The aim of the study was to document the epidemiology of injuries sustained by South African high school soccer players. Subjects for the study were selected from all the high schools (n = 10) in Tembisa (Gauteng, South Africa). A cohort of 227 high school soccer players, representing all the players in the Tembisa schools, was followed over one playing season. All practice and match hours were recorded and specific injury report forms were completed by all the coaches. All injured players were then referred to the principal investigator (JR) for detailed examination to document injuries. Factors such as pre-season training, warm-up, stretching, playing surface, environmental factors, and the use of protective equipment were also recorded. In this study, 63% of all the players sustained an injury during the season (seasonal incidence). The overall incidence of injuries was 9.04/1000 hours of play. The incidence in matches was 274 times higher than in practice. More than half (57%) of the injuries were classified as moderate. The highest incidence of injury per player position was in goalkeepers (13.7/1000 hours play). The lower extremity accounted for most injuries (88.8%), principally the ankle (42.4%) and the knee (27.1%). The most common type of injury was a ligamentous sprain (68%), followed by musculotendinous strains (15.8%). There were only two joint dislocations, and no fractures. All the participants in this study played on gravel pitches and on no occasion was a first-aid kit available. The majority of players were not aware of appropriate stretching, warm-up, and strapping techniques to prevent injuries. None of the players engaged in any form of pre-season training. In two of the schools (20%) the soccer coaches had formal training with coaching certification. Although the injury rate in high school soccer players in this study is only slightly higher than that reported · by others, it is clear that scientifically based measures of injury prevention (pre-season training, warm-up, stretching, and strapping) need to be implemented in these schools. In addition, proper sports and first-aid facilities should be provided, and coaches should receive formal continuous training.

Background: Rugby union ('rugby') has a high injury risk. These Injuries range from having minor consequences to catastrophic injuries with major life changing consequences. In South Africa, previous research indicated that the risk of catastrophic injury was high and that the immediate management was sub-optimal, worsening the injury outcome. In response, the South African Rugby Union launched the BokSmart nationwide injury prevention programme in 2008. Through education - mainly of coaches and referees - this programme aims to improve the prevention and management of catastrophic injuries. Moreover, the programme began administering a standardised questionnaire for all catastrophically injured players to assess the prevention and management of these injuries. Objectives: To assess whether factors in the immediate pre- and post-injury management of catastrophic injuries in rugby were associated with their outcome. In addition, as part of the BokSmart programme in Rugby in South Africa, there were modules developed as part of the education material delivered to referees and coaches in their workshops that deal specifically with safety in the playing environment, and the correct management of catastrophic injuries. We assessed whether these protocols within the modules were implemented. Design: A prospective, cohort study conducted on all catastrophic injuries in rugby collected through a standardised questionnaire by BokSmart between 2008 - 2014. Methods: Secondary analyses were performed on the information collected on all rugby-related catastrophic injuries in BokSmart's serious injury database. Injury outcomes were split into 'permanent' (permanently disabling and fatal) and 'non-permanent' (full recovery/ "near miss"). Immediate post injury management factors as well as protective equipment and ethnicity were analysed for their association with injury outcome using a Fisher's exact test. Results: There were 87 catastrophic injuries recorded between 2008 and 2014. Acute spinal cord injuries (ASCI) made up most of the catastrophic injuries (n=69) with traumatic brain injuries (TBI) the second most common (n = 11 injuries). There were 7 cardiac events. Black African players were associated with a 2.4 times higher proportion of permanent outcome that the injured White players (p=0.001). There was no association between any protective equipment or injury management (including optimal immobilization, time and method of transport taken to hospital) and ASCI outcome (non-permanent vs. permanent) Conclusions: Neither immediate post-injury management, nor the wearing of protective equipment was associated with catastrophic injury outcome in these South African rugby-related injuries. This might indicate that the initial injury is more important in determining the outcome than the post-injury management and associated secondary metabolic cascade, as proposed by some experts in this area. Moreover, that ethnicity was associated with ASCI outcome in this study is indicative of the wider problems in South Africa; not only specific to rugby. It is recommended that BokSmart continue to focus their programme in low socioeconomic areas that play rugby in South Africa.

