Educational intervention promotes injury prevention adherence in club collegiate men’s lacrosse athletes

Methods

This study was exempt from institutional review board review by the Rocky Vista University Institutional Review Board (IRB #2021-174). Injury prevention education given to the athletes in this study focused on stretching the four main muscle groups that are linked to increased rates of injury [30]. These groups included the psoas, ankle, piriformis, and hamstrings. A 30 min lecture was provided by the investigators to athletes in-person at the beginning of their season in January. This lecture detailed an anatomical diagram of the muscle group, information linking the inverse correlation of stretching the muscle to injury, and methods to self-evaluate flexibility of the muscle group.

Optional questionnaires developed by the researchers were distributed to athletes of the men’s club lacrosse teams of Southern Utah University, Utah Valley University, and Utah State University. Informed consent was outlined in the educational lecture and was electronically elaborated and collected in each of the questionnaires. To protect the identity of the student athletes, participants were de-identified from their survey responses. Optional surveys were administered via Qualtrics software at the beginning of the season in January, 2 weeks after the January lecture, and at the end of the season in May. Each survey had the same basic structure but assessed different time periods. Each questionnaire was administered within the months of competitive play by the teams from January to May of 2022. For example, the initial survey asked questions pertaining to “last year,” the second asked about the previous 2 weeks, and the final survey asked about the previous season. The utilization of the 2-week survey was to maximize early-season participation and to reinforce the principles taught in the lecture via spaced repetition. Individualized goal setting was utilized by asking the athletes to rate on a scale of 1–10 their range of motion (ROM), levels of pain, susceptibility to injury, strength, and balance. Athletes were asked to choose which category was their highest priority and to rate each category on a 10-point scale. Athletes were also asked what they would like their categories to be at the end of the season on a 10-point scale. At the end of the season in May, a question was asked of them again to rate each category’s current level on a 10-point scale. Additional questions evaluated individual muscle groups for self-reported levels of pain, ROM, and frequency of stretching. Questions also asked about the number of games or practices missed due to noncontact injury, the number of visits to the trainer, and the reason why the athlete visited the trainer. Exclusion criteria included all responses of players whose injuries during the 2021 spring season were contact-related, such as concussions. Any results of players under 18 years of age were also excluded.

Unpaired two-tailed t tests were calculated by S.G. to determine the statistical significance of changes from survey responses from the beginning of the season compared to the end.

Results

Survey sample sizes returned with 75 responses from the first survey, 54 responses from the second survey (2 weeks), and 39 responses from the last survey at the end of the season. After applying the exclusion criteria for the 2021 season, the responses calculated included 73 responses for the initial survey, 51 responses for the 2-week survey, and 32 responses for the final survey at the end of the season in May.

Accounting for all responses except those under the exclusion criteria, results utilizing a two-tailed, unpaired t test demonstrated p values below 0.05 for several categories, including: overall decreased levels of self-reported pain (p<0.0001); increased ROM (p<0.0001) (Table 1); increased frequency of stretching the muscle groups psoas (p<0.0001), calves (p=0.0081), and piriformis (p<0.0001) (Table 2); decreased pain levels for the hamstring (p=0.0274) (Table 3); and increased frequency of stretching after practice (p<0.0001) (Table 3).

For all responses except those under the exclusion criteria, results demonstrated decreased practices and games missed due to injury, but these results were not significant (p=0.77) (Table 4). The average player missed 0.78 practices or games less than reported for the previous season (Table 4). However, the number of average visits to the trainer per player increased by 3.56 when compared to reported levels from the previous season, but these results were also not significant (p=0.2257) (Table 4).

For all qualified responses collected, the results demonstrated decreased pain levels for the knee and ankle, but these results were not statistically significant. The responses also demonstrated an increased frequency of stretching the hamstrings, but these results were not statistically significant either (p=0.5707) (Table 2).

The most common reported noncontact injuries this year consisted of hamstring (4) and groin (3) strains. There were three reported concussions that resulted in missed practices or games. Athlete responses that involved a concussion from either this season or last season were excluded from the study because they were contact-related injuries.

Discussion

The increased frequency of stretching the psoas, ankle, and piriformis, as well as overall stretching after practice, suggests an increased compliance toward injury-prevention practices. Decreased self-reported levels of pain in the hamstring show the positive effect of athletes stretching. Increased levels of self-reported ROM and decreased levels of overall pain demonstrate an increased capacity to prevent injury among the club athletes.

Although some of the mentioned results lack statistical significance, the average increase in visits to the trainer per player, coupled with fewer missed games and practices with minimal change in the specified reasons for the visit, suggests that athletes were more attentive to pain and injury prevention. All of these results were implemented at no cost to the students, besides the time and attention of those presenting and leading team exercises. Although these results may not be generalizable to other population groups, this study demonstrates that simple interventions, such as these stretches, could be accomplished by osteopathic physicians in a clinical setting. With osteopathic understanding of the relationship between structure and function, doctors could assist their patients in strengthening muscle groups and preventing common injuries. This could be a relatively fast and inexpensive approach that could yield high savings in patients’ time and medical costs. These results warrant further investigation.

This paper is not without substantial limitations. Recall bias and response bias are key issues in studies of this nature. The response rates were limited, and the sample size was relatively small. Additionally, first-year players were not separated from returning players and upperclassmen. The difference in age and experience between these groups warrant being studied in future research. Results were also not team-specific, and that information could yield additional insight into the benefit and success of the intervention among distinct teams. There was also no way to differentiate between major and minor injuries. The study method could have benefited from a control group of teams that were not involved in the educational intervention for comparison.

Conclusions

Educational intervention may offer an alternative measure to reduce club collegiate athletes’ perceived pain level in certain joints through targeted stretches. This intervention also promotes stretching adherence for club athletes, which may promote future reduction in the rate of injuries. Although further studies are warranted to establish a clear effect on injury rates once injury-prevention measures are demonstrated, this educational intervention methodology may provide a template for further stretch and exercise education and intervention for these studies. Due to financial limitations, more widespread survey analysis could not be made to more club programs. However, further research can help expound the optimal implementation of educational interventions to overcome the challenge of limited resources in club collegiate athletic programs.