Journal of Qualitative Research in Health Sciences

Document Type : Original Article

Authors

1 1. PhD Candidate in Sports Injuries and Corrective Exercises, Faculty of Sport Sciences, Shahid Bahonar University of Kerman, Kerman, Iran

2 2. Professor, Faculty of Sport Sciences, Shahid Bahonar University of Kerman, Kerman, Iran

3 3. Associate Professor, Faculty of Sport Sciences, Shahid Bahonar University of Kerman, Kerman, Iran

Abstract

Introduction: Since school sports are the main cause of students’ injuries, awareness of the causes and factors underlying these injuries can pave the way for the development and planning of injury prevention strategies. The present study was conducted in two quantitative and qualitative phases using the data in the sports injury surveillance system and the interviews designed by the researchers to analyze the epidemiological indicators and causes of students’ injuries.
Methods: This mixed-method study was conducted using qualitative and quantitative descriptive techniques. The injuries made to male students of physical education high schools in Kerman were recorded for 6 months in a sports injury surveillance system developed by the researchers. Then, the qualitative data were collected using in-depth and semi-structured interviews to explore the possible causes of sports injuries. The collected data were analyzed using a content analysis method via descriptive statistics and the chi-square test with SPSS software (version 21) at a significance level of P=0.05. Besides, the qualitative data were analyzed using a conventional content analysis technique.
Results: The results of data analysis indicated that most of the injuries occurring in sports movements to the student-athletes were caused by collision. Moreover, muscle strain injuries were the most frequently found sports injuries. Improper techniques were also reported as the most important cause of sports injuries. Pain was found as the most significant indicator of the early post-injury symptoms. An analysis of the quantitative-descriptive data recorded in the sports injury surveillance system showed the injury incidence rate of 33.3 injuries per 100 student-athletes and 63.3 injuries per 100 hours of training and competition. Furthermore, the lower extremity with 51.6% and minor injuries with 45.3% showed the highest rate and improper techniques accounting for 25% of the injuries were the most important risk factor for injury.
Conclusion: Given the high prevalence of muscle strains and the highest percentage of lower extremity injuries in students caused by using improper techniques, addressing sports injury indicators, as well as explaining their causes and underlying factors can significantly contribute to reducing students’ injuries. Moreover, regular systematic reviews of epidemiological studies can be effective in developing practical programs for injury prevention in students.

Keywords

  1. Rahimi M, Ghasemi Gh, Halabchi F, Zolaktaf V. Prevalence of karate injuries in professional karate athletes in Isfahan. J Mil Med Sci Univ Iran. 2009; 3(7):201-7. [In Persian].
  2. Sahebozamani M, Beyranvand R. A review of injury assessment in Iranian martial artists: Systematic review. Scientific Journal of Rehabilitation Medicine. 2016; 5(2):235-48. doi: 10.22037/JRM.2016.1100189. [In Persian].
  3. Rahnama N, Bambaeichi E, Nazariyan AB. Daneshjo A. Incidence and causes of acute injury among collegiate soccer players. Olympic. 2007; 15(2):39-47. [In Persian].
  4. Lauersen JB, Bertelsen DM, Andersen LB. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomized controlled trials. Br J Sports Med. 2013; 48:871-877 doi: 10.1136/bjsports-2013-092538.
  5. Fuller CW, Ekstrand J, Junge A, Andersen TE, Bahr R, Dvorak J, Hägglund M, McCrory P, Meeuwisse WH. Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Clin J Sport Med. 2006; 16(2):97-106. doi: 10.1097/00042752-200603000-00003.
  6. Foss KDB, Thomas S, Khoury JC, Myer GD, Hewett TE. A school-based neuromuscular training program and sport-related injury incidence: a prospective randomized controlled clinical trial. J Athl Train. 2018; 53(1):20-28. doi: 10.4085/1062-6050-173-16. 
  7. Bahr R, Holme I. Risk factors for sports injuries a methodological approach. Br J Sports Med. 2003; 37(5):384-92. doi: 10.1136/bjsm.37.5.384.
  8. Varkiani ME, Alizadeh MH, Pourkazemi L. The epidemiology of futsal injuries via sports medicine federation injury surveillance system of Iran in 2010. Procedia-Social and Behavioral Sciences. 2013; 82:946-51. doi: 10.1016/j.sbspro.2013.08.001.
  9. Nejaati V. Prevalence and causes of sports injuries in female athlete students. Harakat. 2008; 35:117-128. [In Persian].

