The Drawbacks of Increasing Season Length to “Reduce Injury” from Professional to High School Sports

What’s your favorite Ohio sports team?

 

Photo by Dana Lewin on Unsplash

The Buckeyes.  Browns.  Bengals.

Blue Jackets.  Cavaliers.  Columbus Crew.  FC Cincinnati.  Indians.  Reds…

 

All these teams play in leagues where congested match schedules, season length and travel can negatively impact performance and potentially increase injury risk.

Photo by ÁLVARO MENDOZA on Unsplash

Let’s look at the challenges the Columbus Crew and FC Cincinnati face playing in Major League soccer.

Major League Soccer

  • MLS has aggressively expanded from 10 teams in 1996 to 23 teams in 2018.1

 

  • So, what has Major League Soccer done to the season schedule to accommodate so many teams?

  • In order to accommodate more teams, Major League Soccer has lengthened the season. 1
  • The number of games played during regular season has not changed dramatically since 1996, however some teams experience congested weeks of the season due to regular season games and tournament or friendly games being scheduled in the same week. 1
  • Research shows increased injury rates with congested schedules and longer seasons.2
  • Although a longer season may help increase the amount of rest between games in a season, this has potential to limit the amount of off season time and shorten the amount of time for an adequate preseason. 1
  • Learn more and read the full article from Physical Therapy in Sport by clicking here. 1

 

 

Let’s look at the challenges the Reds and the Indians face.

Major League Baseball

  • MLB has 30 teams across the United States with 162 games played from March to October.
  • The United States is one of the largest countries in the world forcing teams to travel long distances to play other teams.
  • Traveling across time zones can result in detriments to performance and a team’s record.3
  • Teams traveling from the eastern time zone to play a team on the west coast tend to have suboptimal performances, likely due to east coast teams playing closer to their normal bed times.4
  • In MLB, teams who had an advantage in regard to time zones had a higher winning percentage. 4

Photo by Keith Johnston on Unsplash

 

What challenges do the Browns and Bengals face?

 

National Football League

  • One potential issue with the NFL is the lack of recovery time for teams that have to play on Thursday Night Football.
  • Some teams have to play Sunday afternoon and then again Thursday evening giving players only three full days of rest.5
  • Although the NFL cites that injury rates are lower on Thursdays than other game days, it’s unknown if playing with less recovery effects player performance or effects the results of games thereafter.6
  • More research is needed on the effects of Thursday Night Football.

 

Photo by Andy Hall on Unsplash

 

How about the Blue Jackets?

National Hockey League

  • The NHL season typically starts in September/October and finishes in April, with each team playing approximately 82 games.
  • NHL has many of the same challenges as other leagues (congested weekly schedule, long season, etc), but the sport requires increased physicality.7

 

Photo by Tim Mossholder on Unsplash

 

How about the Cavaliers?

National Basketball League

  • The commissioner of the NBA has criticized many teams for benching star players during congested times in the season.
  • However, back to back games (3-4 games in five days) was predictive of injury during the 2012-2013 and 2014-2015 NBA seasons.8
  • Although the commissioner’s concern about fan experience are valid, occasionally resting star players may be a good strategy for teams to avoid injury during congested times in the season.

 

Photo by Ben Hershey on Unsplash

 

What about sports that hit a little closer to home, like high school baseball?

Ohio High School Baseball

  • Compared to surrounding states, Ohio had the shortest length of season to play the permitted number of contests and the earliest State
  • Ohio: *42 Days to play 27 games – this has changed for 2019 to include an extra week of play
  • Indiana: 59 Days to play 28 games
  • Kentucky: 74 days to play 36 games
  • Michigan: 69 days to play 38 games
  • Pennsylvania: 72 days to play 20 games

 

  • The concept of providing more rest time between games allows for the coaches to have more options to allow for rest between games and adhere to the recently imposed pitch count rules, but what happens if practice time is increased and the players spend more time throwing and playing?

 

  • The OHSAA has been tracking pitch counts for 2 years now on a voluntary basis, so more enforcement of tracking pitches and also injuries with the new season extension would be of great interest to researchers across the country.

