Browsing by Author "Verhagen, Evert"

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    A novel approach to enhance ACL injury prevention programs
    (Springer Berlin Heidelberg, 2018-06-18) Gokeler, Alli; Seil, Romain; Kerkhoffs, Gino; Verhagen, Evert
    Abstract Efficacy studies have demonstrated decreased anterior cruciate ligament (ACL) injury rates for athletes participating in injury prevention programs. Typically, ACL injury prevention programs entail a combination of plyometrics, strength training, agility and balance exercises. Unfortunately, improvements of movement patterns are not sustained over time. The reason may be related to the type of instructions given during training. Encouraging athletes to consciously control knee movements during exercises may not be optimal for the acquisition of complex motor skills as needed in complex sports environments. In the motor learning domain, these types of instructions are defined as an internal attentional focus. An internal focus, on one’s own movements results in a more conscious type of control that may hamper motor learning. It has been established in numerous studies that an external focus of attention facilitates motor learning more effectively due to the utilization of automatic motor control. Subsequently, the athlete has more recourses available to anticipate on situations on the field and take appropriate feed forward directed actions. The purpose of this manuscript was to present methods to optimize motor skill acquisition of athletes and elaborate on athletes’ behavior.
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    Safer rugby through BokSmart? Evaluation of a nationwide injury prevention programme for rugby union in South Africa
    (2014) Brown, James Craig; van Mechelen, Willem; Lambert, Mike; Verhagen, Evert; Draper, Catherine
    Introduction and objectives: Rugby union ('rugby') is a popular sport that has a high risk of injury. The sport has particular popularity in South Africa with about 500,000 players. Based on concerns about the number of rugby-related catastrophic injuries, the BokSmart nationwide injury prevention programme was launched in July 2009 by South African Rugby Union (SARU). This programme educates coaches and referees on safe techniques during a Rugby Safety Workshop (RSW). To assess real-world injury prevention efforts, researchers have suggested using the six Translating Research into Injury Prevention Practice (TRIPP) stages. Stage 1 and 2 investigate the incidence, severity and aetiology of injuries. Stage 2 investigates the aetiology of injuries. Stage 3 is the introduction of an intervention. Stage 4 is an investigation of the effectiveness of the intervention under ideal conditions. Stages 5 and 6 investigate the real-world implementation of the intervention. Thus, the objective of this thesis is to comprehensively evaluate the BokSmart programme using the TRIPP framework. Methods: TRIPP stages 1 and 2 are investigated in Chapters 2, 3, 4 and 5. Chapter 2 investigates the incidence, severity and aetiology of injuries at four competitive youth tournaments. Chapter 3 used Chapter 2's data to investigate the economic burden of these injuries. Chapter 4 investigates the incidence and severity of catastrophic injuries. Chapter 5 investigates the risk of both general and catastrophic injury specific to the scrum phase of play using the data from Chapters 2 and 4. TRIPP stages 3 and 4 were conducted by SARU and are thus outside the scope of this thesis. TRIPP stages 5 and 6 are investigated in Chapters 6, 7 and 8. Chapter 6 evaluates the effect of BokSmart in on catastrophic injury rates. Chapter 7 evaluates the effect of BokSmart on targeted player behaviours. Chapter 8 uses qualitative methods to investigate coaches and referees' perceptions of BokSmart. Results: Through TRIPP Stages 1 and 2 it was established that South Africa has comparable general and catastrophic injury rates to other countries. Senior players were at significantly (p<0.05) greater risk of suffering a catastrophic injury than younger players. The economic investigation indicated that injury rehabilitation was affected by whether the player had medical insurance or not – this may be unique to South Africa. Through TRIPP stages 5 and 6 BokSmart was associated with a reduction in catastrophic injuries in junior, but not senior players. BokSmart was also associated with a significant improvement in targeted player behaviours. Coaches' perceptions of the programme varied by socioeconomic status (SES). All coaches and referees agreed that the programme was capable of reducing catastrophic injuries in players. However, high SES coaches described difficulties in changing coach and player behaviour, while low SES coaches mentioned their lack of necessary infrastructure as barriers to adoption. There was also negativity about the delivery of BokSmart: coaches and referees felt the course was not practical enough, was too long and should not be compulsory. Conclusions: From BokSmart's perspective, the lack of effectiveness of the programme in senior players should be of concern, considering this age group's greater risk of catastrophic injury. This greater effect in juniors could be explained either by the higher number of players, or greater adoption in this age group. Future research should attempt to elucidate this reason. The barriers and suggestions described by low and high SES coaches and referees should be addressed to optimise the programme's impact. The programme should continue to be evaluated to assess the impact of these suggestions.
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    The effectiveness and implementation of the BokSmart Safe Six Injury prevention programme
    (2018) Sewry, Nicola Ann; Van Mechelen, Willem; Lambert, Mike; Verhagen, Evert; Brown, James
    INTRODUCTION: Injury prevention programmes in rugby union are important to reduce the sport’s injury burden. The BokSmart Safe Six exercise-based injury prevention programme (“Safe Six”) was designed for this purpose. The programme incorporates six targeted exercises as a warm-up for rugby players. The effectiveness of the BokSmart Safe Six programme was assessed using the “Sequence of Prevention” Model. METHODS: The first study was a prospective cohort study using injury surveillance, of players at the South African Rugby (SA Rugby) Youth week tournaments. The study was conducted over six years to determine the injury incidence density (IID) youth players and also factors associated with the IID. The second study was a systematic review with the purpose of determining the effectiveness of exercise-based injury prevention interventions to reduce injury rates in collision sports. The next study was conducted over three years of SA Rugby Youth weeks and assessed the awareness of coaches and players of the BokSmart Safe Six following a targeted-marketing approach. This was followed by a study in which the BokSmart Safe Six programme was implemented in a cohort of apparently healthy non-rugby playing adults. The aim of this study was to determine the efficacy of the programme on injury risk profiles (Functional Movement Screening and Musculoskeletal Screening Assessments). The final study was a cluster-randomised controlled trial (cRCT) over eight weeks, using six schools (n = 210 players) in the Western Cape to determine the effectiveness of the BokSmart Safe Six on injury risk profiles and IID. RESULTS AND CONCLUSIONS: SA youth rugby cohort have a similar IID to other youth rugby cohorts (and in some instances lower). The systematic review identified only one highlevel study (out of three) that was effective for injury prevention. The players’ awareness of the BokSmart Safe Six was associated with the awareness of their specific coaches’ awareness. The awareness increased during the targeted marketing approach. The BokSmart Safe Six was associated with minimal significant improvements of the injury risk profiles in both the healthy adults and in the cRCT intervention group youth rugby players.