Background: Beach volleyball (BVB) is rapidly developing into a popular activity both for recreational and competitive athletes. The majority of injuries sustained playing volleyball (beach and indoor) are considered non-contact. While commonly injured areas (ankle, knee, lower back and shoulder) are similar in beach volleyball (BVB) and indoor volleyball (IVB), injury incidence in BVB players is reported as 3.9-4.9 per 1000 hours, which is significantly lower than in IVB (1.7-10.7 per 1000 hours). Several factors contribute to the level of performance as well as to injury risk in volleyball players: body composition, changes in training load, previous injury, balance, proprioception, joint kinematics and muscle strength. There has been recent growth in the literature investigating the role of proprioception in the assessment, management and prevention of musculoskeletal injuries. Proprioceptive retraining strategies are diverse and yet no conclusive evidence demonstrating the superiority of one exercise over another is available. However, consensus exists that proprioceptive training requires movement on an unstable or uneven surface. Although proprioceptive exercises are commonly integrated into sports rehabilitation, there is a lack of high-quality evidence proving that proprioception can be trained. Maximal vertical jumping, lateral cutting sprints and diving to play the ball are repetitively demanded of volleyball players. BVB players complete these actions on sand (an uneven and unstable surface), making this sport, by definition, a continuous proprioceptive training exercise. By comparing two groups (IVB and BVB players) who perform a very similar sport on different surfaces (indoor and sand), we wish to investigate whether this may have led to differences in proprioception. Furthermore, we would like to measure the possible influence of this training aspect on functional capacity (lower limb range and strength, agility and vertical jump height). Aim: To compare proprioception, functional lower limb capacity, agility and jumping capacity on two different surfaces, between non-professional BVB and IVB players. Methods: A descriptive, cross-sectional, analytical study was conducted. The study adhered to the research ethics guidelines of the Declaration of Helsinki. The study protocol was submitted and approved by the Faculty of Health Sciences Human Research Ethics Committee, University of Cape Town. Convenience sampling was used to recruit 30 non-professional volleyball players (15 BVB and 15 IVB players) in the Western Cape, who met the inclusion criteria. Each player attended a testing session where they were given an informed consent sheet. If they decided to consent to participate and sign the form, a screening questionnaire was administered to determine eligibility to participate. Due to the COVID pandemic, participants also completed a COVID-19 screening tool. If eligible to continue to take part in the study, participants completed two questionnaires (Training and Injury History questionnaire and OSTRC (Oslo Sports Trauma Research Centre) questionnaire), after which they completed seven physical tests (the wedge test, two-point discrimination test, modified balance error scoring system (mBESS) test, modified star excursion balance test (mSEBT), knee-to-wall test, single leg hamstring bridge test (SLHBT) and eccentric-concentric calf raise test). They then proceeded to perform two jumping tests (countermovement jump with arm swing (CMJA) test and single leg triple hop for distance (SLTHD) test) and an agility test agility (modified agility T-test (MAT)) both on sand and hard surfaces. Descriptive statistics were used to present the demographical data, training and injury history. A t-test was used to determine whether the two groups were comparable on anthropometric data. Differences between the two groups (BVB and IVB players) in proprioception, agility and jumping capacity were analysed using Mann-Whitney U and unpaired t-tests. Repeated measures ANOVA were used to determine any differences in agility, jumping height or hopping distance between IVB and BVB players when tested on different surface conditions (the surface being the within-group factor and player type being the between-group factor). Effect size analysis was also reported for the physical outcome measures data, to determine the strength of any trends in differences existing between the two player groups Results: IVB and BVB groups were similar regarding demographics, training history and injury prevalence. Age was the only variable found to be significantly higher in BVB players than IVB players (p = <.001). There were no significant differences in most measures of balance, strength, agility or jumping capacity between the groups. While the results of the proprioception measure (wedge test) were also not significant (p= 0.08), a medium effect size (Cohen's d = 0.66) was found, with the BVB group identifying more differences in wedge heights correctly. There was a significant difference in the anterior reach of the Y-balance test (right and left legs) between the groups (p < 0.05), with the BVB group out-performing the IVB group. The study showed no significant correlations between proprioceptive measures and functional outcomes. A repeated-measures ANOVA determined that there was a significant main effect of surface type on mean CMJA heights (Wilks' Lambda = 0.799, F (1,28) = 7.040, p = .013), mean left leg SLTHD distances (Wilks' Lambda = 0.522, F (1,28) = 25.654, p = < .001) and mean right leg SLTHD distances (Wilks' Lambda = 0.473, F (1,28) = 31.169, p = < .001). However, no surface by player group interactions emerged, indicating that the impact of the surface was not different between groups of players: All volleyball players ran faster, jumped higher and hopped further on the indoor floor than on the sand. Discussion and conclusion: The findings of this study suggest that there are no consistent differences in functional capacity between IVB and BVB players. Despite limited findings, the current study contributes to the literature, as it is one of a few studies to assess the effect of habitual sand training on functional performance measures between IVB and BVB players. It is hoped that this study could provide a basis for further investigation into training on different surfaces to improve functional outcome measures, for overall performance improvement.

