Training Load and Injury Risk in Elite Rugby Union: The Largest Investigation to Date

Author(s):  
Stephen W. West ◽  
Sean Williams ◽  
Dario Cazzola ◽  
Simon Kemp ◽  
Matthew J. Cross ◽  
...  

AbstractTraining load monitoring has grown in recent years with the acute:chronic workload ratio (ACWR) widely used to aggregate data to inform decision-making on injury risk. Several methods have been described to calculate the ACWR and numerous methodological issues have been raised. Therefore, this study examined the relationship between the ACWR and injury in a sample of 696 players from 13 professional rugby clubs over two seasons for 1718 injuries of all types and a further analysis of 383 soft tissue injuries specifically. Of the 192 comparisons undertaken for both injury groups, 40% (all injury) and 31% (soft tissue injury) were significant. Furthermore, there appeared to be no calculation method that consistently demonstrated a relationship with injury. Some calculation methods supported previous work for a “sweet spot” in injury risk, while a substantial number of methods displayed no such relationship. This study is the largest to date to have investigated the relationship between the ACWR and injury risk and demonstrates that there appears to be no consistent association between the two. This suggests that alternative methods of training load aggregation may provide more useful information, but these should be considered in the wider context of other established risk factors.

2019 ◽  
Vol 12 (1) ◽  
pp. 66-73 ◽  
Author(s):  
Ryan T. Li ◽  
Michael J. Salata ◽  
Sagar Rambhia ◽  
Joe Sheehan ◽  
James E. Voos

Background: The relationship of training load to injury using wearable technology has not been investigated in professional American football players. The primary objective of this study was to determine the correlation between player workload and soft tissue injury over the course of a football season utilizing wearable global positioning system (GPS) technology. Hypothesis: Increased training load is associated with a higher incidence of soft tissue injuries. Study Design: Case-control study. Level of Evidence: Level 3. Methods: Player workloads were assessed during preseason and regular-season practice sessions using GPS tracking and triaxial accelerometry from 2014 to 2016. Soft tissue injuries were recorded during each season. Player workload during the week of injury (acute) and average weekly workload during the 4 weeks (chronic) prior to injury were determined for each injury and in uninjured position-matched controls during the same week. A matched-pairs t test was used to determine differences in player workload. Subgroup analysis was also conducted to determine whether observed effects were confounded by training period and type of injury. Results: In total, 136 lower extremity injuries were recorded. Of the recorded injuries, 101 injuries with complete GPS and clinical data were included in the analysis. Injuries were associated with greater increases in workload during the week of injury over the prior month when compared with uninjured controls. Injured players saw a 111% (95% CI, 66%-156%) increase in workload whereas uninjured players saw a 73% (95% CI, 34%-112%) increase in workload during the week of injury ( P = 0.032). Individuals who had an acute to chronic workload ratio higher than 1.6 were 1.5 times more likely to sustain an injury relative to time- and position-matched controls (64.6% vs 43.1%; P = 0.004). Conclusion: Soft tissue injuries in professional football players were associated with sudden increases in training load over the course of a month. This effect seems to be especially pronounced during the preseason when player workloads are generally higher. These results suggest that a gradual increase of training intensity is a potential method to reduce the risk of soft tissue injury. Clinical Relevance: Preseason versus regular-season specific training programs monitored with wearable technology may assist team athletic training and medical staff in developing programs to optimize player performance.


