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A COMPARISON OF KNEE INJURIES AMONG UNIVERSITY BASKETBALL AND SOCCER PLAYERS IN HONG KONG BY LI KIN HEI 09005161 AN HONOURS PROJECT SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF BACHELOR OF ARTS IN PHYSICAL EDUCATION AND RECREATION MANAGEMENT (HONOURS) HONG KONG BAPTIST UNIVERSITY APRIL 2012

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Page 1: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

A COMPARISON OF KNEE INJURIES

AMONG UNIVERSITY BASKETBALL

AND SOCCER PLAYERS IN HONG KONG

BY

LI KIN HEI

09005161

AN HONOURS PROJECT SUBMITTED IN PARTIAL FULFILLMENT OF

THE REQUIREMENTS FOR THE DEGREE OF

BACHELOR OF ARTS

IN

PHYSICAL EDUCATION AND RECREATION MANAGEMENT (HONOURS)

HONG KONG BAPTIST UNIVERSITY

APRIL 2012

2

HONG KONG BAPTIST UNIVRSITY

30TH APRIL 2012

We hereby recommend that the Honours Project by Mr LI KIN HEI

entitled ldquoA COMPARISON OF KNEE INJURIES AMONG UNIVERSITY

BASKETBALL AND SOCCER PLAYERS IN HONG KONGrdquo be accepted in

partial fulfillment of the requirements for the Bachelor of

Arts Honours Degree in Physical Education and Recreation

Management

_______________ _______________

Dr Lobo LOUIE Dr Tom TONG

Chief Adviser Second Reader

3

DECLARATION

I hereby declare that this honours project ldquoA Comparison of

Knee Injuries among University Basketball and Soccer Players

in Hong Kongrdquo represents my own work and had not been previously

submitted to this or other institution for a degree diploma

or other qualification Citations from the other authors were

listed in the references

Li Kin Hei

30th April 2012

4

ACKNOWLEDGEMENTS

I would like to express my deepest gratitude to my chief

adviser Dr Lobo LOUIE for his professional advice and

generous help on this project I would also like to thank Dr

Tom TONG for being my second reader of this project

Thanks must be given to all the participants involved in

this project Without their participation this project could

not be accomplished

Last but not least I would like to give special thanks

to my friends Mr HO Wing Tung Mr KO Chi Yuen Mr KWOK

Yin Hang Ms PONG Ka Man Mr TING Wai Ting and Mr WAN Siu

Ming Timothy and Mr YIU Wai Ming for their help and

encouragement during the entire project period

_______________

Li Kin Hei

Department of Physical Education

Hong Kong Baptist University

Date 30th April 2012

5

ABSTRACT

Basketball and soccer are two popular sports worldwide

However the players are at risk of injuries Basketball and

soccer competitions among the university teams in Hong Kong

are considered as competitions of high level As a result

the injuries are common among players especially knee

injuries The purpose of this study was to understand the

patterns of knee injuries among the university basketball and

soccer players in Hong Kong There were 197 university

basketball and soccer players being the participants in this

study The result showed that 147 of the players (746) have

suffered knee injuries during training or competition in the

past one year The most common types of knee injuries were

abrasion (n=87 592) contusion (n=81 551) and overuse

injury (n=58 395) The major causes of knee injuries were

collision with other players (n=111 755) venue problem

(n=56 381) poor fitness (n=55 374) being over-trained

(n=46 313) and inadequate warm up (n=44 299)

6

TABLE OF CONTENTS

CHAPTER Page

1 INTRODUCTION 10

Statement of Problem 13

Purpose of Study 13

Hypotheses 14

Definition of Terms 15

Delimitations 18

Limitations 19

Significance of Study 20

2 REVIEW OF LITERATURE 21

Knee Injuries in Basketball 21

Knee Injuries in Soccer 24

Gender Difference in the Knee Injuries

in Basketball 26

Gender Difference in the Knee Injuries

in Soccer 28

Anterior Cruciate Ligament Injuries in

Basketball and Soccer 29

7

Summary 32

3 METHOD 34

Participants 34

Development of Questionnaire 35

Pilot Study 36

Procedures 37

Data Analysis 37

4 ANALYSIS OF DATA 39

Results 40

Discussions 61

5 SUMMARY AND CONCLUSION 77

Summary of Results 77

Conclusion 82

Recommendations for Future Studies 83

REFERENCES 84

APPENDIX A

Knee Injury Questionnaire 88

8

LIST OF TABLES

TABLE Page

1 Demographic Information of the

Respondents (N=197) 41

2 Chi Square Test for Different Genders of the

Same Sport with the Rate of Knee Injuries 43

3 Chi Square Test for Different Sports of the

Same Gender with the Rate of Knee Injuries 43

4 Average Amount of Time per Week for Regular

Training of the Players (N=197) 45

5 Average Amount of Time per Training Session

for Fitness Training of the Players (N=197) 47

6 Chi Square Test for Fitness Training with

the Rate of Knee Injuries 47

7 Average Amount of Time for Warm Up (N=197) 49

8 Types of Warm Up of the Players (N=197) 50

9 Categories of Knee Injury of the

Injured Players (N=147) 51

10 Types of Knee Injury (N=147) 53

9

11 Causes of Knee Injuries (N=147) 55

12 Treatments for Knee Injuries (N=147) 57

13 Number of Knee Injuries Requiring

Surgery (N=147) 59

14 Major Knee Injuries Requiring Surgery 59

15 Recovery Time for the Injured

Players (N=147) 60

10

Chapter 1

INTRODUCTION

Basketball and soccer are two popular sports all over the

world According to Yard Schroeder Fields Collins amp

Comstock (2008) and Borowski Yard Fields amp Comstock (2008)

participation in basketball or soccer can lead to a number

of health benefits such as improved physical fitness weight

control increased strength and increased endurance As a

result many PE teachers in Hong Kong would include basketball

and soccer teaching in the syllabus of the PE classes Apart

from those health benefits students could also learn how to

cooperate and communicate with the others when they are

participating in basketball or soccer games due to the fact

that these two sports are kinds of team sports

Apart from having basketball and soccer classes in

schools there are also different levels of competitions in

basketball or soccer in Hong Kong For example there are

inter-primary schools sports competitions and

inter-secondary schools sports competitions organized by the

11

Hong Kong Schools Sports Federation (HKSSF) and inter-varsity

sports competitions organized by the University Sports

Federation of Hong Kong China (USFHK) When students are

representing their schools to compete with the other students

they usually have to be engaged in regular training and

competitions This may lead to an increased risk of injury

as they are participating in physically demanding sports

(Borowski et al 2008)

Among the three different levels of basketball and

soccer competitions mentioned above the inter-varsity

basketball and soccer competitions are expected to be the most

intense and most physically demanding competitions Borowski

et al (2008) found that the injury rate in high school

basketball was 194 per 1000 AEs and Yard et al (2008) found

that the injury rate in soccer in high school was 239 per

1000 AEs It was also found that knee was the second most

commonly injured body site in both basketball and soccer

(Borowski et al 2008 Yard et al 2008)

After getting a knee injury it usually takes the

12

injured player less than one week to return to the

participation but it may take some of them more than three

weeks for recovery (Ingram Fields Yard amp Comstock 2008)

It depends on the severity of the knee injury In order to

reduce the rate of injury especially knee injury and ensure

safe participation in basketball and soccer we have to first

understand the biomechanical risk factors of the injuries and

then identify the changes of the factors that would help to

reduce the injuries (Mihata Beutler amp Boden 2006)

