INTRODUCTION

Professional sport has always been opposed to moderate exercise in terms of the effects it has on the health of a person engaged in it. Although there are many different reasons for the bad reputation ascribed to professional sport, the main factors are exhaustion, routine physical activity patterns, and the injuries-related factors (both extrinsic and intrinsic). Let’s consider them step by step.
Exhaustion. Professional sport is necessarily connected to the level of physical activity that tends to, and in most cases does exceeds, the natural ability of a human organism to successfully overcome both the external and internal pressures.
Thus, heat exhaustion is said to be one of the major causes of death of American football players. According to a North Carolina study, eighteen high school and college players have died from heat exhaustion just since 1995.
Many sportsmen are struck down in their youth due to the heart-related problems. Tremendous levels of physical activity force the heart of a sportsman to work like a pump, which leads to partially irreversible left ventricular hypertrophy with impaired left ventricular diastolic filling.
Routine physical activity patterns. Most of the modern fitness specialists agree that in order to keep oneself in a good shape without harming one’s health, a person has to do exercise that is fun and various. In contrast, when a person is engaged in professional sport, the same movement patterns that are repeated during a long period of time lead to “professional” illnesses that usually are typical for a particular sport.
Thus, professional golfers usually suffer from kidney-related problems, and baseball players end up with problems with thoracic vertebras and neck-bone. Tennis tends to impair the functions of the muscles, which leads to pleurisy, and so on. Another example concerning tennis is severe neurological injury called the N. suprascapularis. The studies show that this injury is reversible if the diagnosis is established early on and if the hurting movement is avoided until full recovery. It is proved that some certain movements are necessary in order to counter the typical movements that cause injuries. In this case, the study suggests that a backhand stroke done with both arms can have a protective effect against this pathology.
The last, but not the least, is the injuries-prone nature of most of the kinds of professional sport. There are various risk factors that are said to be responsible for such a high level of injuries in professional sport. Among the extrinsic risk factors are: excessive load on the body, including the number of repetitions, the speed of movement, etc., lack of enforcement of the safety rules, training errors, and so on. The intrinsic risk factors are, for example, muscle imbalance and joint laxity.
Some sports are considered to be safer than the others. However, it is difficult to find a sport that is completely safe when it is done at a professional level. Thus, football is often opposed to rugby as a safer alternative. However, for example in England neurologists called for football players to start wearing helmets similar to those used by professional rugby players. The calls were prompted by a coroner's finding that one of the England’s leading football players had died from degenerative brain damage caused by heading balls.
Although sport medicine professionals are in a constant search for the measures that can make professional sport safer, to date it still significantly damages the health of those who decide to pursue the career of professional sportsmen. For some particular studies that show how exactly professional sport can harm one’s health, please see the extracts below (35 extracts total).

Echocardiographic findings in 104 professional cyclists with follow-up study.
Miki T, Yokota Y, Seo T, Yokoyama M.
First Department of Internal Medicine, Kobe University School of Medicine, Japan.
Am Heart J. 1994 Apr;127(4 Pt 1):898-905

To assess the effect of long-term athletic training on the heart, 104 professional cyclists and 40 sedentary controls (69 younger cyclists and 26 controls aged 20 to 39 and 35 older cyclists and 14 controls aged 40 to 60) were examined by using M-mode and pulsed Doppler echocardiography. Cyclists had larger and more hypertrophied left ventricle than did controls (p < 0.001) and had normal percentages of fractional shortening (%FS). The ratio of left ventricular late-to-early diastolic peak filling velocity (A/R) of younger cyclists was normal, but the A/R of older cyclists was larger than that of controls (p < 0.001). Of the 104 cyclists, 95 continued cycling and were reexamined 2 years later; 9 of 40 older cyclists retired and were reexamined 20 +/- 8 months after retirement. During the follow-up period for the active cyclists, left ventricular dilatation, hypertrophy, and %FS of both younger and older cyclists and the A/R of younger cyclists did not change. However, the A/R of older cyclists increased (p < 0.01). For the nine retired cyclists, left ventricular dimension decreased (p < 0.001), left ventricular wall thickness and %FS did not change, and A/R increased (p < 0.05) after retirement. We concluded that (1) cyclists had large and hypertrophied left ventricles with normal systolic function, and (2) some cyclists with long-term athletic training may have partly irreversible left ventricular hypertrophy with impaired left ventricular diastolic filling.

Vascular and cardiac remodeling in world class professional cyclists.
Abergel E, Linhart A, Chatellier G, Gariepy J, Ducardonnet A, Diebold B, Menard J.
Centre de Medecine Preventive Cardio-vasculaire, Service d'Informatique Medicale, Institut Coeur Effort Sante, Hopital Broussais, Paris, France.
Am Heart J. 1998 Nov;136(5):818-23

BACKGROUND: Numerous studies have demonstrated that left ventricular (LV) hypertrophy is often associated with conditioning. METHODS AND RESULTS: The aim of the study was to evaluate cardiac and carotid artery changes induced by professional cycling. We collected M-mode left ventricle and B-mode right common carotid artery data from 149 male professional cyclists before the 1995 "Tour de France" race and 52 male control subjects. LV mass indexed to body surface area in cyclists was double that in control subjects, with no overlap of 95% confidence intervals (cyclists 100.9 to 187 g/m2 and control subjects 51.8 to 96.3 g/m2). Both mean arterial diameter and mean arterial diastolic intima-media thickness (IMT) were 13% higher in cyclists than in control subjects, with overlap of 95% confidence intervals (for arterial IMT 0.45 to 0.65 mm in cyclists and 0.38 to 0.60 mm in control subjects). CONCLUSIONS: Our results suggest that intense cycling has an effect on the cardiovascular system, more pronounced on the left ventricle and less pronounced on large arteries. Nevertheless, athletic training should be considered as a potential determinant of carotid modification.