2017 ◽  
Vol 5 (7_suppl6) ◽  
pp. 2325967117S0026
Author(s):  
Ryan Tianran Li ◽  
Sagar Rambhia ◽  
Joe Sheehan ◽  
Michael Jonathan Salata ◽  
James Everett Voos

PEDIATRICS ◽  
1976 ◽  
Vol 57 (5) ◽  
pp. 793-793
Author(s):  
◽  
Fernando Atienza ◽  
Calvin Sia

Skateboard-riding has become increasingly popular among Hawaii's children. The thrill of the ride and the challenge of keeping one's balance and working intricate maneuvers while speeding down a hill captures the fancy of many of our young. This sport, however, has produced an alarmingly high toll of injury and illness. Pediatricians and emergency departments of our major hospitals have seen and taken care of large numbers of patients (aged between 3 years and 35 years, but with a distribution overwhelmingly pediatric) with significant injuries which include cerebral concussion, fractures, soft tissue injuries of varying degrees of severity and complications, and injury to internal organs. During a three-month period at the Kauikeolani Children's Hospital, July to August 1975, there were 16 patients admitted with the following: seven cerebral concussions, one skull fracture, five assorted bone fractures, one soft tissue injury and infection, one retroperitoneal hemorrhage, and one instance of major surgery for removal of the spleen. During the months of August and September 1975 the Emergency Department of Straub Clinic reported the following skateboard injuries: 14 fractures, 14 soft tissue injuries, 5 lacerations, and 2 cerebral concussions. Of the 35 patients seen, three were admitted—one with an open fracture, one with cerebral concussion, and one with a skull fracture. During a four-week period (two weeks in June and July and two weeks in August and September) at the Emergency Department of Kaiser Medical Center, 66 cases of skateboard injuries were seen with six patients requiring admission for fractures and brain concussion.


Author(s):  
Oneida A. Arosarena ◽  
Issam N. Eid

AbstractSoft tissue trauma to the face is challenging to manage due to functional and aesthetic concerns. Management requires careful regional considerations to maintain function such as visual fields and oral competence in periorbital and perioral injuries, respectively. Basic wound management principles apply to facial soft tissue injuries including copious irrigation and tension-free closure. There is no consensus and high-level evidence for antibiotic prophylaxis especially in various bite injuries. Ballistic injuries and other mechanisms are briefly reviewed. Scar revision for soft tissue injuries can require multiple procedures and interventions. Surgery as well as office procedures such as resurfacing with lasers can be employed and will be reviewed.


2019 ◽  
Vol 5 (3) ◽  
pp. 259-265 ◽  
Author(s):  
Niklas Friberg ◽  
Simon Schmidbauer ◽  
Charles Walther ◽  
Elisabet Englund

Abstract Aims To determine the rate of injuries related to cardiopulmonary resuscitation (CPR) in cardiac arrest non-survivors, comparing manual CPR with CPR performed using the Lund University Cardiac Assist System (LUCAS). Methods and results We prospectively evaluated 414 deceased adult patients using focused, standardized post-mortem investigation in years 2005 through 2013. Skeletal and soft tissue injuries were noted, and soft tissue injuries were evaluated with respect to degree of severity. We found sternal fracture in 38%, rib fracture in 77%, and severe soft tissue injury in 1.9% of cases treated with CPR with manual chest compressions (n = 52). Treatment with LUCAS CPR (n = 362) was associated with significantly higher rates of sternal fracture (80% of cases), rib fracture (96%), and severe soft tissue injury (10%), including several cases of potentially life-threatening injuries. Conclusion LUCAS CPR causes significantly more CPR-related injuries than manual CPR, while providing no proven survival benefit on a population basis. We suggest judicious use of the LUCAS device for cardiac arrest.


BMC Genomics ◽  
2017 ◽  
Vol 18 (S8) ◽  
Author(s):  
Shane M. Heffernan ◽  
Liam P. Kilduff ◽  
Robert M. Erskine ◽  
Stephen H. Day ◽  
Georgina K. Stebbings ◽  
...  

2020 ◽  
Author(s):  
yulong xie ◽  
yan peng ◽  
wengzong zhou ◽  
qiantong qin ◽  
hui wang ◽  
...  

