Sports and Recreational Injury Research Projects

A Prospective Investigation of Mild Head Injury (MHI) in Sport: A Prevention Initiative

Mild head injury (MHI) represents one of the most challenging pathologies facing sports medicine personnel. The complexity of the brain and the few objective signs often manifested at the time of injury contribute to the difficulty surrounding MHI assessment. This study is expected to result in validation of a safe, practical, and cost-effective method for assessing concussion and preventing the serious effects of subsequent head injuries among high school and college athletes. Over the course of the study, a total of 9,094 athletes were baseline tested from 120 high schools and 15 colleges. A total of 375 mild head injuries were reported which falls just short of the 5% expected injury rate. In addition, a series of clinician satisfaction surveys are being analyzed. The research findings have been presented at several professional meetings including the American College of Sports Medicine, the American Orthopedic Society for Sports Medicine, and the National Athletic Trainers Association annual meetings. One manuscript was submitted in 2007 that focuses on the epidemiological clinical investigation of concussion in high school and college sports. Another manuscript will be submitted in 2008 regarding recovery patterns of concussed athletes and patterns of return to play decision making among certified athletic trainers managing athletes with concussions.

Key Personnel:

Kevin Guskiewicz, PhD, ATC (PI); Stephen W. Marshall, PhD; Bryan Smith, MD, PhD; Frederick Mueller, PhD

Other Organizations or Institutions Represented:

None

Funding:

National Center for Injury Prevention and Control

National Operating Committee on Standards for Athletic Equipment

Contact:

Kevin Guskiewicz, PhD, ATC

gus@email.unc.edu

Prospective Investigation of Sport-Related Concussion: Relationship Between Biomechanical, Neuroanatomical, and Clinical Factors

Objective, non-invasive, and rapid assessment of the severity of head injury is needed to determine when an individual athlete may return to play following injury. The study is designed to evaluate the relationship between biomechanical, neuroanatomical, and clinical factors associated with sport-related concussion. Symptomatology, neuropsychological function, and postural stability measured at selected post-injury points will be correlated to neuroanatomical measures taken with susceptibility weighted imaging and diffusion tensor imaging, as well as to linear and rotational acceleration of the head at impact, as measured by the Head Impact Telemetry System (HITS). The Fall 2007 season marked the start of the fourth year of data collection. To date, in excess of data on 140,000 head impacts have been collected, registering total of 14 cases of concussion. The initial three years of the study resulted in three companion papers being published in the December 2007 issue of Neurosurgery, and the project was featured in a nationwide NBC news story and on MSNBC.com.

Key Personnel:

Kevin Guskiewicz, PhD, ATC (PI); Stephen W. Marshall, PhD; J. Keith Smith, MD, PhD; Weili Lin, PhD; Mario Ciocca, MD; Daniel Hooker, PhD, ATC, PT; Scott Oliaro, MA, ATC; Dean Crowell, MA, ATC; Michael McCrea, PhD; Robert Cantu, MD; Joseph Bleiberg, PhD; Richard Greenwald, PhD

Other Organizations or Institutions Represented:

Waukesha Memorial Hospital, Emerson Hospital, National Rehabilitation Hospital, Dartmouth College

Funding:

National Center for Injury Prevention and Control

Contact:

Kevin Guskiewicz, PhD, ATC

gus@email.unc.edu

JUMP-ACL (Epidemiology of Jump-Landing Movements and ACL Injury)

Anterior Cruciate Ligament (ACL) injuries are devastating knee injuries that typically occur in physically active populations. Women have a higher risk of ACL injury than men, but the actual mechanism of this injury is unknown. This study focuses on human movement as a risk factor for ACL injury and combines an epidemiologic prospective cohort design with a biomechanical motion analysis assessment. The subjects in the cohort are 4,800 female and male cadets and midshipmen at the U.S. Naval Academy, the U.S. Air Force Academy, and the U.S. Military Academy at West Point. Enrollment will occur over 4 years. With three of the four enrollment years completed, a total of 4,365 of the projected 4,800 subjects (91%) have been enrolled. Of these, 39% are female. Data collection for ACL injuries is on-going, and, to date the study has registered 27 injuries. Preliminary analysis indicates that there are numerous important differences in landing mechanics between men and women, and between those with a history of ACL injury and those with no history of ACL injury. Several conference presentations have been made and several manuscripts are in preparation.