13

Statement of Problem

The focus of this study was on the comparison of the rate

and types of knee injuries between the university basketball

team members and university soccer team members in Hong Kong

It also aimed at examining the relationship between the gender

and the patterns of knee injuries

Purpose of Study

The purpose of this study was to compare the rate and types

of knee injuries between the university basketball team

members and university soccer team members in Hong Kong The

result obtained could provide the coaches and players with

more information about the knee injuries in basketball and

soccer and could help them design preventive measures to

reduce the incidence of knee injuries

14

Hypotheses

The followings were the research hypotheses of this study

1 There would be a difference in the rate of knee injuries

between the university basketball team members and the

university soccer team members

2 There would be a difference in the rate of knee injuries

between the different genders in basketball

3 There would be a difference in the rate of knee injuries

between the different genders in soccer

4 There would be a difference in the rate of knee injuries

between the players who are regularly engaged in fitness

training and those who are not engaged in any fitness

training

5 There would be a difference in the rate of knee injuries

between the players who perform warm up prior to

trainingcompetition and those who do not

15

Definition of Terms

In order to understand this study more clearly the

operational definitions of terms were as follows

University Basketball Team Member

University basketball team member refers to the local

member of any university basketball team in Hong Kong in the

academic year 2011-2012 who has been participating in regular

training provided by the university basketball team

University Soccer Team Member

University soccer team member refers to the local member

of any university soccer team in Hong Kong in the academic

year 2011-2012 who has been participating in regular training

provided by the university soccer team

Knee Injury

Knee injury refers to any injury to the knee that occurs

during sports or exercise (Bellenir 2008) The Capsule

16

ligament synovium and cartilage in the knee are susceptible

to injuries in sports (Harris amp Varney 1977)

Case of Knee Injury

Case of knee injury refers to any reported case of knee

injury in basketball or soccer that occurred within the past

one year either in the training session or competition

Rate of Knee Injury

Rate of knee injury refers to the number of case of knee

injuries in the past one year divided by the number of players

Training Hour

Training hour refers to the time spent on training the

skills or tactics on the basketball court or soccer pitch

excluding the time spent on fitness training

17

Warm Up

Warm up refers to any exercise or activity performed before

the main exercise which aims at increasing the muscle

temperature and increasing the range of motion of the joints

and muscle tendons (Fevre 1998) It usually includes jogging

stretching or sometimes specific warm up

Specific Warm Up

Specific warm up refers to the exercise or activity that

prepares the body for the up-coming exercise using the

specific muscles which will be used mainly in the up-coming

exercise

Fitness Training

Fitness training refers to any kind of exercise that will

help to improve the fitness of the players both the

health-related fitness and skill-related fitness

18

Cool Down

Cool down refers to any light exercise or activity

performed after the main exercise that allows the body to

transit back from an excited state to a resting state It

usually includes slow jogging walking and stretching

Recovery Time

Recovery time refers to the amount of time spent on recovery

of the knee injury from the occurrence of the knee injury until

the player returns to regular training

Delimitations

The delimitations of this study were listed as follows

1 The participants were delimited to the local Hong Kong

members of university basketball or soccer team in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team

19

2 The period of data collection was delimited to March 2012

3 Cases of knee injury were delimited to the reported cases

of knee injury that occurred in either training or

competition in the past one year

Limitations

The following were the limitations that must be considered

when analyzing the results of this study

1 The content of the questionnaire might not provide enough

detailed information for analysis as it was self-designed

2 The questionnaire was not valid and reliable enough as it

was self-designed

3 It was assumed that the participants could correctly

identify the types of knee injuries that they suffered

4 It was assumed that the participants would honestly and

cautiously answer the questionnaire

20

Significance of Study

This study provided information about the pattern of knee

injuries of the local members of the university basketball

and soccer team in Hong Kong It also provided comparisons

of both the rate of knee injuries and types of injuries between

the members of university basketball team and that of

university soccer team Besides the relationship between the

gender and the patterns of knee injuries was examined

Understanding the patterns of knee injuries was important

because it was the primary step to prevent the occurrence of

knee injuries This provided much useful information for the

coaches as well as the players on how to reduce the occurrence

of knee injuries If coaches understood the knee injury

patterns of basketball or soccer they could be able to plan

a better and safer training program for the players For the

players if they understood more about the causes of knee

injuries they could focus more on the preventive measures

of knee injuries when they were engaged in the sports

21

Chapter 2

REVIEW OF LITERATURE

Some past literature focusing on the knee injuries in

basketball and soccer was reviewed in this chapter This

review of literature was divided into six sections (1) knee

injuries in basketball (2) knee injuries in soccer (3)

gender difference in the knee injuries in basketball (4)

gender difference in the knee injuries in soccer (5) anterior

cruciate ligament (ACL) injuries in basketball and soccer

and (6) summary

Knee Injuries in Basketball

Borowski Yard Fields amp Comstock (2008) said that

basketball was one of the most popular sports in the United

States Although basketball players could benefit a lot from

basketball activities such as improved self-esteem and

weight control they had an increased risk of injury as they

were participating in a physically demanding activity Dick

Hertel Agel Grossman amp Marshall (2007) defined collegiate

22

menrsquos basketball as ldquoa contact sport in which numerous

anatomical structures are susceptible to both acute and

overuse injuriesrdquo (p194) It was not uncommon for basketball

players to suffer from injuries

According to Borowski et al (2008) the knee was one of

the most commonly injured body parts in basketball practice

and competition For the female basketball players 172 and

195 of the injuries occurred in the knee during practice

and competition respectively Knee injuries in practice and

in competition accounted for 101 and 115 of the total

injuries respectively for in the male basketball

In 2004 Olympic Games there were seven knee injuries in

the basketball games (Junge et al 2006) There were two

ligament ruptures one meniscus lesion one sprain two

contusions and one laceration According to Dick et al

(2007) knee internal derangements and patellar injuries were

the common knee injuries happened during practice and

competition Borowski et al (2008) suggested that muscle or

tendon strains in knee were another common type of knee

23

injuries in basketball Soft tissue injuries were also common

knee injuries in basketball According to Ingram Fields Yard

amp Comstock (2008) torn cartilage injuries were common in both

male and female basketball players and complete ligament

tears were common in female basketball players

Ingram et al (2008) found that the knee injuries in

basketball for both male and female players were non-contact

injuries meaning that there was no contact between players

when the knee injuries happened However Borowski et al

(2008) found that 246 of the knee injuries in the United

States high school basketball were caused by collision with

other player But still there were some non-contact knee

injuries caused by either rotation around a planted foot or

inversion or jumping or landing

24

Knee Injuries in Soccer

According to Yard Schroeder Fields Collins amp Comstock

(2008) ldquosoccer is one of the most popular sports worldwiderdquo

(p1930) It explained why there have been more and more people

both youngsters and adults participating in different soccer

activities nowadays Upon participation in soccer the

players could get a number of benefits such as becoming

physically active increase in productivity and enhancement

in academic performance but there were still risks for

injuries (Yard et al 2008)

Le Gall Carling amp Reilly (2007) conducted a study on the

soccer injuries in young elite females According to the

result among all anatomical sites in the body the lower

extremities were the most common site for injuries in soccer

with 168 of those injuries affecting the knee It was also

supported by the result of the research conducted by Yard et

al (2008) which showed that 187 of the soccer injuries

occurred in the knee

Concerning the types of knee injuries Junge et al (2006)

