ABSTRACT:Mountain biking has increased in popularity in recent years. This review article provides an overview of the current literature on risk factors and mechanisms of injury in different disciplines of mountain biking. The head and upper extremity continue to be the most common injury sites. Mountain biking can cause serious injuries, including concussions and fractures. Although there are known risks associated with mountain biking, there is a paucity of studies on injury prevention strategies. Understanding risk factors and mechanisms of injuries is vital for improving rider safety and medical care.

The preparticipation physical evaluation (PPE) is important for athlete health and safety, and is required for participation in collegiate sports and the majority of US high schools. The vast majority of PPEs are completed using a paper PPE form. Previous work had developed an ePPE system and found it was efficient and yielded good athlete compliance and high physician satisfaction. Another study showed ePPE’s value for collecting and analyzing college athlete injury and illness data, suggesting strong potential for the ePPE to improve injury analysis as well as efficiency of the PPE. Despite these reports, use of electronic PPE forms has not become widespread. PURPOSE: 1) to develop and implement an ePPE system for collegiate athletes that simultaneously serves as a relational database for research purposes, 2) to assess perceptions of providers on the ePPE system compared to paper PPE forms, and 3) to demonstrate the research potential of an ePPE system by conducting a sample epidemiologic analysis using electronically collected data. METHODS: In this pilot feasibility study, researchers developed an ePPE system using REDCap, a HIPPA-compliant web application designed for academic research purposes. The ePPE form had the identical contents and questions as the paper PPE form already in use at the NCAA Division I institution. Athletes on three teams at were randomized to use the ePPE (n = 22) or the paper PPE (n = 21) form. Providers and athletes were later surveyed regarding their perceptions of the two systems. A sample epidemiologic analysis using ePPE data was conducted. RESULTS: The ePPE system was successfully developed and implemented. All athletic trainers and physicians preferred the ePPE over the paper PPE, and felt that the ePPE was more efficient. Data were easily extracted for analysis from the ePPE system. A sample epidemiologic analysis established concerns about concussions sustained by athletes (27.3% of athletes) and some behavioral and psychological symptoms reported by athletes (trouble sleeping, depression, and anxiety; 13.6-22.7% of athletes). CONCLUSIONS: While this was only a pilot feasibility study involving relatively small teams, we show that development and implementation of an ePPE system is technically feasible, is preferred by users, and facilitates sports research.

Withdrawn 2350 Board #186 June 1 9:30 AM 11:00 AM A Cross-sectional Look At Injuries Among Individuals Engaged In Crossfit Training: A Four-year Study. Yuri Feito, FACSM, Evanette K. Burrows, Loni P. Tabb. Kennesaw State University, Kennesaw, GA. Drexel University, Philadelphia, PA. (No relevant relationships reported) Little epidemiological data exist to describe the incidence of injury among individuals engaged in CrossFit training. PURPOSE: To examine the prevalence and incidence of injury among individuals engaged in CrossFit training over a four-year period. METHODS: Between 2013-2017, individuals (Females = F; Males = M) engaged in CrossFit training were asked to complete a survey designed to examine variables related to their participation in CrossFit training and their injury history over the previous 12 months (survey was distributed at the end of each year). RESULTS: A total of 3,079 individuals responded to the online survey. Data was only analyzed for the cases that had complete data (N = 3,049; F = 48.6%, M = 51.4%). Overall, 30.5% (n = 931) of individuals reported experiencing an injury, with no difference between F and M [14% (n = 436); 16.2% (n = 495), respectively; χ2= 1.65, p = 0.1989]. Of those who experienced an injury, 62.4% (n = 581) reported an injury to a single body part, while 37.6% (n = 350) reported injuries to multiple body parts; in addition, there were significant differences between males and females (χ2=8.43, p=0.0037) in the number of body parts injured. The shoulders (39%), back (36%), knees (15%), elbows (12%), and wrists (11%) recorded the highest prevalence of injury. Based on the assumed maximum number of workout hours per week, the injury rate was 0.27 per 1,000 hours (F = 0.28, M = 0.26); whereas, the assumed minimum number of workout hours per week resulted in an injury rate of 0.74 per 1,000 hours (F = 0.78, M = 0.70). CONCLUSIONS: To our knowledge, this is the first study to examine the prevalence and incidence of injury in a multi-year large sample of individuals participating in CrossFit training. Our findings support the notion that CrossFit training has similar rates of injury than other forms of exercise training. 2351 Board #187 June 1 9:30 AM 11:00 AM Incidence And Severity Of Collegiate Men’s Soccer Lower Leg Injuries On Artificial Versus Natural Grass Shianne M. Blessing, Michael C. Meyers, FACSM, Shad K. Robinson. Idaho State University, Pocatello, ID. Reported Relationships: S.M. Blessing: Contracted Research Including Principle Investigator; Partial support by FieldTurf USA. Recently, artificial turf has been developed to duplicate the playing characteristics of natural grass. No long-term studies have compared match-related, collegiate men’s soccer lower leg trauma between the two surfaces. PURPOSE: To quantify incidence, mechanisms, and severity of match-related lower leg collegiate men’s soccer injuries on artificial turf versus natural grass. METHODS: 11 universities were evaluated over 6 seasons for injury incidence rate (IIR) across injury severity, lower leg joint/muscle, elective imaging/surgery, type of tissue injured, injury mechanism/situation, player position, injury category, field conditions, cleat design, and turf age. RESULTS: Overall, 380 games (49.7%) were played on artificial turf versus 385 games (50.3%) played on natural grass. A total of 256 injuries were documented, with 109 occurring on artificial turf and 147 on natural grass. MANOVAs per 10 games indicated a significant playing surface effect by lower leg trauma-joint/muscle (F 11,256 = 5.668; P < .0001/F 4,256 = 17.931; P < .001), elective imaging/surgery (F 3,256 = 18.129; P < .0001), type of tissue injured (F 5,256 = 12.413; P < .0001), injury mechanism/situation (F 16,256 = 2.305; P < .001/F 8,256 = 5.592; P < .0001), injury category (F 6,256 = 40.251; P < .0001), and cleat design (F 3,256 = 2.258; P < .047), but none observed by severity injury, player position, and field conditions. Significantly lower IIRs (P = .05-.0001) across distal tibiofibular joint, 0.3 (95% CI, 0.2-0.5) vs 0.5 (95% CI, 0.3-0.8); lower leg muscles combined, 1.4 (95% CI, 1.1-1.8) vs 2.2 (95% CI, 1.8-2.6); total medical procedures combined, 0.8 (95% CI, 0.6-1.1) vs 1.2 (95% CI, 0.9-1.6); ligament sprains, 1.4 (95% CI, 1.1-1.8) vs 1.5 (95% CI, 1.2-1.9); muscle-tendon strain/spasm/tears, 0.6 (95% CI, 0.4-0.9) vs 0.3 (95% CI, 0.2-0.5); tackled from the side/behind, 0.7 (95% CI, 0.5-1.0) vs 1.2 (95% CI, 0.9-1.5); playerturf impacts, 0.2 (95% CI, 0.10.3) vs 0.4 (95% CI, 0.2-0.6); adverse weather conditions combined, 0.5 (95% CI, 0.3-0.8) vs 1.3 (95% CI, 1.0-1.7) between artificial turf and natural grass, respectively. CONCLUSION: Although similarities exist between both surfaces during competitive play, artificial turf is in many cases safer than natural grass when comparing this specific artificial surface and level of play. Copyright © 2018 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.