The aim of this thesis was first to review the current literature that deals with patellofemoral pain in cyclists. The second aim was to investigate the possibility of reducing media-lateral deviation during the down stroke of cycling, by altering the biomechanics of the lower limb and, to observe the effect of this reduction on patellofemoral pain in a clinical trail. This thesis is in the format of two papers that is submitted for publication in sports medicine journals. The first paper is a review of the aetiology, biomechanics, diagnosis and management of patellofemoral pain in cyclists. The second is a research paper, titled: correcting lower limb biomechanics decreases patellofemoral pain (PFP) in cyclists.

This study investigated the epidemiology of injury in a population of first league field hockey players during a playing season, establishing the true incidence (injuries/ 1000 hours) of injury, as well as the risk factors associated with field hockey injuries. Both the epidemiology of field hockey injuries, and associated risk factors, have not been well investigated on an international level, and no data on Southern African players have been published. A study population of 222 first league hockey players (males n= 111, females n= 111) from one particular region were followed over the duration of a hockey season (7 months). A preseason player profile questionnaire established player characteristics and training methods. A pre-season fitness assessment recorded the flexibility (sit and reach test), muscle power (standing broad jump), speed (40 m sprint) and endurance capacities (double winder) of all the players. Male players performed significantly better in the muscle power (p=0.0001), speed (p=0.0001) and muscle endurance (p=0.0001) tests compared to female players. However, female players recorded significantly better flexibility results (p=0.012) compared with male players. Player position influenced the results of the pre-season fitness assessment. Attacking players (strikers, midfielders) achieved significantly better results in the muscle power (p=0.0704), speed (p=0.0003) and muscle endurance (p=0.002) tests compared with defending players (defenders, goalkeepers). During the prospective study, an injury report form was completed for players that sustained injuries during the season. An injury was defined as physical damage that resulted in (i) a player being unable to complete the match or practise, (ii) a player missing a subsequent match or practise, or (iii) a player requiring medical attention. An overall incidence of injury of 10/1000 hours was reported for the playing population, with an injury risk of 0.59 injuries per player per season. No other study of hockey injuries has recorded the true incidence of injury. A number of factors were associated with field hockey injuries. The incidence of injury was significantly greater in matches compared to practices (p=0.003). The highest incidence of injury was recorded in the beginning of the season (month 2) (16 injuries/1000 hrs). Strikers reported the highest incidence of injury (11/1000 hrs). In certain instances, the player position could be associated with an injury to a specific anatomical area or mechanism of injury. For example, goalkeepers sustained significantly more upper limb injuries than players in outfield positions (p=0.001), which can be attributed to the nature of their play. The activities of a goalkeeper include diving, and fending off the ball with their hands. The most frequently injured anatomical areas were similar to those reported in other studies of field hockey injuries, namely the fingers (1.6/1000 hrs), knee (1.4/1000 hrs) and ankle (1.4/1000 hrs) joints, and hamstring muscle (0.8/1000 hrs). The type of injuries sustained were predominantly muscle strains (2.4/1000 hrs), ligament sprains (2/1000 hrs) and fractures (1.7/1000 hrs). The most frequent mechanism of injury was tackling (2.3/1000 hrs). There was a significantly higher incidence of injury reported on artificial turf (13/1000 hrs) compared with grass (4/1000 hrs) (p=0.015). Players who discontinued hockey due to injury missed an average of four subsequent matches or practices. There was no significant association between past injury history, pre-season training, stretching methods, equipment usage and pre-season fitness assessments and the incidence or epidemiology of injury in hockey players.

Fats and carbohydrates are the major fuels utilized during exercise and it has been suggested that carbohydrate depletion is the cause of exhaustion during prolonged exercise lasting more than two hours. However, there is some disagreement in the literature as to whether this exhaustion is due either to muscle glycogen depletion or to hypoglycaemia secondary to liver glycogen depletion. I therefore undertook three studies to determine the roles of hypoglycaemia in explaining fatigue in marathon and ultra-marathon runners.

