Masters of Science - Msc (Physiotherapy) / Concussion is one of the most common injuries in contact sports such as rugby and hockey. Concussion awareness has dramatically increased over the last 20 years. Concussion is a mild traumatic brain injury that often gets overlooked but can be fatal if not taken seriously. Early diagnosis and appropriate management of concussion is vital for safely integrating a player back into sport. Return to play guidelines serves to ensure the safety of the players. Even though a few studies have investigated the knowledge of concussion and the return to play guidelines amongst therapists, there are no South African studies focusing on high school rugby and hockey players.

Objective: To determine the change in HRV in concussed varsity athletes from baseline to post-injury to return to play. Design: Quasi-experimental, repeated measures design. Participants: five male varsity athletes four rugby, one basketball (mean age 19.6 ± 1.52 years), number of previous concussion 1.6 ± 0.55. Measurements: HR & HRV frequency domain (LF n.u., HF n.u., LF/HF ratio, Total Power) & Heart rate (bpm) during both seated rest and steady state exercise using a stationary cycle. Results: Repeated measures ANOVA revealed a significant difference between baseline (pre- injury) resting heart rate and first post-injury assessment resting heart rate (p=0.037). Resting Total Power was significantly different between baseline (pre-injury) and first post-injury assessment (p=0.044) and between first post-injury and second post-injury assessment (p=0.010). No statistical significant differences in any variables were found during exercise, however the trends in the changes of HRV were similar to other research studies and could be of clinical importance. Conclusion: Athletes display dysfunction in neuroautonomic cardiovascular regulation post-concussion as seen with changes in HRV. Findings of this study warrant further investigation into the use of HRV as a marker of concussion and concussion recovery. / Graduate

Abstract Background: Soccer includes quick turns, jumps and decelerations, which entails an increased risk of injury. Women are exposed to more long-term injuries than men. Physiotherapists who work with injury management and return to play need to take account factors from a biopsychosocial perspective. Purpose: The aim of this study is to explore physiotherapist's experiences of working with injury management and returning to play in Damallsvenskan, after common injuries in soccer. Method: A descriptive qualitative study based on five semi-structured interviews was applied. The content of the interviews was analyzed with qualitative content analysis. Results: The results show that physiotherapist´s in Damallsvenskan experience that good communication between affected parties facilitates the work with injury management. The work includes considering risks, working with mental barriers and helping the player to be physically ready for recovery by treating the damaged tissue. Physiotherapists experience that different resources affect injury management. Conclusion: The physiotherapists describe how an important part of the work is to help the player to become physically ready for recovery by treating the tissue and working with mental barriers. Good communication facilitates cooperation within the team. The pressure to get players ready for a match in a short time includes considerations of risks, which is affected by work experience. Physiotherapists in Damallsvenskan experience that resources affect injury management. Furthermore, quantitative research should focus on whether an increased presence of physiotherapists in Damallsvenskan can reduce the risk of players injuring themselves again. / Sammanfattning Bakgrund: Fotboll inkluderar snabba vändningar, hopp och inbromsningar, vilket medför en ökad risk för skador. Kvinnor utsätts för mer långvariga skador än män. Fysioterapeuter som arbetar med skadehantering och återgång till spel behöver ta hänsyn till faktorer ur ett biopsykosocialt perspektiv.  Syfte: Syftet med studien är att belysa fysioterapeuters upplevelser och erfarenheter av att arbeta med skadehantering och återgång till spel i Damallsvenskan, efter vanligt förekommande skador i fotboll. Metod: Studien är en deskriptiv kvalitativ studie baserad på fem semistrukturerade intervjuer. Innehållet i intervjuerna analyserades med kvalitativ innehållsanalys. Resultat: Resultatet visar att fysioterapeuter i Damallsvenskan upplever att en god kommunikation mellan berörda parter underlättar arbetet med skadehantering. Arbetet inkluderar övervägande av risker, arbete med mentala hinder och hjälpa spelaren att bli kroppsligt redo för återgång, genom att behandla den skadade vävnaden. Fysioterapeuterna upplever att olika resurser påverkar skadehanteringen.  Konklusion: Fysioterapeuterna beskriver hur en viktig del av arbetet är hjälpa spelaren att bli kroppsligt redo för återgång genom att behandla vävnaden och arbeta med mentala hinder. En god kommunikation underlättar samarbetet inom teamet. Pressen att få spelare matchklara på kort tid inkluderar överväganden av risker, vilket påverkas av arbetslivserfarenhet. Fysioterapeuter i Damallsvenskan upplever att resurser påverkar skadehanteringen. Vidare bör kvantitativ forskning fokusera på om en ökad närvaro av fysioterapeuter i Damallsvenskan kan minska risken för spelare att åter skada sig.