Objectives: Injury management is critical in the National Basketball Association (NBA), as players experience a wide variety of injuries. Recently, it has been suggested that game schedules, such as back-to-back games and four games in five days, increase the risk of injuries in the NBA. The aim of this study was to examine the association between game schedules and player injuries in the NBA.Design: Descriptive epidemiology study.Methods: The present study analyzed game injuries and game schedules in the 2012-13 through 2014-15 regular seasons. Game injuries by game schedules and players' profiles were examined using an exact binomial test, the Fisher's exact test and the Mann-Whitney-Wilcoxon test. A Poisson regression analysis was performed to predict the number of game injuries sustained by each player from game schedules and injured players' profiles.Results: There were a total of 681 cases of game injuries sustained by 280 different players during the three years (total N= 1443 players). Playing back-to-back games or playing four games in five days alone was not associated with an increased rate of game injuries, whereas a significant positive association was found between game injuries and playing away from home (p <0.05). Playing back-to-back games and away games were significant predictors of frequent game injuries (p <0.05).Conclusions: Game schedules could be one factor that impacts the risk of game injuries in the NBA. The findings could be useful for designing optimal game schedules in the NBA as well as helping NBA teams make adjustments to minimize game injuries. (C) 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

HISTORY: The patient is a 23 year-old recreational runner who reported acute onset of left foot pain while training for her first marathon. She was on mile 10 of a 16-mile run when she suddenly experienced pain in the region of the medial, plantar aspect of the left mid-foot. There was no specific event that caused the injury, such as stepping on an object or twisting her foot. She was able to finish her run, although the foot pain persisted. The medial mid-foot pain was exacerbated by weight bearing and relieved with non-weight bearing. She provided a history of a leg length discrepancy with the left side long. This had been treated with an insert. She reported no prior foot injuries and no history of stress fractures. There was no numbness, tingling, or weakness, and she reported normal menstrual periods. She had no medical problems and had no surgeries. PHYSICAL EXAMINATION: There was normal foot and ankle alignment. No swelling was present. She was tender to palpation only over the midpoint of the medial longitudinal arch. Active and passive tibiotalar and subtalar motion was normal and did not reproduce any symptoms. There was no pain with motion testing or palpation of the metatarsals, except over the medial longitudinal arch as previously noted. There was normal strength, sensation, and reflexes in the lower limbs. Distal pulses were normal. She did appear to have a leg length discrepancy with the left side 1.5 cm longer. Her gait was antalgic. Pain was reproduced with hopping on the left lower limb. DIFFERENTIAL DIAGNOSIS: 1. Plantar muscle strain 2. Plantar ligament sprain 3. Acute tendon injury 4. Stress fracture TEST AND RESULTS: Left foot AP, lateral, and oblique radiographs: - Normal alignment - No fracture, dislocation, or arthritis Left foot MRI - Partial rupture of the peroneus longus tendon at the distal attachment FINAL WORKING DIAGNOSIS: Partial left peroneus longus tendon rupture at its distal insertion. TREATMENT AND OUTCOMES: 1. Short leg walking boot for four weeks. 2. Physical therapy for a foot and ankle strengthening program. 3. Running gait evaluation. 4. Full, pain-free return to running at eight weeks.

