<p>Our healthcare system is experiencing a substantial economic burden, and one of the contributing factors is ankle injury - particularly ankle sprains - and the resulting chronic conditions like ankle instability and osteoarthritis. Ankle sprains commonly occur in sports such as basketball, where sudden, lateral changes in direction are common. As a shoe provides the foundational support for an athlete, a simple slipping/tipping analysis was performed to derive a stability criterion that relates impact forces and shoe geometry. The criterion was populated with geometric measurements from seven currently-available basketball shoes and impact forces seen in lateral maneuvers from several published studies to generate multiple cases to observe if the shoes were safe. Of the 35 cases (seven different shoes applied in six different loading conditions) there were six cases where the shoe passed the stability criterion and was considered safe. Given that the impact forces in lateral movements likely will not change, the geometry of the shoes should be considered to reduce the chance of tipping of the shoe (i.e. rolling of the ankle) and risk of injury to the athlete.</p><p>Another contributing factor to the healthcare system's economic burden is limb loss, and the negative effects of ill-fitting and ill-functioning prosthetic devices. Examples of these secondary complications are osteoarthritis and tissue breakdown, which are thought to result from uneven joint loading and asymmetric gait. In light of this, a prosthetic ankle was developed that employs a three degree of freedom system modeled with a ball-in-socket joint. The range of motion of this joint can be custom-bounded by the system of nubs and cavities, along with shims that can be inserted around the joint shaft, to control dorsiflexion, plantarflexion, inversion, eversion, and medial/lateral rotation in the transverse plane. A joint like this, which enables the user to have a more natural gait, will help reduce the onset of conditions like osteoarthritis, ultimately reducing the demand on resources from the healthcare system.</p><p>Another effort to mitigate the burden on the healthcare system is seen through the development of a wearable resistance device that is designed to help prevent injury by strengthening musculoskeletal and neuromuscular systems during sport-specific movements. While traditional gym training is beneficial for an athlete's overall health and fitness, it tends to lack in adequately preparing the athlete for sport-specific movements. Thus, a wearable resistance system is beneficial in that it can provide resistance training during sport to enhance and strengthen an athlete's neuromuscular and musculoskeletal systems. In this study, five recreational runners performed running trials on an instrumented treadmill with and without the wearable resistance system. Force plate and surface electromyography (sEMG) data were collected to observe changes in the muscle activation in both legs. Additionally, sEMG data was examined to detect any effect on left/right symmetry in each subject. </p><p>These studies can all be enhanced with the incorporation of a newly-developed skeletal muscle force model that provides more accurate estimates of individualized muscle forces to better predict surrounding musculoskeletal tissue and joint contact loading. It is founded in dimensional analysis and uses electromyography and the muscle force-length, force-velocity, and force-frequency curves as inputs. The constitutive equation gives way to a unique application of inverse-dynamics that avoids the issue of indeterminacy when reaction moments and ligament loading are minimized in a joint. The ankle joint is used as an example for developing the equations that culminate into a system of linear equations. Seventeen subjects (8 males, 9 females) performed five different exercises geared towards activating the primary muscles crossing the ankle joint. The moments about the ankle joint due to the calculated muscle forces were compared to the sum of the moments due to all other sources and the kinematic terms in the second Newton-Euler equation of rigid body motion. Average percent errors for the \(\vec{B}\) components for each subject ranged from 4.2\% to 15.5\% with a total average percent error across all subjects of 8.2\%. Not only is this muscle force model physiologically relevant, but it can be calibrated and used to predict joint contact loading and loading in the surrounding tissues. Thus, it will be beneficial for use in designing biomechanics equipment for athletes like basketball players, or in designing prosthetic devices that function more like a natural joint. Furthermore, this model can be used in conjunction with the wearable resistance device to validate it's effects on the strengthening of neuromuscular and musculoskeletal systems over time.</p>