Effect of detraining on the cardiopulmonary reflex in professional runners and hammer throwers.
Giannattasio C, Seravalle G, Cattaneo BM, Cuspidi C, Sampieri L, Bolla GB, Grassi G, Mancia G.
Cattedra di Medicina Interna, Universita di Milano, Italy.
Am J Cardiol. 1992 Mar 1;69(6):677-80

In professional athletes with marked cardiac hypertrophy, reflex influences originating from cardiopulmonary receptors are impaired. To determine whether the reflex is restored after termination of physical training and regression of cardiac hypertrophy 8 former athletes (age 31 +/- 6 years, mean +/- SD) who stopped agonistic activity for 5 +/- 1 years were compared with 15 sedentary subjects (27 +/- 7 years) and 19 active professional athletes (22 +/- 7 years). Cardiopulmonary receptor stimulation and deactivation were obtained by increasing and reducing left ventricular end-diastolic diameter (echocardiography) through leg raising and nonhypotensive lower body negative pressure, respectively. Left ventricular mass index (echocardiography) was markedly and significantly (p less than 0.01) greater in athletes (135 +/- 6 g/m2) than in former athletes (105 +/- 4 g/m2) whose value was similar to that of sedentary subjects (98 +/- 4 g/m2). The reduction in forearm vascular resistance and plasma norepinephrine induced by increasing left ventricular end-diastolic diameter was 24 and 23% less in athletes than in former athletes whose responses were similar to those of sedentary subjects. This was the case also for the responses induced by reducing left ventricular end-diastolic diameter. In contrast, the hemodynamic responses to cold pressor test were similar in the 3 groups. It is concluded that the impairment of the cardiopulmonary reflex observed in athletes is largely reversible when physical training is terminated. This may be due to regression of left ventricular hypertrophy.

Neuropsychological impairment in soccer athletes.
Downs DS, Abwender D.
Department of Exercise and Sport Sciences, University of Florida, Gainesville, Florida 32611-8205, USA.
J Sports Med Phys Fitness. 2002 Mar;42(1):103-7

BACKGROUND: Soccer reportedly places participants at risk for neuropsychological impairment, although it is unknown if the risk is associated primarily with concussion, subconcussive blows from heading the ball, or some combination thereof. Moreover, the extent to which younger versus older athletes are at risk for soccer-related cognitive impairment is unclear. We hypothesized that soccer athletes, especially older ones, would show poorer neuropsychological test performance than comparable swimmers. METHODS: Thirty-two soccer (26 college and 6 professional) and 29 swimmers (22 college and 7 masters level), all involved for at least 4 years in their sport at collegiate or national levels, participated. In a 2 X 2 (sport X age category) factorial design, all participants underwent 4 neuropsychological tests with 11 outcome measures assessing motor speed, attention, concentration, reaction time, and conceptual thinking. RESULTS: Soccer athletes performed worse than swimmers on measures of conceptual thinking. The older soccer group in particular performed poorly on measures of conceptual thinking, reaction time, and concentration. Among non-goaltender soccer athletes, estimates of career exposure to brain trauma (based on length of career and level of play) predicted significantly poorer test performance on 6 of 11 measures, even after statistically controlling for age. CONCLUSIONS: Results provide additional evidence that participation in soccer may be associated with poorer neuropsychological performance, although the observed pattern of findings does not specifically implicate heading as the cause. Although deficits were most apparent among older soccer players, serial neuropsychological testing for early detection of impairment is recommended for younger players as well.

Ex-professional association footballers have an increased prevalence of osteoarthritis of the hip compared with age matched controls despite not having sustained notable hip injuries.
Shepard GJ, Banks AJ, Ryan WG.
Royal Bolton Hospital, Minerva Road, Farnworth, Bolton, Lancashire, UK.
Br J Sports Med. 2003 Feb;37(1):80-1

OBJECTIVE: To compare the prevalence of self reported, physician diagnosed osteoarthritis (OA) of the hip in ex-professional footballers with that in age matched controls in the general public. METHOD: A questionnaire was sent to the 92 football league and premiership managers to assess the prevalence of OA of various joints. The prevalence of OA of the hip in those managers that were ex-professional footballers was assessed. Radiographic controls were obtained and used to assess the prevalence of OA of the hip in the general population. The results of the two groups were compared statistically using chi(2) tabulation. RESULTS: Seventy four (80%) of the managers responded to the questionnaire. Nine of the 68 ex-professional footballers who replied had OA of the hip, and six of these had undergone a total of eight total hip replacements. Of the 18 managers who did not respond, 12 were known to be ex-professionals. In the control group of 136, two had OA of the hip. The two groups differed significantly (p<0.001). The odds ratio for OA of the hip was 10.2 (95% confidence interval 2.1 to 48.8). CONCLUSION: The ex-professional footballers had a significantly higher prevalence of OA of the hip than an age matched group of radiographic controls.

