There has been considerable public concern regarding the effects of repetitive head impacts associated with heading the ball in soccer. This is relevant for adolescents whose brains are undergoing rapid development. The study investigated the relationship between strength, proprioception, endurance and range of motion of the cervical spine and impacts associated with heading the ball in adolescent male soccer players. The participants were 20 skilled players aged 15-18 years. Outcome measures included questionnaires, assessments of cervical spine function (range of motion, joint position error, isometric muscle strength and endurance) and the ratio of maximum head acceleration to maximum T3 acceleration (impact ratio) during each ball impact when heading the ball. Results showed that increased range of motion of extension of the cervical spine and lower joint position error in flexion of the cervical spine were associated with higher impact ratios. Greater isometric strength of the lateral flexors was associated with lower impact ratios. Endurance of the deep neck flexors was not associated with impact ratios. Strength training may be beneficial to decrease head impacts during soccer ball heading, especially in those with increased range of motion of extension of the cervical spine.

Due to its dynamic nature, lower limb injuries are common in badminton. Overuse injuries of the knee, including tendon related conditions, are the most common. During jumping and landing, force transference and dissipation through the trunk is required, with the trunk muscles playing a vital role. However, the relationship between knee pain and the ability to voluntarily contract the trunk muscles has not yet been explored in badminton players. A cross-sectional study of Australian badminton players was therefore conducted. Players performed a single leg decline squat to identify those with knee pain. Ultrasound imaging was used to image and measure the size of the multifidus and quadratus lumborum, and the ability to contract the abdominal and multifidus muscles. Voluntary contraction of the trunk muscles was conducted with the subjects lying down. Independent samples TTests were performed to test for between group differences. Badminton players with knee pain had larger quadratus lumborum muscles and demonstrated a greater change in muscle thickness from the rested to contracted state. While we cannot comment on causation or direction, over co-contraction of trunk muscles has been shown in other studies to be associated with increased ground reaction forces on landing. Motor control training has been successfully used in other conditions to modify trunk muscle recruitment patterns and may therefore potentially represent a useful approach for badminton players.

BACKGROUND:Health care organizations understand the importance of new technology implementations; however, the best strategy for implementing successful digital transformations is often unclear. Digital health maturity assessments allow providers to understand the progress made toward technology-enhanced health service delivery. Existing models have been criticized for their lack of depth and breadth because of their technology focus and neglect of meaningful outcomes.OBJECTIVE:We aimed to examine the perceived impacts of digital health reported by health care staff employed in health care organizations across a spectrum of digital health maturity.METHODS:A mixed methods case study was conducted. The digital health maturity of public health care systems (n=16) in Queensland, Australia, was examined using the quantitative Digital Health Indicator (DHI) self-assessment survey. The lower and upper quartiles of DHI scores were calculated and used to stratify sites into 3 groups. Using qualitative methods, health care staff (n=154) participated in interviews and focus groups. Transcripts were analyzed assisted by automated text-mining software. Impacts were grouped according to the digital maturity of the health care worker's facility and mapped to the quadruple aims of health care: improved patient experience, improved population health, reduced health care cost, and enhanced provider experience.RESULTS:DHI scores ranged between 78 and 193 for the 16 health care systems. Health care systems in the high-maturity category (n=4, 25%) had a DHI score of ≥166.75 (the upper quartile); low-maturity sites (n=4, 25%) had a DHI score of ≤116.75 (the lower quartile); and intermediate-maturity sites (n=8, 50%) had a DHI score ranging from 116.75 to 166.75 (IQR). Overall, 18 perceived impacts were identified. Generally, a greater number of positive impacts were reported in health care systems of higher digital health maturity. For patient experiences, higher maturity was associated with maintaining a patient health record and tracking patient experience data, while telehealth enabled access and flexibility across all digital health maturity categories. For population health, patient journey tracking and clinical risk mitigation were reported as positive impacts at higher-maturity sites, and telehealth enabled health care access and efficiencies across all maturity categories. Limited interoperability and organizational factors (eg, strategy, policy, and vision) were universally negative impacts affecting health service delivery. For health care costs, the resource burden of ongoing investments in digital health and a sustainable skilled workforce was reported. For provider experiences, the negative impacts of poor usability and change fatigue were universal, while network and infrastructure issues were negative impacts at low-maturity sites.CONCLUSIONS:This is one of the first studies to show differences in the perceived impacts of digital maturity of health care systems at scale. Higher digital health maturity was associated with more positive reported impacts, most notably in achieving outcomes for the population health aim.