25

did a research on the injuries in team sport tournaments during

the 2004 Olympic Games and found that there were totally 17

knee injuries in soccer Of these 17 knee injuries 1 was

meniscus lesion 7 were sprain and 9 were contusion Apart

from that ligament tears were common in soccer players too

Ingram et al (2008) showed that incomplete ligament tears

and complete ligament tears were common in male soccer players

and female soccer players respectively A similar result was

obtained by Yard et al (2008) It showed that incomplete knee

ligament sprains were common among both male and female soccer

players but complete knee ligament sprains were only common

in female soccer players Both Ingram et al and Yard et al

suggested that the both the complete and incomplete knee

ligament injuries in the male soccer players were caused by

contact with other players while the incomplete knee ligament

injuries in the female soccer players were not caused by any

contact with others

According to Le Gall et al (2007) serious injuries

usually occurred in the knee and those serious injuries

26

included ligament sprain or rupture meniscus lesion and

patellar tendinitis or bursitis Overuse injuries were also

commonly occurred in the knee Yard et al (2008) suggested

that ldquogirl soccer players sustained a larger proportion of

knee injuriesrdquo (p1932) Darrow Collins Yard amp Comstock

(2009) supported that more female soccer players suffered from

severe knee injuries than male soccer players did

Gender Difference in the Knee Injuries in Basketball

According to Borowski et al (2008) female high school

basketball players in the United States were more likely to

injure their knees during practice and competition than the

male players A similar result was also found in the study

done by Ingram et al (2008) which showed that female high

school basketball players had a higher rate of major knee

injuries than the male players Darrow et al (2009) further

showed that female high school basketball players in the

United States had a higher chance of suffering from severe

knee injuries than the male players

27

The reasons for the difference in the rate of knee injuries

in basketball among the female and male players could be

divided into two categories intrinsic factors and extrinsic

factors Borowski et al (2008) suggested that the intrinsic

factors were mainly physiological differences between boys

and girls Examples for these physiological differences were

anatomical differences in joint and bone structure

differences in flexibility and strength and differences in

hormone secretions Differences in equipment differences in

facilities and differences in competition environment were

the extrinsic factors for the difference in the rate of knee

injury

Ingram et al (2008) mentioned that the likeliness of

female basketball players to sustain major knee injuries in

basketball was due to the vulnerability of their knees It

was associated with various risk factors such as hormonal

difference neuromuscular difference and mechanical

difference These risk factors made the female basketball

players four to six times more susceptible to major knee

28

injuries than the male basketball players

Gender Difference in the Knee Injuries in Soccer

The result of the study conducted by Yard et al (2008)

showed that female soccer players sustained a higher rate of

knee injuries than the male soccer players Le Gall et al

(2007) suggested that the reasons for the higher rate in knee

injuries for the female soccer players included weaker

technical and tactical ability poorer muscular strength and

endurance and weaker coordination The rapid development of

the female soccer game which led to an increased in

aggressiveness of the players was another cause of the higher

knee injury rate

Specifically female soccer players had a higher rate of

sustaining complete knee ligament sprains than the male soccer

players (Yard et al 2008) This was supported by the result

of the research done by Ingram et al (2008) which showed

that complete ligament tears were more common in female soccer

than in male soccer It might due to that fact that there were

29

structural differences and neuromuscular differences between

female and male soccer players Yard et al also found that

the rate of complete knee ligament sprains requiring surgery

in female soccer players was higher than that in male soccer

players Female soccer players were found to be 13 times more

susceptible to knee ligament injuries that required surgery

The reasons for this high rate against male soccer players

included the shoe-surface interaction differences in

anthropometry and increased joint laxity

Ingram et al (2008) also showed that non-contact knee

injuries were more common in female soccer than in male soccer

The reasons for this result were suggested to be that the knee

joint of the female soccer players were more vulnerable to

the stress created by rapid acceleration deceleration and

cutting movement on the grass surfaces

Anterior Cruciate Ligament Injuries in Basketball and Soccer

According to Mihata Beutler amp Boden (2006) anterior

cruciate ligament (ACL) injuries were not uncommon in

30

collegiate sports The most common type of ACL injuries was

non-contact or minimal contact ACL injuries The actions of

cutting jumping sudden deceleration and checking with

another player were the high risk mechanisms for this kind

of ACL injuries Basketball players and soccer players were

found to be often exposing to these damaging forces because

they had to perform these actions repeatedly during practice

and competition

From the result shown by Dick et al (2007) 18 of the

total game injuries in male basketball were ACL injuries and

603 of these ACL injuries were non-contact ACL injuries

This result was supported by Mihata et al (2006) whose result

showed that ACL injuries accounted for 14 of all injuries

in male basketball from 1989 to 2004 For the female basketball

players they had a higher rate of ACL injuries than the male

players It was shown by Mihata et al that the ACL injuries

accounted for 52 of all injuries in female basketball from

1989 to 2004 which was about four times higher than in male

basketball

31

For the soccer players the female soccer players also had

higher rates of ACL injuries than the male soccer players

In between 1989 and 2004 39 of the total injuries in female

soccer were ACL injuries while only 16 of the total injuries

in male soccer were ACL injuries (Mihata et al 2006) The

rate of ACL injuries in female soccer was almost three times

higher than that in male soccer in that period of time A more

serious result was shown by Le Gall et al (2007) In their

result ACL injuries mainly ACL sprains or ruptures

accounted for 156 of all major injuries of the young elite

female soccer players

According to Mihata et al (2006) the reasons for the

female players having higher rates of ACL injuries than the

male players were that they had only participated in such

organized sports for a brief period of time they were less

fit and they received less training Another reason was a

disturbance in the neuromuscular patterns received by the

female players which protected the knee created by

incidental or minimal trauma

32

The rate of ACL injuries could be reduced effectively

Understanding the biomechanical risk factors and identifying

and changing those risk factors were the necessary steps to

decrease the long-term ACL injury rates (Mihata et al 2006)

Summary

Soccer and basketball are common sports all over the world

and they are generally regarded as kinds of contact sports

as there is direct contact between players Players are

required to have good muscular strength and power in order

to compete with others Collision and contacting with other

players would lead to imbalance and maybe fall which in turn

lead to injury

Knee was found to be one of the most common body sites

susceptible to injuries in basketball and soccer during both

practice and competition Different types of knee injuries

were sustained by the players such as contusion laceration

sprain ligament tear meniscus lesion and torn cartilage

According to Ingram et al (2008) 168 of all knee injuries

33

were surgery-requiring injuries Examples of these major

knee injuries were complete ligament tears torn cartilage

incomplete ligament tears and fractures

Female players no matter they were soccer players or

basketball players would have a higher chance of injuring

their knee especially the ACL than their male counterparts

It might due to both intrinsic factors such as muscular

strength and endurance and hormonal differences and

extrinsic factors such as game environment and sports

facilities

However knee injuries could be prevented Preventive

measures for knee injuries included lower-extremity landing

skills plyometrics (Le Gall et al 2007) neuromuscular

training programs added supervision (Dick et al 2007)

muscle strengthening and movement training (Ingram et al

2008)

34

Chapter 3

METHOD

The method of this study was divided into the following

sections 1) Participants 2) Development of questionnaire

3) Pilot study 4) Procedures and 5) Data analysis

Participants

The participants were both male and female local members

of university basketball or soccer team in Hong Kong in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team The total number of subjects was 197 with

48 male members of university basketball team 51 female

members of university basketball team 56 male members of

university soccer team and 42 female members of university

soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 2: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

