Head, face and neck injury in youth rugby: Incidence and risk factors
- Authors: McIntosh, Andrew , McCrory, Paul , Finch, Caroline , Wolfe, Rory
- Date: 2010
- Type: Text , Journal article
- Relation: British Journal of Sports Medicine Vol. 44, no. 3 (2010), p. 188-193
- Relation: http://purl.org/au-research/grants/nhmrc/565900
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- Description: OBJECTIVES: In this study, the incidence of head, neck and facial injuries in youth rugby was determined, and the associated risk factors were assessed. DESIGN: Data were extracted from a cluster randomised controlled trial of headgear with the football teams as the unit of randomisation. No effect was observed for headgear use on injury rates, and the data were pooled. SETTING: General school and club-based community competitive youth rugby in the 2002 and 2003 seasons. PARTICIPANTS: Young male rugby union football players participating in under-13, under 15, under 18 and under 21 years competitions. Eighty-two teams participated in year 1 and 87 in year 2. MAIN OUTCOME MEASURES: Injury rates for all body regions combined, head, neck and face calculated for game and missed game injuries. RESULTS: 554 head, face and neck injuries were recorded within a total of 28 902 h of rugby game exposure. Level of play and player position were related to injury risk. Younger players had the lowest rates of injury; forwards, especially the front row had the highest rate of neck injury; and inside backs had the highest rate of injuries causing the player to miss a game. Contact events, including the scrum and tackle, were the main events leading to injury. CONCLUSION: Injury prevention must focus on the tackle and scrum elements of a youth rugby game.
Combining epidemiology and biomechanics in sports injury prevention research : A new approach for selecting suitable controls
- Authors: Finch, Caroline , Ullah, Shahid , McIntosh, Andrew
- Date: 2011
- Type: Text , Journal article
- Relation: Sports Medicine Vol. 41, no. 1 (2011), p. 59-72
- Relation: http://purl.org/au-research/grants/nhmrc/565900
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- Description: Several important methodological issues need to be considered when designing sports injury case-control studies. Major design goals for case-control studies include the accounting for prior injury risk exposure, and optimal definitions of both cases and suitable controls are needed to ensure this. This article reviews methodological aspects of published sports injury case-control studies, particularly with regard to the selection of controls. It argues for a new approach towards selecting controls for case-control studies that draws on an interface between epidemiological and biomechanical concepts. A review was conducted to identify sport injury case-control studies published in the peer-review literature during 1985-2008. Overall, 32 articles were identified, of which the majority related to upper or lower extremity injuries. Matching considerations were used for control selection in 16 studies. Specific mention of application of biomechanical principles in the selection of appropriate controls was absent from all studies, including those purporting to evaluate the benefits of personal protective equipment to protect against impact injury. This is a problem because it could lead to biased conclusions, as cases and controls are not fully comparable in terms of similar biomechanical impact profiles relating to the injury incident, such as site of the impact on the body. The strength of the conclusions drawn from case-control studies, and the extent to which results can be generalized, is directly influenced by the definition and recruitment of cases and appropriate controls. Future studies should consider the interface between epidemiological and biomechanical concepts when choosing appropriate controls to ensure that proper adjustment of prior exposure to injury risk is made. To provide necessary guidance for the optimal selection of controls in case-control studies of interventions to prevent sports-related impact injury, this review outlines a new case-control selection strategy that reflects the importance of biomechanical considerations, which ensures that controls are selected based on the presence of the same global injury mechanism as the cases. To summarize, the general biomechanical principles that should apply to the selection of controls in future case-control studies are as follows: (i) each control must have been exposed to the same global injury mechanism as the case, (e.g. head impact, fall onto outstretched arm); and (ii) intrinsic (individual) factors (e.g. age, sex, skill level) that might modify the person's response to the relevant biomechanical loads are adjusted when either selecting the controls or are in the analysis phase. The same considerations for control selection apply to other study designs such as matched cohort studies or case-crossover studies. © 2011 Adis Data Information BV. All rights reserved.
