improving the understanding of the complexity of tendon pathologies. The Continuum is based on three states of tendon structure: reactive tendon, tendon disrepair and degenerative tendon. In contrast to other proposals, the Continuum model describes continuous changes in tendon structure. Each state of tendon structure represents a particular clinical presentation and requires a particular type of management. Evidence seen in histopathological studies, imaging and clinical studies all support the Continuum model for the analysis of tendon pathologies. © 2017 Consell Català de l'Esport. Generalitat de Catalunya
Does type 1 diabetes mellitus affect Achilles tendon response to a 10 km run? A case control study
- Authors: Wong, Andrea , Docking, Sean , Cook, Jill , Gaida, Jamie
- Date: 2015
- Type: Text , Journal article
- Relation: Bmc Musculoskeletal Disorders Vol. 16, no. (2015), p. 1-7
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- Description: Background: Achilles tendon structure deteriorates 2-days after maximal loading in elite athletes. The load-response behaviour of tendons may be altered in type 1 diabetes mellitus (T1DM) as hyperglycaemia accelerates collagen cross-linking. This study compared Achilles tendon load-response in participants with T1DM and controls. Methods: Achilles tendon structure was quantified at day-0, day-2 and day-4 after a 10 km run. Ultrasound tissue characterisation (UTC) measures tendon structural integrity by classifying pixels as echo-type I, II, III or IV. Echo-type I has the most aligned collagen fibrils and IV has the least. Results: Participants were 7 individuals with T1DM and 10 controls. All regularly ran distances greater than 5 km and VISA-A scores indicated good tendon function (T1DM = 94 +/- 11, control = 94 +/- 10). There were no diabetic complications and HbA1c was 8.7 +/- 2.6 mmol/mol for T1DM and 5.3 +/- 0.4 mmol/mol for control groups. Baseline tendon structure was similar in T1DM and control groups -UTC echo-types (I-IV) and anterior-posterior thickness were all p > 0.05. No response to load was seen in either T1DM or control group over the 4-days post exercise. Conclusion: Active individuals with T1DM do not have a heightened Achilles tendon response to load, which suggests no increased risk of tendon injury. We cannot extrapolate these findings to sedentary individuals with T1DM.
Achilles tendon structure improves on UTC imaging over a 5-month pre-season in elite Australian football players
- Authors: Docking, Sean , Rosengarten, Samuel , Cook, Jill
- Date: 2016
- Type: Text , Journal article
- Relation: Scandinavian Journal of Medicine and Science in Sports Vol. 26, no. 5 (2016), p. 557-563
- Full Text: false
- Reviewed:
- Description: Pre-season injuries are common and may be due to a reintroduction of training loads. Tendons are sensitive to changes in load, making them vulnerable to injury in the pre-season. This study investigated changes in Achilles tendon structure on ultrasound tissue characterization (UTC) over the course of a 5-month pre-season in elite male Australian football players. Eighteen elite male Australian football players with no history of Achilles tendinopathy and normal Achilles tendons were recruited. The left Achilles tendon was scanned with UTC to quantify the stability of the echopattern. Participants were scanned at the start and completion of a 5-month pre-season. Fifteen players remained asymptomatic over the course of the pre-season. All four echo-types were significantly different at the end of the pre-season, with the overall echopattern suggesting an improvement in Achilles tendon structure. Three of the 18 participants developed Achilles tendon pain that coincided with a change in the UTC echopattern. This study demonstrates that the UTC echopattern of the Achilles tendon improves over a 5-month pre-season training period, representing increased fibrillar alignment. However, further investigation is needed to elucidate with this alteration in the UTC echopattern results in improved tendon resilience and load capacity. © 2016 John Wiley & Sons A/S.
Quantification of Achilles and patellar tendon structure on imaging does not enhance ability to predict self-reported symptoms beyond grey-scale ultrasound and previous history
- Authors: Docking, Sean , Rio, Ebonie , Cook, Jill , Carey, David , Fortington, Lauren
- Date: 2019
- Type: Text , Journal article
- Relation: Journal of Science and Medicine in Sport Vol. 22, no. 2 (2019), p. 145-150
- Full Text: false
- Reviewed:
- Description: Background: Tendon pathology on imaging has been associated with an increased risk of developing symptoms. This evidence is based on classifying the tendon as normal or pathological. It is unclear whether the extent of tendon pathology is associated with the development or severity of symptoms. Objectives: To investigate whether the presence and extent of tendon pathology on ultrasound tissue characterisation (UTC), or a previous history of symptoms, were associated with the development of symptoms over a football season. Methods: 179 male Australian football players underwent UTC imaging of their Achilles and/or patellar tendon at the start of the pre-season. Players completed monthly OSTRC overuse questionnaires to quantify the presence and severity of Achilles and/or patellar tendon symptoms. Risk factor analysis was performed to identify associations between imaging and the development of symptoms. Results: A pathological Achilles tendon increased the risk of developing symptoms (RR = 3.2, 95%CI 1.7–5.9). Conversely, a pathological patellar tendon was not significantly associated with the development of symptoms (RR = 1.8, 95%CI 0.9–3.7). Quantification of tendon structure using UTC did not enhance the ability to identify athletes who developed symptoms. Previous history of symptoms was the strongest predictor for the development of symptoms (Achilles RR = 3.0 95%CI 1.8–4.8; patellar RR = 3.7 95%CI 2.2–6.1). Conclusion: Tendon pathology was associated with the development of self-reported symptoms; however previous history of symptoms was a stronger risk factor. The extent of disorganisation quantified by UTC should not be used as a marker for the presence or severity of current and future symptoms.
