How can injuries be prevented in the World Cup soccer athlete?

In order to prevent soccer injuries, different risk factors have to be identified as intrinsic (e.g., joint stability or muscle imbalance) and extrinsic (e.g., equipment, turf, and rules risk factors). Some preventive measures are discussed in this article, such as shin guards, prophylactic braces and taping (or both), and proprioceptive training.     

Groin pain in the soccer athlete: fact, fiction, and treatment

Groin pain in the soccer athlete is a common problem accounting for 5% of soccer injuries. Groin distribution has proved to be the most common cause of groin pain. Other causes are direct trauma, ostetis pubis, muscle injuries, fractures, bursitis, hip problems, and hernia and referred pain. Soccer players with groin pain present a complex management problem that is discussed.     

MR imaging of the inner ear and cerebellopontine angle: comparison of three-dimensional and two-dimensional sequences

OBJECTIVE: To determine the presence of chronic traumatic brain injury in professional soccer players. METHODS: Fifty-three active professional soccer players from several professional Dutch soccer clubs were compared with a control group of 27 elite noncontact sport athletes. All participants underwent neuropsychological examination. The main outcome measures were neuropsychological tests proven to be sensitive to cognitive changes incurred during contact and collision sports. RESULTS: The professional soccer players exhibited impaired performances in memory, planning, and visuoperceptual processing when compared with control subjects. Among professional soccer players, performance on memory, planning, and visuoperceptual tasks were inversely related to the number of concussions incurred in soccer and the frequency of "heading" the ball. Performance on neuropsychological testing also varied according to field position, with forward and defensive players exhibiting more impairment. CONCLUSION: Participation in professional soccer may affect adversely some aspects of cognitive functioning (i.e., memory, planning, and visuoperceptual processing).     

Some biomechanical aspects of the foot and ankle in athletes with and without shin splints

Thirteen adult male athletes (long-distance runners and orienteerers without foot problems) and 35 male athletes with shin splints were compared with respect to: 1) the position of the lower leg and the heel while standing, 2) the passive range of mobility in the subtalar joint, and 3) the angular displacement between the calcaneus and the midline of the lower leg (Achilles tendon angle) while running with bare feet on a treadmill. In standing, the two groups differed statistically significantly in the Achilles tendon angle, which values were greater in the shin splint group. With respect to passive mobility, the athletes with shin splints had significantly greater (P less than 0.05-0.01) angular displacement values in inversion, eversion, and in their sum than the control group. While running, the Achilles tendon angle of the shin splint group was significantly greater (P less than 0.01) at the heel strike. Further, the shin splints group had a significantly greater (P less than 0.01) angular displacement between the heel strike and the maximal everted position. The results suggest structural and functional differences in the feet and ankles between healthy athletes and those with shin splints.     

Functional results and long-term outcome after bilateral lung transplantation for pulmonary hypertension

With the growing popularity of soccer both in the United States and worldwide, reports of adverse effects of 'heading' on brain function are a source of concern. This article reviews the related research literature on neurologic and neuropsychological findings. Neurologic and neuropsychological abnormalities have been reported in a significant minority of older former professional players in Norway. Purportedly unrelated to age, the most prominent findings were cerebral atrophy and impairment on intelligence test abilities that are particularly vulnerable to brain damage. Also noteworthy in these retired players were persistent physical, cognitive, and emotional complaints consistent with a postconcussive syndrome. Younger amateur players appear to be free of major abnormalities, although some report persistent difficulties with memory and concentration. The severity of these complaints may be related to a history of soccer-related head injuries and not necessarily specific to heading. Research findings specific to heading are not more than suggestive at best, and clarification of the risks of heading a soccer ball awaits more definitive studies.     

Shin splints and forefoot contact running: a case report

Many athletes develop shin splints after athletic activity. The purpose of this case report is to describe the treatment of a patient with posteromedial tibial pain (shin splints) who habitually ran with a forefoot contact running style. The 20-year-old male patient, who played volleyball and basketball about 7 hours a week, complained of pain in the middle one-third of the posteromedial tibia after an acute but prolonged episode of running. Routine observational analysis and in-shoe pressure analysis of the patient's running style showed that he habitually ran on his toes with an absence of heelstrike (forefoot contact running). After instructing the patient on heel-toe running, he no longer complained of posteromedial tibial bone pain. Several possible reasons are proposed for the reduction of leg pain following cessation of forefoot contact running. This case report proposes forefoot contact running as a possible contributor to posteromedial shin splints and that a change in running style may be the optimal treatment for some patients.     