2

HONG KONG BAPTIST UNIVRSITY

30TH APRIL 2012

We hereby recommend that the Honours Project by Mr LI KIN HEI

entitled ldquoA COMPARISON OF KNEE INJURIES AMONG UNIVERSITY

BASKETBALL AND SOCCER PLAYERS IN HONG KONGrdquo be accepted in

partial fulfillment of the requirements for the Bachelor of

Arts Honours Degree in Physical Education and Recreation

Management

_______________ _______________

Dr Lobo LOUIE Dr Tom TONG

Chief Adviser Second Reader

3

DECLARATION

I hereby declare that this honours project ldquoA Comparison of

Knee Injuries among University Basketball and Soccer Players

in Hong Kongrdquo represents my own work and had not been previously

submitted to this or other institution for a degree diploma

or other qualification Citations from the other authors were

listed in the references

Li Kin Hei

30th April 2012

4

ACKNOWLEDGEMENTS

I would like to express my deepest gratitude to my chief

adviser Dr Lobo LOUIE for his professional advice and

generous help on this project I would also like to thank Dr

Tom TONG for being my second reader of this project

Thanks must be given to all the participants involved in

this project Without their participation this project could

not be accomplished

Last but not least I would like to give special thanks

to my friends Mr HO Wing Tung Mr KO Chi Yuen Mr KWOK

Yin Hang Ms PONG Ka Man Mr TING Wai Ting and Mr WAN Siu

Ming Timothy and Mr YIU Wai Ming for their help and

encouragement during the entire project period

_______________

Li Kin Hei

Department of Physical Education

Hong Kong Baptist University

Date 30th April 2012

5

ABSTRACT

Basketball and soccer are two popular sports worldwide

However the players are at risk of injuries Basketball and

soccer competitions among the university teams in Hong Kong

are considered as competitions of high level As a result

the injuries are common among players especially knee

injuries The purpose of this study was to understand the

patterns of knee injuries among the university basketball and

soccer players in Hong Kong There were 197 university

basketball and soccer players being the participants in this

study The result showed that 147 of the players (746) have

suffered knee injuries during training or competition in the

past one year The most common types of knee injuries were

abrasion (n=87 592) contusion (n=81 551) and overuse

injury (n=58 395) The major causes of knee injuries were

collision with other players (n=111 755) venue problem

(n=56 381) poor fitness (n=55 374) being over-trained

(n=46 313) and inadequate warm up (n=44 299)

6

TABLE OF CONTENTS

CHAPTER Page

1 INTRODUCTION 10

Statement of Problem 13

Purpose of Study 13

Hypotheses 14

Definition of Terms 15

Delimitations 18

Limitations 19

Significance of Study 20

2 REVIEW OF LITERATURE 21

Knee Injuries in Basketball 21

Knee Injuries in Soccer 24

Gender Difference in the Knee Injuries

in Basketball 26

Gender Difference in the Knee Injuries

in Soccer 28

Anterior Cruciate Ligament Injuries in

Basketball and Soccer 29

7

Summary 32

3 METHOD 34

Participants 34

Development of Questionnaire 35

Pilot Study 36

Procedures 37

Data Analysis 37

4 ANALYSIS OF DATA 39

Results 40

Discussions 61

5 SUMMARY AND CONCLUSION 77

Summary of Results 77

Conclusion 82

Recommendations for Future Studies 83

REFERENCES 84

APPENDIX A

Knee Injury Questionnaire 88

8

LIST OF TABLES

TABLE Page

1 Demographic Information of the

Respondents (N=197) 41

2 Chi Square Test for Different Genders of the

Same Sport with the Rate of Knee Injuries 43

3 Chi Square Test for Different Sports of the

Same Gender with the Rate of Knee Injuries 43

4 Average Amount of Time per Week for Regular

Training of the Players (N=197) 45

5 Average Amount of Time per Training Session

for Fitness Training of the Players (N=197) 47

6 Chi Square Test for Fitness Training with

the Rate of Knee Injuries 47

7 Average Amount of Time for Warm Up (N=197) 49

8 Types of Warm Up of the Players (N=197) 50

9 Categories of Knee Injury of the

Injured Players (N=147) 51

10 Types of Knee Injury (N=147) 53

9

11 Causes of Knee Injuries (N=147) 55

12 Treatments for Knee Injuries (N=147) 57

13 Number of Knee Injuries Requiring

Surgery (N=147) 59

14 Major Knee Injuries Requiring Surgery 59

15 Recovery Time for the Injured

Players (N=147) 60

10

Chapter 1

INTRODUCTION

Basketball and soccer are two popular sports all over the

world According to Yard Schroeder Fields Collins amp

Comstock (2008) and Borowski Yard Fields amp Comstock (2008)

participation in basketball or soccer can lead to a number

of health benefits such as improved physical fitness weight

control increased strength and increased endurance As a

result many PE teachers in Hong Kong would include basketball

and soccer teaching in the syllabus of the PE classes Apart

from those health benefits students could also learn how to

cooperate and communicate with the others when they are

participating in basketball or soccer games due to the fact

that these two sports are kinds of team sports

Apart from having basketball and soccer classes in

schools there are also different levels of competitions in

basketball or soccer in Hong Kong For example there are

inter-primary schools sports competitions and

inter-secondary schools sports competitions organized by the

11

Hong Kong Schools Sports Federation (HKSSF) and inter-varsity

sports competitions organized by the University Sports

Federation of Hong Kong China (USFHK) When students are

representing their schools to compete with the other students

they usually have to be engaged in regular training and

competitions This may lead to an increased risk of injury

as they are participating in physically demanding sports

(Borowski et al 2008)

Among the three different levels of basketball and

soccer competitions mentioned above the inter-varsity

basketball and soccer competitions are expected to be the most

intense and most physically demanding competitions Borowski

et al (2008) found that the injury rate in high school

basketball was 194 per 1000 AEs and Yard et al (2008) found

that the injury rate in soccer in high school was 239 per

1000 AEs It was also found that knee was the second most

commonly injured body site in both basketball and soccer

(Borowski et al 2008 Yard et al 2008)

After getting a knee injury it usually takes the

12

injured player less than one week to return to the

participation but it may take some of them more than three

weeks for recovery (Ingram Fields Yard amp Comstock 2008)

It depends on the severity of the knee injury In order to

reduce the rate of injury especially knee injury and ensure

safe participation in basketball and soccer we have to first

understand the biomechanical risk factors of the injuries and

then identify the changes of the factors that would help to

reduce the injuries (Mihata Beutler amp Boden 2006)

13

Statement of Problem

The focus of this study was on the comparison of the rate

and types of knee injuries between the university basketball

team members and university soccer team members in Hong Kong

It also aimed at examining the relationship between the gender

and the patterns of knee injuries

Purpose of Study

The purpose of this study was to compare the rate and types

of knee injuries between the university basketball team

members and university soccer team members in Hong Kong The

result obtained could provide the coaches and players with

more information about the knee injuries in basketball and

soccer and could help them design preventive measures to

reduce the incidence of knee injuries

14

Hypotheses

The followings were the research hypotheses of this study

1 There would be a difference in the rate of knee injuries

between the university basketball team members and the

university soccer team members

2 There would be a difference in the rate of knee injuries

between the different genders in basketball

3 There would be a difference in the rate of knee injuries

between the different genders in soccer

4 There would be a difference in the rate of knee injuries

between the players who are regularly engaged in fitness

training and those who are not engaged in any fitness

training

5 There would be a difference in the rate of knee injuries

between the players who perform warm up prior to

trainingcompetition and those who do not

15

Definition of Terms

In order to understand this study more clearly the

operational definitions of terms were as follows

University Basketball Team Member

University basketball team member refers to the local

member of any university basketball team in Hong Kong in the

academic year 2011-2012 who has been participating in regular

training provided by the university basketball team

University Soccer Team Member

University soccer team member refers to the local member

of any university soccer team in Hong Kong in the academic

year 2011-2012 who has been participating in regular training

provided by the university soccer team

Knee Injury

Knee injury refers to any injury to the knee that occurs

during sports or exercise (Bellenir 2008) The Capsule

16

ligament synovium and cartilage in the knee are susceptible

to injuries in sports (Harris amp Varney 1977)