The role of hip arthroscopy in the elite athlete.
McCarthy J, Barsoum W, Puri L, Lee JA, Murphy S, Cooke P.
Department of Radiology, New England Baptist Hospital, 125 Parker Hill Avenue, Boston, MA 02120-1636, USA.
Clin Orthop. 2003 Jan;(406):71-4

Intraarticular hip disorders in the elite athlete are a relatively rare but serious potential consequence of high-level competition. Axial and torsional forces involving the hips of elite athletes place them at potentially higher risk for chondral injuries, labral injuries, or both. Ten patients (13 hips) had arthroscopy. Of the 10 patients, the average age was 24 years. Nine patients were men and one was a woman. Of the 13 (10 patients) arthroscopies done two cases were bilateral, and one patient had the same hip operated on twice. Seven of the patients were professional hockey players, one patient was a football player, one patient was a baseball player, and one patient was a golfer. All 13 hips (10 patients) had anterior labral tears, whereas two hips had anterior and posterior labral tears. Two hips had an average of four loose bodies, four had evidence of chondral lesions, and one had an anterior margin acetabular fracture. Twelve of 13 arthroscopies were successful; however, one patient had recurrent symptoms. There were no surgical complications. Hip arthroscopy is a safe and reproducible method to diagnose and treat intraarticular hip disorders in athletes, which facilitates earlier return to their respective sport.

Imaging of hip disorders in athletes.
Bencardino JT, Palmer WE.
Division of Bone and Joint Radiology, Massachusetts General Hospital, Boston 02114, USA.
Radiol Clin North Am. 2002 Mar;40(2):267-87, vi-vii.

Normal hip joint function is fundamental in running-, jumping-, and kicking-based sporting activities. Hip disorders do not account for a large portion of exercise-related injuries, but they can pose a clinical dilemma since symptoms tend to be non-specific. Conventional radiographs may demonstrate some causes of hip pain, such as stress fractures and degenerative joint disease. Magnetic resonance (MR) imaging of the hip has proven valuable in the diagnosis of radiographically occult osseous abnormalities and periarticular soft tissue disorders such as stress fractures, avulsion injuries, musculotendinous abnormalities, and bursitis. Conventional MR imaging has been less useful in the evaluation of intra-articular lesions including acetabular labral tears, intra-articular loose bodies, and cartilage lesions. The visualization of intra-articular structures and their abnormalities can be improved by the injection of diluted Gadolinium, which distends the capsule and leaks into labral tears. This article will focus on the use of conventional radiography and MR imaging in recreational and professional athletes with painful hip joints, and where possible it will compare MR imaging with other diagnostic modalities such as bone scan and CT.

[Paralysis of the suprascapular nerve and tennis. Apropos of 3 groups of professional players]
[Article in French]
Daubinet G, Rodineau J.
Hopitaux de Paris.
Schweiz Z Sportmed. 1991 Sep;39(3):113-8. French

A recent surge of interest for tennis has given rise to an increased incidence of injuries to the N. suprascapularis. The early symptoms of this pathology are often missed, leading subsequently to a chronic condition, including an irreversible trauma to the nerve. Nevertheless, through the study of three groups of professional tournament players, we were able to show that the neurological injury is reversible if the diagnosis is established early on and if the hurting movement is avoided until full recovery. A backhand stroke done with both arms seems to have a protective effect against this pathology.

[Effect of intensive physical loads on renal function]
[Article in Russian]
Bukaev IuN, Gusev BS, Darenkov AF, Makarova TI, Vladimirova NN.
Urol Nefrol (Mosk). 1989 Mar-Apr;(2):3-7. Russian

The purpose of the study was to evaluate the extent of renal functional disorders, developing in response to muscular exercise of varying intensity and duration in 64 professional athletes, aged 17 to 26 years. Comparative characteristics of 131I-hippuran kinetics through the urinary tract both at rest and after "acute" (single) and chronic (many years') physical exercise are obtained. There was a direct relationship between effective renal blood flow and the magnitude of muscular exercise. It is demonstrated that post-exercise renal changes disappear without trace, while individuals, exposed to extreme muscular stress for long periods of time, i.e. the professional athletes, may develop irreversible functional changes. Impaired renal function can hardly be attributed to the emergence of yet another compensatory mechanism, for such notions as 'compensation' and "persistent impairement of functional potentials of an organ" are mutually exclusive.

Incidence of injury in semi-professional rugby league players.
Gabbett TJ.
Queensland Academy of Sport, PO Box 8103, Wooloongabba, Queensland 4102, Australia.
Br J Sports Med. 2003 Feb;37(1):36-43; discussion 43-4

OBJECTIVES: To investigate the site, nature, cause, and severity of injuries in semi-professional rugby league players. METHODS: The incidence of injury was prospectively studied in one hundred and fifty six semi-professional rugby league players over two competitive seasons. All injuries sustained during matches and training sessions were recorded. Injury data were collected from a total of 137 matches and 148 training sessions. Information recorded included the date and time of injury, site, nature, cause, and severity of injury. RESULTS: During the two seasons, 1,694 playing injuries and 559 training injuries were sustained. The match injury incidence was 824.7 per 1,000 player-position game hours and training injury incidence was 45.3 per 1,000 training hours. Over 20% of the total training (17.4 per 1,000) and playing (168.0 per 1,000) injuries sustained were to the thigh and calf. Muscular injuries (haematomas and strains) were the most common type of injury sustained during training (22.0 per 1,000, 48.7%) and matches (271.7 per 1,000, 32.9%). Playing injuries were most commonly sustained in tackles (382.2 per 1,000, 46.3%), while overexertion was the most common cause of training injuries (15.5 per 1,000, 34.4%). The majority of playing injuries were sustained in the first half of matches (1,013.6 per 1,000, 61.5% v 635.8 per 1,000, 38.5%), whereas training injuries occurred more frequently in the latter stages of the training session (50.0 per 1,000, 55.3% v 40.5 per 1,000, 44.7%). Significantly more training injuries were sustained in the early half of the season, however, playing injuries occurred more frequently in the latter stages of the season. CONCLUSIONS: These results suggest that changes in training and playing intensity impact significantly upon injury rates in semi-professional rugby league players. Further studies investigating the influence of training and playing intensity on injuries in rugby league are warranted.