Background: Unhelmeted motorcyclists injured in states with lax or poorly enforced helmet safety laws are frequently seen in rural trauma centers. A trauma surgeon started a comprehensive injury prevention and research fund with outreach to a three-state trauma center catchment area promoting injury prevention at area high schools and local communities. We hypothesized that unhelmeted riders would have more severe head injuries and fatalities than helmeted riders. Methods: A trauma registry review of 708 injured motorcycle riders over an 11-year period examined demographics, helmet use, and clinical outcomes of helmeted and unhelmeted riders. A full-time injury prevention coordinator collaborating with law enforcement provided electronic and mechanical simulations with discussions regarding helmet use, alcohol avoidance, and responsible motorcycle riding for area high school students. This program coincided with the second half of our 11-year study. Multiple regression analysis evaluated predictors for head injury and death. Results: Unhelmeted motorcyclists suffered worse head injuries, (OR 8.8, CI 1.6-2.4, P <.001), more severe overall injury (OR 10, CI 12.7-18.6, P <.001), and higher mortality (OR 2.7, CI.02-.15, P <.001). Local motorcycle-related trauma center admissions and deaths have stabilized in recent years while statewide motorcycle crashes have increased (P <.05). Discussion: Unhelmeted motorcyclists suffer worse head injuries and mortality rates. Physician-led outreach efforts for injury prevention may be effective. Trauma surgeons have ongoing opportunities to promote responsible motorcycle riding for schools and local communities.

Playing-related pain, discomfort, and injuries are significant health concerns for musicians. Most of these are classified as playing-related musculoskeletal disorders (PRMDs), which are any physical symptoms that interfere with a musician’s ability to play their instrument at the level to which they are accustomed (Zaza et al., 1998). The prevalence of PRMDs for professional musicians can range from 62% to 93% (Kok et al., 2016). Researchers have found similar PRMD prevalence rates among tertiary music students at universities, colleges, and conservatories (Larsson et al., 1993; Stanek et al., 2017). Additionally, young musicians in primary and secondary school also experience PRMDs (Burkholder & Brandfonbrener, 2004; Lockwood, 1988; Ranelli et al., 2011). It seems that PRMDs may be a consequence of not only the way people make music, but also of how they learned and were taught to make music. Many performing arts medicine researchers recommend prevention education to combat PRMDs. Although studies examining stretching, warm-ups, yoga, and somatic education techniques have shown promising results, the majority of these prevention education research studies have focused on tertiary music students (Barton & Feinberg, 2008; López & Martínez, 2013; Salonen, 2018). As many tertiary music students report experiencing PRMDs even before arriving at school, waiting to teach prevention may be too late (Brandfonbrener, 2009; Foxman & Burgel, 2006). Additionally, the rate of PRMDs among young musicians demonstrates a need to determine how and when prevention education is implemented. As musicians of all ages continue to experience PRMDs, current teaching practices may not be adequate to help prevent PRMDs—in fact, the way music is taught may be contributing to their development. Efforts to understand how to incorporate prevention education into pedagogical practices from the very beginning of musical study are necessary. Body Mapping is a somatic education technique that was designed specifically for music teachers to educate musicians about their bodies. Utilizing the senses, movement, and attention, Body Mapping guides musicians to understand the size, structure, and function of the body in movement to help them achieve their musical intentions (Conable, 2000; Johnson, 2009). The purpose of this study was to investigate the impact of Body Mapping-informed pedagogy as primary prevention on beginning string students’ body awareness and levels of pain and discomfort as measured by standard self-perception tools. In a quasi-experimental design, data collection occurred before and after a 12-week intervention period using the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ), the Multidimensional Assessment of Interoceptive Awareness 2 (MAIA-2), and the Body Mapping Knowledge Inventory (BMKI). Participants (N = 68) were 6th grade beginning string students in the Western United States separated into an experimental group (n = 41) receiving Body Mapping instruction while learning their instrument, and a control group (n = 27) that learned their instrument only with traditional pedagogy. T-tests revealed a limited number of statistically significant results, but a closer examination of data also uncovered some interesting non-significant trends. Although there were no significant differences in pain and discomfort between groups on the CMDQ, the control group did have a more obvious upward trend of pain and discomfort between testing points. On the MAIA-2, the experimental group maintained their body awareness over the intervention period, whereas the control group had a significant loss of body awareness (p = .042). Additionally, the experimental group significantly increased their Body Mapping knowledge on the BMKI (p = .020). Finally, Spearman’s correlations revealed a significant direct relationship (𝜌 = .28, p = .019) between increased Body Mapping knowledge and higher body awareness on the BMKI and MAIA-2, respectively. The results of this study indicate that Body Mapping concepts can be learned from the beginning of study, although it is not clear what the implications are for long-term injury prevention. Further, the data suggest the continued examination of pedagogical practices. More research efforts are needed to understand the long-term effects of somatic education such as Body Mapping, and to determine quantitative data collection instruments appropriate to reveal subtle changes in pain, discomfort, and body awareness for this population.