10. Pakravan M, Sahebozamani M, Ghahramantabrizi K. Investigating the prevalence and causes of sports injuries among physical education students. J Sport Medicine. 2009; 2:81-95. [In Persian].

11. Baher R HLSM, Rahnama N, Mohammadi H. Rahnama N. Sports sciences research institute. Tehran: Sports Injuries Prevention Guide. 2002; (1):25-8.

12. Nelson LD, Guskiewicz KM, Barr WB, Hammeke TA, Randolph C, Ahn KW, Wang Y, McCrea MA. Age differences in recovery after sport-related concussion: a comparison of high school and collegiate athletes. J Athl Train. 2016; 51(2):142-52. doi: 10.4085/1062-6050-51.4.04. 

13. Stracciolini A, Casciano R, Levey Friedman H, Stein CJ, Meehan WP 3rd, Micheli LJ. Pediatric sports injuries: a comparison of males versus females. Am J Sports Med. 2014; 42(4):965-72. doi: 10.1177/0363546514522393.

14. Dadgar H, Sahebozamani M, Noraei T, Sharifiyan E. The relationship between angular Q amount and noncontact injuries of lower limbs in male karate. Journal of Sports Medicin. 2009; 1(3):97-83. [In Persian].

15. Daneshjoo A, Mokhtar AH, Rahnama N, Yusof A. The effects of injury preventive warm-up programs on knee strength ratio in young male professional soccer players. PLoS ONE. 2012; 7(12):e509.79. doi: 10.1371/journal.pone.0050979.

16. Sharifi M, Sahebozamani M, Ghahramantabrizi K. The relationship between the prevalence of injury and the performance of women in the Premier League against injury prevention strategies. Sport Medicine Studies, 2010; 2(7):99-108. [In Persian].

17. Møller M, Wedderkopp N, Myklebust G, Lind M, Sørensen H, Hebert JJ, Emery CA, Attermann J. Validity of the SMS, Phone, and medical staff Examination sports injury surveillance system for time-loss and medical attention injuries in sports. Scand J Med Sci Sports. 2018; 28(1):252-259. doi: 10.1111/sms.12869.

18. Meeuwisse WH, Love EJ. Athletic injury reporting. Development of universal systems. Sports Med. 1997; 24(3):184-204. doi: 10.2165/00007256-199724030-00008. 

19. Sadeghi J. Yousefi S, Saeid S, Rezaei S, Sahebozamani M. Relationship between the prevalence of injury and the performance of rugby players against the prevention strategies of the eighth. International Sporting Medicine Congress of Iran, Tehran; 2014. [In Persian].

20. Van Mechelen W. Sports injury surveillance systems. 'One size fits all'? Sports Med. 1997; 24(3):164-8. doi: 10.2165/00007256-199724030-00003. 

21. Daneshjoo A, Mokhtar A, Rahnama N, Toutouni M, Reisi J, Yusof A. The effects of injury prevention programs on anthropometric factors in professional male soccer players. Biol Sport. 2013; 30(4):281–288. doi: 10.5604/20831862.1077554.

22. Llinas PJ, Serrano RF, Quintero Barrera L, Quiceno Noguera JC, Martinez Cano JP. Sports injuries and ill-health episodes in the Cali 2013 World Games. BMJ Open Sport Exerc Med. 2016; 2(1):e000072. doi: 10.1136/bmjsem-2015-000072.

23. Orchard J, Newman D, Stretch R, Frost W, Mansingh A, Leipus A. Methods for injury surveillance in international cricket. J Sci Med Sport. 2005; 8(1):1-14. doi: 10.1016/s1440-2440(05)80019-2.

24. Meeuwisse WH, Sellmer R, Hagel BE. Rates and risks of injury during intercollegiate basketball. Am J Sports Med. 2003; 31(3):379-85. doi: 10.1177/03635465030310030901.

25. Hammond LE, Lilley JM, Ribbans WJ. Defining recovery: an overlooked criterion in sports injuries surveillance. Clin J Sport Med. 2013; 23(3):157-9.

26. Rahnama N, Bambaeichi E, Daneshjoo A. The epidemiology of knee injuries in Iranian male professional soccer players. Sport Sciences for Health. 2009; 5(1):9-14.

27. Olsen L, Scanlan A, MacKay M, Babul S, Reid D, Clark M, et al. Strategies for prevention of soccer-related injuries: a systematic review. Br J Sport Med. 2004; 38(1):89-94. doi: 10.1136/bjsm.2002.003079.

28. Vanderlei FM, Bastos FN, Tsutsumi GY, Vanderlei LC, Netto Júnior J, Pastre CM. Characteristics and contributing factors related to sports injuries in young volleyball players. BMC Res Notes. 2013; 6:415. doi: 10.1186/1756-0500-6-415.