Skiing and snowboarding are sports with an inherent risk of injury. Recently there has been an increasing interest in performing tricks, with the implementation of terrain parks at resorts worldwide. The addition of terrain parks at resorts has likely changed injury patterns and frequencies. PURPOSE: The purpose of this study is to characterize the types of injuries that skiers and snowboarders incur when riding inside versus outside terrain parks, broken down by age group. METHODS: This is a descriptive sports injury epidemiology study in a cohort of patients seen at a large western resort ski clinic. All patients presenting to the clinic during the 2007-2008 and 2008-2009 seasons were included. Injuries were categorized by age, body part and location (i.e. inside versus outside terrain parks). RESULTS: Of the injuries seen in clinic, 22.1% occurred inside terrain parks. The young adult group (17-24 years old) accounted for 47.6% of all terrain park injuries and the child/adolescent (24 years old) groups accounted for 36.5% and 15.9% respectively. In the child/adolescent group the most commonly injured body part inside and outside terrain parks was the wrist (33% and 36.8% respectively). The most commonly injured body part inside and outside terrain parks among the young adult group was the shoulder (25.4% and 22%). In the adult group shoulder injuries occurred more often inside terrain parks (22.2%) while knee injuries were more common outside terrain parks (36.7%). The percent of spine and head injuries inside the terrain parks was double that outside the terrains parks. The most common feature on which injury occurred inside terrain parks was jumps (64.1%). Among those injured on jumps the most commonly injured body part for skiers was shoulder (21.7%) and for snowboarders it was wrist (20.5%). CONCLUSIONS: Injury patterns differ inside versus outside terrain parks with a higher percentage of spine and head injuries inside terrain parks. Injury patterns also differ among age groups. Further research is needed to attempt to make skiing and snowboarding safer.

PURPOSE: Roller Derby has recently experienced a strong increase in popularity, with more than three hundred amateur leagues worldwide. Due to the physical nature of the sport, Roller Derby injuries are thought to be common. To date, however, there are no reports in the medical literature regarding injuries associated with the sport. The purpose of this study was to identify the incidence and injury patterns, as well as the risk factors associated with injuries in Roller Derby athletes. METHODS: A cross-sectional study utilizing a computer-based survey was used to document injuries associated with Roller Derby participation. Participants were solicited from members of an online Roller Derby discussion forum as well as through word of mouth, and received no incentive for completion of the survey. Epidemiologic data was collected regarding the incidence, nature, and treatment of Derby-related injuries, as well as the impact of those injuries on athlete participation. We examined differences in injury frequency and distribution with athlete characteristics using chi-squared analyses and two-sided t-tests. RESULTS: 918 questionnaires were completed, with participants ranging in age from 19-54 years (mean 31.7 years). 83% of respondents reported having sustained at least one Roller Derby-related injury. The most common site of injury was the knee (46%) followed by the foot/ankle (15%) and shoulder (12%). Acute, traumatic injuries were more common than those related to overuse (79% vs. 21%, respectively; c2=246.53; df=1; p<0.05). Half of all respondents reported experiencing two or more Roller Derby-related injuries, and most (70%) reported incomplete recovery (c2=119.36; df=1; p<0.05). Those who had experienced complete recovery were less likely to sustain recurrent injuries (t=4.105; df=746; p<0.05). The incidence of practice-related injuries was significantly higher than that of competition-related injuries (72% vs. 25%, respectively; c2=171.46; df=1; p<0.05). The incidence of injury increased with age (t=1.977; b=0.065; p<0.05). CONCLUSIONS: Roller Derby injuries are very common. Most are acute traumatic injuries, and many are associated with incomplete recovery and reduced Roller Derby participation. More research is needed on injury epidemiology and prevention in this unique population.

Medical care of athletes with disabilities parallels medical care for nondisabled athletes. Limb deficiencies, whether congenital, traumatic, or secondary to disease, confer certain challenges to sports participation. Although sports medicine research for people with disabilities lags behind sports medicine research for the nondisabled, there are nonetheless important points to be learned from the available body of published literature in this area. This article reviews the pertinent research literature and supplements it with clinical wisdom that may assist physicians, coaches, prosthetists, and trainers to help keep athletes with limb deficiencies active. The relevant epidemiologic, biomechanical, medical, and psychological issues are discussed.