View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Carolina Digital Repository EPIDEMIOLOGY OF CERVICAL MUSCLE STRAINS IN HIGH SCHOOL AND COLLEGIATE MALE COLLISION ATHLETES Katherine Margaret Lee A thesis defense submitted to the faculty of the University of North Carolina at Chapel Hill in partial fulfillment of the requirements for the degree of Master of Arts in the Department of Exercise and Sport Science (Athletic Training) in the College of Arts & Sciences. Chapel Hill 2018 Approved by: Zachary Y. Kerr Melissa Kay Kristen L. Kucera William E. Prentice © 2018 Katherine Margaret Lee ALL RIGHTS RESERVED ii ABSTRACT Katherine Margaret Lee: Epidemiology of cervical muscle strains in high school and collegiate male collision athletes (Under the direction of Zachary Y. Kerr) Cervical muscle strains are an often-overlooked injury, with neck-/spine-related research typically focusing on spinal cord and vertebral injuries. Using data from two high school and one collegiate sports injury surveillances systems, this thesis describes the epidemiology of cervical muscle strains in four male sports in which contact is legal (football, ice hockey, lacrosse, and wrestling). Injury counts, injury rates, injury rate ratios, and distributions of participation restriction time, injury mechanism, and injury activity were examined by sport and level of play. At both the high school and collegiate levels, football had the highest cervical muscle strain injury rate. Most injuries occurred in competitions, were non-time loss (<24 hours of participation restriction time), and were due to player contact. Despite the low incidence, it is important to consider the development and evaluation of prevention strategies that may help reduce the negative effects sustained by athletes who suffer cervical muscle strains. iii TABLE OF CONTENTS TABLE OF CONTENTS ................................................................................................... iv LIST OF TABLES ............................................................................................................. vi LIST OF ABBREVIATIONS .......................................................................................... viii CHAPTER 1 ....................................................................................................................... 1 Clinical Significance ....................................................................................................... 3 Research Questions and Hypotheses ............................................................................... 4 CHAPTER 2 ....................................................................................................................... 7 Introduction ..................................................................................................................... 7 Cervical muscle strains.................................................................................................... 7 Epidemiology of neck strains in high school and college athletes .................................. 9 Injury surveillance systems with adolescent and young adult populations ................... 12 Using sports injury surveillance to examine neck strains in high school and college athletes ............................................................................................ 16 CHAPTER 3 ..................................................................................................................... 18 NCAA-ISP .................................................................................................................... 19 NATION........................................................................................................................ 20 Data Collection Process ................................................................................................ 21 Validity of HS NATION, NCAA-ISP, and HS RIO ..................................................... 22 iv Statistical Analyses ....................................................................................................... 23 Power ............................................................................................................................. 25 CHAPTER 4 ..................................................................................................................... 27 Frequencies.................................................................................................................... 27 Rates .............................................................................................................................. 29 Injury rate comparisons, by sport .................................................................................. 32 Injury rate comparisons, by level of play ...................................................................... 32 Participation restriction time ......................................................................................... 32 Injury Mechanism ......................................................................................................... 33 Injury Activity ............................................................................................................... 34 CHAPTER 5 ..................................................................................................................... 36 Rates .............................................................................................................................. 37 Participation Restriction Time ...................................................................................... 40 Injury Mechanism and Activity..................................................................................... 41 Strengths and Limitations.............................................................................................. 42 Clinical Implications ..................................................................................................... 43 Conclusion ..................................................................................................................... 45 TABLES ........................................................................................................................... 48 REFERENCES ................................................................................................................. 67 v LIST OF TABLES Table 1 Definitions and variables ........................................................................................... 48 Table 2 Validity of sports injury surveillance......................................................................... 50 Table 3 Variable coding for participation restriction time...................................................... 51 Table 4 Variable coding for basic mechanism ........................................................................ 52 Table 5 Variable coding for injury activity for football ......................................................... 53 Table 6 Variable coding for injury activity for ice hockey ..................................................... 54 Table 7 Variable coding for injury activity for lacrosse ......................................................... 55 Table 8 Variable coding for injury activity for wrestling ....................................................... 56 Table 9 Injury counts and athlete-exposures in NCAA men’s and high school boys’ football for cervical muscle strains .................................................................................. 57 Table 10 Injury counts, athlete exposures in NCAA men’s and high school boys’ ice hockey for cervical muscle strains ............................................................................. 58 Table 11 Injury counts, athlete exposures in NCAA men’s and high school boys’ lacrosse for cervical muscle strains ................................................................................. 59 Table 12 Injury counts, athlete exposures in NCAA men’s and high school boys’ wrestling for cervical muscle strains ............................................................................... 60 Table 13 Injury Rate Ratios (IRR) comparing cervical muscle strain rates within NCAA men’s and high school boys’ sports, by event type and time in season .............. 61 Table 14 Injury Rate Ratios (IRR) comparing cervical muscle strain rates within level of play, by sport ........................................................................................... 62 Table 15 Injury Rate Ratios (IRR) comparing cervical muscle strain rates within sport, by level of play ........................................................................................... 63 Table 16 Cervical muscle strain frequencies in NCAA men’s and high school boys’ sports, by participation restriction time ...................................................... 64 Table 17 Cervical muscle strain frequencies in NCAA men’s and high school boys’ sports, by injury mechanism....................................................................... 65 vi Table 18 Cervical muscle strain frequencies in NCAA men’s and high school boys’ sports, by injury activity ............................................................................. 66 vii LIST OF ABBREVIATIONS AE Athlete-Exposures CI Confidence Interval CPSC Consumer Product Safety Commission EMR Electronic Medical Record HS High School HS RIO High School Reporting Information Online HS NATION National Athletic Treatment, Injury, and