Common rugby league injuries. Recommendations for treatment and preventative measures.
Gibbs N.
South Sydney Orthopaedic and Sports Medicine Centre, Maroubra, New South Wales, Australia.
Sports Med. 1994 Dec;18(6):438-50.

Rugby league is the main professional team sport played in Eastern Australia. It is also very popular at a junior and amateur level. However, injuries are common because of the amount of body contact that occurs and the amount of running that is required to participate in the game. Injuries to the lower limbs account for over 50% of all injuries. The most common specific injuries are ankle lateral ligament tears, knee medial collateral and anterior cruciate ligament tears, groin musculotendinous tears, hamstring and calf muscle tears, and quadriceps muscle contusions. Head injuries are common and consist of varying degrees of concussion as well as lacerations and facial fractures. Serious head injury is rare. Some of the more common upper limb injuries are to the acromioclavicular and glenohumeral joints. Accurate diagnosis of these common injuries using appropriate history, examination and investigations is critical in organising a treatment and rehabilitation plan that will return the player to competition as soon as possible. An understanding of the mechanism of injury is also important in order to develop preventative strategies.

Increased diffusion in the brain of professional boxers: a preclinical sign of traumatic brain injury?
Zhang L, Ravdin LD, Relkin N, Zimmerman RD, Jordan B, Lathan WE, Ulug AM.
Department of Radiology, Weill Medical College of Cornell University, New York, NY 10021, USA.
AJNR Am J Neuroradiol. 2003 Jan;24(1):52-7

BACKGROUND AND PURPOSE: Professional boxing is associated with chronic, repetitive head blows that may cause brain injuries. Diffusion-weighted imaging is sensitive to microscopic changes and may be a useful tool to quantify the microstructural integrity of the brain. In this study, we sought to quantify microscopic alterations associated with chronic traumatic brain injury in professional boxers. METHODS: MR and diffusion-weighted imaging were performed in 24 boxers and in 14 age- and sex-matched control subjects with no history of head trauma. Using distribution analysis, the average diffusion constant of the entire brain (BD(av)) and diffusion distribution width (sigma) were calculated for each subject; findings in professional boxers were compared with those of control subjects. In the boxer group, correlations between diffusion changes and boxing history and diffusion changes and MR imaging findings were assessed. RESULTS: The measured diffusion values in the boxer group were significantly higher than those measured in the control group (BD(av), P <.0001; sigma, P <.01). In the boxer group, a robust correlation was found between increased BD(av) and frequency of hospitalization for boxing injuries (r = 0.654, P <.05). The most common MR finding in the boxer group was volume loss inappropriate to age followed by cavum septum pellucidum, subcortical white matter disease, and periventricular white matter disease. CONCLUSION: Boxers had higher diffusion constants than those in control subjects. Our data suggest that microstructural damage of the brain associated with chronic traumatic brain injury may elevate whole-brain diffusion. This global elevation can exist even when routine MR findings are normal.

Injuries among world-class professional beach volleyball players. The Federation Internationale de Volleyball beach volleyball injury study.
Bahr R, Reeser JC; Federation Internationale de Volleyball.
Oslo Sports Trauma Research Center, University of Sport and Physical Education, Oslo, Norway.
Am J Sports Med. 2003 Jan-Feb;31(1):119-25

BACKGROUND: Very little is known about the injury characteristics of beach volleyball. PURPOSE: To describe the incidence and pattern of injuries among professional male and female beach volleyball players. STUDY DESIGN: Cohort study--retrospective injury recall and prospective registration. METHODS: Injuries occurring over a 7.5-week interval of the summer season were retrospectively registered by interviewing 178 of the 188 participating players (95%) in the 2001 Beach Volleyball World Championships. Injuries were also cataloged prospectively during five of the tournaments held during this interval. RESULTS: Fifty-four acute injuries was recorded, of which 23 (43%) resulted in 1 or more days of missed practice or competition. The incidence of acute time-loss injuries was estimated to be 3.1 per 1000 competition hours and 0.8 per 1000 training hours. Knee (30%), ankle (17%), and finger injuries (17%) accounted for more than half of all acute time-loss injuries. In addition, 67 players reported 79 overuse injuries for which they received medical attention during the study period. The three most common overuse conditions were low back pain (19%), knee pain (12%), and shoulder problems (10%). Similar results were observed in the prospective portion of the study. CONCLUSIONS: The rate of acute time-loss injuries in beach volleyball is considerably lower than that in most other team sports, but overuse injuries affecting the low back, knees, and shoulder represent a significant source of disability and impaired performance for professional beach volleyball players. Copyright 2003 American Orthopaedic Society for Sports Medicine.

Stress fractures in athletes: review of 196 cases.
Iwamoto J, Takeda T.
Department of Sports Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
J Orthop Sci. 2003;8(3):273-8

The purpose of this study was to investigate the association of stress fractures with age, sex, sport level, sporting activity, and skeletal site in athletes seen at our sports medicine clinic between September 1991 and May 2001. During these 10 years, 10 726 patients (6415 males, 3861 females) visited our clinic because of sport-related injuries, and 196 patients [125 males (1.9%), 71 females (1.8%)] sustained stress fractures. The average age of the patients with stress fractures was 20.1 years (range 10-46 years); 84 patients (42.6%) were 15-19 years of age, and 68 (34.7%) were 20-24 years of age. Altogether, 74 patients (37.8%) were active at the high recreational level and 122 (62.2%) at the competitive level. The sites of the stress fractures varied from sport to sport. The ulnar olecranon was the most common stress fracture site among baseball athletes and the rib among the rowing athletes. Classical ballet, aerobics, tennis, and volleyball athletes predominantly sustained stress fractures of the tibial shaft. Basketball athletes predominantly sustained stress fractures of the tibial shaft and medial malleolus and the metatarsal bone, whereas track and field and soccer athletes predominantly sustained stress fractures of the tibial shaft and pubic bone. Our results show that stress fractures are seen even in high-level adolescent athletes, with similar proportions for males and females, and that particular sports are associated with specific sites for stress fractures.