No description available.

No description available.

The project focus has been development of guidelines and methods for upper extremity injury reduction in car crashes. The safety of the central body parts improves which indicates the need to develop methods for avoiding non-life threatening injuries such as fracture of the arms. The purpose of the project was to study the injury mechanisms for the upper extremity in car crashes, and the aim has been to propose methods to reduce the injuries. The project focuses on adult occupants inside the vehicles front seat, and frontal and side impacts. The procedure began with understanding and identifying the injury mechanisms. Studies show that most fractures occur on the forearm (radius and ulna) and on the wrists and hands. To determine which injury mechanisms that were most frequent, data were collected from 29 computer simulations with 29 different crash scenarios. The most common kind of impact was the medial part of the wrist in the central part of the instrument panel, combined with the impact of the elbow in the center consol. The results of the simulations created a basis for the method of the component test, with focus on the injury mechanism i.e. the forward movement of the arms into the instrument panel. The component test consisted of a test rig, on which was mounted with a measuring arm of a 50th percentile male dummy. The arm dropped into a block of expanded polypropylene (EPP-block) for observation and study, and with following variable parameters: the impact angle of the surface, velocity and position of the wrist. Then also an instrumented measuring arm from a 5th percentile female dummy was released into an instrument panel. The project contributes to knowledge about the injury mechanism of the upper extremity in car crashes. The most frequent injury mechanism is a forward movement of the arms resulting in an impact with the interior structure of the car. The most frequent injured region is the distal part of the upper extremity. The project has developed and suggested the first step to a test method for the specific injury mechanism. There is a need of more research on how impact angles and velocity affect the violence on the arm.

Anterior cruciate ligament (ACL) ruptures are one of the most common knee ligament injuries suffered by both male and female athletes. These injuries are severe in nature and also have long-term impacts on activities of daily living. Significant research has been conducted utilizing a drop landing task to attempt to better understand the mechanics behind the injury and to help identify at-risk athletes for targeted intervention. However, there have not been any published standards for the height of the drop landing activity, and previous researchers have also raised some concerns about the ability of a drop landing task to replicate the landing mechanics of a sport-specific task. To examine possible differences in performance based on specific landing tasks, the first study compared the landing mechanics of male and female high school athletes in three different landing conditions (drop landing, DL; adjusted height drop landing, AHDL; and a vertical jump task, VJL) (Chapter 3). Thirty-seven (37) athletes completed bilateral landings in the three conditions, and their kinetic and kinematic landing mechanics were compared across conditions. For the male participants, maximum knee flexion during landing was greater in AHDL condition as compared to the DL and VJL conditions. Both male and female participants demonstrated greater hip adduction at impact and overall maximum value in the VJL condition as compared to the two drop landings. As drop landing tasks have been used to identify at-risk athletes, it was important to examine the three different tasks’ ability to predict lower extremity ligamentous injuries, and whether those 3D motion analysis predictors were more precise than a quick clinical symmetry screening tool (Chapter 4). One-hundred-and-sixty-five (165) athletes completed the clinical symmetry screen, and a subgroup of thirty-seven (37) athletes completed the 3D motion analysis. All of these participants were surveyed for lower extremity ligamentous injuries over the course of a season. Due to a small number of reported injuries, none of the injury predictor models based on 3D motion analysis landing mechanics or the clinical symmetry screening tool were able to produce accurate predictor models of injury. Knee abduction moment has been shown to be one of the strongest predictors of ACL injuries, and due to the collection of bilateral kinetics for a previous study (Chapter 3), there was a need to examine differences in KAM between the three different