Athletes participating in ice hockey are at a high risk of experiencing a concussion which can lead to impairments in cognitive functions. Deciding when a player can be returned to playing ice hockey is part of the concussion management called return to play (RTP). This can bebased on subjective or objective measures. Returning a concussed hockey player too soon can result in devastating consequences. This review aimed to investigate what objective measure could be used to assess a concussed player. It specifically focused on Immediate Post Concussion Assessment and Cognitive Test (ImPACT) and a cognitive motor integration (CMI) performance task. It was hypothesized that by combining the two could contribute to an optimal objective assessment and be used as accurate indicators in the RTP decision. This review involved searches from PubMed, Scopus and Web of Science which resulted in a total of four articles. The amount of articles was a big limitation. Main findings are that concussed participants showed decreased cognitive performance relative to baseline despite subjectively reporting being symptom free. Findings in this review suggest that adding a CMI performance task to the ImPACT test battery could be a way to objectively catch several composites incognitive recovery including tasks that require higher levels of cognitive functioning. Administering an assessment based on two objective measures could add accuracy and contribute to a safe RTP not risking a second impact syndrome or prolonged cognitive impairments.

Concussion is a popular clinical topic that has been the subject of unprecedented recent media coverage. As concerns about the potential short- and long-term implications of repetitive head injury in sports such as football continue to mount, the proper clinical management of concussion seems to increase in importance. The days of ignoring the ''ding'' on the sideline are definitely over. A series of updated clinical evaluation and management recommendations from international experts are highlighted in this review. The clinical presentation of an acute concussion, both the typical and more subtle variations, may be evaluated with new validated sideline evaluation tools (eg, Sports Concussion Assessment Tool 2). In addition, the role of computerized neuropsychological and balance testing in the acute and ongoing evaluation are discussed, along with how they contribute to the return-to-play decision. Same-day return to play is outdated, and the relative insensitivity of current neuroimaging modalities to demonstrate structural damage is highlighted. New therapeutic interventions such as amantadine and cognitive rest may improve recovery time. The appropriate management of concussion typically results in a normal functional and neurocognitive outcome. The recommendations in this article may guide clinicians, with varying degrees of prior experience managing concussion, to increase the likelihood of an excellent outcome.

No description available.