Objective: To investigate trunk muscle size and function in elite and community volleyball players with and without a history of head, neck or upper limb injury. Design: Cross-sectional observational study. Setting: Volleyball training camp or training sessions. Participants: 86 volleyball players (elite = 29; community = 57). Main outcome measures: Information regarding history of head, neck or upper limb injuries was collected by self-report questionnaires. Trunk muscle size (multifidus, transversus abdominis, internal oblique and quadratus lumborum) and voluntary contraction (multifidus, transversus abdominis, internal oblique) were assessed using ultrasound imaging. Results: For trunk muscle size, no significant differences were found between elite and community volleyball players with and without a history of injury (all p > 0.05). A significant difference was found for voluntary contraction of the multifidus and transversus abdominis muscles for elite and community volleyball players with and without a history of injury (all p < 0.05). Conclusion: A difference in trunk muscle contraction but no change in trunk muscle size in players with a history of head, neck or upper limb injuries may represent an altered muscle recruitment pattern rather than a deficiency in trunk muscle strength. Prospective studies are required to determine if these adaptations are compensatory (and protective) or predispose players to further injuries.

Objectives: Test the odds of factors previously associated with lower limb injury (decreased size of the multifidus (MF) and increased size of the quadratus lumborum (QL) muscle) in an independent sample of Australian Rules Football (ARF) players. Design: Prospective cohort study. Setting: Professional ARF. Participants: Forty-three male ARF players. Main outcome measures: Cross-sectional areas (CSAs) of MF and QL muscles measured from pre-season ultrasound images. Playing season injuries were recorded by club personnel. A multivariable logistic regression model was used to evaluate the usefulness of MF and QL muscle size for predicting playing season lower limb injuries. Results: Fifteen players (35%) sustained a playing season lower limb injury. The multivariable model indicated that the odds of sustaining a lower limb injury during the season was 2.38 (95% CI: 1.18, 5.00; P 1/4 0.017) times less likely for a one cm(2) increase from the mean value in MF muscle CSA at the L5 vertebral level after adjusting for CSA of the QL, age and BMI. The main effect and interaction models positively predicted 75% of players that sustained a lower limb injury during the season (sensitivity 80%, specificity 85%). Conclusion: Future studies could examine the efficacy, feasibility and adherence of 'at risk' players to a pre-season training program aimed at increasing MF muscle size and monitor playing season injuries. (c) 2020 Elsevier Ltd. All rights reserved.

OBJECTIVES:To describe injuries associated with netball and risk factors for lower limb injuries. DESIGN:Prospective study. In the preseason, risk factors were investigated using self-report questionnaires and physical measurements. During the season, injuries were reported using a standardised report, verified by follow-up phone calls. Player training and game hours were recorded. SETTING:Australian community netball club. PARTICIPANTS:269 players from 9 divisions, aged 7-42 years. MAIN OUTCOME MEASURES:Injury incidence rates per 1000 exposure hours were calculated. The most common mechanism, nature and consequence of injury were determined from frequencies. Logistic regression was used to identify predictors of lower limb injury and determine adjusted odds ratios for each risk factor. RESULTS:169 injuries occurred with a rate of 13.8/1000 exposure hours (95% CI 11.8-16.0), majority (60%) to the lower limb. The most frequent injury mechanisms were collisions (28%) and awkward landings (27%), nature was 'Inflammation/swelling' (32%) and consequence was 'unable to continue playing/training' (50%). Previous history of injury (OR 6.9, 95% CI 3.7-13.0) and age greater than 13.5 years (OR 3.1, 95% CI 1.6-5.9) were significant risk factors for a season lower limb injury. CONCLUSION:Injury rates in this community netball club were high. Results suggest that further research regarding the implementation and effectiveness of injury prevention programs for community netballers is required.