Case of Knee Injury

Case of knee injury refers to any reported case of knee

injury in basketball or soccer that occurred within the past

one year either in the training session or competition

Rate of Knee Injury

Rate of knee injury refers to the number of case of knee

injuries in the past one year divided by the number of players

Training Hour

Training hour refers to the time spent on training the

skills or tactics on the basketball court or soccer pitch

excluding the time spent on fitness training

17

Warm Up

Warm up refers to any exercise or activity performed before

the main exercise which aims at increasing the muscle

temperature and increasing the range of motion of the joints

and muscle tendons (Fevre 1998) It usually includes jogging

stretching or sometimes specific warm up

Specific Warm Up

Specific warm up refers to the exercise or activity that

prepares the body for the up-coming exercise using the

specific muscles which will be used mainly in the up-coming

exercise

Fitness Training

Fitness training refers to any kind of exercise that will

help to improve the fitness of the players both the

health-related fitness and skill-related fitness

18

Cool Down

Cool down refers to any light exercise or activity

performed after the main exercise that allows the body to

transit back from an excited state to a resting state It

usually includes slow jogging walking and stretching

Recovery Time

Recovery time refers to the amount of time spent on recovery

of the knee injury from the occurrence of the knee injury until

the player returns to regular training

Delimitations

The delimitations of this study were listed as follows

1 The participants were delimited to the local Hong Kong

members of university basketball or soccer team in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team

19

2 The period of data collection was delimited to March 2012

3 Cases of knee injury were delimited to the reported cases

of knee injury that occurred in either training or

competition in the past one year

Limitations

The following were the limitations that must be considered

when analyzing the results of this study

1 The content of the questionnaire might not provide enough

detailed information for analysis as it was self-designed

2 The questionnaire was not valid and reliable enough as it

was self-designed

3 It was assumed that the participants could correctly

identify the types of knee injuries that they suffered

4 It was assumed that the participants would honestly and

cautiously answer the questionnaire

20

Significance of Study

This study provided information about the pattern of knee

injuries of the local members of the university basketball

and soccer team in Hong Kong It also provided comparisons

of both the rate of knee injuries and types of injuries between

the members of university basketball team and that of

university soccer team Besides the relationship between the

gender and the patterns of knee injuries was examined

Understanding the patterns of knee injuries was important

because it was the primary step to prevent the occurrence of

knee injuries This provided much useful information for the

coaches as well as the players on how to reduce the occurrence

of knee injuries If coaches understood the knee injury

patterns of basketball or soccer they could be able to plan

a better and safer training program for the players For the

players if they understood more about the causes of knee

injuries they could focus more on the preventive measures

of knee injuries when they were engaged in the sports

21

Chapter 2

REVIEW OF LITERATURE

Some past literature focusing on the knee injuries in

basketball and soccer was reviewed in this chapter This

review of literature was divided into six sections (1) knee

injuries in basketball (2) knee injuries in soccer (3)

gender difference in the knee injuries in basketball (4)

gender difference in the knee injuries in soccer (5) anterior

cruciate ligament (ACL) injuries in basketball and soccer

and (6) summary

Knee Injuries in Basketball

Borowski Yard Fields amp Comstock (2008) said that

basketball was one of the most popular sports in the United

States Although basketball players could benefit a lot from

basketball activities such as improved self-esteem and

weight control they had an increased risk of injury as they

were participating in a physically demanding activity Dick

Hertel Agel Grossman amp Marshall (2007) defined collegiate

22

menrsquos basketball as ldquoa contact sport in which numerous

anatomical structures are susceptible to both acute and

overuse injuriesrdquo (p194) It was not uncommon for basketball

players to suffer from injuries

According to Borowski et al (2008) the knee was one of

the most commonly injured body parts in basketball practice

and competition For the female basketball players 172 and

195 of the injuries occurred in the knee during practice

and competition respectively Knee injuries in practice and

in competition accounted for 101 and 115 of the total

injuries respectively for in the male basketball

In 2004 Olympic Games there were seven knee injuries in

the basketball games (Junge et al 2006) There were two

ligament ruptures one meniscus lesion one sprain two

contusions and one laceration According to Dick et al

(2007) knee internal derangements and patellar injuries were

the common knee injuries happened during practice and

competition Borowski et al (2008) suggested that muscle or

tendon strains in knee were another common type of knee

23

injuries in basketball Soft tissue injuries were also common

knee injuries in basketball According to Ingram Fields Yard

amp Comstock (2008) torn cartilage injuries were common in both

male and female basketball players and complete ligament

tears were common in female basketball players

Ingram et al (2008) found that the knee injuries in

basketball for both male and female players were non-contact

injuries meaning that there was no contact between players

when the knee injuries happened However Borowski et al

(2008) found that 246 of the knee injuries in the United

States high school basketball were caused by collision with

other player But still there were some non-contact knee

injuries caused by either rotation around a planted foot or

inversion or jumping or landing

24

Knee Injuries in Soccer

According to Yard Schroeder Fields Collins amp Comstock

(2008) ldquosoccer is one of the most popular sports worldwiderdquo

(p1930) It explained why there have been more and more people

both youngsters and adults participating in different soccer

activities nowadays Upon participation in soccer the

players could get a number of benefits such as becoming

physically active increase in productivity and enhancement

in academic performance but there were still risks for

injuries (Yard et al 2008)

Le Gall Carling amp Reilly (2007) conducted a study on the

soccer injuries in young elite females According to the

result among all anatomical sites in the body the lower

extremities were the most common site for injuries in soccer

with 168 of those injuries affecting the knee It was also

supported by the result of the research conducted by Yard et

al (2008) which showed that 187 of the soccer injuries

occurred in the knee

Concerning the types of knee injuries Junge et al (2006)