A 7-year study on risks and costs of knee injuries in male and female youth participants in 12 sports.
de Loes M, Dahlstedt LJ, Thomee R.
Institute of Research in Sports Sciences, Swiss School of Sports, Macolin.
Scand J Med Sci Sports. 2000 Apr;10(2):90-7

Knee injuries are common and account in various sports for 15-50% of all sports injuries. The cost of knee injuries is therefore a large part of the cost for medical care of sports injuries. Furthermore, the risk of acquiring a knee injury during sports is considered higher for females than for males. The nationwide organization "Youth and Sports" represents the major source of organized sports and recreation for Swiss youth and engages annually around 370000 participants in the age group of 14 to 20 years. The purpose of this study was to combine data on knee injuries from two sources, the first being data on the exposure to risk found in the activity registration in "Youth and Sports" and the second injuries with their associated costs resulting from the activities and filed at the Swiss Military Insurance. This allowed calculation of knee injury incidences, to compare risks between males and females and to estimate the costs of medical treatment. The study comprises 3864 knee injuries from 12 sports during 7 years. Females were significantly more at risk in six sports: alpinism, downhill skiing, gymnastics, volleyball, basketball and team handball. The incidences of knee injuries and of cruciate ligament injuries in particular, together with the costs per hour of participation, all displayed the same sports as the top five for both females and males: ice hockey, team handball, soccer, downhill skiing and basketball. Female alpinism and gymnastics had also high rankings. Knee injuries comprised 10% of all injuries in males and 13% in females, but their proportional contribution to the costs per hour of participation was 27% and 33%, respectively. From this study it can be concluded that females were significantly more at risk for knee injuries than males in six sports and that knee injuries accounted for a high proportion of the costs of medical treatment.

Gender differences in muscular protection of the knee in torsion in size-matched athletes.
Wojtys EM, Huston LJ, Schock HJ, Boylan JP, Ashton-Miller JA.
University of Michigan, Ann Arbor, USA.
J Bone Joint Surg Am. 2003 May;85-A(5):782-9

BACKGROUND: Female athletes who participate in sports involving jumping and cutting maneuvers are up to eight times more likely to sustain a rupture of the anterior cruciate ligament than are men participating in the same sports. We tested the hypothesis that healthy young women are able to volitionally increase the apparent torsional stiffness of the knee, by maximally activating the knee muscles, significantly less than are size-matched men participating in the same type of sport. METHODS: Twenty-four NCAA (National Collegiate Athletic Association) Division-I athletes (twelve men and twelve women) competing in sports associated with a high risk of injury to the anterior cruciate ligament (basketball, volleyball, and soccer) were compared with twenty-eight collegiate endurance athletes (fourteen men and fourteen women) participating in sports associated with a low risk of such injuries (bicycling, crew, and running). Male and female pairs were matched for age, height, weight, body mass index, shoe size, and activity level. Testing was performed with a weighted pendulum that applied a medially directed 80-N impulse force to the lateral aspect of the right forefoot. The resulting internal rotation of the leg was measured optically, to the nearest 0.25 degrees, at 30 degrees and 60 degrees of knee flexion, both with and without maximal activation of the knee muscles. RESULTS: Maximal rotations of the leg were greater in women than in men in both the passive and the active muscle state (16% and 27% greater [p = 0.01 and p = 0.02], respectively). Moreover, female athletes exhibited a significantly (18%) smaller volitional increase in apparent torsional stiffness of the knee under internal rotation loading than did the matched male athletes (p = 0.014); this was particularly the case for those who participated in sports involving jumping and pivoting maneuvers (42% difference between genders, p = 0.001). CONCLUSIONS: The collegiate female athletes involved in high-risk sports exhibited less muscular protection of the knee ligaments during external loading of the knee than did size and sport-matched male athletes.

The prevalence of chronic knee injury in triathletes.
Clements K, Yates B, Curran M.
University College Northampton, Nene Centre for Healthcare Education, United Kingdom.
Br J Sports Med. 1999 Jun;33(3):214-6

OBJECTIVES: To add to the area of triathlon research by providing much needed prevalence data on knee injury in triathletes. METHOD: An incidental "in field" sampling technique was used to interview 58 triathletes aged between 15 and 55 years about knee injury during a triathlon event. The sample comprised 46 men and 12 women. RESULTS: Most knee injuries occurred during the running event (72%) and affected the lateral side of the knee (38%). In all, 78% of the sample sought treatment from a healthcare professional. CONCLUSION: The study has provided much needed prevalence data on chronic knee injury in triathletes.

Prevention and treatment of common eye injuries in sports.
Rodriguez JO, Lavina AM, Agarwal A.
Department of Family Medicine, East Carolina University/Brody School of Medicine, Greenville, North Carolina, 27858-5434, USA.
Am Fam Physician. 2003 Apr 1;67(7):1481-8

Sports have become increasingly popular and account for numerous eye injuries each year. The sports that most commonly cause eye injuries, in order of decreasing frequency, are basketball, water sports, baseball, and racquet sports. Sports are classified as low risk, high risk, and very high risk. Sports-related eye injuries are blunt, penetrating, and radiation injuries. The use of eye protection has helped to reduce the number and severity of eye injuries. The American Society for Testing and Materials has established performance standards for selected eyewear. Consultation with an eye care professional is recommended for fitting protective eyewear. The functionally one-eyed, or monocular, athlete should take extra precautions. A preparticipation eye examination is helpful in identifying persons who may be at increased risk for eye injury. Sports-related eye injuries should be evaluated on site with an adequate examination of the eye and adnexa. Minor eye injuries may be treated on site. The team physician must know which injuries require immediate referral to an ophthalmologist and the guidelines for returning an athlete to competition.