 

So, in the end what can we make of these season extensions and additional games?  Sports is a business at many levels, but the idea of increasing injury potential or reducing performance levels needs to be strongly considered in light of revenue generation.

Another consideration is maybe sports will completely change and everyone will be playing League of Legends or NBA2K or some other esports game and watch their favorite athletes play continuously.  Of course, esport athletes are the next generation of high level performers that needs investigation.

Gotta run, time to get back to the lab and look at how we can help high level performers optimize and sustain performance daily and throughout their lifetimes.

 

Post Credit:

Cody Mansfield and James Onate

MOvES Lab Team

 

References:

1 Mansfield CJ, Ferkovic-Mack C, Eibensteiner J, Zwolski C. A review advocating caution with major league soccer expansion and investment in more rehabilitation professionals. Physical Therapy in Sport. 2018 May 9.

2Dupont G, Nedelec M, McCall A, McCormack D, Berthoin S, Wisløff U. Effect of 2 soccer matches in a week on physical performance and injury rate. The American journal of sports medicine. 2010 Sep;38(9):1752-8.

3Leatherwood WE, Dragoo JL. Effect of airline travel on performance: a review of the literature. Br J Sports Med. 2012 Nov 1:bjsports-2012.

4Winter WC, Hammond WR, Green NH, Zhang Z, Bliwise DL. Measuring circadian advantage in Major League Baseball: a 10-year retrospective study. International journal of sports physiology and performance. 2009 Sep;4(3):394-401.

5Simmons, B. (2012). A hierarchy of hypocrites. Grantland.

6Florio, M. (2016). What does the future hold for Thursday night Football?. Pro-FootballTalk. NBC sports.

7Kneeland AT. Man Games Lost in the NHL: A Correlation between Travel, Rest Periods and Injuries in the National Hockey League.

8Teramoto M, Cross CL, Cushman DM, Maak TG, Petron DJ, Willick SE. Game injuries in relation to game schedules in the National Basketball Association. Journal of science and medicine in sport. 2017 Mar 1;20(3):230-5.

 

 

Sport Specialization in Youth

Approximately 60 million children and adolescents between the ages of 6 and 18 years participate in some form of organized athletics in the United States (Fig 1).1 Single sport specialization is a growing topic of discussion in youth athletics. The American Medical Society for Sports Medicine (AMSSM) characterizes sport specialization as year round intense training in only one sport at the exclusion of other sports.2 Recent reports found that within a group of 1200 youth athletes, approximately one third participated in a single sport year-round.3,4 

Figure 1. Youth sports participation in the US. Adapted from the National Council of Youth Sports.1

Sports specialization, high intensity training, and participating in competitive events outside of the regular season are byproducts of an increasingly competitive nature of youth sports fueled even further by big business ventures from personal coaches, showcase events, etc.2 For several decades, it has been well documented that developing bones, specifically during puberty or growth, are more prone to injury from tensile, shear, and compressive forces.5-7 Bones more prone to injury, combined with the high intensities or frequencies of training that potentially accompany specialization, may contribute to a possible increase in risk of overuse injuries, albeit not directly.2 Studies have suggested that exceeding 16 hours of intense training per week8-10 (Fig 2)11 may increase injury rates. Year-round participation in sports, defined as playing sports over 4 seasons, may also increase risk of overuse injury among high school athletes.12 Although young athletes can often tolerate stress, there is a limit to the stress a youth athlete should experience and therefore proper time off and rest from sport activity is recommended to reduce risk of injury while maintaining long-term healthy athletic performance.2

Figure 2. Relationship of injury to exposure hours in high school athletes. Adapted from Jayanthi et al.11