25

did a research on the injuries in team sport tournaments during

the 2004 Olympic Games and found that there were totally 17

knee injuries in soccer Of these 17 knee injuries 1 was

meniscus lesion 7 were sprain and 9 were contusion Apart

from that ligament tears were common in soccer players too

Ingram et al (2008) showed that incomplete ligament tears

and complete ligament tears were common in male soccer players

and female soccer players respectively A similar result was

obtained by Yard et al (2008) It showed that incomplete knee

ligament sprains were common among both male and female soccer

players but complete knee ligament sprains were only common

in female soccer players Both Ingram et al and Yard et al

suggested that the both the complete and incomplete knee

ligament injuries in the male soccer players were caused by

contact with other players while the incomplete knee ligament

injuries in the female soccer players were not caused by any

contact with others

According to Le Gall et al (2007) serious injuries

usually occurred in the knee and those serious injuries

26

included ligament sprain or rupture meniscus lesion and

patellar tendinitis or bursitis Overuse injuries were also

commonly occurred in the knee Yard et al (2008) suggested

that ldquogirl soccer players sustained a larger proportion of

knee injuriesrdquo (p1932) Darrow Collins Yard amp Comstock

(2009) supported that more female soccer players suffered from

severe knee injuries than male soccer players did

Gender Difference in the Knee Injuries in Basketball

According to Borowski et al (2008) female high school

basketball players in the United States were more likely to

injure their knees during practice and competition than the

male players A similar result was also found in the study

done by Ingram et al (2008) which showed that female high

school basketball players had a higher rate of major knee

injuries than the male players Darrow et al (2009) further

showed that female high school basketball players in the

United States had a higher chance of suffering from severe

knee injuries than the male players

27

The reasons for the difference in the rate of knee injuries

in basketball among the female and male players could be

divided into two categories intrinsic factors and extrinsic

factors Borowski et al (2008) suggested that the intrinsic

factors were mainly physiological differences between boys

and girls Examples for these physiological differences were

anatomical differences in joint and bone structure

differences in flexibility and strength and differences in

hormone secretions Differences in equipment differences in

facilities and differences in competition environment were

the extrinsic factors for the difference in the rate of knee

injury

Ingram et al (2008) mentioned that the likeliness of

female basketball players to sustain major knee injuries in

basketball was due to the vulnerability of their knees It

was associated with various risk factors such as hormonal

difference neuromuscular difference and mechanical

difference These risk factors made the female basketball

players four to six times more susceptible to major knee

28

injuries than the male basketball players

Gender Difference in the Knee Injuries in Soccer

The result of the study conducted by Yard et al (2008)

showed that female soccer players sustained a higher rate of

knee injuries than the male soccer players Le Gall et al

(2007) suggested that the reasons for the higher rate in knee

injuries for the female soccer players included weaker

technical and tactical ability poorer muscular strength and

endurance and weaker coordination The rapid development of

the female soccer game which led to an increased in

aggressiveness of the players was another cause of the higher

knee injury rate

Specifically female soccer players had a higher rate of

sustaining complete knee ligament sprains than the male soccer

players (Yard et al 2008) This was supported by the result

of the research done by Ingram et al (2008) which showed

that complete ligament tears were more common in female soccer

than in male soccer It might due to that fact that there were

29

structural differences and neuromuscular differences between

female and male soccer players Yard et al also found that

the rate of complete knee ligament sprains requiring surgery

in female soccer players was higher than that in male soccer

players Female soccer players were found to be 13 times more

susceptible to knee ligament injuries that required surgery

The reasons for this high rate against male soccer players

included the shoe-surface interaction differences in

anthropometry and increased joint laxity

Ingram et al (2008) also showed that non-contact knee

injuries were more common in female soccer than in male soccer

The reasons for this result were suggested to be that the knee

joint of the female soccer players were more vulnerable to

the stress created by rapid acceleration deceleration and

cutting movement on the grass surfaces

Anterior Cruciate Ligament Injuries in Basketball and Soccer

According to Mihata Beutler amp Boden (2006) anterior

cruciate ligament (ACL) injuries were not uncommon in

30

collegiate sports The most common type of ACL injuries was

non-contact or minimal contact ACL injuries The actions of

cutting jumping sudden deceleration and checking with

another player were the high risk mechanisms for this kind

of ACL injuries Basketball players and soccer players were

found to be often exposing to these damaging forces because

they had to perform these actions repeatedly during practice

and competition

From the result shown by Dick et al (2007) 18 of the

total game injuries in male basketball were ACL injuries and

603 of these ACL injuries were non-contact ACL injuries

This result was supported by Mihata et al (2006) whose result

showed that ACL injuries accounted for 14 of all injuries

in male basketball from 1989 to 2004 For the female basketball

players they had a higher rate of ACL injuries than the male

players It was shown by Mihata et al that the ACL injuries

accounted for 52 of all injuries in female basketball from

1989 to 2004 which was about four times higher than in male

basketball

31

For the soccer players the female soccer players also had

higher rates of ACL injuries than the male soccer players

In between 1989 and 2004 39 of the total injuries in female

soccer were ACL injuries while only 16 of the total injuries

in male soccer were ACL injuries (Mihata et al 2006) The

rate of ACL injuries in female soccer was almost three times

higher than that in male soccer in that period of time A more

serious result was shown by Le Gall et al (2007) In their

result ACL injuries mainly ACL sprains or ruptures

accounted for 156 of all major injuries of the young elite

female soccer players

According to Mihata et al (2006) the reasons for the

female players having higher rates of ACL injuries than the

male players were that they had only participated in such

organized sports for a brief period of time they were less

fit and they received less training Another reason was a

disturbance in the neuromuscular patterns received by the

female players which protected the knee created by

incidental or minimal trauma

32

The rate of ACL injuries could be reduced effectively

Understanding the biomechanical risk factors and identifying

and changing those risk factors were the necessary steps to

decrease the long-term ACL injury rates (Mihata et al 2006)

Summary

Soccer and basketball are common sports all over the world

and they are generally regarded as kinds of contact sports

as there is direct contact between players Players are

required to have good muscular strength and power in order

to compete with others Collision and contacting with other

players would lead to imbalance and maybe fall which in turn

lead to injury

Knee was found to be one of the most common body sites

susceptible to injuries in basketball and soccer during both

practice and competition Different types of knee injuries

were sustained by the players such as contusion laceration

sprain ligament tear meniscus lesion and torn cartilage

According to Ingram et al (2008) 168 of all knee injuries

33

were surgery-requiring injuries Examples of these major

knee injuries were complete ligament tears torn cartilage

incomplete ligament tears and fractures

Female players no matter they were soccer players or

basketball players would have a higher chance of injuring

their knee especially the ACL than their male counterparts

It might due to both intrinsic factors such as muscular

strength and endurance and hormonal differences and

extrinsic factors such as game environment and sports

facilities

However knee injuries could be prevented Preventive

measures for knee injuries included lower-extremity landing

skills plyometrics (Le Gall et al 2007) neuromuscular

training programs added supervision (Dick et al 2007)

muscle strengthening and movement training (Ingram et al

2008)

34

Chapter 3

METHOD

The method of this study was divided into the following

sections 1) Participants 2) Development of questionnaire

3) Pilot study 4) Procedures and 5) Data analysis

Participants

The participants were both male and female local members

of university basketball or soccer team in Hong Kong in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team The total number of subjects was 197 with

48 male members of university basketball team 51 female

members of university basketball team 56 male members of

university soccer team and 42 female members of university

soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 3: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

3

DECLARATION

I hereby declare that this honours project ldquoA Comparison of

Knee Injuries among University Basketball and Soccer Players

in Hong Kongrdquo represents my own work and had not been previously

submitted to this or other institution for a degree diploma

or other qualification Citations from the other authors were

listed in the references

Li Kin Hei

30th April 2012

4

ACKNOWLEDGEMENTS

I would like to express my deepest gratitude to my chief

adviser Dr Lobo LOUIE for his professional advice and

generous help on this project I would also like to thank Dr

Tom TONG for being my second reader of this project

Thanks must be given to all the participants involved in

this project Without their participation this project could

not be accomplished

Last but not least I would like to give special thanks

to my friends Mr HO Wing Tung Mr KO Chi Yuen Mr KWOK

Yin Hang Ms PONG Ka Man Mr TING Wai Ting and Mr WAN Siu

Ming Timothy and Mr YIU Wai Ming for their help and

encouragement during the entire project period

_______________

Li Kin Hei

Department of Physical Education

Hong Kong Baptist University

Date 30th April 2012

5

ABSTRACT

Basketball and soccer are two popular sports worldwide

However the players are at risk of injuries Basketball and

soccer competitions among the university teams in Hong Kong

are considered as competitions of high level As a result

the injuries are common among players especially knee

injuries The purpose of this study was to understand the

patterns of knee injuries among the university basketball and

soccer players in Hong Kong There were 197 university

basketball and soccer players being the participants in this

study The result showed that 147 of the players (746) have

suffered knee injuries during training or competition in the

past one year The most common types of knee injuries were

abrasion (n=87 592) contusion (n=81 551) and overuse

injury (n=58 395) The major causes of knee injuries were

collision with other players (n=111 755) venue problem

(n=56 381) poor fitness (n=55 374) being over-trained

(n=46 313) and inadequate warm up (n=44 299)

