BASKETBALL INJURIES - Definition and Anatomy

BASKETBALL INJURIES

- Definition and Anatomy -

Basketball is one of the most popular sports, and it is also one of the highest contributors to sport and recreation-related injuries. [1] As the sport grows, in terms of number of participants and intensity, so does the number of injuries. In 2006 FIBA (Fédération Internationale du Basketball Association) has estimated that 11% of the world´s population plays basketball.

So far, there is not a great deal of data to be found on the injury of basketball players in European countries. Studies concerning the epidemiology of basketball injuries have been very popular in the USA. When we compare injury data between USA and European players, we have to bear in mind that the game of basketball as played in the USA is different from its European counterpart, which is partly caused by the different rules maintained by the NBA (National Basketball Association) and FIBA. [2]

The game of basketball is physically and mentally demanding. Basketball is characterized by intermittent bouts of high-intensity activity that occurs in the context of an endurance event. [3, 4, 5] Though players rarely reach maximal running speeds when playing, they often overcome movement momentum to change direction or to accelerate/decelerate. Technically basketball is considered as non-contact sport, but there is usually a high level of physical interaction between players on opposing teams, suggesting that basketball evolves into a semi-contact sport. [2, 6] The contact is responsible for 52.3% of the game-related injuries in male and 46.0% of injuries in female collegiate players. [6]

Definition of Injury
There is a notable variability in used injury definitions among researchers. One of the broad injury definitions define injury as any muscular-skeletal complaint newly incurred due to competition and/or training that received medical attention regardless of absence from competition or training. [7] The advantage of this definition is possibility to assess full spectrum of injuries from mild contusions to fractures and not only those which result in time lost from participation, bearing in mind that athletes sometimes compete despite an injury. [6] Although in practice researchers more often apply the „time loss" definition.

Type of Injuries

The types of injuries experienced by basketball players reflect the physical demands of the game. [8]

An acute (traumatic) injury was defined as being a basketball accident with a sudden, direct cause/event responsible for the injury. In general, sprains (injuries to ligaments) are the most common type of acute injury. In college basketball sprains were experienced 37.1%, and in professional basketball sprains often accounted for about 27.8%. Other common injuries are contusions and strains (injuries to muscles). [8]      

An overuse injury refers to an injury resulting from repeated micro trauma without a single, identifiable event responsible for the injury. An athlete sustained an overuse injury when he/she suffered a physical discomfort which caused pain and/or stiffness of the musculoskeletal system, and which is present during and/or after the basketball activity. [7, 2] It appears that overuse injuries account for between 12.8% and 37.7% of all injuries. Tendinopathies, particularly patellar tendinopathy, are the most common overuse injury. [6]

A significant proportion of these injures remain difficult to treat, and many individuals have long-term pain and discomfort, which cause significant loss of performance and decreased functional capacity.

Anatomical Location
Basketball requires repetitive jumping interspersed with running and rapid change of direction, and this pattern is indicated in the lower limb being more affected by injury than the upper limb. Regarding the distribution of injuries by body region, the lower limb accounts for 46.4% to 68.0% of injuries, while head and neck injuries were responsible for 5.8% to 23.7%. Upper-limb injuries account for 5.6% to 23.2% of injuries, and spine and pelvis injuries for 6.0% to 14.9%. [6]

The most common lower-limb injuries in basketball occur at the ankle and knee. In collegiate basketball, the ankle and knee were the affected respectively 28.8% and 12.0% and in NBA basketball on the top injury locations were the ankle (14.3%) followed by patellofemoral complex (12.5%). [8] While a European player during one season sustained 15.0% of ankle injuries and 23.01% of knee injuries. [2]

Compared with adults, children more seldom sustain lower extremities injuries 19.8-26%. As well, reversal finding is repeated in upper extremities data with studies reporting between 11-72%. Fingers are the body part most often involved in the injury, and the injury is usually associated with improper pass and reception. The young athlete may be particularly vulnerable to sport injury due to the physical and physiological processes of growth. Injury risk factors unique to the growing athlete include: susceptibility to growth plate injury, the adolescent growth spurt, limited thermoregulatory capacity, and maturity-associated variation between players. The more frequent and intense training and competition of young athletes today may create conditions under which these risk factors may exert their influence. [9]

Ankle injuries are among the most common injuries in basketball

Ankle
In basketball, ankle injuries are among the most common injuries sustained and the high prevalence of ankle injuries is supported by findings from many epidemiological studies. [2, 8, 10] Empirically and anecdotally, ankle sprains are synonymous with the game of basketball.

Ankle sprains were reported, with most involving the lateral ligaments 92.8%. Trauma to the deltoid ligament complex was reported in 6.4% instances, while the distal ankle syndesmosis was involved in 0.8% injuries.

Landing on someone else's foot been identified as the first major inciting event causing ankle sprains, which is mainly the result of jumping tasks. In second place, ankle sprains were brought on by sudden changes of direction. [2, 10] It was reported that 66.7% of athletes who injured their ankles had a history of ankle sprain and follow-up of ankle injuries after 6 to 18 months have shown that residual ankle symptoms occur in 40% to 50% of cases. [6]

Knee
Among knee injuries which have been recognized as being common and of high importance in basketball are Jumper's knee and anterior cruciate ligament (ACL) damage.