Purification and characterization of agarases from a marine bacterium, Vibrio sp. PO-303

OBJECTIVE: To examine the relationship of skill, as represented by NCAA division level, to anterior cruciate ligament rupture in collegiate men's and women's basketball and soccer players. DESIGN: Randomized, retrospective. PARTICIPANTS: Women's and men's basketball and soccer players at NCAA Division I, II, and III institutions. MAIN OUTCOME MEASURE: Athletes with or without ACL injury. RESULTS: There was no relationship of ACL injury rate to NCAA division level in men's or women's basketball or soccer. CONCLUSIONS: There are many different variables that contribute to a player's skill level. Although these variables may relate to ACL injury and may be responsible for the differential in injury rate between men and women, skill level as represented by collegiate division does not relate to ACL injury. When considering possible etiologies of the differential in ACL injury rates between men and women, the use of the term "skill" should be avoided, and more specific terms used.     

Influence of acute endurance activity on leg neuromuscular and musculoskeletal performance

PURPOSE: The purpose of this study was to investigate the effect of endurance activities designed to simulate the physiological demands of soccer match-play and training, on leg strength, electromechanical delay, and knee laxity. METHODS: Eight recreational soccer players completed four exercise trials in random order: 1) a prolonged intermittent high intensity shuttle run (PHISR) which required subjects to complete a total distance of 9600 m in a form simulating the pattern of physical activity in soccer match-play (activity mode; rest-to-work intervals; approximately 90 min duration), 2) a shuttle-run (SR), (3) a treadmill run (TR) which required subjects to complete an equivalent distance at a running speed corresponding to 70% VO2max, and 4) a control condition consisting of no exercise. RESULTS: Results from repeated measures ANOVA revealed significant condition (PHISR; SR; TR; control) by time (pre; mid; post) interactions for peak torque (PT: knee extension and flexion: 1.05 rad.s-1), EMD and anterior tibio-femoral displacement (TFD) (P < 0.05). Impairment to indices of knee joint performance was observed in PHISR, SR, and TR trials. The greatest decrement occurred in PHISR and SR trials (up to 44%). Knee extensor and flexor strength performance near to full knee extension (0.44 rad knee flexion) was not changed following the functionally-relevant endurance activities. CONCLUSIONS: Even though strength performance near to full knee extension was preserved following acute endurance activities, the risk of ligamentous injury may be increased by concomitant impairment to EMD and anterior TFD.     

Neuropsychological assessment of soccer players.

Assessed the attention and concentration of 31 soccer players (aged 18–24 yrs), who deliberately use the head to propel the ball, and 31 tennis players (aged 18–22 yrs). Ss were administered the Raven Progressive Matrices, Symbol Digit Modalities Test, Perceptual Speed Test, and Paced Auditory Serial Addition Test (PASAT). There were no significant differences between the 2 groups on these tests. However, there was a significant negative correlation between number of games played and performance on the PASAT. Also, a significantly greater number of soccer players reported experiencing headaches, dizziness, and passing out after a game. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quantitative computed tomography for measuring bone mineral density in athletes