Professional rugby union has grown to become the third most popular team contact sport in the world. The physical nature of the game results in a high prevalence of injuries on all levels of play. Injury prevalence as high as 83.9 injuries per 1000 playing hours has been reported for the 2007 Rugby World Cup in France. Although research indicates schoolboy rugby union to be safer than professional rugby, injury rates as high as 65.8 injuries per 1000 playing hours have been reported. These injuries are mostly caused by the tackle situation, with the knee– and shoulder–joints being the most injured site. The risk of injuries in rugby union is heightened by professionalism, previous injuries, higher training demands, intrinsic factors and psychological issues. Due to the professional nature the game has taken on, the management of rugby union injuries has become increasingly more important. This should include prehabilitation or injury prevention programs, rehabilitation up until the final, sport specific phase as well as structured return to play testing. Another important aspect of injury management is the education of coaches, players and other persons involved in the sport. Objectives The first objective of the study was to observe the prevalence and nature of injuries in South African schoolboy rugby union players. Secondly, the treatment of these injuries was observed as well as the return to play criteria used to determine readiness to return to play after injury. The association between the treatment of injuries and the severity of injuries was then obtained. Lastly re–injury prevalence was compared to treatment received and return to play criteria used to determine readiness. Methods Ten schools from across South Africa partook in the study. The schools were all identified by the NWU–PUK as elite schools due to performances in the previous year (2008). Only the first team squad of each school was participated, amounting to a total number of 194 boys answering questionnaires conducted by the researcher for each of their injuries. The questionnaires included injury severity and site, recurrence of injury, cause of injury, treatment procedures and criteria used for return to play. Severity was defined in terms of game and training days missed due to injury and are describe as slight (0 – 1 day), minimal (2 - 3 days), mild (4 - 7 days), moderate (8 - 28 days) or severe (>28 days). The results were then analyzed and presented through descriptive statistics. Statistical significance was indicated by p <= 0.05. Practical significance was described by the Phi–coefficient. The practical significance indicated by phi, was indicated as large if phi >= 0.5. Results A total number of 118 injuries were reported amounting to 78.51 injuries per 1000 playing hours. New injuries accounted for 68.64% (n=81) while recurrent injuries was reported to be 31.36% (n=37). The most frequent site of injury was the knee (n=26), followed by the shoulder (n=21). The event leading to injury that was most frequently reported, was the tackle (including making the tackle and being tackled) (n=49). Most injuries were slight (48%) but a high rate of moderate and severe injuries (39%) were reported. These moderate to severe injuries resulted in a minimum total of 360 days missed. Severe injuries were more likely to be treated by a doctor. Treatment by a doctor for severe injuries indicated the only significance in the study (p = 0.7). No fixed return to play protocol was in place for deciding if a player should be allowed to return to play. Thirteen of the injuries were however investigated through further testing (either through isokinetic or on–field testing). Conclusion Injury prevalence amongst top teams in South African schoolboy rugby union is very high. Rehabilitation does not follow a structured program or guidelines and there is no definite return to play protocols available. Re–injury rates are high, possibly due to the lack of structured rehabilitation and return to play protocols. / Thesis (M.Sc. (Biokinetics))--North-West University, Potchefstroom Campus, 2011.