Background: Rugby is a popular international sport for male and female youth and adult players (6). Injury incidence including sport-related concussion (SRC) is high in youth rugby (7, 8) . This is concerning as youth are more vulnerable to SRC and take longer to recover from SRC than adults (9, 10). Females are also more susceptible to sustaining a SRC, take longer to recover from SRC and have a higher incidence of SRC complications than men (11-15). Most research has focused on SRC in adult male players. There are fewer studies on youth, in particular female youth. Further research into SRC in youth male and female players is thus required. Aim: The aim of this study was to determine the incidence and mechanism of SRC among youth male and female rugby players at the 2011 to 2018 and 2015 to 2018 South African Rugby Union Youth Week Tournaments respectively. Specific objectives: a) To determine the incidence of SRC among boys U13-U18 and girls U16-U18 players; b) To describe SRC mechanism of injury in boys U13-U18 and girls U16-U18 players; c) To determine if a difference in SRC incidence exists between boys U13-U18 and girls U16-U18 players, and also, between age groups; d) To determine if a difference in mechanism of SRC exists between boys U13-U18 and girls U16-U18 players, and also, whether the difference exists between age groups; and e) To describe l factors associated with SRC in boys U13-U18 and girls U16-U18 players. Methods: The study had a retrospective, epidemiological design. The study reviewed SRC injury data collected at the 2011-2018 South African Rugby Union Youth Week Rugby Tournaments. SRC injury data for boys was collected at the 2011-2018 South African Rugby Union Youth Week Rugby Tournaments. SRC injury data for girls was collected only at the 2015-2018 South African Rugby Union Youth Week Rugby Tournaments, as the girl's tournaments were only introduced in 2015. Results: Data from 266 SRC events were analysed in the study. Overall SRC incidence was 7.0 SRC per 1000 match playing hours (95% CI, 6.2.-7.8). Overall SRC incidence for boys was 6.9 SRC per 1000 match playing hours (95% CI, 6.0-7.8). Overall SRC incidence for girls was 7.9 SRC per 1000 match playing hours (95% CI, 5.3-9.9). There was no significant difference in SRC incidence between boys and girls. SRC incidence from 2011-2018 was 10.7 (95% CI, 8.2-13.1), 7.5 (95% CI, 5.5-9.6) and 5.3 (95% CI, 3.4-6.5) SRC per 1000 match playing hours for boys U13, U16 and U18 age groups respectively. SRC incidence from 2015- 2018 was 7.2 (95% CI, 3.7-10.2) and 7.9 (95% CI, 4.7-10.9) SRC per 1000 match playing hours for girls U16 and U18 age groups respectively. There was a significantly higher incidence of SRC in the boys U13 age group when comparing boys U13 and U18 age groups (IRR 2.0; 95% CI, 1.5-2.7; p=0.00014). Boys U13 players were twice as likely to sustain a SRC than their U18 counterparts. The tackle (65%) and ruck (20%) were responsible for the majority of SRC. Boys U13 players were significantly more likely to sustain a SRC from a tackle than boys U18 players (p= 0.01). Boys U16 players had a significantly greater incidence of SRC resulting from the ruck than boys U18 players (p=0.02). Overall the most common primary mechanisms of SRC were front-on tackles (27%) and collisions (18%). Boys U16 players had a significantly higher rate of SRCs due to front-on tackles than boys U18 players (p=0.00007). U16 boy players also had a significantly higher rate of SRCs caused by collisions than U18 boy players (p=0.00007). Similarly, boys U13 players had significantly higher incidences of SRCs due to collision than boys U18 players (p=0.003). Factors that were associated with SRC incidence were tournament day and the use of headgear. SRC was more likely to occur on day two than day four (p=0.0008), day five (p=0.0002) and day six (p<0.001). Players who did not wear headgear were more likely to sustain a concussion than those who did (p<0.001). Conclusion: Overall SRC incidence at the 2011 to 2018 South African Youth Week Rugby Tournaments was 7.0 SRC per 1000 match playing hours. This study is unique as it reports SRC incidence for youth female players. The overall SRC incidence for girls U16 and U18 groups was 7.7 SRC per 1000 match playing hours. As no significant difference was found for the incidence, injury event and mechanism of SRC between male and female players, similar injury prevention strategies can be implemented with these groups. Injury prevention strategies should focus on teaching safe contact technique in the tackle and ruck. Particular attention should be focused on teaching safe contact technique in U13 boys as the SRC incidence was highest in this group. Injury prevention strategies should also focus on teaching U13 and U16 boy players how to avoid collisions; and teaching U16 boy players how to execute safe front-on tackles and rucks. Further research should focus on identifying what aspects of the tackle and ruck result in SRC so more tailored and specific injury prevention strategies can be implemented.