Use of field-based tests to identify risk factors for injury to fast bowlers in cricket
- Authors: Dennis, Rebecca , Finch, Caroline , McIntosh, Andrew , Elliott, Bruce
- Date: 2008
- Type: Text , Journal article
- Relation: British Journal of Sports Medicine Vol. 42, no. 6 (Jun 2008), p. 477-482
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- Description: Objective: To identify risk factors for injury to cricket fast bowlers using field-based tests. Design: Prospective cohort study. Setting: High performance Australian cricket. Participants: Ninety-one male adolescent and adult fast bowlers (aged 12-33 years). Assessment of risk factors: A field-based pre-participation screening, consisting of musculoskeletal, fitness and anthropometric assessments and analysis of bowling technique was undertaken. Bowlers were prospectively monitored over the 2003-4 season and bowling workload and injuries were recorded. Logistic regression was used to identify injury risk factors. Main outcome measurement: Repetitive microtrauma injury to the trunk, back or lower limb associated with fast bowling. Results: Two variables were identified as independent predictors of injury in the multivariate logistic regression analysis. Bowlers with hip internal rotation of <= 30 degrees on the leg ipsilateral to the bowling arm were at a significantly reduced risk of injury (OR 0.20, 95% CI 0.06 to 0.73) compared with bowlers with >40 degrees of rotation. Bowlers with an ankle dorsiflexion lunge of 12.1-14.0 cm on the leg contralateral to the bowling arm were at a significantly increased risk (OR 4.03, 95% CI 1.07 to 15.21) than bowlers with a lunge of >14 cm. Bowlers with a lunge of (12 cm were also at an increased risk, but not significantly so (OR 1.38, 95% CI 0.40 to 4.84). Conclusions: Biomechanical research is needed to investigate how these two intrinsic risk factors increase injury risk so that appropriate interventions can be developed.
SCAT3 changes from baseline and associations with X2 Patch measured head acceleration in amateur Australian football players
- Authors: Willmott, Catherine , McIntosh, Andrew , Howard, Teresa , Mitra, Biswadev , Dimech-Betancourt, Bleydy , Donovan, Jarrod , Rosenfeld, Jeffrey
- Date: 2018
- Type: Text , Journal article
- Relation: Journal of Science and Medicine in Sport Vol. 21, no. 5 (2018), p. 442-446
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- Description: Objectives: To investigate changes from baseline on SCAT3 as a result of football game exposure, and association with X2 Patch measured head acceleration events in amateur Australian footballers. Design: Prospective cohort. Methods: Peak linear acceleration (PLA) of the head (>10 g) was measured by wearable head acceleration sensor X2 Biosystems X-Patch in male (n = 34) and female (n = 19) Australian footballers. SCAT3 was administered at baseline (B) and post-game (PG). Results: 1394 head acceleration events (HEA) >10 g were measured. Mean and median HEA PLA were recorded as 15.2 g (SD = 9.2, range = 10.0–115.8) and 12.4 g (IQR = 11.0–15.6) respectively. No significant difference in median HEA PLA (g) was detected across gender (p = 0.55), however, more HEAs were recorded in males (p = 0.03). A greater number (p = 0.004) and severity (p < 0.001) of symptoms were reported PG than at B. No significant association between number of HEA or median PLA, and SCAT3 change scores (p > 0.05 for all), was identified for either gender. Conclusions: Increase in symptom severity post game was not associated with X2 measured HEA. Males sustained more HEA, however HEA PLA magnitude did not differ across gender. Further work on the validation of head acceleration sensors is required and their role in sports concussion research and medical management. © 2017 Sports Medicine Australia
Accelerometers for the assessment of concussion in male athletes : A systematic review and meta-analysis
- Authors: Brennan, James , Mitra, Biswadev , Synnot, Anneliese , McKenzie, Joanne , Willmott, Catherine , McIntosh, Andrew , Maller, Jerome , Rosenfeld, Jeffrey
- Date: 2017
- Type: Text , Journal article , Review
- Relation: Sports Medicine Vol. 47, no. 3 (2017), p. 469-478
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- Description: Background Concussion is common in the sporting arena and is often challenging to diagnose. The development of wearable head impact measurement systems has enabled measurement of head kinematics in contact sports. Objectives The objective of this systematic review was to determine the characteristics of head kinematics measured by an accelerometer system among male athletes diagnosed with concussion. Methods A systematic search was conducted in July 2015. Inclusion criteria were English-language studies published after 1990 with a study population of male athletes, in any sport, where objectively measured biomechanical forces were reported in the setting of a concussive event. The random effects meta-analysis model was used to combine estimates of biomechanical force measurements in concussed athletes. Results Thirteen studies met the inclusion criteria, the majority of which were conducted with high school and college football teams in the US. Included studies measured a combination of linear and rotational acceleration. The meta-analysed mean peak linear head acceleration associated with a concussive episode was 98.68 g (95 % CI 82.36-115.00) and mean peak rotational head acceleration was 5776.60 rads/s 2 (95 % CI 4583.53-6969.67). The estimates of the biomechanical forces were consistent across studies, with I 2 values of 0 % for both metaanalyses. Conclusions Head impact monitoring through accelerometery has been shown to be useful with regard to characterising the kinematic load to the head associated with concussion. Future research with improved clinical outcome measures and head kinematic data may improve accuracy when evaluating concussion, and may assist with both interpretation of biomechanical data and the development and utilisation of implementation strategies for the technology.