We studied the effect of different training patterns on vertebral trabecular and cortical bone mineral density (BMD) in male athletes using quantitative computed tomography. Vertebral trabecular (t) and cortical (c) BMDs of the first three lumbar vertebrae were measured using single energy quantitative computed tomography in 51 athletes including 10 weight lifters (mean age 20 years), 13 soccer players (mean age 27 years), 28 wrestlers (mean age 17 years), and 45 age-matched volunteers (mean age 21 years). Measured BMDs were correlated with age, body height and weight, training hours per week, sports years, and type of physical activity. Vertebral tBMDs were found to be 44%, 23%, and 24% higher in the weight lifters, soccer players, and wrestlers, respectively, compared with the volunteers. The corresponding cBMDs were 18%, 6%, and 11% higher than that of volunteers. There was significant correlation between the trabecular and cBMD, and height of the athletes, sports years, training hours per week, and physical activity. The most significant correlation with BMD was the type of physical activity. Both the height of the subjects and physical activity variables showed variations of 47% and 32% in trabecular and cBMD, respectively. According to the multiple analysis of variance (MANOVA) only the physical activity factor was effective, with a significance level of P < 0.01; the other factors and interactions were not effective (P > 0.05) on trabecular and cBMD. Different training patterns have a different anabolic effect on both trabecular and cBMDs of the vertebrae, and this effect is more pronounced on the trabecular compartment. Weight lifting showed the highest anabolic effect on both trabecular and cBMDs compared with soccer playing and wrestling. Of the independent variables, physical activity showed the highest anabolic effect on the vertebrae. These results may have implications for devising exercise strategies to reduce the possibility of fracture in old age.     

Wide tissue distribution of axolotl class II molecules occurs independently of thyroxin

The mouthguard is a resilient device or appliance which is placed inside the mouth to protect against injuries to the teeth, lacerations to the mouth and fractures and dislocations of the jaw. There is clear support in the scientific literature for the use of mouthguards in contact sports such as rugby. Moreover, there is evidence that mouthguards are effective in protecting against concussion and injuries to the cervical spine. There is a high level of acceptance of mouthguards by players and an increasing number are regularly wearing mouthguards. This is especially true among the elite players, but acceptance and wearing rates are moderately high among club players as well. There is strong support among players and researchers for mouthguard wearing to be made compulsory. It is generally recommended that: (i) mouthguards be worn during both practice sessions and games; (ii) the habit of wearing a mouthguard begins at an early age; (iii) mouthguards be regularly replaced while children are still growing; and (iv) adult players replace their mouthguards at least every 2 years. The selection of a mouthguard will depend on a number of factors including the age of the individual, effectiveness and cost. The type I (stock), or 'off-the-shelf', mouthguards are considered inferior when compared with the other available types, and their use is discouraged. Type II (mouth-formed) mouthguards come in 2 forms, the shell-liner version and the popular thermoplastic 'boil and bite' version. While the effectiveness of the shell-liner mouthguard was examined in one experimental study, no such research has been reported for the thermoplastic mouthguard. Type III (custom-fabricated) mouthguards are recommended for players playing in the more vulnerable positions and in the higher grades. Most experimental studies in which the effectiveness of mouthguards has been demonstrated have involved type III mouthguards.     

Mechanisms of injury of the anterior cruciate ligament in soccer players

Despite the great amount of research that has been focused on the anterior cruciate ligament in recent years, relatively little is known about the exact mechanisms that cause these injuries. By defining the factors that contribute to these injury mechanisms in soccer players, the authors hope to facilitate appropriate training methods and work at preventing these serious injuries.     

Smoking, intra-uterine growth retardation and sudden infant death syndrome

A unique aspect of soccer is the use of the head for directing the ball. The potential for resultant head injuries has been the focus of discussions worldwide. Prior work has attributed neuropsychologic deficits to the cumulative effects of heading, without evaluating concussion rates in soccer players. We prospectively studied the seven men's and eight women's varsity soccer teams in the Atlantic Coast Conference during two seasons to document concussion incidence. The 29 concussions diagnosed over the 2 years in 26 athletes, 17 (59%) concussions in men and 12 (41%) in women, resulted from contact with an opponent's head (8, 28%), elbow (4, 14%), knee (1, 3%), or foot (1, 3%); the ball (7, 24%); the ground (3, 10%); concrete sidelines (1, 3%); goalpost (1, 3%); or a combination of objects (3, 10%). Twenty concussions (69%) occurred in games; none resulted from intentional heading of the ball. The basic incidence was 0.96 concussions per team per season. The overall incidence was 0.6 per 1000 athlete-exposures for men, and 0.4 per 1000 athlete-exposures for women. By concussion grade, there were 21 (72%) grade 1, 8 (28%) grade 2, and no grade 3 concussions. These findings suggest that concussions are more common in soccer than anticipated and that acute head injuries may have potential for long-term neuropsychologic changes.     