Background Professional Rugby Union is a popular international team sport and is known to have one of the highest reported incidences of injury and illness across sporting codes. The Super Rugby tournament is played annually between professional Rugby Union teams and is one of the most competitive sports tournaments in the world. The demanding nature of the tournament has been associated with high rates of injury and illness, but the relationship between training loads on injury and illness profiles are unclear. As a result, the Super Rugby tournament is a platform to further investigate injury, illness and training load patterns within Rugby Union. Epidemiological data on training loads, injury profiles and illness patterns assist the development of preventative measures. Aim The aim of this study was to assess the relationships between training loads, injury profiles and illness rates in elite South African rugby players competing in the 2017 Super Rugby tournament. Specific objectives (a) To determine the incidence of training and match injuries during pre-season training, and early and late competition during the 2017 Super Rugby tournament; (b) To determine the incidence of illness during pre-season training, and early and late competition during the 2017 Super Rugby tournament; (c) To determine the anatomical site, type, mechanism and time-loss of injuries sustained during preseason training, and early and late competition during the 2017 Super Rugby tournament; (d) To determine potential associations between internal and external training loads; and injury and illness, respectively. Methods A descriptive, observational, surveillance study design was conducted on the 2017 Super Rugby tournament. Thirty-nine adult participants were recruited from one South African team over a complete season, including preseason, early and late competition. Data were collected from the team medical personnel who routinely collected data on a daily basis. Training load data included squad size, training or match day, the duration of training or matches, and internal and external training load measures for training and matches. Injury data included the participants age, the injury counts, the type of injury, the main and specific anatomical location, and the mechanism and severity of injury. Illness data included illness counts, the bodily system affected, symptoms and cause of illness, the specific diagnosis and time-loss. Results The overall incidence of injury was 12.8 per 1000 player hours. The majority (48.8%) of injuries occurred in the early competition phase. The incidence of match injuries (241.0 per 1000 player hours) was significantly higher than training injuries (3.3 per 1000 player hours). The lower limb (62.5%) sustained the greatest proportion of injuries. Muscle or tendon injuries accounted for 64.9% of all injuries. The tackle accounted for 28.8% of all injuries and 37.5% of all injuries were of a ‘moderate' severity. The proportion of players that sustained a time-loss injury was 76.9% (n = 30) and 25.6% (n = 10) of players sustained a time-loss injury severe enough to prevent eight days or more of participation in training or matches. The overall incidence of illness was 1.8 per 1000 player days. The proportion of players that acquired an illness was 28.3% (n = 11). Acute respiratory tract infections (28.6%) was the most common specific A significant negative correlation between injury and internal training loads were detected in the preseason phase (r = -0.34, p = 0.03). There were no significant correlations between external training load and injury incidence. No significant correlations were observed between internal and external training loads and illness incidence. There were no significant odds ratios demonstrated between internal and external acute to chronic ratios, and injury and illness risk. Conclusion The incidence of match injuries in this study was significantly higher than previously reported incidence rates in the Super Rugby tournament. The profiles of match and training injuries, anatomical location, type, mechanism and severity of injuries are similar to previous studies. Illness rates were significantly lower than reported in previous studies. Internal training load and injury were significantly correlated in the preseason phase. Further studies are required to determine the relationship of training loads on injury and illness over consecutive seasons and in multiple teams. diagnosis. A large majority of illnesses (64.3%) did not result in time-loss.

