An operational model to investigate contact sports injuries CONOR GISSANE, JOHN WHITE, KATHLEEN KERR, and DEANNA JENNINGS Department of Health Studies, Brunel University, Osterley Campus, Isleworth, Middlesex, TW5 7DU, UNITED KINGDOM; Division of Public Health Sciences, Queen’s Medical Centre, University Hospital, Nottingham, NG7 2UH, UNITED KINGDOM; Division of Physiotherapy Education, Clinical Sciences Building, University of Nottingham, Nottingham, NG5 1PB, UNITED KINGDOM; and Wall House Surgery, Yorke Road, Reigate, Surrey, RH2 9HG, UNITED KINGDOM ABSTRACT GISSANE, C., J. WHITE, K. KERR, and D. JENNINGS. An operational model to investigate contact sports injuries. Med. Sci. Sports Exerc., Vol. 33, No. 12, 2001, pp. 1999 –2003. Purpose: A cyclical operational model is proposed to examine the interrelationship of a number of factors that are involved in sports injury epidemiology. In sports injury research, investigations often attempt to identify a unique risk factor that distinguishes an injured player. However, a wide variety of factors can contribute to a sports injury occurring, and an understanding of the cause of injury is important to advance knowledge. Methods: The proposed model identifies a healthy/fit player initially, although the player may exhibit a number of intrinsic risk factors for sports injury. Before exposure to extrinsic risk factors, there is the opportunity for implementation of prevention strategies by coaching personnel and the sports medicine team. These strategies might include, among others, appropriate warm-up, adequate hydration, wearing protective equipment, and prophylactic taping. Additionally, preventative screening could take place to assess the various intrinsic and extrinsic risk factors that could lead to sports injury. Discussion: Two examples of how the operational model relates to contact sports injury cases are presented. Participating in sport inevitably exposes the player to external risk factors that predispose toward injury. The treatment of the injured player aims to restore the player to preinjury playing status and to prevent the injury from becoming chronic. Conclusions: It is suggested that the application of this proposed cyclical model may lead to greater success in understanding the multifaceted nature of sports injuries and furthermore help minimize injury risk and support the rehabilitation of injured contact sports participants. Key Words: EPIDEMI- OLOGY, INJURY, INCIDENCE, PREVALENCE, RISK FACTORS, PREDISPOSITION I n sports injury research, the aim of inquiries has often been to find a unique marker or risk factor that will identify injured players (24). Usually the frequency of injury is examined in relation to the presence or absence of a specific risk factor (28). However, most sports injuries are rarely attributed to a single risk factor. Although injuries may sometimes appear to be random accidents, many fac- tors play a role before the actual occurrence of an injury event (24). An understanding of the etiology of injury is also important for the advancement of knowledge (23). Although sports participation is acknowledged as having a health-promoting benefit, it can also have deleterious effects on health in the form of injuries and accidents (37). Action to prevent sports injuries should be based on the knowledge of etiological factors that contribute to increased injury risk (38). Various authors have described many risk factors, which are usually grouped into intrinsic (subject related) factors and extrinsic (externally related) factors (2,19,20). Intrinsic factors have been defined as individual biolog- ical, biomechanical, and psychosocial characteristics predis- posing a person to the outcome of injury (2). Extrinsic risk factors are independent of the injured person and are related to the types of activity during the incident of injury (35) and the manner in which sport is practiced (20). A summary of both intrinsic and extrinsic risk factors documented in the sports injury literature is presented in Table 1. However, even the classification of risk factors into intrinsic and extrinsic could be criticized as being artificial (19), because injuries that result from participation are multi-risk phenom- ena, with a variety of risk factors interacting at a given time (20). Because sports injuries do not occur independently, pre- vious research has suggested strategies for the investigation of sports injuries (37,40) by using a sequence of events with four stages (37); 1. The initial stage involves the identification of the problem and the description of injury in terms of injury incidence and the severity of injury. 2. The next stage identifies the risk factors and mecha- nisms that play a part in sports injury episodes. 3. Once these have been identified, measures that will have the likely effect of reducing sports injuries can be introduced. These measures are based on the injury mech- anisms and risk factors that have been identified in stage 2. 4. The final stage of the sequence is to repeat the initial stage with the preventive measures in place, in order to determine the extent to which such measures are effective. 0195-9131/01/3312-1999/$3.00/0 MEDICINE & SCIENCE IN SPORTS & EXERCISE ® Copyright © 2001 by the American College of Sports Medicine Submitted for publication June 2000. Accepted for publication March 2001. 1999