Future research in this area should focus on what frequencies and intensities of training may correlate with overuse injuries or risk of injury with sport specialization.2 Such information could allow athletes to follow training programs that minimize injuries and maximize performance. Additionally, long-term studies comparing the effects of sport specialization with participation in multiple sports could prove worthwhile.2 These may allow insight on developmental differences and long-term implications resulting from participation variation.Minimal scientific evidence supporting the notion that earlier single-sport training is beneficial for success currently exists and further research is warranted.13 However, based on research that does exist, sport specialization may have some benefits. There is a general agreement in the sports medicine field that the number of purposeful hours spent in either training or practice is correlated with success.11 Some debate exists as to when intense training or practice should begin.11 It is also recognized that some degree of specialization is necessary to attain elite-level skills.14-18 This becomes more applicable as athletes age for most sports. Peak performance in some individual sports, such as diving or figure skating, may occur before the body matures, making specialization at preadolescent ages common (Figure 3).13 However, it is recommended that intense training in one single sport be delayed until late adolescence if possible in order to optimize success and reduce risk for injury and psychological stress.19-26

Figure 3. Recommendations for stage of specialization and sport. Adapted from Myer et al.13

As mentioned, there may be risks associated with specializing including the potential for increased psychological stress and overuse injuries. Although specialization may be appropriate for some athletes, the type of sport and age of the athlete should be considered. Regardless of whether youth choose to specialize or not, it is important to foster an environment that encourages athleticism and builds positive athletic experiences. Athleticism may be built through a variety of sports and training programs which cater to each child’s needs and interests.  The notion of playing multiple sports should not be the sole focus for injury prevention and performance enhancement considerations, the concept of athleticism and physical literacy are factors that should be strongly encouraged.  Individuals need to be provided various avenues for development and some may partake in a single sport, but need to supplement with cross sport sampling or less intense multi-sport  choices (e.g., playing high level baseball but playing recreational or social basketball) while others may choose to play two high level sports. Most importantly, children should enjoy sports and participating in an activity that builds positive healthy individuals who can grow physically and mentally.