Introduction: Despite the lack of scientific knowledge on the physiological and biomechanical effects of wearing compression garments, there has been an increase in the use of these garments in endurance running. The purpose of this study was to compare the performance, pain and thigh circumference changes in endurance runners using upper leg compression garments while competing against runners who did not use compression garments in the same marathon race. Methods: A randomised controlled intervention study was conducted in endurance runners (n=18) participating in the 2019 Winelands Marathon (42.2km). The compression garment group (n=10) participated in the race wearing upper leg compression garments while the control group (n=8) did not. Participants in the compression garment group only wore the compression garments during the marathon. Various outcome measures of perceived exercise-induced muscle damage (EIMD) and running performance were assessed three days before, immediately post-race and two days post-race. Three days prior to the race, mid-thigh circumference measurements were performed. Immediately post-race, mid-thigh circumference measurements, Visual Analogue Scale (VAS) pain ratings and Likert scale for determination of muscle soreness were assessed and race performance times were recorded. Two days post-race, mid-thigh circumference measurements, VAS pain rating and Likert scale for determination of muscle soreness were repeated. Results: VAS pain ratings for hamstring (compression garment 2.50 vs control group 4.00) (p=0.04), knee flexion (compression garment 2.50 vs control group 5.00) (p=0.02) and hip extension (compression garment 2.50 vs control group 4.00) (p=0.04) had a statistically significant difference between the compression garment and control group immediately post-race. VAS pain ratings for hamstring (compression garment 0.00 vs control group 1.00) (p=0.04), knee flexion (compression garment 1.00 vs control group 2.00) (p=0.02) and hip extension (compression garment 1.00 vs control group 2.50) (p=0.04) had a statistically significant difference between the compression garment and control group two days post-race. There were no statistically significant differences in any other outcome measures (i.e. Likert scale for determination of muscle soreness, mid-thigh circumference and race performance) between the compression garment and control group. Conclusion: The use of upper leg compression garments is a recovery ergogenic aid which improves VAS pain ratings post-race. The results suggest that upper leg compression garments have a protective effect on the hamstring muscle in runners in the recovery phase. However, since a runner would be in a recovery phase after a marathon, a minor difference would be of little practical advantage since, importantly, there was no statistically significant differences in race performance and thigh circumference measures.

Water polo is a fast-growing adolescent sport that consists of swimming, defending and overhead shooting in an aquatic environment. The high demands on the shoulder to complete these tasks are proposed to cause the high injury incidence reported in the sport. The novelty of this research rests in its clinically valuable contribution to understanding shoulder injury aetiology in adolescent water polo players as overhead throwing athletes. The overall research aim of this thesis explores the musculoskeletal profile of a male adolescent water polo players shoulder and the intrinsic factors associated with shoulder injury risk. An overview of the literature (Chapter 2) explores the biomechanics of water polo including swimming and overhead throwing; the musculoskeletal adaptations of overhead throwing in water polo compared to other overhead sports; and the epidemiology of shoulder injury in water polo players relative to other overhead sports. Due to the absence of a consensus-based definition of injury in water polo comparison of existing quality epidemiological studies in the sport was limited. Additionally, although a limited amount of studies have proposed potential risk factors to shoulder injury in water polo players, significant correlations are yet to be found. As with other overhead sports, the water polo shoulder is prone to injury due to the generation of high force during a modified upright swimming posture, repetitive swimming stroke and overhead throwing at high velocities. Male adolescent water polo players were recruited for this study. Chapter 3 describes the adolescent water polo player's shoulder musculoskeletal profile and its association with shoulder injury prevalence throughout a single water polo season. The musculoskeletal variables included pain provocation, range of motion, strength, flexibility and shoulder stability tests which have been used previously in overhead athletes to investigate injury prevention and performance. There were three steps in the data collection process. Firstly, informed consent and assent, demographic, competition, training and injury history, and a shoulder-specific functional questionnaire was acquired from participants. Secondly, a battery of pre-season musculoskeletal tests was performed. The battery of tests included: anthropometry, pain-provocation, glenohumeral and upward scapula range of motion, glenohumeral and scapula muscle strength, glenohumeral flexibility and shoulder stability measurements. Thirdly, at the end of the season participants completed an injury report and training load questionnaire. Participants who experienced shoulder pain, with or without medical management, were categorised into the injury group and those who