A review of the anthropometric characteristics, grading and dispensation of junior and youth rugby union players in Australia
- Authors: Patton, Declan , McIntosh, Andrew , Denny, Greg
- Date: 2016
- Type: Text , Journal article , Review
- Relation: Sports Medicine Vol. 46, no. 8 (2016), p. 1067-1081
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- Description: The grading of Australian junior and youth rugby union players has received substantial media attention in recent years. Media reports have focussed on size mismatches observed between players, especially players with Polynesian heritage, and the concerned parents who fear for the safety of their child owing to perceived mismatches. Although such concerns are well meaning, few media reports recognise the need for substantial evidence to determine the best grading system for junior and youth rugby union players. The current study reviewed relevant literature pertinent to the grading and dispensation of junior and youth rugby union players. Using primary and secondary search strategies, a total of 33 articles reporting the anthropometric characteristics of junior and youth rugby players were identified. Anthropometric data from the literature were compared with normative population data and currently used dispensation criteria. Junior and youth rugby players were found to be taller and heavier than normative population data. Current dispensation criteria, in terms of body mass, were found to vary and it is suggested that criteria be revised and standardised across rugby unions throughout Australia. Although it is acknowledged that other factors are important for grading players, anthropometric characteristics should be considered as potential dispensation criteria to supplement current age-based grading for junior and youth rugby union players. Measuring the body mass and stature of each junior player upon pre-season registration is suggested, which would provide data to establish valid dispensation criteria for the following season.
An assessment of the utility and functionality of wearable head impact sensors in Australian Football
- Authors: McIntosh, Andrew , Willmott, Catherine , Patton, Declan , Mitra, Biswadev , Brennan, James , Dimech-Betancourt, Bleydy , Howard, Teresa , Rosenfeld, Jeffrey
- Date: 2019
- Type: Text , Journal article
- Relation: Journal of Science and Medicine in Sport Vol. 22, no. 7 (2019), p. 784-789
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- Description: Objectives: To assess the utility and functionality of the X-Patch® as a measurement tool to study head impact exposure in Australian Football. Accuracy, precision, reliability and validity were examined. Designs: Laboratory tests and prospective observational study. Methods: Laboratory tests on X-Patch® were undertaken using an instrumented Hybrid III head and neck and linear impactor. Differences between X-Patch® and reference data were analysed. Australian Football players wore the X-Patch® devices and games were video-recorded. Video recordings were analysed qualitatively for head impact events and these were correlated with X-Patch® head acceleration events. Wearability of the X-Patch® was assessed using the Comfort Rating Scale for Wearable Computers. Results: Laboratory head impacts, performed at multiple impact sites and velocities, identified significant correlations between headform-measured and device-measured kinematic parameters (p < 0.05 for all). On average, the X-Patch®-recorded peak linear acceleration (PLA) was 17% greater than the reference PLA, 28% less for peak rotational acceleration (PRA) and 101% greater for the Head Injury Criterion (HIC). For video analysis, 118 head acceleration events (HAE) were included with PLA ≥30 g across 53 players. Video recordings of X-Patch®-measured HAEs (PLA ≥30 g) determined that 31.4% were direct head impacts, 9.3% were indirect impacts, 44.1% were unknown or unclear and 15.3% were neither direct nor indirect head impacts. The X-Patch® system was deemed wearable by 95–100% of respondents. Conclusions: This study reinforces evidence that use of the current X-Patch® devices should be limited to research only and in conjunction with video analysis.