Post Credit: Michael Lantz, Dan Clifton, Dr. James Onate

References

  1. National Council of Youth Sports. Report on trends and participation in organized youth sports 2008. http://www.ncys.org/pdfs/2008/2008-ncys- market-research-report.pdf. 2008. Accessed January 16, 2018.
  2. Difiori JP, Benjamin HJ, Brenner JS, et. al. Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine. Br J Sports Med. 2014; 48(4), 287-288.
  3. Jayanthi NA, Labella CR, Fischer D, et. al. Sports-specialized intensive training and the risk of injury in young athletes. Am J Sports Med. 2015;43(4):794-801.
  4. Wiersma LD. Risks and benefits of youth sport specialization: perspectives and recommendations. Pediatr Exerc Sci. 2000;12(1):13-22.
  5. Alexander CJ. Effects of growth rate on the strength of the growth plateshaft junction. Skel Radiol. 1976;1:67–76.
  6. Bright RW, Burstein AH, Elmore SM. Epiphyseal-plate cartilage. J Bone Joint Surg Am. 1974;56(4):688-703.
  7. Flachsmann R, Broom ND, Hardy AE,et. al. Why is the adolescent joint particularly susceptible to osteochondral shear fracture? Clin Orthop Relat Res. 2000;381:212-221.
  8. Rose MS, Emery CA, Meeuwisse WH, Sociodemographic predictors of sport injury in adolescents. Med Sci Sports Exerc. 2008;40(3):444-450.
  9. Jayanthi N, Dechert A, Durazo R, et. al. Training and sports specialization risks in junior elite tennis players. J Med Sci Tennis. 2011;16:14-20.
  10. Loud KJ, Gordon CM, Micheli LJ, et. al. Correlates of stress fractures among preadolescent and adolescent girls. Pediatrics. 2005;115:e399-e406.
  11. Jayanthi N, Pinkham C, Dugas L, et. al. Sports specialization in young athletes: evidence based recommendations. Sports Health. 2012;5(3):251-257.
  12. Cuff S, Loud K, Oriordan MA, Overuse injuries in high school athletes. Clin Pediatr. 2010;49(8):731-736.
  13. Myer GD, Jayanthi N, Difiori JP, et al. Sports specialization, part II alternative solutions to early sport specialization in youth athletes. Sports Health. 2016;8(1):65-73.
  14. American Academy of Pediatrics . Committee on Sports Medicine and Fitness. Intense training and sports specialization in young athletes . Pediatrics. 2000; 106: 154-157.
  15. American College of Sports Medicine . The prevention of sport injuries of children and adolescents . Med Sci Sport. 1993; 25(8): 1-7.
  16. FIMS/WHO Ad Hoc Committee on Sports and Children. Sports and children: consensus statement on organized sports for children. Bull World Health Organ. 1998;76(5): 445-447.
  17. Hughson R, Children in competitive sports: a multi-disciplinary approach. Can J Appl Sport Sci. 1986;11(4):162-172
  18. McLeod TCV, Decoster L, Loud KJ, et al. National Athletic Trainers’ Association position statement: prevention of pediatric overuse injuries. J Athl Train. 2011;46(2):206-220.
  19. Baker J , Côté J , Abernethy B . Sport-specific practice and the development of expert decision-making in team ball sports . J Appl Sport Psychol . 2003;15:12-25 .
  20. Barynina II , Vaitsekhovskii SM. The aftermath of early sports specialization for highly qualified swimmers. Fitness Sports Rev Int. 1992;27:132-133.
  21. Carlson R . The socialization of elite tennis players in Sweden: an analysis of the players’ backgrounds and development. Sociol Sport J. 1988;5:241-256 .
  22. Helsen WF , Starkes JL , Hodges NJ. Team sports and the theory of deliberate practice. J Sport Exerc Psychol. 1998; 20:12-34
  23. Hodges NJ, Starkes JL. Wrestling with the nature of expertise: a sport specific test of Ericsson, Krampe, and Tesh-Romer’s (1993) theory of “deliberate practice.” Int J Sport Psychol. 1996;27:400-424.
  24. Hume PA, Hopkins WG, Robinson DM, et. al. Predictors of attainment in rhythmic sportive gymnastics. J Sports Med Phys Fitness. 1994;33(4):367-377.
  25. Law M, Côté J, Ericsson KA. Characteristics of expert development in rhythmic gymnastics: a retrospective study. Int J Exerc Sport Psychol. 2007;5:82-103.
  26. Moesch K, Elbe AM, Hauge ML, et. al. Late specialization: the key to success in centimeters, grams, or seconds (cgs) sports. Scand J Med Sci Sports. 2011;21(6):e282-e290.

Alumni Spotlight: Kristen Looman

The MOvES Lab would like to recognize alumnus Kristen Looman, who graduated with a B.S. in Biology in 2016. In her three undergraduate years spent in the lab, Kristen was involved in various projects with a main focus in prediction and prevention of musculoskeletal injury in collegiate athletes. Currently, Kristen is working full-time as an Anesthesiology Technician at the Ohio State Wexner Medical Center and volunteers Monday evenings with the Physician’s Care Connection. Her future aspirations are to attend a physician assistant program.

During her time in the lab she gained hands-on experience in the field of sports medicine and biomechanics, and learned about the fundamentals of scientific research. Furthermore, she learned how to overcome adversity, approach issues in new ways, and gain new confidence in academic settings.

“As a scientist and young professional, I understand the importance to advance the field of medicine. With sports being a huge part of my life growing up, I felt an interest in sports medicine, and this led me to join Dr. Onate’s team. During my time, I was able to learn about issues that fascinated me with other like-minded individuals. I found a group of mentors who guided me to communicate my own ideas while analyzing and critiquing others’ work. With their help, I gained confidence in myself and overall became a self-sufficient individual. I did the classwork to earn a Bachelor of Science, but it was through this lab that I became scientist.”

We are very proud of Kristen and wish her the best of luck on her future endeavors!

 

 

Welcome Dr. Boucher to The MOvES Lab!

The MOvES Lab would like to extend a warm welcome to Laura Boucher, PhD, AT, ATC, in her new role as Associate Lab Director! Dr. Boucher was hired as an Assistant Professor-Clinical in in 2014, with a teaching focus in musculoskeletal and orthopedic anatomy. Her research focuses on our improving anatomical and biomechanical understanding to reduce risk of injury in car crashes and sports.