did not were categorised as uninjured. Chapter 3 documents the adolescent water polo players shoulder musculoskeletal profile, shoulder injury prevalence and the association between these intrinsic risk factors and injury. Specifically, adolescent water polo players present with significant side-to-side asymmetry in the lower trapezius (p = 0.01), upward scapula rotation ROM at 90° glenohumeral elevation (p = 0.03), glenohumeral internal and external rotation ROM (p = 0.01), glenohumeral internal and external strength (p = 0.05 and p = 0.01 respectively) and the pectoralis minor index (p = 0.01). Twenty-four participants (49%) sustained a shoulder injury during the season with the dominant shoulder more commonly affected (54.2%). The most common aggravating factors were identified as throwing (41.7%) and shooting (20.8%). Although significantly lower scores on the pre-season shoulder-specific functional questionnaire (p = 0.01) and significantly greater upward scapula rotation at 90° glenohumeral elevation (p = 0.01) on the dominant shoulder was found in the injured group compared to the uninjured group, no factors were significantly associated with increased injury risk. In conclusion, the findings suggest that male adolescent water polo players are a high-risk population for shoulder injury. It is suggested that improving the players, coaches and parents' health literacy, particularly of the shoulder, and incorporating preventative exercises, targeting modifiable risk factors and side-to-side asymmetry, into pre-season conditioning programmes may reduce the prevalence of shoulder injury in this sporting population. While this research contributes to the epidemiology of shoulder injuries in water polo players, further research is needed to continue to report on injury incidence and associated risk factors, particularly training and workload characteristics in the water polo population.

Background: Ultramarathon running has become extremely popular over the years. Despite the numerous health benefits of running, there are also many negative effects of running such as increased risk of musculoskeletal injury and illness. Training loads imposed on an athlete should induce positive physiological adaptations to improve their performance. Monitoring of an athlete's training load has become extremely important in terms of injury prevention. Currently, the relationship between training loads and injury and illness incidence is uncertain. More research is needed in this field to minimise the risk of injury and illness and maximise performance in ultramarathon runners. Aim: To determine if there are any associations between injury and illness incidences and training loads among ultramarathon runners in the 12 week period preceding an ultramarathon event and the four week period after the event. Specific Objectives: - To describe the incidence rate of overall and region-specific running-related injuries in a population of ultramarathon runners in the 16 week period surrounding an ultramarathon event. - To describe the incidence rate of illness and illness-related symptoms in a population of ultramarathon runners in the 16 week period surrounding an ultramarathon event. - To describe the weekly and cumulative training parameters (training volume, training frequency, training intensity, training duration) of the injured and uninjured groups and the ill and healthy groups over the 16 week period. - To describe the weekly and cumulative absolute training load parameters (internal load, external load) of the injured and uninjured groups and the ill and healthy groups over the 16 week period. - To describe the weekly relative training load parameters (ACWR) of the injured and uninjured groups and the ill and healthy groups over the 16 week period. - To determine whether there are any significant differences between the injured and uninjured groups and the ill and healthy groups with regard to: a) mean training parameters; b) mean internal training load; and c) mean external training load, over the 16 week period. - To identify any significant associations between: a) absolute training load (internal training load; external training load) and injury and illness incidence; and b) relative training load and injury and illness incidence over the 16 week period. Methods: A prospective, descriptive, longitudinal study design was conducted in runners who were training for the 2019 Two Oceans Ultramarathon. One hundred and nineteen participants were recruited for this study and tracked over a period of 16 weeks (12 weeks leading up to the Two Oceans Ultramarathon event and for four weeks afterwards). Data was collected once a week via an online logbook. Training parameters measured included weekly average running distance, average duration, average frequency and average session RPE. Injury data included injury counts, the structure injured, the main anatomical location and time-loss from injury. Illness data included illness counts, the main illness-related symptoms and time-loss from illness. Results: The overall injury incidence proportion was 31%. The week after the ultramarathon race had the highest injury proportion of 7%. The overall injury incidence was 5 per 1000 training hours. The average time-loss due to injury was three training sessions missed. The overall illness incidence proportion was 66%. The week after the ultramarathon race also had the highest illness proportion of 22%. The overall illness incidence was 16 per 1000 training days. The average time-loss due to illness was three training sessions. A moderate significant negative association was found between external training