29. Erfani M, Saheboamaani M, Marefati H, Sharifin E. The survey of Sole Arch index and its relation to non-contact ankle sprain in athlete. Journal of Exercise Science and Medicine. 2011; 1(3):99-112. [In Persian].

30. Caswell S, Prebble M, Romm K, Ambegaonkar J, Caswell A, Cortes N. Epidemiology of sports injuries among middle school students. Br J Sports Med. 2017; 51(4):305. doi: 10.1136/bjsports-2016-097372.56.

31. Timpka T, Jacobsson J, Bickenbach J, Finch CF, Ekberg J, Nordenfelt L. What is a sports injury? Sports Med. 2014; 44(4):423-8. doi: 10.1007/s40279-014-0143-4. 

32. Speziale HS, Streubert HJ, Carpenter DR. Qualitative research in nursing: advancing the humanistic imperative. Philadelphia: Wolters Kluwer; 2011.

33. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005; 15(9):1277-88. doi: 10.1177/1049732305276687.

34. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004; 24(2):105-12. doi: 10.1016/j.nedt.2003.10.001. 

35. Polit DF, Beck CT, Hungler BP. Essentials of nursing research: methods, appraisal, and utilization. Philadelphia: Lippincott Williams & Wilkins; 2006.

36. Del Coso J, Herrero H, Salinero JJ. Injuries in Spanish female soccer players. J Sport Health Sci. 2018; 7(2):183-190. doi: 10.1016/j.jshs.2016.09.002.

37. Hamilton B, Alonso JM, Best TM. Time for a paradigm shift in the classification of muscle injuries. J Sport Health Sci. 2017; 6(3):255-261. doi: 10.1016/j.jshs.2017.04.011.

38. Montalvo AM, Shaefer H, Rodriguez B, Li T, Epnere K, Myer GD. Retrospective injury epidemiology and risk factors for injury in cross fit. J Sports Sci Med. 2017; 16(1):53-59. 

39. DiStefano LJ, Dann CL, Chang CJ, Putukian M, Pierpoint LA, Currie DW, Knowles SB, Wasserman EB, Dompier TP, Comstock RD, Marshall SW, Kerr ZY. The first decade of web-based sports injury surveillance: descriptive epidemiology of injuries in us high school Girls' soccer (2005-2006 through 2013-2014) and national collegiate athletic association women's soccer (2004-2005 through 2013-2014). J Athl Train. 2018; 53(9):880-892. doi: 10.4085/1062-6050-156-17.

40. Rossler R, Junge A, Chomiak J, Němec K, Dvorak J, Lichtenstein E, Faude O. Risk factors for football injuries in young players aged 7 to 12 years. Scand J Med Sci Sports. 2018; 28(3):1176-1182. doi: 10.1111/sms.12981.

41. Schroeder AN, Comstock RD, Collins CL, Everhart J, Flanigan D, Best TM. Epidemiology of overuse injuries among high-school athletes in the United States. J Pediatr. 2015; 166(3):600-6. doi: 10.1016/j.jpeds.2014. 09.037.

42. Alentorn-Geli E, Mendiguchía J, Samuelsson K, Musahl V, Karlsson J, Cugat R, Myer GD. Prevention of anterior cruciate ligament injuries in sports. Part I: systematic review of risk factors in male athletes. Knee Surg Sports Traumatol Arthrosc. 2014; 22(1):3-15. doi: 10.1007/s00167-013-2725-3.

43. Dai B, Herman D, Liu H, Garrett WE, Yu B. Prevention of ACL injury, part I: injury characteristics, risk factors, and loading mechanism. Res Sports Med. 2012; 20(3-4):180-97. doi: 10.1080/15438627.2012.680990.

44. Colston MA, Wilkerson GB, ATC, Dreyfus H, Ross R. Methods for prediction of core or lower extremity injury among high school football players as a strategy for longitudinal reduction of injury risk. International Journal of Athletic Therapy and Training. 2018; 23(5):205-9. doi: 10.1123/ijatt.2017-0085.

45. Raschner C, Platzer HP, Patterson C, Werner I, Huber R, Hildebrandt C. The relationship between ACL injuries and physical fitness in young competitive ski racers: a 10-year longitudinal study. Br J Sports Med. 2012; 46(15):1065-71. doi: 10.1136/bjsports-2012-091050.