Key Personnel:

Stephen W. Marshall, PhD (PI); Darin Padua, PhD; Anthony Beutler, MD; Sue Wolf, MS; Dean Taylor, MD; William E. Garrett Jr., MD, PhD; Bing Yu, PhD; Kevin Guskiewicz, PhD, ATC; Barry Boden, MD; Scott Pyne, MD; John Tokish, MD; Thomas DeBerardino, MD

Other Organizations or Institutions Represented:

Uniformed Sciences Health Services University
United States Naval Academy
The Orthopedics Center
United States Air Force Academy
United States Military Academy at West Point

Funding:

National Institute for Arthritis, Musculoskeletal, and Skin Disorders
The American Orthopedic Society for Sports Medicine

Project Website:

JUMP-ACL

Contact:

Stephen W. Marshall, PhD

steve_marshall@unc.edu

Center for the Study of Retired Athletes

Hundreds of athletes retire every year, many of whom were forced to abuse their bodies throughout a career that likely caused them to play injured and crippled on occasion. These very same “bodies” which provided an opportunity of a lifetime for some players, are now deteriorating. The Center for the Study of Retired Athletes, which is housed in the Department of Exercise and Sport Science at UNC-Chapel Hill, was developed in 2000. The primary goals of the Center are to: 1) collect epidemiological data on retired professional athletes; and 2) provide medical care for select retirees in a research setting. The hope is that the research findings will help improve the quality of life for many retired athletes. This information also will be used to prepare active athletes for a healthier retirement. Now the Center is focusing on part two of its mission; to provide medical care to select retired NFL players in a research setting. Retired NFL players with chronic low back pain are invited to the Center for an intensive physical therapy evaluation that includes: 1) a prescription for therapeutic exercises; 2) a consultation with an orthopedic surgeon; 3) a nutrition consultation; and 4) a screening for depression. To expand the scope of this work, in 2007, two proposals were submitted, that if funded, would allow Center personnel to explore the relationship between recurrent concussion and hypopituitarism in retired NFL players, and to explore the effects of Omega-3 fatty acid supplementation in retired NFL players who suffer from memory dysfunction.

UNC IPRC assists the Center for the Study of Retired Athletes by providing biostatistical support and participating on the Center’s advisory board.

Key Personnel:

Kevin Guskiewicz, PhD, ATC (PI); Stephen W. Marshall, PhD

Other Organizations or Institutions Represented:

National Football League Player’s Association

Funding:

Office of the UNC Vice Chancellor for Research and Economic Development

Office of the Dean, UNC College of Arts and Sciences

The National Football League Player’s Association

Professional Athletes Foundation

Medtronic, Inc

Contact:

Amy Matthews, MSW

novello@email.unc.edu

A Prospective Analysis of Head Impacts Sustained in Bantam-Aged Minor Hockey Players

As with UNC IPRC’s similar study in football players (above), objective, non-invasive, and rapid assessment of the severity of head injury is needed to determine when an individual hockey player may return to play following head injury. The study is designed to describe and compare specific measures for a representative level Bantam-aged minor hockey team in Canada (Ontario, Toronto Region), and a similarly matched representative level Bantam-aged minor hockey in the U.S. (North Carolina). Primary data will be collected from the Head Impact Telemetry System or HITS. At both sites, the researchers are conducting qualitative and quantitative kinematic descriptions of impact events and measure time in play to establish a baseline for the number and severity of head impacts among Bantam-aged minor league hockey players. During the past year, there were several conference presentations, manuscript development, and the development of a research proposal to the National Operating Committee on Standards for Athletic Equipment (NOCSAE) which would allow inclusion of a second team in the study and follow-up of both teams for a period of two more seasons.

Key Personnel:

Kevin Guskiewicz, PhD, ATC (PI); William Montelpare, PhD; Jason Mihalik, MS, CAT(C), ATC

Other Organizations or Institutions Represented:

Lakehead University ( Canada)

Funding:

Ontario Neurotrauma Foundation ( Canada)

USA Hockey

Contact:

Kevin Guskiewicz, PhD, ATC

gus@email.unc.edu

A Comparison of Lower Extremity Kinematics, Muscle Activation, and Strength Between Individuals With and Without Patellofemoral Pain

Patellofemoral pain syndrome (PFPS) is one of the most common causes of knee pain in the U.S. The overall goal of this investigation is to compare lower extremity kinematics, muscle activity, and strength between individuals with and without PFPS. The specific aims are to compare: 1) lower extremity kinematics between individuals with and without PFPS during a walking, jump-landing, stair ascent, and stair descent task; 2) muscle activity of the vastus medialis oblique, vastus lateralis, and gluteus medius between individuals with and without PFPS during a walking, jump-landing, stair ascent, and stair descent task; and 3) the strength of the hip abductors, hip external rotators, and hip extensors between individuals with and without PFPS. One presentation and a manuscript have been prepared. Others are underway.