Skateboard-associated injuries: participation-based estimates and injury characteristics.
Kyle SB, Nance ML, Rutherford GW Jr, Winston FK.
Epidemiology and Health Statistics, Consumer Product Safety Commission, Bethesda, Maryland, USA.
J Trauma. 2002 Oct;53(4):686-90

BACKGROUND: Skateboarding is a popular recreational activity but has attendant associated risks. To place this risk in perspective, participation-based rates of injury were determined and compared with those of other selected sports. Skateboard-associated injuries were evaluated over time to determine participation-based trends in injury prevalence. METHODS: Rates of skateboard-associated injury were studied for the 12-year period 1987 to 1998 for participants aged 7 years or older. The National Electronic Injury Surveillance System provided injury estimates for skateboarding and the selected additional sporting activities. The National Sporting Goods Association annual survey of nationally representative households provided participation estimates. A participation-based rate of injury was calculated from these data sets for the selected sports for the year 1998. RESULTS: The 1998 rate of emergency department-treated skateboard-associated injuries-8.9 injuries per 1,000 participants (95% confidence interval [CI], 6.2, 11.6)-was twice as high as in-line skating (3.9 [95% CI, 3.1, 4.8]) and half as high as basketball (21.2 [95% CI, 18.3, 24.1]). The rate of skateboard-associated injuries declined from 1987 to 1993 but is again increasing: the 1998 rate was twice that of 1993 (4.5 [95% CI, 1.6, 7.4] and 8.9 [95% CI, 6.2, 11.6], respectively). Increases occurred primarily among adolescent and young adult skateboarders. The most frequent injuries in 1998 were ankle strain/sprain and wrist fracture: 1.2 (95% CI, 0.8, 1.6) and 0.6 (95% CI, 0.4, 0.8) per 1,000, respectively. Skateboard-associated injuries requiring hospitalization occurred in 2.9% and were 11.4 (95% CI, 7.5, 17.5) times more likely to have occurred as a result of a crash with a motor vehicle than injuries in those patients not hospitalized. CONCLUSION: This study is the first to relate skateboarding and other sport injuries to participation exposures. We found that skateboarding is a comparatively safe sport; however, increased rates of injury are occurring in adolescent and young adult skateboarders. The most common injuries are musculoskeletal; the more serious injuries resulting in hospitalization typically involve a crash with a motor vehicle. This new methodology that uses participation-based injury rates might contribute to more effective injury control initiatives.

Dental trauma and level of information: mouthguard use in different contact sports.
Ferrari CH, Ferreria de Mederios JM.
Department of Dentistry, Biology and Health Center, Sao Francisco University, Braganca Paulista, Sao Paulo, Brazil.
Dent Traumatol. 2002 Jun;18(3):144-7

The objective of the present work was to study the occurrence of dental trauma in different sports, as well as to check if athletes used mouthguard during sport activities, and knew the significance of its utilization. The professional and semi-professional athletes who practised contact sports were interviewed, and were analyzed to determine the occurrence of dental trauma during sport practice, as well as if the athletes used a mouthguard and knew its indication. Results showed a high rate of dental trauma in athletes compared to the general population. The majority of athletes also demonstrated little utilization of mouthguard, in spite of the information about usage during sports practices and a general knowledge of its uses.

Catastrophic pediatric sports injuries.
Luckstead EF, Patel DR.
Pediatric Medicine Department, Texas Tech Medical School-Amarillo, 1400 Coulter Drive, Amarillo, TX 79160, USA.
Pediatr Clin North Am. 2002 Jun;49(3):581-91

The high school sports of wrestling, gymnastics, ice hockey, baseball, track, and cheerleading should receive closer attention to prevent injury. Safer equipment and sport-specific conditioning should be provided and injuries strictly monitored. Greater attention must also be paid to swimming and diving techniques, and continued observation is needed for heat stroke and heat intolerance in sports such as football, wrestling, basketball, track and field, and cross-country. An increased awareness of commotio cordis in sports other than baseball should include ice hockey, football, track field events, and lacrosse. American football because of the sheer numbers and associated catastrophic injury potential must continue to be monitored at the highest medical levels!

Is it possible to prevent sports injuries? Review of controlled clinical trials and recommendations for future work.
Parkkari J, Kujala UM, Kannus P.
Tampere Research Center of Sports Medicine, President Urho Kaleva Kekkonen Institute for Health Promotion Research, Finland.
Sports Med. 2001;31(14):985-95