Dr. Boucher completed her undergraduate studies at Ohio University with a BS in Athletic Training. She then earned her Master’s degree at the University of North Carolina-Chapel Hill in Exercise Science-Athletic Training, where she also served as a Graduate Assistant Athletic Trainer. Her master’s thesis explored the effects of fatigue on core muscle activation during sporting tasks.

Following graduate school, she was hired at Capital University in Bexley, Ohio as an Assistant Athletic Trainer. After two years, she moved into a duel faculty/athletic training position, teaching and advising within the Health and Sport Sciences Department, while continuing to provide athletic training services to Capital University Athletics teams. Her teaching responsibilities spanned from health and nutrition classes, to motor learning and biomechanics, and upper and lower extremity physical exam courses. Dr. Boucher provided Athletic training services to a variety of teams while at Capital University, including Football, Volleyball, Indoor and Outdoor Track and Field, and Women’s Basketball.

Her love of teaching and research continued to grow while working at Capital, which eventually led her to purse a PhD in Anatomy at The Ohio State University. She studied under the direction of Dr. John Bolte IV and completed her research in the Injury Biomechanics Research Center. Her work focused on evaluating pediatric ankle biomechanics, which led to the development a more biofidelic pediatric crash test dummy ankle and leg. Upon finishing her PhD, she was hired by The Ohio State University in the Division of Anatomy in 2014. In 2016 she joined the Athletic Training faculty. Her academic responsibilities include teaching gross anatomy in the Bone and Muscle Disorders Block for the first-year Medical students. She also teaches gross anatomy to the Physical and Occupational Therapy students and team teaches other courses to Biomedical Engineering and Athletic Training undergraduate students. She mentors and advises numerous students and serves as the Associate Block Director for the Bone and Muscles Disorders Block in the College of Medicine.

Dr. Boucher’s research continues to focus on pediatric injury biomechanics and more recently has started to explore the role of using musculoskeletal ultrasound in teaching physical exam skills, exploring how tissue responds to stress, as well as applications to aid in clinical decision making. We are excited to grow our faculty and add Dr. Boucher’s perspective to the MOvES lab.

https://www.researchgate.net/profile/Laura_Boucher2

Student Spotlight- Maria Talarico, MS

The MOvES Lab would like to extend a warm welcome to Maria Talarico, a new, but returning member of the lab!  Maria started in the MOvES Lab as a Biomedical Engineering undergraduate student during her junior year (2011) with a research focus on postural control stability and variability of athletes while completing the anterior reach task.  Upon completion of her B.S. in Biomedical Engineering with a Minor in Exercise Science at Ohio State in 2013, Maria continued her studies in biomechanics at the University of North Carolina at Chapel Hill and North Carolina State University through the Joint Department of Biomedical Engineering.  While completing her M.S., Maria conducted research in the Matthew A. Gfellar Sport-Related Traumatic Brain Injury Research Center under the guidance of Dr. Jason Mihalik.  Her thesis concentrated on the effects of single leg squat performance, functional and postural control parameters, and visual reaction time performance under single- and dual-task paradigms.  In addition to research, Maria was a Teaching Assistant to undergraduate Biomedical Engineering students in quantitative human physiology, fundamental biomechanics and human kinetics, and biomedical instrumentation courses.  In September 2015, Maria started working at the U.S. Army Research Laboratory (ARL) in Aberdeen Proving Ground, MD as a Post-Graduate Biomechanics Researcher.  Maria worked with a Biomechanics research team until July 2017 investigating physical and cognitive performance of Dismounted Soldiers during load carriage tasks and with physical augmentation devices in operationally-relevant situations.  After 2 years of working with the Army, Maria is very excited to return to Ohio State where she will apply her biomechanics expertise and research experiences as a member of the MOvES Lab while pursuing a PhD in Biomedical Engineering.  Maria’s research interests include functional and cognitive performance in dual-task paradigms in healthy and concussed individuals, human movement patterns of specialized tasks in athletics and the military, and the neuromechanical effects pre- and post-injury.