Jumper's knee mostly affects the proximal end of the patellar tendon in basketball players and account for approximately 70% of patellar tendon injury. [6] In the literature, this overuse condition of the patellar tendon has been referred to as ‘jumper's knee', ‘patellar tendonitis', ‘patellar tendinitis', ‘patellar tendinosis', ‘patellar tendon disorder', ‘patellar apicitis',  ‘patellar enthesitis', ‘partial rupture of the patellar tendon' or  ‘patellar tendinopathy'. [11] Because of its insidious nature, patellar tendon disorder may be the "silent endemic" among professional basketball players. All players are vulnerable, particularly those that are aerial players by nature. [6] This condition is the leading cause of players missing practices and games, but in multiple, small increments rather than the season-ending magnitude as some other injuries. [8] In a survey independent of applied treatment strategy, one-third of the athletes presenting with patellar tendinopathy were unable to full practice their sport for >6 months. [10] Overuse of the patellar tendon can lead to pain, tenderness and functional deficit. Patellar tendinopathy, as a typical overuse injury, is related to intensity of training, jumping performance, and ankle and knee joint dynamics. [11]

Anterior cruciate ligament (ACL) damage is a knee injury, which is often of serious nature, because it can be season-ending or, at times, career-ending. Female basketball players have 3-7.8 times increased risk to suffer an ACL injury in comparison to male counterparts when they compete at the same level of competition.

ACL injuries have been reported as non-contact injuries in 65.2 % of male and 80.1% of female college players. Even though majority of ACL injuries were from noncontact mechanisms, after video analysis of 39 ACL injuries it was shown that one half of the ACL injuries in women involved the player being pushed or collided with before the time of injury. A majority (71.8%) occurred while the injured player was in possession of the ball, and over half (56.4%) occurred while attacking. For female players, 59.1% of ACL injuries occurred during single-leg landings, while in male basketball players 35.3% occurred during single-leg landing. [6]

Teeth
Although dental injuries are thought to account for only 1% of basketball-related injuries, they are of concern because they can be permanent, disfiguring, and expensive. [6] The use of mouth guards is commonly used preventive strategy in contact sports. Studies on adults have shown that mouth guards can prevent injury. [12]

Severity of Injury
Athletes of all ages and everyone who works with them, whether they be parents, coaches, team managers or sports medicine personnel need to know answer to questions: What is the time lost from injury and when the player will be ready to back on court?

The number of days the athletes will not be able to undertake their normal training programme or will not be able to compete also serve to assess severity of injury. Injuries are usually classified as minor (1 to 7 days), moderate (8 to 28 days), severe (>28 days), and career-ending injuries. [7]

Knee injuries appear to be responsible for the most time lost, and they required surgery more often than other injuries. In intercollegiate players on average, knee injuries caused 18.3 days to be missed [6]

Ankle injuries also cause substantial time to be missed. It was reported for intercollegiate basketball players reported that ankle injuries caused, on average, 5.5 days to be missed, while for high school players reported a mean of 7.6 days. Among high school athletes it was found that 35.4% of ankle injuries caused >1 week to be missed. In a sample of Australian players, it was noted for 43.3% of ankle injuries for which >1 week was missed. [6]

References:

1.Scanlan A, MacKay M. Sports and Recreation Injury Prevention Strategies: Systematic Review and Best Practices.

2. Cumps E, Verhagen E,  Meeusen R. Prospective epidemiological study of basketball injuries during one competitive season: Ankle sprains and overuse knee injuries J Sports Sci and Med 2007; 6: 204-211

3.Maughan RJ, Shirreffs S M. Development of hydration strategies to optimize performance for athletes in high-intensity sports and in sports with repeated intense efforts. Scand J Med Sci Sports 2010: 20(2): 59-69

4.Dougherty KA, Baker LB, Chow M, Kenney W L. Two Percent Dehydration Impairs and Six Percent Carbohydrate Drink Improves Boys Basketball Skills. Med. Sci. Sports Exerc. 2006: 38(9):1650-1658

5. Baker LB, Dougherty KA, Chow M, Kenney WL. Progressive Dehydration Causes a Progressive Decline in Basketball Skill Performance. Med. Sci. Sports Exerc. 2007: 39(7): 1114-1123

6. Caine DJ, Harnmer PA,Shiff M. Epidemiology of injuries in Olympic sports. 2010. Blackwell Publishing Ltd

7. Junge A, Engebretsen L, Alonso JM, Renström P, Mountjoy ML, Aubry M, Dvorak J. Injury surveillance in multi-sport events - the IOC approach. Br. J. Sports Med. published online 7 Apr 2008; doi:10.1136/bjsm.2008.046631

8. Starkey C. Injuries and Illnesses in the National Basketball Association: A 10-Year Perspective Journal of Athletic Training 2000;35(2):161-167

9. Maffulli N, Caine DJ. Epidemioogy of pediatric sports injuries. Team sports. Med and Sci Sport 2005; 49

10.  McKay GD, Goldie PA, Payne WR, Oakes BW. Ankle injuries in basketball: injury rate and risk factors. Br J Sports Med 2001;35:103-108

11. Stasinopoulos D. Comparison of three preventive methods in order to reduce the incidence of ankle inversion sprains among female volleyball players. Br J Sports Med 2004 38: 182-185

12. Abernethy L, Bleakley C. Strategies to prevent injury in adolescent sport: a systematic review. Br J Sports Med 2007 41: 627-638

Prepared by: Dr. Jelena Oblakovic-Babic 


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