Sports injuries are one of the most common injuries in modern western societies. Treating sports injuries is often difficult, expensive and time consuming, and thus, preventive strategies and activities are justified on medical as well as economic grounds. A successful injury surveillance and prevention requires valid pre- and post-intervention data on the extent of the problem. The aetiology, risk factors and exact mechanisms of injuries need to be identified before initiating a measure or programme for preventing sports injuries, and measurement of the outcome (injury) must include a standardised definition of the injury and its severity, as well as a systematic method of collecting the information. Valid and reliable measurement of the exposure includes exact information about the population at risk and exposure time. The true efficacy of a preventive measure or programme can be best evaluated through a well-planned randomised trial. Until now, 16 randomised, controlled trials (RCT) have been published on prevention of sports injuries. According to these RCT, the general injury rate can be reduced by a multifactorial injury prevention programme in soccer (relative risk 0.25, p < 0.001, in the intervention group), or by ankle disk training, combined with a thorough warm-up, in European team handball [odds ratio 0.17; 95% confidence interval (CI) 0.09 to 0.32, p < 0.01]. Ankle sprains can be prevented by ankle supports (i.e. semirigid orthoses or air-cast braces) in high-risk sporting activities, such as soccer and basketball (Peto odds ratio 0.49; 95% CI 0.37 to 0.66), and stress fractures of the lower limb by the use of shock-absorbing insoles in footwear (Peto odds ratio 0.47; 95% CI 0.30 to 0.76). In future studies, it is extremely important for researches to seek consultation with epidemiologists and statisticians to be certain that the study hypothesis is appropriate and that the methodology can lead to reliable and valid information. Further well-designed randomised studies are needed on preventive actions and devices that are in common use, such as preseason medical screenings, warming up, proprioceptive training, stretching, muscle strengthening, taping, protective equipment, rehabilitation programmes and education interventions (such as increasing general injury awareness among a team). The effect of a planned rule change on the injury risk in a particular sport could be tested via a RCT before execution of the change. The most urgent needs are in commonly practised or high-risk sports, such as soccer, American football, rugby, ice hockey, European team handball, karate, floorball, basketball, downhill skiing and motor sports.

A prospective study of injuries in basketball: a total profile and comparison by gender and standard of competition.
McKay GD, Goldie PA, Payne WR, Oakes BW, Watson LF.
School of Physiotherapy, La Trobe University, Victoria, Australia.
J Sci Med Sport. 2001 Jun;4(2):196-211

The study aimed to determine prospectively a basketball injury profile, including severity of injury, and to compare the injury profile by gender and standard of competition. Trained observers viewed basketball games, noting the occurrence of injuries, and confirmed injuries by questioning all players on site after the game. Injured players completed a questionnaire and the progress of their injury was monitored by telephone interview. A total of 10,393 basketball participations were observed. An overall injury rate was documented of 18.3 per 1,000 participations (24.7 per 1,000 playing hours), and was comparable by gender and standard of competition. Serious injuries (missing one or more weeks of play) occurred at a rate of 2.89/1,000 participations; with the ankle joint the most common serious injury (1.25/1,000 participations), followed by the calf/anterior leg (0.48/1,000 participations) and knee joint (0.29/1,000 participations). The severity of the injury was significantly associated with the body region injured, with more serious injuries incurred to the lower limb than other body regions (p <.05). The severity of the injury incurred was not related to the standard of competition, gender, age, height, number of games played per week, amount of training undertaken, type of injury, or the mechanism of injury (p> .05).

The sprained ankle.
Puffer JC.
Division of Sports Medicine, Department of Family Medicine, UCLA School of Medicine, Los Angeles, California, USA.
Clin Cornerstone. 2001;3(5):38-49

The sprained ankle is the most common musculoskeletal injury seen by physicians caring for active youngsters and adults. It accounts for approximately one fourth of all sports-related injuries and is commonly seen in athletes participating in basketball, soccer, or football. It has been shown that one third of West Point cadets suffer an ankle sprain during their 4 years at the military academy. While diagnosis and management of the sprained ankle is usually straightforward, several serious injuries can masquerade as an ankle sprain, and it is important for the clinician to recognize these to prevent long-term morbidity. In this article the basic anatomy of the ankle, mechanisms by which the ankle is injured, and the differential diagnosis of the acutely injured ankle are reviewed. Appropriate evaluation of the injured ankle and the criteria that should be utilized for determining the necessity of radiographs are discussed as well as management of the acutely sprained ankle and the role of prevention in reducing the risk of ankle injury.

Sports activities related to injuries? A survey among 9-19 year olds in Switzerland.
Michaud PA, Renaud A, Narring F.
Groupe de Recherche sur la Sante des Adolescents, Institut Universitaire de Medecine Sociale et Preventive, Lausanne, Switzerland.
Inj Prev. 2001 Mar;7(1):41-5

BACKGROUND: Most data on sports injuries are gathered in clinical settings so that their epidemiology in the general population is not well known. OBJECTIVE: To explore the link between sports injuries with the type and the amount of sports activity and biological factors. METHODS: In 1996, 3,609 in-school adolescents 10-19 years (1,847 girls and 1,762 boys) participated in a regional survey. This included anthropometric measurements and a self administered questionnaire. RESULTS: Altogether 28.2% of girls and 35.9% of boys reported one or more sports injuries during the previous year and 2.1% of girls and 6.5% of boys reported at least one hospitalization due to a sports injury. Using the mean rate of injuries as reference level, some sports are highly related to injury occurrence: body building (relative risk (RR) 1.7, 95% confidence interval (CI) 1.5 to 1.9), skateboarding and rollerskating (RR 1.6, 1.4 to 1.8), athletics (RR 1.5, 1.3 to 1.7), snowboarding (RR 1.5, 1.4 to 1.6), basketball (RR 1.3, 1.2 to 1.4), soccer (RR 1.3, 1.2 to 1.4), and ice hockey (RR 1.2, 1.1 to 1.3). Using a logistic regression, several variables associated with a higher risk of injury were identified: the amount of physical activity, high risk sports, and Tanner pubertal stages. CONCLUSION: The risk of sports injury increases not so much with age but with exposure to specific sports and with pubertal development.