The self-reported factors that influence Australian physiotherapists’ choice to promote non-treatment physical activity to patients with musculoskeletal conditions
- Authors: Kunstler, Breanne , Cook, Jill , Kemp, Joanne , O'Halloran, Paul , Finch, Caroline
- Date: 2019
- Type: Text , Journal article
- Relation: Journal of Science and Medicine in Sport Vol. 22, no. 3 (2019), p. 275-280
- Full Text: false
- Reviewed:
- Description: Objectives: To determine the factors that influence physiotherapists’ choice to promote non-treatment physical activity to patients with musculoskeletal conditions. Design: Cross sectional survey. Methods: A national, online self report survey was targeted at Australian registered physiotherapists primarily treating patients with musculoskeletal conditions in private practice and outpatient settings. Likert scale questions were used to measure the factors influencing non-treatment physical activity promotion by physiotherapists. Results: Two hundred and sixteen full responses were received. Most (56.6%) respondents irregularly promoted non-treatment physical activity, whereas 43.4% always promoted non-treatment physical activity. Promotion of non-treatment physical activity was bivariately associated with respondents’ own physical activity level (x2[2] = 7.670, p = 0.022) and exercise science education (x2[1] = 4.613, p = 0.032). Multivariable analysis identified that Knowledge (knowing how to promote non-treatment physical activity) (OR = 1.60, 95%CI 1.026–2.502), Goals (other patient problems are more important) (OR = 0.62, 95%CI 0.424–0.897) and Innovation (compatibility of non-treatment physical activity promotion with the clinical environment) (OR = 1.75, 95%CI 1.027–2.985) were significantly and independently associated with non-treatment physical activity promotion. Conclusions: The majority of surveyed Australian physiotherapists irregularly promoted non-treatment physical activity. Lack of knowledge of how to promote non-treatment physical activity, prioritising other patient problems before non-treatment physical activity promotion and using promotion methods that are not compatible with current practice might reduce non-treatment physical activity promotion frequency by physiotherapists.
Sports-related workload and injury risk : Simply knowing the risks will not prevent injuries : Narrative review
- Authors: Drew, Michael , Cook, Jill , Finch, Caroline
- Date: 2016
- Type: Text , Journal article , Review
- Relation: British Journal of Sports Medicine Vol. 50, no. 21 (2016), p. 1306-1309
- Relation: http://purl.org/au-research/grants/nhmrc/1058737
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- Description: Training loads contribute to sports injury risk but their mitigation has rarely been considered in a sports injury prevention framework. A key concept behind monitoring training loads for injury prevention is to screen for those at increased risk of injury so that workloads can be adjusted to minimise these risks. This review describes how advances in management of workload can be applied as a preventive measure. Primary prevention involves screening for preparticipation load risk factors, such as low training loads, prior to a training period or competition. Secondary prevention involves screening for workloads that are known to precede an injury developing so that modification can be undertaken to mitigate this risk. Tertiary prevention involves rehabilitation practices that include a graded return to training programme to reduce the risk of sustaining a subsequent injury. The association of training loads with injury incidence is now established. Prevention measures such as rule changes that affect the workload of an athlete are universal whereas those that address risk factors of an asymptomatic subgroup are more selective. Prevention measures, when implemented for asymptomatic individuals exhibiting possible injury risk factors, are indicated for an athlete at risk of developing a sports injury. Seven key indicated risks and associated prevention measures are proposed.
Controlled ecological evaluation of an implemented exercise-training programme to prevent lower limb injuries in sport : Population-level trends in hospital-treated injuries
- Authors: Finch, Caroline , Gray, Shannon , Akram, Muhammad , Donaldson, Alex , Lloyd, David , Cook, Jill
- Date: 2019
- Type: Text , Journal article
- Relation: British Journal of Sports Medicine Vol. 53, no. 8 (2019), p. 487-492
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- Reviewed:
- Description: Objective Exercise-training programmes have reduced lower limb injuries in trials, but their population-level effectiveness has not been reported in implementation trials. This study aimed to demonstrate that routinely collected hospital data can be used to evaluate population-level programme effectiveness. Method A controlled ecological design was used to evaluate the effect of FootyFirst, an exercise-training programme, on the number of hospital-treated lower limb injuries sustained by males aged 16-50 years while participating in community-level Australian Football. FootyFirst was implemented with a € support' (FootyFirst+S) or a € without support' (FootyFirst+NS) in different geographic regions of Victoria, Australia: 22 clubs in region 1: FootyFirst+S in 2012/2013; 25 clubs in region 2: FootyFirst+NS in 2012/2013; 31 clubs region 3: control in 2012, FootyFirst+S in 2013. Interrupted time-series analysis compared injury counts across regions and against trends in the rest of Victoria. Results After 1 year of FootyFirst+S, there was a non-statistically significant decline in the number of lower limb injuries in region 1 (2012) and region 3 (2013); this was not maintained after 2 years in region 1. Compared with before FootyFirst in 2006-2011, injury count changes at the end of 2013 were: region 1: 20.0% reduction (after 2 years support); region 2: 21.5% increase (after 2 years without support); region 3: 21.8% increase (after first year no programme, second year programme with support); rest of Victoria: 12.6% increase. Conclusion Ecological analyses using routinely collected hospital data show promise as the basis of population-level programme evaluation. The implementation and sustainability of sports injury prevention programmes at the population-level remains challenging.