Professional rugby union has grown to become the third most popular team contact sport in the world. The physical nature of the game results in a high prevalence of injuries on all levels of play. Injury prevalence as high as 83.9 injuries per 1000 playing hours has been reported for the 2007 Rugby World Cup in France. Although research indicates schoolboy rugby union to be safer than professional rugby, injury rates as high as 65.8 injuries per 1000 playing hours have been reported. These injuries are mostly caused by the tackle situation, with the knee– and shoulder–joints being the most injured site. The risk of injuries in rugby union is heightened by professionalism, previous injuries, higher training demands, intrinsic factors and psychological issues. Due to the professional nature the game has taken on, the management of rugby union injuries has become increasingly more important. This should include prehabilitation or injury prevention programs, rehabilitation up until the final, sport specific phase as well as structured return to play testing. Another important aspect of injury management is the education of coaches, players and other persons involved in the sport. Objectives The first objective of the study was to observe the prevalence and nature of injuries in South African schoolboy rugby union players. Secondly, the treatment of these injuries was observed as well as the return to play criteria used to determine readiness to return to play after injury. The association between the treatment of injuries and the severity of injuries was then obtained. Lastly re–injury prevalence was compared to treatment received and return to play criteria used to determine readiness. Methods Ten schools from across South Africa partook in the study. The schools were all identified by the NWU–PUK as elite schools due to performances in the previous year (2008). Only the first team squad of each school was participated, amounting to a total number of 194 boys answering questionnaires conducted by the researcher for each of their injuries. The questionnaires included injury severity and site, recurrence of injury, cause of injury, treatment procedures and criteria used for return to play. Severity was defined in terms of game and training days missed due to injury and are describe as slight (0 – 1 day), minimal (2 - 3 days), mild (4 - 7 days), moderate (8 - 28 days) or severe (>28 days). The results were then analyzed and presented through descriptive statistics. Statistical significance was indicated by p <= 0.05. Practical significance was described by the Phi–coefficient. The practical significance indicated by phi, was indicated as large if phi >= 0.5. Results A total number of 118 injuries were reported amounting to 78.51 injuries per 1000 playing hours. New injuries accounted for 68.64% (n=81) while recurrent injuries was reported to be 31.36% (n=37). The most frequent site of injury was the knee (n=26), followed by the shoulder (n=21). The event leading to injury that was most frequently reported, was the tackle (including making the tackle and being tackled) (n=49). Most injuries were slight (48%) but a high rate of moderate and severe injuries (39%) were reported. These moderate to severe injuries resulted in a minimum total of 360 days missed. Severe injuries were more likely to be treated by a doctor. Treatment by a doctor for severe injuries indicated the only significance in the study (p = 0.7). No fixed return to play protocol was in place for deciding if a player should be allowed to return to play. Thirteen of the injuries were however investigated through further testing (either through isokinetic or on–field testing). Conclusion Injury prevalence amongst top teams in South African schoolboy rugby union is very high. Rehabilitation does not follow a structured program or guidelines and there is no definite return to play protocols available. Re–injury rates are high, possibly due to the lack of structured rehabilitation and return to play protocols. / Thesis (M.Sc. (Biokinetics))--North-West University, Potchefstroom Campus, 2011.

Bakgrund Skador är vanligt förekommande i den professionella herrfotbollen och skador på det främre korsbandet (anterior cruciate ligament, ACL) är en skada med lång rehabiliteringstid. Efter en ACL-skada tar det i snitt 6,6 månader att återgå till träning och 7,4 månader att återgå till matchspel för spelare. 90% av spelare som skadat ACL återvänder till matchspel inom ett år, men det är inte känt om spelare får lika mycket speltid som tidigare. Syfte I vilken utsträckning återvänder spelare till sin tidigare nivå och finns det en korrelation mellan skadefrånvaro och speltid? Metod 40 professionella herrfotbollsspelare med bekräftad ACL-skada identifierades varav 34 uppfyllde inklusionskriterierna i denna retrospektiva kohortstudie. Skadefrånvaro, skada och spelardata identifierades via databaserna Transfermarkt.com, fbref.com och whoscoored.com Resultat Säsong 1 efter skada (S1ES) fick spelare 19,3 minuter mindre speltid jämfört med Säsong 1 innan skada (S1IS) (p&lt;0,01). Säsong 2 efter skada (S2ES) fick spelare 6,4 minuter mindre speltid (p=0,20). Det fanns en icke-signifikant (p=0,60) svag negativ korrelation (r=-,094) mellan differensen av genomsnittlig speltid i minuter/match S1IS mot S1ES och skadefrånvaro i dagar. Det fanns en icke-signifikant (p=0,60) svag positiv korrelation (r=,094) för S2ES. S1ES fick spelare speltid i 14,8% (p=&lt;0,01) färre matcher och S2ES fick spelare speltid i 5,7% (p=0,15) färre matcher jämfört med S1IS Slutsats Spelare är tillbaka till sin tidigare nivå vid två säsonger efter skadan. Längd på skadefrånvaron påverkar inte nivån som spelaren återvänder till. Spelare sitter mer på avbytarbänken säsongen efter skadan än tidigare. / Background Injuries are common in professional men's football and injuries to the anterior cruciate ligament (ACL) are injuries with a long rehabilitation period. After an ACL injury, it takes an average of 6.6 months to return to training and 7.4 months to return to match play for players. 90% of players who have injured their ACL return to match play within a year, but it is not known if players get as much playing time as before. Purpose To what extent do players return to their previous level and is there a correlation between injury absence and playing time? Method 40 professional men's football players with confirmed ACL injury were identified, 34 of whom met the inclusion criteria in this retrospective cohort study. Absence, injury, and player data were identified via the databases Transfermarkt.com, fbref.com and whoscoored.com Results Season 1 after injury, players got 19.3 (p&lt;0.01) minutes less playing time compared to season 1 before injury. Season 2 after injury, players received 6.4 (p=0.20) minutes less playing time. There was a non-significant (p=0.60) weak negative correlation (r=-,094) between the difference of average playing time in minutes/match season 1 before injury against season 1 after injury and injury absence for days. There was a non-significant (p=0.60) weak positive correlation (r=.094) for season 2 after injury. Season 1 after injury, players played in 14.8% (p=0.00003) fewer matches and season 2 after injury, players played in 5.7% (p=0.15) fewer matches. Conclusion Players are back to their previous level two seasons after the injury. Length of injury absence does not affect the level to which the player returns. Players sit more on the bench the season after the injury than before.