6

TABLE OF CONTENTS

CHAPTER Page

1 INTRODUCTION 10

Statement of Problem 13

Purpose of Study 13

Hypotheses 14

Definition of Terms 15

Delimitations 18

Limitations 19

Significance of Study 20

2 REVIEW OF LITERATURE 21

Knee Injuries in Basketball 21

Knee Injuries in Soccer 24

Gender Difference in the Knee Injuries

in Basketball 26

Gender Difference in the Knee Injuries

in Soccer 28

Anterior Cruciate Ligament Injuries in

Basketball and Soccer 29

7

Summary 32

3 METHOD 34

Participants 34

Development of Questionnaire 35

Pilot Study 36

Procedures 37

Data Analysis 37

4 ANALYSIS OF DATA 39

Results 40

Discussions 61

5 SUMMARY AND CONCLUSION 77

Summary of Results 77

Conclusion 82

Recommendations for Future Studies 83

REFERENCES 84

APPENDIX A

Knee Injury Questionnaire 88

8

LIST OF TABLES

TABLE Page

1 Demographic Information of the

Respondents (N=197) 41

2 Chi Square Test for Different Genders of the

Same Sport with the Rate of Knee Injuries 43

3 Chi Square Test for Different Sports of the

Same Gender with the Rate of Knee Injuries 43

4 Average Amount of Time per Week for Regular

Training of the Players (N=197) 45

5 Average Amount of Time per Training Session

for Fitness Training of the Players (N=197) 47

6 Chi Square Test for Fitness Training with

the Rate of Knee Injuries 47

7 Average Amount of Time for Warm Up (N=197) 49

8 Types of Warm Up of the Players (N=197) 50

9 Categories of Knee Injury of the

Injured Players (N=147) 51

10 Types of Knee Injury (N=147) 53

9

11 Causes of Knee Injuries (N=147) 55

12 Treatments for Knee Injuries (N=147) 57

13 Number of Knee Injuries Requiring

Surgery (N=147) 59

14 Major Knee Injuries Requiring Surgery 59

15 Recovery Time for the Injured

Players (N=147) 60

10

Chapter 1

INTRODUCTION

Basketball and soccer are two popular sports all over the

world According to Yard Schroeder Fields Collins amp

Comstock (2008) and Borowski Yard Fields amp Comstock (2008)

participation in basketball or soccer can lead to a number

of health benefits such as improved physical fitness weight

control increased strength and increased endurance As a

result many PE teachers in Hong Kong would include basketball

and soccer teaching in the syllabus of the PE classes Apart

from those health benefits students could also learn how to

cooperate and communicate with the others when they are

participating in basketball or soccer games due to the fact

that these two sports are kinds of team sports

Apart from having basketball and soccer classes in

schools there are also different levels of competitions in

basketball or soccer in Hong Kong For example there are

inter-primary schools sports competitions and

inter-secondary schools sports competitions organized by the

11

Hong Kong Schools Sports Federation (HKSSF) and inter-varsity

sports competitions organized by the University Sports

Federation of Hong Kong China (USFHK) When students are

representing their schools to compete with the other students

they usually have to be engaged in regular training and

competitions This may lead to an increased risk of injury

as they are participating in physically demanding sports

(Borowski et al 2008)

Among the three different levels of basketball and

soccer competitions mentioned above the inter-varsity

basketball and soccer competitions are expected to be the most

intense and most physically demanding competitions Borowski

et al (2008) found that the injury rate in high school

basketball was 194 per 1000 AEs and Yard et al (2008) found

that the injury rate in soccer in high school was 239 per

1000 AEs It was also found that knee was the second most

commonly injured body site in both basketball and soccer

(Borowski et al 2008 Yard et al 2008)

After getting a knee injury it usually takes the

12

injured player less than one week to return to the

participation but it may take some of them more than three

weeks for recovery (Ingram Fields Yard amp Comstock 2008)

It depends on the severity of the knee injury In order to

reduce the rate of injury especially knee injury and ensure

safe participation in basketball and soccer we have to first

understand the biomechanical risk factors of the injuries and

then identify the changes of the factors that would help to

reduce the injuries (Mihata Beutler amp Boden 2006)

13

Statement of Problem

The focus of this study was on the comparison of the rate

and types of knee injuries between the university basketball

team members and university soccer team members in Hong Kong

It also aimed at examining the relationship between the gender

and the patterns of knee injuries

Purpose of Study

The purpose of this study was to compare the rate and types

of knee injuries between the university basketball team

members and university soccer team members in Hong Kong The

result obtained could provide the coaches and players with

more information about the knee injuries in basketball and

soccer and could help them design preventive measures to

reduce the incidence of knee injuries

14

Hypotheses

The followings were the research hypotheses of this study

1 There would be a difference in the rate of knee injuries

between the university basketball team members and the

university soccer team members

2 There would be a difference in the rate of knee injuries

between the different genders in basketball

3 There would be a difference in the rate of knee injuries

between the different genders in soccer

4 There would be a difference in the rate of knee injuries

between the players who are regularly engaged in fitness

training and those who are not engaged in any fitness

training

5 There would be a difference in the rate of knee injuries

between the players who perform warm up prior to

trainingcompetition and those who do not

15

Definition of Terms

In order to understand this study more clearly the

operational definitions of terms were as follows

University Basketball Team Member

University basketball team member refers to the local

member of any university basketball team in Hong Kong in the

academic year 2011-2012 who has been participating in regular

training provided by the university basketball team

University Soccer Team Member

University soccer team member refers to the local member

of any university soccer team in Hong Kong in the academic

year 2011-2012 who has been participating in regular training

provided by the university soccer team

Knee Injury

Knee injury refers to any injury to the knee that occurs

during sports or exercise (Bellenir 2008) The Capsule

16

ligament synovium and cartilage in the knee are susceptible

to injuries in sports (Harris amp Varney 1977)

Case of Knee Injury

Case of knee injury refers to any reported case of knee

injury in basketball or soccer that occurred within the past

one year either in the training session or competition

Rate of Knee Injury

Rate of knee injury refers to the number of case of knee

injuries in the past one year divided by the number of players

Training Hour

Training hour refers to the time spent on training the

skills or tactics on the basketball court or soccer pitch

excluding the time spent on fitness training

17

Warm Up

Warm up refers to any exercise or activity performed before

the main exercise which aims at increasing the muscle

temperature and increasing the range of motion of the joints

and muscle tendons (Fevre 1998) It usually includes jogging

stretching or sometimes specific warm up

Specific Warm Up

Specific warm up refers to the exercise or activity that

prepares the body for the up-coming exercise using the

specific muscles which will be used mainly in the up-coming

exercise

Fitness Training

Fitness training refers to any kind of exercise that will

help to improve the fitness of the players both the

health-related fitness and skill-related fitness

18

Cool Down

Cool down refers to any light exercise or activity

performed after the main exercise that allows the body to

transit back from an excited state to a resting state It

usually includes slow jogging walking and stretching

Recovery Time

Recovery time refers to the amount of time spent on recovery

of the knee injury from the occurrence of the knee injury until

the player returns to regular training

Delimitations

The delimitations of this study were listed as follows

1 The participants were delimited to the local Hong Kong

members of university basketball or soccer team in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team