46. Goossens L, De Ridder R, Cardon G, Witvrouw E, Verrelst R, De Clercq D. Injury prevention in physical education teacher education students: lessons from sports. A systematic review. European Physical Education Review. 2017; 25:156-173. doi: 10.1177/1356336X17711675.

47. Dyakova G, Angelova P, Angelova I, Dyakov T, Belomazheva-Dimitrova S. Sports injuries in student-athletes. Trakia Journal of Sciences. 2017; 15(1):369-74. doi: 10.15547/tjs.2017.s.01.062.

48. Pierpoint LA, Williams CM, Fields SK, Comstock RD. Epidemiology of injuries in united states high school track and field: 2008-2009 through 2013-2014. Am J Sports Med. 2016; 44(6):1463-8. doi: 10.1177/0363546516629950. 

49. Schroeder AN, Comstock RD, Collins CL, Everhart J, Flanigan D, Best TM. Epidemiology of overuse injuries among high-school athletes in the United States. J Pediatr. 2015; 166(3):600-6. doi: 10.1016/j.jpeds.2014.09.037.

50. Roos KG, Marshall SW, Kerr ZY, Golightly YM, Kucera KL, Myers JB, Rosamond WD, Comstock RD. Epidemiology of overuse injuries in collegiate and high school athletics in the United States. Am J Sports Med. 2015; 43(7):1790-7. doi: 10.1177/0363546515
580790.

51. Pfirrmann D, Herbst M, Ingelfinger P, Simon P, Tug S. Analysis of injury incidences in male professional adult and elite youth soccer players: a systematic review. J Athl Train. 2016; 51(5):410-24. doi: 10.4085/1062-6050-51.6.03.

52. Abernethy L, MacAuley D, McNally O, McCann S. Immediate care of school sport injury. Inj Prev. 2003; 9(3):270-3. doi: 10.1136/ip.9.3.270.

53. Pfeifer CE, Beattie PF, Sacko RS, Hand A. Risk factors associated with non-contact anterior cruciate ligament injury: a systematic review. Int J Sports Phys Ther. 2018; 13(4):575-587.

54. Ryman Augustsson S, Ageberg E. Weaker lower extremity muscle strength predicts traumatic knee injury in youth female but not male athletes. BMJ Open Sport Exerc Med. 2017; 3:e000222.  doi: 10.1136/bmjsem-2017-000222.

55. Kerr ZY, Quigley A, Yeargin SW, Lincoln AE, Mensch J, Caswell SV, Dompier TP. The epidemiology of NCAA men's lacrosse injuries, 2009/10-2014/15 academic years. Inj Epidemiol. 2017; 4(1):6. doi: 10.1186/s40621-017-0104-0. 

56. Franco MF, Madaleno FO, de Paula TMN, Ferreira TV, Pinto RZ, Resende RA. Prevalence of overuse injuries in athletes from individual and team sports: A systematic review with meta-analysis and GRADE recommendations. Brazilian Journal of Physical Therapy; 2021. (In Press).

57. Ebrahimi Varkiani M, Nayeb Mahdi Abadi F, Shakourian A, Najafi M. Epidemiologic table tennis damage using the sports medicine federation damage monitoring database. 2nd National Conference on Physical Education and Sports, Chabahar International University, Chabahar; 2016. [In Persian].

58. Ziaee V, Shobbar M, Lotfian S, Ahmadinejad M. Sport  injuries of karate during training: an epidemiologic study in Iran. Asian J Sports Med. 2015; 6(2):e26832. doi: 10.5812/asjsm.26832.

59. Kerr ZY, Lynall RC, Roos KG, Dalton SL, Djoko A, Dompier TP. Descriptive epidemiology of non-time-loss injuries in collegiate and high school student-athletes. J Athl Train. 2017; 52(5):446-456. doi: 10.4085/1062-6050-52.2.15. 

60. Knobloch K, Rossner D, Gossling T, Richter M, Krettek C. Volleyballverletzungen im schulsport [volleyball sport school injuries]. Sportverletz Sportschaden. 2004; 18(4):185-9. German. doi: 10.1055/s-2004-813481. 

61. Pierpoint LA, LaBella CR, Collins CL, Fields SK, Dawn Comstock R. Injuries in girls' soccer and basketball: a comparison of high schools with and without athletic trainers. Inj Epidemiol. 2018; 5(1):29. doi: 10.1186/
s40621-018-0159-6.

62. Owoeye OBA, Ghali B, Befus K, Stilling C, Hogg A, Choi J, et al. Epidemiology of all-complaint injuries in youth basketball. Scandinavian Journal of Medicine & Science in Sports. 2020; 30(12):2466-2476. doi: 10.1111/sms.13813. 