Bakgrund: Hjärnskakning i idrott är vanligt och det finns etablerade riktlinjer för identifiering, hantering och rehabilitering. För tidig återgång till idrott kan medföra risker. Kvalitativ forskning om idrottares upplevelser och erfarenheter av och om idrottsrelaterad hjärnskakning har ej påträffats. Syfte: Att undersöka hjärnskakningsdrabbade idrottares upplevelser och erfarenheter om hjärnskakning inom idrott samt återgång till idrottsaktivitet efter skadehändelsen. Metod: Data insamlades från fem idrottare med hjälp av semistrukturerade intervjuer som analyserades med hjälp av innehållsanalys. Resultat: I studien framkom tre teman; ”Föranledd vårdkontakt”, ”Motiverande och hindrande faktorer för återgång till idrott”, samt ”Resonemang kring hjärnskakning” som innefattade bland annat att idrottarna upplevde undermålig information från vården gällande återgång till idrott efter hjärnskakning och att tränare hade bristande kunskap om omhändertagande vid idrottsskada. Idrottarna uppfattade ett behov av ökad kunskap. Stöttning och förståelse för idrottarens situation från omgivningen påverkade positivt för återgång medan press och rädsla för en ny hjärnskakning hämmade. Konklusion: Föreliggande studie har uppnått syftet att undersöka hjärnskakningsdrabbade idrottares upplevelser och erfarenheter om hjärnskakning samt återgång. Resultaten ökar förståelsen för idrottare som råkar ut för hjärnskakning i idrottssammanhang. Ytterligare forskning behövs för att bilda uppfattning om läget av idrottsrelaterad hjärnskakning i Sverige. / Background: Concussion in sport is common and there are established guidelines for identification, management and rehabilitation. Premature return to play may be dangerous. Qualitative research on athletes' experiences on sport-related concussion has not been found. Objective: To examine concussed athletes' perceptions and experiences about concussion in sports and return to play after their concussion. Method: Data was collected from five athletes using semi-structured interviews and was analyzed through content analysis. Results: Three themes emerged; "Cause for health care", "Motivations and hindrances on return to play", and "Reasoning about concussion”. They included for instance that athletes experienced poor information from health institutions regarding return to play, and coaches had insufficient knowledge of sport-injury management. The athletes perceived a need for increased knowledge. Support and understanding for the athlete's situation had a positive impact on the return to play while pressure and fear of a new concussion inhibited return to play. Conclusion: The objective to examine concussed athletes' perceptions and experiences about concussion in sports and return to play, has been achieved. The results increase our understanding for athletes who sustain concussions in sports. Further research is needed to form an estimation of ​​the extent of sports-related concussions in Sweden.