Football incident analysis: a new video based method to describe injury mechanisms in professional football.
Andersen TE, Larsen O, Tenga A, Engebretsen L, Bahr R.
Oslo Sports Trauma Research Center, Norwegian University of Sport and Physical Education, Norway.
Br J Sports Med. 2003 Jun;37(3):226-32

OBJECTIVES: To develop and test a new video based method for match analysis that combines football specific and medical information to achieve a better understanding of the injury mechanisms and events leading up to high risk situations. METHODS: Football incident analysis (FIA) is a video based method describing incidents that may result in an injury using 19 variables and categories modified from match analysis. Videos from 35 of 76 (46%) official Norwegian under 21 matches played from 1994 to 1998 were analysed. Two football experts classified each incident on the basis of predetermined criteria, and their results were compared using interobserver and intraobserver reliability tests. RESULTS: kappa correlation coefficients for interobserver and intraobserver agreement were very good for 63% and 95% and good for 37% and 5% of the variables respectively. Fifty two incidents were recorded (1.6 incidents per team per match or 94 per 1000 player hours), and 16 (31%) led to injuries (0.5 injuries per match or 29 injuries per 1000 player hours). FIA results showed that 28 incidents occurred while attacking in midfield zone 2 or the attacking zone, and 24 took place while defending in the defensive zone or midfield zone 1. Midfielders were exposed in 67% of the incidents, mainly in breakdown attacks or during long attacks by the opposing team. Of the 28 incidents during offence, only one was classified as having great potential to score a goal. Most incidents (70%) were the result of tackling duels both in the offensive and defensive playing phases. Of the 21 offensive incidents resulting from tackling duels, in 19 cases the exposed player was unaware of the tackling (passive duellist). CONCLUSIONS: This study shows that football incident analysis is a potentially valuable tool for understanding the events leading up to injuries in football.

Injury Risk in Men's Canada West University Football.
Hagel BE, Fick GH, Meeuwisse WH.
Department of Epidemiology and Biostatistics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
Am J Epidemiol. 2003 May 1;157(9):825-33

Injury and participation information was collected over 5 years (1993-1997) on varsity men's football players in the Canada West Universities Athletic Association. The locations of acute time-loss injuries or neurologic injures were coded as head and neck, upper extremity (shoulder to hand), or lower extremity (hip to foot). Poisson regression-based generalized estimating equations were used to estimate rate ratios and 95% confidence intervals. Injury rates were higher during games as compared with practice periods (for the head and neck, rate ratio (RR) = 9.75 (95% confidence interval (CI): 7.50, 12.67); for upper extremities, RR = 5.76 (95% CI: 4.46, 7.45); and for lower extremities, RR = 7.06 (95% CI: 6.03, 8.25)). In dry-field game situations, head and neck injury rates were 1.59 times higher on artificial turf than on natural grass (95% CI: 1.04, 2.42). Lower extremity game injury rates were higher on artificial turf than on natural grass under both dry (RR = 1.83, 95% CI: 1.35, 2.48) and wet (RR = 2.31, 95% CI: 1.18, 4.52) field conditions. Injury rates increased with every additional year of participation. Past injury increased the rate of subsequent injury. The effect of an artificial field surface may be related to infrequent use. Risk factors for injury included participation in a game, playing on artificial turf, being a veteran player, and having a past injury.

Sports injury or trauma? Injuries of the competition off-road motorcyclist.
Colburn NT, Meyer RD.
Division of Orthopaedics, University of Alabama Medical Center, and the Baptist Health Systems, 3317 Teakwood Road, Birmingham, AL 35226, USA.
Injury. 2003 Mar;34(3):207-14

A prospective analysis of the injuries of off-road competition motorcyclist at four International Six Day Enduro (ISDE) events was performed utilizing the injury severity score (ISS) and the abbreviated injury scale (AIS). Of the 1787 participants, approximately 10% received injuries that required attention from a medical response unit. The majority (85%) sustained a mild injury (mean ISS 3.9). Loss of control while jumping and striking immovable objects were important risk determinants for serious injury. Although seasoned in off-road experiences, mean 15.3 years, 54% of those injured were first year rookies to the ISDE event. Speeds were below 50 km/h in the majority of accidents (80%), and were not statistically correlated with severity. The most frequently injured anatomical regions were the extremities (57%). The most common types of injury were ligamentous (50%). Seventy-seven percent of all fractures were AIS grades 1 and 2. The most common fractures were those of the foot and ankle (36%). Multiple fractures involving different anatomical regions, or a combination of serious injuries was seen with only one rider. When compared to the injuries of the street motorcyclist, competition riders had lower AIS grades of head and limb trauma. Off-road motorcycle competition is a relatively safe sport with injury rates comparably less than those of contact sports such as American football and hockey.

Neurovascular trauma in athletes.
Koffler KM, Kelly JD 4th.
Department of Orthopaedic Surgery, Temple University School of Medicine, Temple University Center for Sports Medicine, One Greentree Center, Suite 104, Marlton, NJ 08053, USA.
Orthop Clin North Am. 2002 Jul;33(3):523-34, vi. Review. Erratum in: Orthop Clin North Am. 2003 Jan;34(1):xiii

Injuries to neurovascular structures are not the most common injuries seen in athletes and for this reason may often be overlooked. Additionally, diagnosis and management may be more difficult because of inexperience with these injuries. The majority of acute sports-related neurovascular injuries are associated with contact sports such as rugby, wrestling, ice hockey, and especially football. These injuries most commonly occur about the shoulder girdle and brachial plexus, with "burners" syndrome being the most common. Less common injuries include thoracic outlet syndrome, effort-induced thrombosis, axillary artery occlusion, and peripheral nerve injuries, as well as compression syndromes involving the axillary, suprascapular, and long thoracic nerves.