The female athlete

Women's participation in sporting activities is now diverse with new opportunities arising yearly. As a result, care of the the female athlete's unique medical concerns has become an important challenge and issue to the primary care physician. The major focus when caring for the female athlete should be the diagnosis and treatment of the female athlete triad. The components of the triad--disordered eating, amenorrhea, and osteoporosis--can have serious implications for the health of the female athlete. Appropriate prevention and screening methods for early diagnosis of the female athlete triad require future study and improvement. Healthy pregnant, postpartum, and breastfeeding women can continue to maintain physical activity. Musculoskeletal injuries from sports are, in general, not gender specific but are more often sport specific. One exception is the increased prevalence of anterior cruciate ligament injuries occurring in women soccer and basketball players. The exact cause of this is unknown but is continuing to be investigated.     

Degenerative changes at the knee and ankle related to malunion of tibial fractures. 15-year follow-up of 88 patients

We re-examined clinically and radiologically 88 patients with a fracture of the lower leg at a mean follow-up of 15 years. Forty-three fractures (49%) had healed with malalignment of at least 5 degrees. More arthritis was found in the knee and ankle adjacent to the fracture than in the comparable joints of the uninjured leg. Malaligned fractures showed significantly more degenerative changes. Eighteen patients (20%) had symptoms in the fractured leg. There was a significant correlation between symptoms in the knee and arthritis but not between symptoms and ankle arthritis or malalignment. We conclude that fractures of the lower leg should be managed so that the possibility of angular deformity and thereby late arthritis is minimised.     

A review of lower limb overuse injuries during basic military training. Part 1: Types of overuse injuries

Lower limb injuries present the greatest source of medical problems during basic military training. These main overuse lower limb injuries, anterior compartment syndrome, stress fractures, Achilles tendinitis, plantar fasciitis, shin splints, and chondromalacia patellae, are reviewed with respect to current knowledge of rates, diagnosis, and treatment. Part 2 shall review possible etiological factors involved in the causation of these injuries.     

Changes in therapeutic principles in fractures of the extremities with severe soft tissue injuries exemplified by tibial fracture

Functional results after open fractures have been improved during the last decades. Especially the rates of amputation and chronic osteitis after open tibial fractures have been reduced from 30% to less than 5%. The initial management of this type of fracture includes reconstruction of the perfusion of the involved vessels, subsequent debridement with resection of avascular tissues, decompression of compartments by fasciotomy and initial shortening of the tibia by osteotomy and followed by callus distraction in order to achieve the physiological length of the leg. Cortical bone with periostal stripping has to be covered by local muscle transfer or by free vascularized tissue transfer within 3-7 days. Bone defects are either reconstructed by cancellous bone graft or, if the defect is longer than 2 cm, by continuous segmental transfer, according to the technique described by Ilizarov.     

Snowboarding injuries

Snowboarding is a popular winter sport that involves riding a single board down a ski slope or on a half-pipe snow ramp. Compared with injuries resulting from traditional alpine skiing, snowboarding injuries occur more frequently in the upper extremities and ankles and less frequently in the knees. Different types of snowboard equipment, rider stance and snowboarding activity tend to result in different types of injury. Snowboarder's ankle, a fracture of the lateral talus, must be considered in a snowboarder with a "severe ankle sprain" that has not responded to treatment. Risk of injury may be lowered by using protective equipment, such as a helmet and wrist guards.     

Performance of soccer players on tests of field dependence/independence and soccer-specific decision-making tests

The purpose of this study was to examine the relationship of the performance of male amateur soccer players on tests of field dependence/independence and soccer-specific decision-making tests. The relationships between the participants' (N = 14) accuracy, and speed of decision, on simple and complex soccer decision-making tests; scores on Parts B or C of the Group Embedded Figures Test under normal conditions: scores on Parts B or C of the Group Embedded Figures Test when timed; and time taken to complete the timed condition of the Group Embedded Figures Test were examined. There were no significant correlations between performance on the soccer specific tests and the tests of field dependence/independence.