The first aim of this study was therefore to review the available literature on the epidem iology of injuries in professional rugby. The second aim was to collect data on medical profiles, previous injuries, use of protective gear, medication and nutritional supplements in South African professional rugby players. Thirdly, the incidence, nature and circumstances surrounding injuries in a cohort of professional South African rugby players were documented. The data collected was compared with available literature.

Introduction Patient Reported Outcome Measures (PROMs) are an integral part of evidence-based medicine and provide the necessary information for clinicians to make decisions in patient management. The Knee Osteoarthritis Outcome Score-Physical Function Short Form (KOOS-PS) was developed to assess patients’ perception of their knee’s function. Yet, there are cultural and language barriers, when implementing PROMs in a setting for which it was not originally designed, particularly in low-middle income countries with low levels of education. To address these challenges, the study introduces a video version of the KOOS-PS with the aim to validate it in a local setting. Methods This is a validation study of a video version of the KOOS-PS against various other knee scores. The KOOS-PS was converted into videos and a Likert scale in form of icons was used as grading system. The videos were reviewed by a panel for acceptance and comprehensibility. Second, the video score was tested in a prospective study against other internationally accepted and validated knee PROMs. Patients were recruited from both the public and private sectors of healthcare. Descriptive statistics, Pearson’s correlation coefficient and Cronbach’s Alpha were used for psychometric testing. Results The mean time taken to complete the video score was 79 seconds. Internal consistency received an excellent Cronbach’s Alpha of 0.89. Reproducibility received a Pearson Correlation Coefficient of r=0.91 which illustrates there was no significant difference. Pearson Correlation coefficients between the converted video score and other validated scores indicated high correlation. Conclusion This is the first validation study that converts a written PROM into a video format. The results show that the video score is reliable, acceptable, and valid, and can therefore be used in clinical practice.

Includes abstract. Includes bibliographical references.

Includes bibliographical references (leaves 73-77). / Exercise-associated muscle cramping (EAMC) is a common condition of spontaneous, painful skeletal muscle spasms that occur in exercising muscles during exercise or in the immediate post-exercise period. There is a high prevalence in endurance athletes, including ultra-distance triathletes. The exact cause for this condition has not been defined but various hypotheses have been proposed. Over the last decade the ""fatigue hypothesis"" has received most of the support in the scientific literature. Evidence from animal experiments, clinical studies on endurance athletes and situational information, suggest that neuromuscular fatigue may precede the increased neuromuscular excitability leading to EAMC. The objective of this research study was to identify factors associated with EAMC in endurance triathletes in an attempt to further elucidate the aetiology. Triathletes competing in the 2006 South African lronman triathlon were recruited as subjects in a prospective cohort study. A total of 44 triathletes made up the cramping group and 166 the non-cramping group. A detailed questionnaire, including information on training, personal best performances and a cramping history was completed by both groups of triathletes. Full clinical data was also collected from both groups. This included pre-and post race body weights, and pre- and post-race serum electrolyte concentrations. The main findings of the study were that the two independent risk factors for EAMC in these triathletes were a faster overall race time (and cycling time), and a past history of cramping (in the last 10 races). Results showed that EAMC was correlated with faster overall and cycle section times. The athletes who had experienced cramps in this event not only achieved taster race times but also predicted faster times, despite similarly matched preparation and performance histories as those who did not cramp. A higher intensity of racing would thus be required by these athletes, predisposing them to premature fatigue. The results thus agree with the ""fatigue hypothesis"" as an aetiological mechanism for EAMC. This study also showed no correlation between EAMC and changes in hydration status or changes in serum electrolyte concentration. This study thus adds to the evidence against disturbances in hydration and electrolyte balance as causes for cramping in exercise and further focuses attention on neuromuscular fatigue as a possible primary factor.

Includes bibliographical references (leaves 71-79). / Neuromuscular activity of the scapular stabilizing muscles in subjects with and and without chronic shoulder impingement syndrome. To examine differences in neuromuscular activity of the scapular stabilizing muscles in subjects with and without chronic shoulder impingement syndrome during an abduction movement of the shoulder.