load and injury (r=-0.56; p=0.025). No associations were found between internal training load and injury; or between internal and external training load and illness respectively. A significant relationship was found for external training load and injury incidence in weeks 5 to 8 for participants who ran less than 30km per week. A significant relationship was found for external training load and illness incidence in weeks 5 to 8, 9 to 12 and 13 to 16 for participants who ran less than 30km per week. A significant relationship was found between the ACWR of >1.5 and injury incidence in weeks 1 to 4, 5 to 8 and 13 to 16. A significant relationship was found between the ACWR of <0.5 and illness incidence in weeks 13 to 16. Conclusion: In conclusion a lower training load could potentially predispose to running-related injuries or the development of illness. Specifically, a weekly mileage of less than 30km per week may increase the risk of sustaining an injury or illness when training for an Ultramarathon event. An ACWR greater than 1.5 may increase the risk of injury in the subsequent week of training and an ACWR less than 0.5 may increase the risk of illness in the following week. Non-gradual changes to a weekly training load, whether increases or decreases, could increase the risk of incurring a running-related injury or illness. Maintaining an ACWR between 0.5 and 1.5 appears to be optimal in minimising the risk of sustaining a running-related injury or illness. We therefore recommend the use of both absolute and relative workloads in the monitoring of an athlete's training load with the aim of minimising injury and illness risk and maximising performance in ultramarathon runners.

Background Field Hockey is an Olympic sport that is played widely across the world at various levels. In South Africa, it is a growing sport with increasing participation for both males and females. It is a high-speed team sport, consisting of short bursts of sprinting with technical coordination of a stick and ball, as well as the tactical execution of a coach's game plan. Participation in sports, including field hockey, comes with an accepted risk of injury; however, within the team setting it can have several implications for the individual: their health, physical performance, and psychological state, both immediately and in the long term. Despite injury incidence in other team sports being well-documented, there is limited research in field hockey generally, and injury incidence and associated risk factors in South African field hockey specifically. Aim The aim of the present study was to determine the incidence of injury and associated factors amongst players participating in the 2018 South African men's and women's inter provincial field hockey tournament. Objectives The specific objectives of the study were to determine (at the 2018 men's and women's senior field hockey seven-day inter provincial tournament in South Africa): • the incidence of injury amongst players; • the burden of acquired sport injuries defined by time loss and medical attention; • the associative factors related to injury (i.e. coaching qualifications, presence of medical staff, and other non-modifiable risk factors); and • the injury incidence, injury burden and distribution of anatomical injuries between males and females. Methods The study had a descriptive, longitudinal design. All players and coaches attending the 2018 South African Hockey Association men's and women's IPT were invited to enrol in the study and were recruited prior to the start of the respective tournament periods. All the attending players participate in senior field hockey, either for club or university teams in their province. Each provincial hockey union selects their best available team of players to represent them at the inter provincial tournament which comprises of three sections. Only the teams participating in the “A” sections were eligible for recruitment into the study. The female tournament was hosted in Durban during May of 2018 and the male tournament was hosted in Pietermaritzburg in August of 2018. Participants were excluded if they were under 18 years of age or did not provide informed consent. Enrolled coaches and players were asked to complete a self-reported questionnaire. Players information was used to gather the provincial team, playing position and previous injury history. Coaching information was used to gather the educational level, years of experience and the resources available to coaches. Players were additionally asked to independently complete daily injury report forms on all seven tournament match days. This was used to collect information on injury incidence and nature, medical attention required, and time loss during the tournament week. Results Two hundred and seventy-two players (133 females; 139 males) and 22 coaches took part in this study. All injury incidence was found to be 99.5 (95% CI: 71.9 – 127.1) injuries per 1000 player match hours for males and 77.9 (95% CI: 47.1 - 108.1) injuries per 1000 player match hours for females. The incidence of medical attention injuries was 70.3 (95% CI: 46.1 – 94.4) injuries per 1000 player match hours for males, and 51.9 (95% CI: 32.3 – 71.5) injuries per 1000 player match hours for females. The incidence of time loss was 7.5 (95% CI: -0.7 – 15.75) injuries per 1000 player match hours for males, and 4.3 (95% CI: 1.04 – 9.7) injuries per 1000 player match hours for females. A large portion of injuries affected the lower extremity, accounting for 69% of injuries in male players and 70% of injuries in female players. There were no significant relationships between injury