University of Alberta INJfTRIES IN ELITE CANADLAN WOMEN'S FIELD HOCKEY by A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Master of Science. Faculty of Physical Education and Recreation Edmonton, Alberta Spnng, 2000 National Library Bibliiéque nationale I*I ofCada du Canada Acquisitions and Acquisitions et Bibliographic Services senrices bibliographiques 395 Weinngton Street 395, rue Weüargtcm OttawaON K1AON4 ûttawON K1AW Canada canada The author has granted a non- L'auteur a accordé une licence non excIusive licence dowing the exchwve permettant à la National Libmry of Canada to Bibliothèque nationale du Canada de reproduce, loan, distn'bute or sell reproduire, prêter, distn'buer ou copies of this thesis in rnicroform, vendre des copies de cette thèse sous papa or elecironic formats. la forme de microfiche/nlm, de reproduction sur papier ou sur fonnat électronique. The author retains ownership of the L'auteur conserve la propriété du copyright in this thesis. Neither the droit d'auteur qui protège cette thèse. thesis nor substantial extracts fiom it Ni la thèse ni des extraits substantieIs may be p~tedor otherwise de celiesi ne doivent être imprimes reproduced without the author's ou autrement reproduits sans son perrm*ssion. autorisation. ABSTRACT A prospective cohort study was undertaken to ascertain the patterns and nature of injuries and the extrinsic risk factors associated with these injuries that occurred during the Canadian women's national field hockey team's preparation for the 1999 Pan Amencan Games. Chronic injuries caused by ovemse, including fatigue, cramps and non- specific joint trauma, muscle strains, tendinitis and poshual mechanical dys function, occurred most fkequently during ski11 training in practices. Acute injuries caused by contact and rnechanical stress, such as contusions, spins and traumatic mechanical dysfunction, occurred more frequently in games than in practices, and more fiequently in the second hdf. The majority of injuries were of rnoderate severity. The lack of effect of extrinsic nsk factors on injury and the theoretical basis for the causes of chronic and mechanical stress injury suggest that iùture research should be directed toward intrinsic causes of injury. ACKNOWLEDGEMENTS 1 would like to thank the following for their contribution to this thesis. Dr. W. Meeuwisse - for allowing me to adapt the Canadian Intercollegiate Sport Injury Registry (CISIR) for use in data collection. Members of the Canadian women's national field hockey squad - without their participation, this study would not have been possible. Field Hockey Canada - for granting permission to conduct this study. Dr Brian Fisher, Dr. Dru Marshall, Dr. David Magee and Dr. Eugene Romaniuk - a very special thank you for their advice and guidance. TABLE OF CONTENTS Chapter 1 Introduction 1.1 Introduction 1.2 Purpose 1.3 Benefits 1.4 Delimitations 1.5 Limitations 1.6 Definitions 1.7 Summary 1 -8 References Chapter 2 Review of Literatiire 2-1 Introduction 2.2 Review of Literature 2.2.1 Injuries in Field Hockey 2.2.2 Difficulties Associated with Sport Injury Studies 2.2.3 Considerations for Conducting an Injury Study 2.3 Summary 2.4 References Chapter 3 Methods 3.1 Introduction 3.2 Research Design 3.3 Subject Selection 3.4 Procedures 3.5 Definitions 3.6 Data Entry 3.7 Statistical Andysis 3.8 References Chapter 4 Results 4.1 Introduction 4.2 Summary of Finding 4.3 Incidence of Injuries 4.4 Patterns of Injury Occurrence 4.5 Nature of the Injuries 4.6 CauseofInjury 4.7 Seventy of Injury 4.8 Playing Position 4.9 Weather Conditions 4.1 0 Equipment 4.1 1 Bracing and Taping 4.12 References Chapter 5 Discussion 5.1 Introduction 5.2 Incidence 5.3 Patterns of Injury Occurrence 5.4 Nature of the Injuries 5.4.1 The Types of Injuries Observed 5.4.2 The Area Where Injuries Occurred 5.4.3 The Causes of Injury 5.4.4 The Severity of the Injuries 5.4.5 The Extrinsic Risk Factors Associated with Injury 5.5 Chronic Injury 5.6 Mechanical Stress 5.7 Contact Injuries 5.8 Summary 5.9 References Chapter 6 Summary, Conclusions, Recommendntioas 6.1 Suxnmary 6.2 Conclusions 6.3 Recommendations 6.4 References Appendix A Consent Form .. ,105 Appendix B Questionnaire on History of Previous Injury JO7 Appendix C Exposure Sheet ...109 Appendix D Injury Report Form ...Il0 Appendk E Original CISIR Report Form for Football ...Il2 Appendix F Primary and Secondary Muscles used in Strengthening .. -1 16 Exercises LIST OF TABLES Dates, Location and Number of Participants for Each Section of Centralized Training Frequency of Injury for the Different Types of Activities during Centralized Training Number of Weeks Participated in Cenûalized Training and Frequency of Injury for Each Study Participant Frequency of the Different types of Lnjury Frequency of New, Recurring and Ongohg Injuries Frequency of the Different Areas of the Body that