landing tasks (Chapter 5). Ten (10) recreational athletes completed bilateral landings in the three conditions, with foot placement relative to force plates to enable KAM calculation. The participants did not demonstrate any difference in KAM between the three landing conditions; however, a test for constant variance showed that the AHDL resulted in significantly less variance in KAM than DL or VJL. The results of these studies suggest that while easy to standardize, a set height drop landing task does not produce identical landing mechanics to those from an adjusted height drop landing task or a vertical jump task. Further research is needed to create or justify standardized landing tasks for researchers to utilize that produce consistent results that best duplicate the landing mechanics athletes performed during sporting activities. While the landing mechanics demonstrated in the three tasks and the results from the clinical screening were not able to predict injuries, future studies should examine quick clinical screening tools to identify athletes at a high risk of injury.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Introduction: The majority of University of the Western Cape coaches believe that in most sport codes, many female and male athletes get injured at least once a season. Consequently, occurrence of injuries signifies many set-backs in any team sports. University of the Western Cape sports injury intervention and rehabilitation strategies are relatively under-developed, and have not been systematically implemented, despite their proven effectiveness. However, due to intensive training, local and national league competitions, the number of injured athletes at University of the Western Cape has increased, and so delays of athletes’ recovery are caused. Thus, it is assumed that University of the Western Cape efforts may have lack of the necessary injury precautions on prevention and rehabilitation such as proactive injury treatment, paying special attention to the therapeutic process, including other necessary mechanisms. The current study has explored facilitating factors and some of the barriers on the implementation of injury prevention strategies, and determined the effectiveness of rehabilitation within University of the Western Cape sport teams in views of athletes, coaches, and medical staff. Methods: This study used a sequential exploratory design which entailed an initial phase of quantitative data collection and analysis, followed by a phase of qualitative data collection and analysis. This study used a close-ended survey and semi-structured interviews to identify the barriers and facilitators associated with the implementation of injury prevention strategies among sports clubs at the University of the Western Cape. Results: Data were collected on the general knowledge of players and team coaches about injury prevention as well as their sources of information regarding injury prevention. Football players were 49.5% while 15.8% were basketball players in this study. Cricket players were 10.9% while rugby players were 9.9%. Sources of players’ knowledge of injury prevention included doctor/physiotherapist, coaches and the media. Sources of coaches’ knowledge of injury prevention included doctor/physiotherapist, media and seminars. Most players and coaches agreed that there is a greater chance of sustaining an injury during a competitive match than during training. Players and coaches also agree that the risk of injury is reduced by wearing preferred protective clothing and thoroughly warming up and stretching prior to training or competition. Barriers to the implementation of an injury prevention strategy include not having enough time, being too tired after training, no advice given on such techniques, the notion that nobody else does it and lack of proper equipment. Facilitators of an injury prevention strategy include availability of medical staff (doctors and physiotherapists), players’ understanding of the coach’s instructions, and injury prevention facilities at University of the Western Cape, services accessibility and quality, injury discovery and follow-up, and injury prevention policy at University of the Western Cape. Conclusion: Based on the findings of this study, the following recommendations were made: (i) Intervention directed at players and coaches in the form of health promotion programmes through education to increase their knowledge and support in implementation of all prevention strategies either in training or in competition; (ii) Governing bodies at University of the Western Cape should develop and disseminate written sports safety policies and guidelines and supervise clubs in their development programmes.