incidence and the availability of team medical support staff, coaches' education level, coaches South African Hockey Association (SAHA) level, or coaches' first aid qualifications respectively. However, players with coaches who had a Federation of International Hockey (FIH) qualification had lower injury incidence rates compared to players with coaches who did not hold this qualification (p = 0.015; Fisher exact), with a lower incidence of injury in players coached by a FIH qualified coach (logistic regression analysis p = 0.054). Players who reported previous injuries within the last 12 months were 3.5 times more likely to sustain an injury during the tournament, compared to players with no previous injury history (p < 0.0001). Female players were 2.4 times more likely to seek medical attention compared to male players (p = 0.046). There was a statistically significant association between players reporting previous injury (within the past two years) and injury during the tournament (p < 0.0001), with players who had a previous injury being 5 times more likely of sustaining an injury during the tournament. Conclusion To our knowledge, this was the largest observational study conducted in South African field hockey that included both male and female players. High incidence rates of all injuries and medical attention injuries were identified, however, the incidence of time loss injuries was much lower in comparison to existing literature. It is possible that players continue to participate in matches despite injuries requiring medical attention, that medical support staff may not limit match participation for injured players adequately, or that players seek reassurance from medical support staff for minor injuries. The findings support the existing literature reporting that the lower extremity experiences the largest amount of injuries reported by field hockey players. In the present study, the lower extremity was affected in 69% of all injuries reported in the male tournament, and in 70% of all injuries in the female tournament. In addition, previous injury history was identified as a significant risk factor for injury, which is aligned with findings from injury monitoring studies of different team sports. The findings of this study highlight the need for consensus on injury definitions in field hockey. Further research is critical to determine injury prevention strategies for male and female field hockey players.

This thesis includes four manuscripts with overarching objectives to identify if Canadians experience unmet need for physiotherapy. McIntyre et al.’s framework was utilized across the manuscripts to explore reasons why unmet need may exist. The first manuscript presents a scoping review investigating unmet need for physiotherapy across Canada. The objective was to describe current evidence for unmet need for community-based physiotherapy services (CBPTS). Adults with chronic conditions versus those without, or who lived in rural versus urban communities were more likely to report unmet need for CBPTS. Availability and affordability were identified as reasons for unmet need. The second manuscript presents a secondary data analysis of three Canadian Community Health Survey (CCHS) cycles (2001, 2003, 2005) for three provinces: Ontario (ON), Alberta (AB), British Columbia (BC). This study investigated factors that explain variations in self-reported unmet needs of individuals with specific chronic conditions. Unmet need for treatment of a physical health problem (PHP) was the most common type of need in all three cycles. Affordability was the only domain with significant differences between cycles in two provinces. Women were less likely than men, and older persons less likely than persons 40 – 45 years, to report unmet need for treatment of a PHP. The third manuscript analyzed CCHS data for ON, AB and BC to investigate which socio-demographic variables were associated with reporting a visit to a physiotherapist in three cycles. People with lower income were less likely to report a physiotherapy visit compared to people with higher income. Women, and individuals with an injury or physical activity limitation were more likely to report a physiotherapy visit. The fourth manuscript presents themes from key informant interviews that explored the partial removal of physiotherapy from the Ontario Health Insurance Plan (“delisting”). Partial delisting contributed to increased unmet need immediately following, and more than ten years post implementation. Longstanding unmet need due to affordability and availability was identified. / Thesis / Doctor of Philosophy (PhD) / Physiotherapy is a health profession that works with people to help them stay healthy and maintain physical function. There are many people with chronic conditions who would benefit from receiving physiotherapy treatment, but are not able to do so. Three reasons that may explain why people do not receive physiotherapy are they: cannot afford to pay; cannot find a physiotherapist close to where they live or work; or they do not believe a physiotherapist will improve their health. This thesis includes four papers aimed at better understanding the reasons why people in three Canadian provinces, Ontario, Alberta and British Columbia, do not see a physiotherapist when their health would benefit from doing so. The results suggest that cost and the location where physiotherapy services are provided are reasons why some people do not receive physiotherapy care - even if they believe physiotherapy is needed. The findings from this thesis may help to inform the future organization and delivery of physiotherapy services.