63. Kerr ZY, Wilkerson GB, Caswell SV, Currie DW, Pierpoint LA, Wasserman EB, Knowles SB, Dompier TP, Comstock RD, Marshall SW. The first decade of web-based sports injury surveillance: descriptive epidemiology of injuries in united   state high school football (2005-2006 through 2013-2014) and national collegiate athletic association football (2004-2005 through 2013-2014). J Athl Train. 2018; 53(8):738-751. doi: 10.4085/1062-6050-144-17.

64. McGuine TA, Post EG, Hetzel SJ, Brooks MA, Trigsted S, Bell DR. A Prospective Study on the Effect of Sport Specialization on Lower Extremity Injury Rates in High School Athletes. Am J Sports Med. 2017; 45(12):2706-2712. doi: 10.1177/0363546517710213.

65. Niknejad M, Balochi R, Ghadimy Ilkhanlar H. The survey of physical education teachers’ viewpoints on causes and prevalence of sport injury at school. Sports Medicine Journal. 2010; 2(1):91-101. [In Persian].

66. Hoge C, Sabbagh R, Morgan M, Grawe BM. Epidemiology of youth and high school American football-related injuries presenting to United States emergency departments: 2010-2019. Phys Sportsmed. 2021; 31:1-6. doi: 10.1080/00913847.2021.1931980.

67. Yalfani A, Naderi A, Anbariyan M, Biglarbigi A. The comprasion of prevalance, type and severity of injury in professional and amateur freestyles’ wrestlers Journal of Research in Rehabilitation Sciences. 2013; 9)4(:606. doi: 10.22122/jrrs.v9i4.866.

68. Hodgson L, Gissane C, Gabbett TJ, King DA. For debate: consensus injury definitions in team sports should focus on encompassing all injuries. Clin J Sport Med. 2007; 17(3):188-91. doi: 10.1097/JSM.0b013e
3180547513. 

69. Mohamadi H, Daneshmandi H, Alizadeh MH, Shamsimajlan A. The effect of ACL intervention programs on the improvement of neuromuscular deficiencies and reducing the incidence of ACL injury. Scientific Journal of Rehabilitation Medicine. 2015; 4(2):159-169. [In Persian].

70. Kramer LC, Denegar CR, Buckley, WE,   Hertel J. Factors associated with anterior cruciate ligament injury: history in female athletes. J Sports Med Phys Fitness. 2007; 47(4):446-54.

71. Caine D, Maffulli N, Caine C. Epidemiology of injury in child and adolescent sports: injury rates, risk factors, and prevention. Clin Sports Med. 2008; 27(1):19-50. doi: 10.1016/j.csm.2007.10.008.

72. Saragiotto BT, Di Pierro C, Lopes AD. Risk factors and injury prevention in elite athletes: a descriptive study of the opinions of physical therapists, doctors and trainers. Braz J Phys Ther. 2014; 18(2):137-43. doi: 10.1590/s1413-35552012005000147.

73. Khayambashi K, Ghoddosi N, Straub RK, Powers CM. Hip muscle strength predicts noncontact anterior cruciate ligament injury in male and female athletes: a prospective study. Am J Sports Med. 2016; 44(2):355-61. doi: 10.1177/0363546515616237.

74. Wang V, Mayer F, Bonaventura K, Wippert M. Intrinsic and extrinsic injury risk factors of elite winter sports athlete in training. Br J Sports Med. 2017; 51(4):406. doi: 10.1136/bjsports-2016-097372.309.

75. Acevedo RJ, Rivera-Vega A, Miranda G, Micheo W. Anterior cruciate ligament injury: identification of risk factors and prevention strategies. Curr Sports Med Rep. 2014; 13(3):186-91. doi: 10.1249/JSR.00
00000000000053.

76. Emery C, Tyreman H. Sport participation, sport injury, risk factors and sport safety practices in Calgary and area junior high schools. Paediatr Child Health. 2009; 14(7):439-44. doi: 10.1093/pch/14.7.439. 

77. Andersen LB, Riddoch C, Kriemler S, Hills AP. Physical activity and cardiovascular risk factors in children. Br J Sports Med. 2011; 45(11):871-6. doi: 10.1136/bjsports-2011-090333.

78. Jacobsson J, Timpka T, Kowalski J, Nilsson S, Ekberg J, Dahlström O, Renstrom PA. Injury patterns in Swedish elite athletics: annual incidence, injury types and risk factors. Br J Sports Med. 2013; 47(15):941-52. doi: 10.1136/bjsports-2012-091651.