Background: Lower extremity (LE) musculoskeletal injuries in soccer players are extremely common. These injuries can result in many days of lost time in competition, severely impacting players and their respective teams. Implementation of group injury prevention programs has gained popularity due to time and cost-effectiveness. Though participation in group injury prevention programs has been successful at reducing injuries, programs often target a single injury and all players do not benefit from participation. Players with a greater number of risk factors are most likely to sustain an injury, and unfortunately, less likely to benefit from a group injury prevention program. The purpose of the proposed research is to determine if targeting these high risk players with one-on-one treatment will result in a reduction in the number of risk factors they possess. Objectives: 1) Determine the effectiveness of one-on-one intervention for reducing the number of risk factors for LE musculoskeletal injury in soccer players with 3 or more risk factors; 2) Assess the effectiveness of matched interventions on reducing the magnitude of identified risk factors. Hypothesis: Fifty percent or more of subjects receiving one-on-one intervention will have a reduction of ≥ 1 risk factor(s). Design: Quasi-experimental pretest-posttest design. Subjects: NCAA Division I men’s and women’s soccer players. Methods: All subjects were screened for modifiable risk factors using a battery of tests which assessed mobility, asymmetry in fundamental movement pattern performance, neuromuscular control, and pain with movement. Players with ≥ 3 risk factors (“high risk”) were placed in the treatment group and received one-on-one treatment from a physical therapist. An algorithm was created with interventions matched to specific deficits to determine the treatment each subject received. Subjects in the intervention group were treated twice per week for four weeks. Players with < 3 risk factors (“low risk”) were placed in the control group and did not receive one-on-one intervention. Analysis: The primary outcome measure was proportion of treatment successes, defined as a reduction of ≥ 1 risk factor(s). Secondary outcomes included analysis of within group and between group differences. Results: Thirteen subjects were treated with one-on-one intervention, with twelve having a reduction of at least 1 risk factor at posttest. The proportion of treatment successes in the intervention group was 0.923 (95%CI 0.640-0.998). The proportion of high risk subjects that became low risk at posttest was 0.846, which was statistically significant (p = 0.003). Within group differences were noted in active straight leg raise (left; p = 0.017), hip external rotation (right, p=0.000; left, p = 0.001) thoracic spine rotation (left; p=0.026), and upper quarter neuromuscular control measures (left inferolateral reach, p = 0.003; left composite, p = 0.016). A statistically significant between group difference was noted in risk factor change from pretest to posttest (p = 0.002), with the median risk factor change in the intervention group and control group being -3 and -1, respectively. Conclusion: Utilizing one-on-one interventions designed to target evidence-based risk factors is an effective strategy to reduce LE musculoskeletal injury risk factors in high risk individuals.

Title: Relation between power ratios of adductors, abductors, external and internal hip rotators at shooting speed of ice hockey players Objectives: The main aim of this thesis is to find out the relationship between the rate of fire on the ice and the strength abilities of the hand and hip rotators Methods: The research group consisted of 20 adult probands (age = 24.8 ± 3.4; height = 181 cm ± 6.13 cm; weight = 80.1 kg ± 9.9 kg). The research took place in the summer preparation period after the season. The laboratory tests were carried out at the Charles University FTVS under the supervision of qualified and trained experts. An isokinetic dynamometer (Cybex NORM ®, Humac, CA, USA) was used to test external and internal rotators. A hand isometric dynamometer (Takei 5401) was used to evaluate the handgrip. Field tests were conducted on the ice, where the rate of fire was recorded using radar (V-max). Results: The results showed a significant degree of association between SBN and SVN shooting and rotator force at concentric contraction (30ř∙s-1 , 90ř∙s-1 ) for the dominant leg, reaching values (r = 0.45) for the angular velocity of 30ř∙s-1 and at higher angular velocities it assumed values (r = 0.44 and 0.54). Statistical analyzes also showed a significant degree of association between SVN-firing and...