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Thesis (MScPhysio)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Ankle sprains are reportedly the most common lower limb injury amongst active individuals. Aim: The aim of this study was to investigate whether treatment interventions employed by physiotherapists during the first week of functional rehabilitation of an ankle sprain, at primary care level, were aligned with evidence-based guidelines for acute ankle sprains. Design: A descriptive cross-sectional study was conducted. Participants: A total of 91 physiotherapists from the Western Cape Metropole (WCM) completed questionnaires. Method: Physiotherapists' treatment interventions were recorded based on a case study of a typical moderately sprained ankle. According to classification of the West Point Ankle Grading System, a moderate sprain is a partial macroscopic tear of the ligaments with moderate pain, swelling and tenderness with some loss of motion and mild to moderate instability of the joint. Anticipated return to sport is two to six weeks. Relative occurrence of selected interventions during the first week of rehabilitation was calculated. Chi-square tests were used to compare differences between physiotherapists' responses and the recommendations of the practice guidelines. Results: Physiotherapists' overall selections of treatment interventions were in alignment with the "Koninklijk Nederlands Genootschap voor Fysiotherapie" (KNGF) guidelines and correlated positively to the recommendations stipulated by KNGF therein. Physiotherapists indicated many interventions for which good evidence exists: compression, cryotherapy, early mobilisation, and neuromuscular exercises. It is of concern that 49% – 91% (n = 91) physiotherapists indicated some form of manual mobilisations for which there is a lack of evidence, and more than two-thirds indicated the application of an electrotherapy intervention, which is not recommended in the guidelines. Conclusion: Physiotherapists should reconsider interventions for which there is no evidence as this may reduce cost of care, without compromising patient outcomes. / AFRIKAANSE OPSOMMING: Verslae dui daarop dat verstuite enkels die mees algemene besering van die onderste ledemaat van aktiewe persone is. Doelwit: Die doel van hierdie ondersoek was om vas te stel of fisioterapeute in primere gesondheidsorg se keuse van rehabilitasie tegnieke gedurende die eerste week van funksionele rehabilitasie na 'n enkel besering, op koers is met bewysgebaseerde kliniese riglyne in die hantering van akute enkel beserings. Ontwerp: 'n Beskrywende deursnit ondersoek is geloods. Deelnemers: 'n Vooraf opgestelde vraelys is deur 91 fisioterapeute in die Weskaapse metropool voltooi. Metodiek: 'n Gevalle studie is aangebied van 'n tipiese matige verstuite enkel. Die respondent moes hulle tegnieke in die hantering van die geval aandui. Volgens die klassifikasie van die “West Point Grading System” word so 'n verstuiting gekenmerk deur makroskopiese gedeeltelike skeur van die enkel ligamente, matige pyn, swelsel en tasteerheid van die area. Dit gaan gepaard met 'n effense verlies van beweging en stabiliteit van die gewrig. Die prognose vir so 'n besering om na sport terug te keer is om en by twee tot ses weke. Die insidensie van aanwending van geselekteerde metodes van behandeling gedurende die eerste week en die verhouding met die vooraf geselekteerde behandelings riglyne opgestel deur die “Koninklijk Nederlands Genootschap voor Fysiotherapie” (KNGF) is bereken en ontleed. Die “Chi-square” toets is gebruik om die verskil te bereken tussen die respons van die Fisioterapeute en die aanbevelings van die kliniese riglyne. Resultate: Oorkoepelend is die keuses van behandelings tegnieke deur die fisioterapeute in lyn met die riglyne van die 'Koninklijk Nederlands Genootschap voor Fysiotherapie' (KNGF). Verskeie sinvolle behandelings is gekies waarvoor daar positiewe aanduidings was, byvoorbeeld: lokale kompressie, ys terapie, en oefeninge. Dit is egter kommerwekkend dat 49 – 91% (n=91) van die deelnemers 'n manuele tegniek ingesluit het waar daar tans gebrekkige aanduidings voor bestaan. Verder, het meer as twee derdes van die fisioterapeute aangedui dat hulle elektroterapie sou gebruik wat nie in riglyne aanbeveel word nie. Gevolgtrekking: Fisioterapeute moet die gebruik van tegnieke waarvoor daar nie duidelike bewyse in die literatuur bestaan nie, heroorweeg, want dit mag die koste van behandeling verminder, sonder om die positiewe resultate van herstel, negatief te beinvloed.