were Injured Frequency of the Injuries that Occurred per Gross Area of the Body Frequency of Chronic and Acute Injuries that Occurred for Each Area of the Body Frequency of Chronic and Acute Injuries that Occurred in Practices And Games Frequency oFChronic and Acute Injuries that Occurred in the Specific Phases of Practices 4.10 ~re~uenc~of Chronic and Acute Injuries that Occurred in the Specific Phases of Games 4.1 1 Frequencies of the Different Causes of Injury 4.12 Frequencies of the Different Causes of Contact Injury 4.1 3 Causes of Injury for the Phases of Practice 4.14 Causes of Injury for the Phases of Games 4.15 Causes of Contact Injury for the Phases of Games 4.16 Frequency of the Seventy of Injury 4.17 Frequency of Injuries that Occurred Amongst the Various Playing Positions 4.18 Frequency of Injuries that Occurred in Different Weather Conditions 4.19 Frequency of the Type of Contact for Each Area of Injury 4.20 Frequency of the Type of Contact Injuries for the Different Types of Equipment Wom 4.2 1 Crosstabulation of Whether or Not the Player was Braced or Taped at the Time of Injury LIST OF FIGURES 4.1 The Number of Athletes who Suffered Different Numbers of Injuries .. .4 1 4.2 Number of Injuries per Day of Centralued Training ...42 4.3 TotalNumberofhjuriesthatOcc~edinEachZoneofPlayforAll ...54 the Games PIayed during Centraiized Training 4.4 The Number of Injuries that Occurred per Practice or Game Session .. -55 versus Turf Temperature CHAPTER 1 Introduction 1.1 Introduction Safe participation and performance enhancement are the cornerstones of sports medicine. Idormation regarding the incidence and severity of injuries and risk factors leading to injuries provides important idonnation to enhance both safety in training and competition and athietic success. Field hockey has the potential for many injuries. Serious injuries can include a loss of vision caused by a blow to the eye by a ball or stick and brain damage caused by a blow to the head by a stick, ball, or another player (Moore, 1987). Because of this injury potential, coaches need access to injury statistics in order to be aware of potentially dangerous situations and, consequently, to create safe training environments. Coaches at the elite level stnve to develop athletes and teams that are successful intemationally. At the highest levels of competition, such as the Olympic Garnes, success is measured by performance. At this Ievel of athletic involvement, small changes in physical characteristics of an athiete can translate into large changes in physicai performance. Injuries can create changes in the physical characteristics of an athlete. Some athletes will not be able to participate at al1 following an injury. Other athletes, while able to participate, may not be able to generate the full force, power, or range of motion that is required to be successful. When cornpeting for international prowess, the physical diffaences between participants can be mùiiscule. Consequentiy, any advantage an athlete can have physically may translate to a huge competitive advantage. Preventing injury, thus presenring the athlete's abiliîy to perform, can be considered a competitive advantage. Injury statistics that provide information regarding the risk factors of injury allow therapists and coaches to prepare athletes for the physical rigors of the sport. Unfortunately, there are few studies which describe in depth the incidence and severity of injuries occurrhg in field hockey (Fox, 1981; Jamison & Lee, 1989). Shidies that do exist describe university cornpetition or cornpetition only at toumaments, but not national team training and cornpetition. The Canadian women's national field hockey team has been involved in centralized training since the late 1980's. Centralized training refers to a situation where al1 athletes fiom one team train in one location for a period of weeks or months. During the period of centralization, technical, tactical and conditionhg training is closely monitored by the coaches and therapists. When the centralization ends, athletes retum to their home cities and continue to train in a Iess controlled environment. Because this tearn has chosen to train in a centralized fashion, and in order to provide a safe training environment and to preserve the athlete's ability to physically perform, it is important to have an understanding of the patterns of injuries that rnight occur. However, there are no studies that document injury rates or nsk factors during these periods. There are also no injury studies for other Canadian national team sports that train in a centralized fashion, such as men's and women's volleyball and women's ice hockey. While anecdotal experience by the medical staffinvolved with the national field hockey team recognized patterns of injuries occ&g fiom year to year, there has been no fomal documentation.