Key Personnel:

Michele Boling, MS, ATC (PI); Darin Padua, PhD, ATC (advisor); Alex Creighton, MD

Other Organizations or Institutions Represented:

None

Funding:

National Center for Injury Prevention and Control (IPRC Student Small Grant)

Contact:

Michele Boling, MS, ATC

boling@email.unc.edu

Triathlete Health and Fitness Survey: An Epidemiological Study of Training Practices and Injury Patterns in Amateur North Carolina Triathletes (Student Project)

There is little in the way of literature on the topic of injuries in triathletes. The ultimate purpose of this study is to guide injury prevention methods to be used by clinicians, coaches, and triathletes themselves by examining the associations between training patterns, demographics, and injury incidence over the course of an entire triathlon season (March to October 2006) in amateur triathletes in North Carolina. The specific research questions are designed to determine if there is: 1) an association between lower extremity overuse injuries and running training (distance and intensity); 2) an association between diagnosis of trochanteric bursitis or diagnosis of lower back pain and cycling training (distance and intensity); 3) an association between shoulder injuries and swimming training (distance and intensity). Secondary questions involved: observing associations between diagnoses of select traumatic and overuse injuries; individuals’ experience in the sport; the influence of somatotype and anatomical factors such as height, weight, and body mass index; effects related to gender; and use of dietary supplements. Two presentations of the findings have been made.

Key personnel:

Joshua Tennant, MD, MPH (PI); Kevin Guskiewicz, PhD, ATC (advisor)

Other Organizations or Institutions Represented:

None

Funding:

National Center for Injury Prevention and Control (UNC IPRC Student Small Grant)

Contact:

Joshua Tennant, MD, MPH

josh.tennant@gmail.com

Electrical Stimulation to Improve Proprioception in the Normal Knee (Student Project)

It is estimated that by the year 2030, 20% of Americans (about 70 million people) will have passed their 65th birthday, and will be at risk for osteoarthritis (OA) -- the most common joint disorder throughout the U.S. -- with OA of the knee being especially common and debilitating. The objective of this proposed research is to evaluate knee proprioception during both a nonweight bearing (NWB) and partial weight bearing (PWB) task for the following four conditions: 1) no electrical stimulation/no knee sleeve (control), 2) electrical stimulation/no sleeve, 3) no electrical stimulation/sleeve, and 4) electrical stimulation/sleeve. The study is complete and was presented on August 20, 2007 as partial fulfillment of a Master of Science in Biomedical Engineering.

Key personnel:

Amber Collins, BA (PI); Paul Weinhold, PhD (advisor)

Other Organizations or Institutions Represented:

None

Funding:

National Center for Injury Prevention and Control (UNC IPRC Student Small Grant)

Contact:

Amber Collins, BA

collins.at@gmail.com

The Effects of Hormone Concentration on Muscle Stiffness and Electromechanical Delay (Student Project)

ACL injuries occur at an annual rate of 1 per 3000 people, and the associated per year health care cost is estimated to be more than $2 billion. Females are 2-8 times more likely to injure the ACL compared to males when participating in sports such as basketball and soccer that involve jumping, landing, and cutting. Hormonal differences have been a proposed explanation for the ACL injury rate discrepancy between genders. The purpose of this investigation is to determine the influence of reproductive hormones on biomechanical and neuromuscular properties of muscle. The specific aims of this study are to: 1) determine the relationship between hormone concentration (estrogen and progesterone) and active hamstring stiffness and electromechanical delay (EMD) in young adult females not using an oral contraceptive; and 2) determine the relationship between the concentration of testosterone and active hamstring stiffness and EMD in males.

Key personnel:

David Bell, Med, ATC (PI); Darin Padua, PhD, (advisor)

Other Organizations or Institutions Represented:

None

Funding:

National Center for Injury Prevention and Control (UNC IPRC Student Small Grant)

Contact:

David Bell, MEd, ATC

bell@email.unc.edu