2017 Denman Research Forum

Yesterday was a big day for the MOvES Lab, as we had eight of our lab members present at the 2017 Denman Forum. The Denman Forum provides an opportunity for undergraduate students to showcase their research, scholarship, and creative activities to the OSU community and beyond.  We are so proud of everyone’s great professionalism, support, enthusiasm and critical thinking. Congratulations, MOvES Lab!

A “Living Bandage” For Knee Injuries

Over one million people a year in the United States and Europe alone suffer from meniscal tears. Scientists at the Universities of Liverpool and Bristol have tested a “living bandage” comprised of stem cells to repair such injuries. The difficulty in treating this common sports knee injury is that more than 90% of tears occur in the meniscus’ “white zone” where there is a great lack of blood supply.

Azellon has designed the Cell Bandage which encourages cell growth of the meniscal tissue in order for the tear to repair itself. The prototype was trialed in five patients with white zone meniscal tears. Stem cells which were harvested in the patient’s bone marrow were grown for two weeks and then delivered into the site of injury. The Cell Bandage was then implanted into the middle of the meniscal tear, and cartilage was sewn around the bandage to secure it in place.

12 months post-op, all five patients had an intact meniscus. 24 months post-op, three of the five still had success and returned to normal knee function. The other two of the five had removal of the meniscus due to the return of symptoms or a new tear.

Chair of Stem Cell Biology at the University of Liverpool and Founder and Chief Scientific Officer of Azellon, Anthony Hollander says, “The Cell Bandage trial results are very encouraging and offer a potential alternative to surgical removal that will repair the damaged tissue and restore full knee function. We are currently developing an enhanced version of the Cell Bandage using donor stem cells, which will reduce the cost of the procedure and remove the need for two operations.”

Professor Ashley Blom, Head of Orthopedic Surgery at the University of Bristol commented: “The Cell Bandage offers an exciting potential new treatment option for surgeons that could particularly benefit younger patients and athletes by reducing the likelihood of early onset osteoarthritis after meniscectomy.”

 

Post Credit

Study Finds Girls Have Higher Risk of Overuse Injuries in High School Athletics

 

Researchers at The Ohio State University Wexner Medical Center have found that female high school athletes have a much higher risk of overuse injuries than males of the same age. Overuse injuries include stress fractures, tendonitis, and joint pain. These injuries occur when athletes repeatedly perform the same motion. Overuse injuries account for half of all athletic injuries and are more prevalent in teens ages 13-17.

Dr. Thomas Best studied 3,000 male and female injury cases across a seven year period. The cases came from twenty high school sports which included lacrosse, gymnastics, soccer, and volleyball. He and his team found that girls track reported the highest rate of overuse injuries (3.82). Girls field hockey (2.93) and girls lacrosse (2.73) followed. Boys overuse injuries were most prominent in swimming and diving (1.3).

“These young people spend more time playing sports both in competition and in practice. So, there’s a correlation there between the amount of time that they’re playing and the increased incidence of injuries,” said Best.

According to Best, some high school athletes spend upwards of 18 hours a week participating in athletics. Many even participate in more than one sport at a time.

The lower leg is generally the most common site of overuse injuries. The knee and the shoulder follow next. Best recommends that teen athletes vary their movement. This can be accomplished by playing more than one sport. He also advises his patients to focus on rest and proper nutrition.

“During this point of their lives, this is when girls are developing bones at the greatest rate,” Best said. “It’s incredibly important that they’re getting the proper amounts of calcium and vitamin D.”

 

Post Credit

MOvES Lab Graduates!

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Congratulations to two excellent undergraduate research assistants, Kristen Looman and Olivia DiCarlantonio, for their recent graduation!  Kristen received her B.S. in Biology and will be working as an Anesthesia Technician at the Wexner Medical Center as she prepares for medical school.  Olivia graduated with a B.S. in Public Health and is pursuing a career in medical device sales.