Abstract Background Acupuncture therapy is well known. But there is no report that acupuncture in patients with coagulation dysfunction in stroke may lead to severe soft tissue injury. we report a case of acupuncture leading to severe soft tissue injury.Methods A 63-year-old female patient was hospitalized for stroke rehabilitation. After 2 years of discharge, severe subcutaneous hematoma caused by acupuncture was readmitted to hospital. She received medication and physical rehabilitation. we monitored the international standardized ratio (INR) in plasma and observed the degree of dissipation of subcutaneous hematoma. the changes of patients during treatment were explored by data analysis.Findings Subcutaneous hematoma (area 20×20 cm) disappeared completely after 3 weeks of physical factor therapy. Small range (area ≤3×3 cm) subcutaneous hematoma can heal itself within 2 weeks. Improper acupuncture is only one of the causes of soft tissue injury. Stroke with coagulation dysfunction is not a contraindication of acupuncture treatment.Interpretation Our report suggests that previously unanticipated acupuncture treatment for stroke patients with coagulation dysfunction may lead to severe multiple soft tissue injuries. Although coagulation dysfunction is not a contraindication of acupuncture treatment, acupuncture treatment for stroke patients with coagulation dysfunction should be vigilant, strengthen the level of acupuncture operation, and fundamentally eliminate the problem. These cases are validation and supplement of adverse clinical reactions caused by improper acupuncture.


2011 ◽  
Vol 24 (02) ◽  
pp. 126-131 ◽  
Author(s):  
C. Davidson ◽  
G. I. Arthurs ◽  
R. L. Meeson

Summary Objectives: Casts applied for orthopaedic conditions can result in soft-tissue injuries. The purpose of our study was to describe the nature and prevalence of such complications. Methods: We performed a retrospective review of medical records of dogs and cats that had a cast placed for an orthopaedic condition between October 2003 and May 2009. The data were analysed and categorised. Results: Of the 60 animals that had a cast placed, 63% developed a soft-tissue injury (60% mild, 20% moderate and 20% severe). Injuries could occur any time during coaptation, and an association with duration of casting and severity (p = 0.42) was not shown. Severe injuries took the longest to resolve (p = 0.003). Sighthounds were significantly more likely to develop a soft-tissue injury (p = 0.04), and cross-breeds were less likely (p = 0.01). All common calcaneal tendon reconstructions suffered soft-tissue injuries, but significance was not shown (p = 0.08). Veterinarians identified the majority of injuries (80%) rather than the owners. The financial cost of treating soft-tissue injuries ranged from four to 121% the cost of the original orthopaedic procedure. Clinical significance: Soft-tissue injuries secondary to casting occur frequently, and can occur at any time during the casting period. Within our study, sighthounds were more likely to develop soft tissue injuries, and should therefore perhaps be considered as a susceptible group. The only reliable way to identify an injury is to remove the cast and inspect the limb.


2020 ◽  
Vol 4 (4) ◽  
pp. 642-643
Author(s):  
Daniel Porter ◽  
Jeff Conley ◽  
John Ashurst

Introduction: Soft tissue injuries are a common presenting complaint seen in the emergency department following trauma. However, internal degloving injuries are not commonly seen by the emergency provider. Case Report: A 57-year-old male presented with right lower extremity pain, bruising, and swelling after a low-speed bicycle accident five days prior. Physical examination revealed an edematous and ecchymotic right lower extremity extending from the mid-thigh distally. Computed tomography of the thigh demonstrated a hyperdense foci within the fluid collection suggesting internal hemorrhage and internal de-gloving suggestive of a Morel-Lavallée lesion. Discussion: The Morel-Lavallée lesion is a post-traumatic soft tissue injury that occurs as a result of shearing forces that create a potential space for the collection of blood, lymph, and fat. First described in 1853 by French physician Maurice Morel-Lavallée, this internal degloving injury can serve as a nidus of infection if not treated appropriately. Magnetic resonance imaging has become the diagnostic modality of choice due to its high resolution of soft tissue injuries. Treatment has been focused on either conservative management or surgical debridement after consultation with a surgeon. Conclusion: The emergency physician should consider Morel-Lavallée lesions in patients with a traumatic hematoma formation to avoid complications that come from delayed diagnosis.


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