Tackling reliability and construct validity : The systematic development of a qualitative protocol for skill and incident analysis
- Authors: Savage, Trevor , McIntosh, Andrew
- Date: 2017
- Type: Text , Journal article
- Relation: Journal of Sports Sciences Vol. 35, no. 5 (2017), p. 449-456
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- Description: It is important to understand factors contributing to and directly causing sports injuries to improve the effectiveness and safety of sports skills. The characteristics of injury events must be evaluated and described meaningfully and reliably. However, many complex skills cannot be effectively investigated quantitatively because of ethical, technological and validity considerations. Increasingly, qualitative methods are being used to investigate human movement for research purposes, but there are concerns about reliability and measurement bias of such methods. Using the tackle in Rugby union as an example, we outline a systematic approach for developing a skill analysis protocol with a focus on improving objectivity, validity and reliability. Characteristics for analysis were selected using qualitative analysis and biomechanical theoretical models and epidemiological and coaching literature. An expert panel comprising subject matter experts provided feedback and the inter-rater reliability of the protocol was assessed using ten trained raters. The inter-rater reliability results were reviewed by the expert panel and the protocol was revised and assessed in a second inter-rater reliability study. Mean agreement in the second study improved and was comparable (52-90% agreement and ICC between 0.6 and 0.9) with other studies that have reported inter-rater reliability of qualitative analysis of human movement.
Rating of perceived exertion is a stable and appropriate measure of workload in judo
- Authors: Bromley, Sally , Drew, Michael , McIntosh, Andrew , Talpey, Scott
- Date: 2018
- Type: Text , Journal article
- Relation: Journal of Science and Medicine in Sport Vol. 21, no. 10 (2018), p. 1008-1012
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- Description: Objectives: Heart rate (HR), blood lactate concentration [La] and/or rating of perceived exertion (RPE) have been utilised to monitor judo training load in technical and randori (competition training) sessions, but are yet to be investigated in mixed sessions containing both elements. Therefore the purpose of this study was to: (1) determine the stability of these variables, and (2) to assess the efficacy of RPE as a load variable for mixed judo sessions. Design: Cross-sectional study. Methods: Twenty-nine athletes attended two mixed training sessions at an international training camp. Bout and session characteristics, including RPE, physical and mental effort, heart rate (HR) and post-session [La] were recorded. A two-way random-effects intra-class correlation assessed variable stability. Multilevel mixed-effects ordered logistic regression investigated relationships between RPE and other variables for bouts and sessions. Results: Average and minimum HR across sessions correlated highly (ICC = 0.95 and 0.94, respectively). Good correlations existed between [La], session-RPE and mental effort, and fair correlation of max HR and physical effort. No relationships existed between [La]/HR and session-RPE. A unit increase in bout-RPE resulted in a 2.09 unit increase in physical, or a 1.36 unit increase in mental, effort holding all other bout variables constant. Gender and competitive level did not influence statistical models. Conclusions: Results provide further evidence that RPE can be used across a range of competitive levels and genders to monitor workload of mixed sessions and individual randori in judo. Physical effort may play a larger role than mental effort when athletes reflect on exertion during training. © 2018
Analysis of a severe head injury in World Cup alpine skiing
- Authors: Yamazaki, Junya , Gilgien, Matthias , Kleiven, Svein , McIntosh, Andrew , Nachbauer, Werner , Muller, Erich , Bere, Tone , Bahr, Roald , Krosshaug, Tron
- Date: 2015
- Type: Text , Journal article
- Relation: Medicine and Science in Sports and Exercise Vol. 47, no. 6 (2015), p. 1113-1118
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- Description: Traumatic brain injury (TBI) is the leading cause of death in alpine skiing. It has been found that helmet use can reduce the incidence of head injuries between 15% and 60%. However, knowledge on optimal helmet performance criteria in World Cup alpine skiing is currently limited owing to the lack of biomechanical data from real crash situations. Purpose: This study aimed to estimate impact velocities in a severe TBI case in World Cup alpine skiing. Methods: Video sequences from a TBI case in World Cup alpine skiing were analyzed using a model-based image matching technique. Video sequences from four camera views were obtained in full high-definition (1080p) format. A three-dimensional model of the course was built based on accurate measurements of piste landmarks and matched to the background video footage using the animation software Poser 4. A trunk-neck-head model was used for tracking the skier's trajectory. Results: Immediately before head impact, the downward velocity component was estimated to be 8 m.s(-1). After impact, the upward velocity was 3 m.s(-1), whereas the velocity parallel to the slope surface was reduced from 33 m.s(-1) to 22 m.s(-1). The frontal plane angular velocity of the head changed from 80 radIsj1 left tilt immediately before impact to 20 rad.s(-1) right tilt immediately after impact. Conclusions: A unique combination of high-definition video footage and accurate measurements of landmarks in the slope made possible a high-quality analysis of head impact velocity in a severe TBI case. The estimates can provide crucial information on how to prevent TBI through helmet performance criteria and design.