19

2 The period of data collection was delimited to March 2012

3 Cases of knee injury were delimited to the reported cases

of knee injury that occurred in either training or

competition in the past one year

Limitations

The following were the limitations that must be considered

when analyzing the results of this study

1 The content of the questionnaire might not provide enough

detailed information for analysis as it was self-designed

2 The questionnaire was not valid and reliable enough as it

was self-designed

3 It was assumed that the participants could correctly

identify the types of knee injuries that they suffered

4 It was assumed that the participants would honestly and

cautiously answer the questionnaire

20

Significance of Study

This study provided information about the pattern of knee

injuries of the local members of the university basketball

and soccer team in Hong Kong It also provided comparisons

of both the rate of knee injuries and types of injuries between

the members of university basketball team and that of

university soccer team Besides the relationship between the

gender and the patterns of knee injuries was examined

Understanding the patterns of knee injuries was important

because it was the primary step to prevent the occurrence of

knee injuries This provided much useful information for the

coaches as well as the players on how to reduce the occurrence

of knee injuries If coaches understood the knee injury

patterns of basketball or soccer they could be able to plan

a better and safer training program for the players For the

players if they understood more about the causes of knee

injuries they could focus more on the preventive measures

of knee injuries when they were engaged in the sports

21

Chapter 2

REVIEW OF LITERATURE

Some past literature focusing on the knee injuries in

basketball and soccer was reviewed in this chapter This

review of literature was divided into six sections (1) knee

injuries in basketball (2) knee injuries in soccer (3)

gender difference in the knee injuries in basketball (4)

gender difference in the knee injuries in soccer (5) anterior

cruciate ligament (ACL) injuries in basketball and soccer

and (6) summary

Knee Injuries in Basketball

Borowski Yard Fields amp Comstock (2008) said that

basketball was one of the most popular sports in the United

States Although basketball players could benefit a lot from

basketball activities such as improved self-esteem and

weight control they had an increased risk of injury as they

were participating in a physically demanding activity Dick

Hertel Agel Grossman amp Marshall (2007) defined collegiate

22

menrsquos basketball as ldquoa contact sport in which numerous

anatomical structures are susceptible to both acute and

overuse injuriesrdquo (p194) It was not uncommon for basketball

players to suffer from injuries

According to Borowski et al (2008) the knee was one of

the most commonly injured body parts in basketball practice

and competition For the female basketball players 172 and

195 of the injuries occurred in the knee during practice

and competition respectively Knee injuries in practice and

in competition accounted for 101 and 115 of the total

injuries respectively for in the male basketball

In 2004 Olympic Games there were seven knee injuries in

the basketball games (Junge et al 2006) There were two

ligament ruptures one meniscus lesion one sprain two

contusions and one laceration According to Dick et al

(2007) knee internal derangements and patellar injuries were

the common knee injuries happened during practice and

competition Borowski et al (2008) suggested that muscle or

tendon strains in knee were another common type of knee

23

injuries in basketball Soft tissue injuries were also common

knee injuries in basketball According to Ingram Fields Yard

amp Comstock (2008) torn cartilage injuries were common in both

male and female basketball players and complete ligament

tears were common in female basketball players

Ingram et al (2008) found that the knee injuries in

basketball for both male and female players were non-contact

injuries meaning that there was no contact between players

when the knee injuries happened However Borowski et al

(2008) found that 246 of the knee injuries in the United

States high school basketball were caused by collision with

other player But still there were some non-contact knee

injuries caused by either rotation around a planted foot or

inversion or jumping or landing

24

Knee Injuries in Soccer

According to Yard Schroeder Fields Collins amp Comstock

(2008) ldquosoccer is one of the most popular sports worldwiderdquo

(p1930) It explained why there have been more and more people

both youngsters and adults participating in different soccer

activities nowadays Upon participation in soccer the

players could get a number of benefits such as becoming

physically active increase in productivity and enhancement

in academic performance but there were still risks for

injuries (Yard et al 2008)

Le Gall Carling amp Reilly (2007) conducted a study on the

soccer injuries in young elite females According to the

result among all anatomical sites in the body the lower

extremities were the most common site for injuries in soccer

with 168 of those injuries affecting the knee It was also

supported by the result of the research conducted by Yard et

al (2008) which showed that 187 of the soccer injuries

occurred in the knee

Concerning the types of knee injuries Junge et al (2006)

25

did a research on the injuries in team sport tournaments during

the 2004 Olympic Games and found that there were totally 17

knee injuries in soccer Of these 17 knee injuries 1 was

meniscus lesion 7 were sprain and 9 were contusion Apart

from that ligament tears were common in soccer players too

Ingram et al (2008) showed that incomplete ligament tears

and complete ligament tears were common in male soccer players

and female soccer players respectively A similar result was

obtained by Yard et al (2008) It showed that incomplete knee

ligament sprains were common among both male and female soccer

players but complete knee ligament sprains were only common

in female soccer players Both Ingram et al and Yard et al

suggested that the both the complete and incomplete knee

ligament injuries in the male soccer players were caused by

contact with other players while the incomplete knee ligament

injuries in the female soccer players were not caused by any

contact with others

According to Le Gall et al (2007) serious injuries

usually occurred in the knee and those serious injuries

26

included ligament sprain or rupture meniscus lesion and

patellar tendinitis or bursitis Overuse injuries were also

commonly occurred in the knee Yard et al (2008) suggested

that ldquogirl soccer players sustained a larger proportion of

knee injuriesrdquo (p1932) Darrow Collins Yard amp Comstock

(2009) supported that more female soccer players suffered from

severe knee injuries than male soccer players did

Gender Difference in the Knee Injuries in Basketball

According to Borowski et al (2008) female high school

basketball players in the United States were more likely to

injure their knees during practice and competition than the

male players A similar result was also found in the study

done by Ingram et al (2008) which showed that female high

school basketball players had a higher rate of major knee

injuries than the male players Darrow et al (2009) further

showed that female high school basketball players in the

United States had a higher chance of suffering from severe

knee injuries than the male players

27

The reasons for the difference in the rate of knee injuries

in basketball among the female and male players could be

divided into two categories intrinsic factors and extrinsic

factors Borowski et al (2008) suggested that the intrinsic

factors were mainly physiological differences between boys

and girls Examples for these physiological differences were

anatomical differences in joint and bone structure

differences in flexibility and strength and differences in

hormone secretions Differences in equipment differences in

facilities and differences in competition environment were

the extrinsic factors for the difference in the rate of knee

injury

Ingram et al (2008) mentioned that the likeliness of

female basketball players to sustain major knee injuries in

basketball was due to the vulnerability of their knees It

was associated with various risk factors such as hormonal

difference neuromuscular difference and mechanical

difference These risk factors made the female basketball

players four to six times more susceptible to major knee

28

injuries than the male basketball players

Gender Difference in the Knee Injuries in Soccer

The result of the study conducted by Yard et al (2008)

showed that female soccer players sustained a higher rate of

knee injuries than the male soccer players Le Gall et al

(2007) suggested that the reasons for the higher rate in knee

injuries for the female soccer players included weaker

technical and tactical ability poorer muscular strength and

endurance and weaker coordination The rapid development of

the female soccer game which led to an increased in

aggressiveness of the players was another cause of the higher

knee injury rate

Specifically female soccer players had a higher rate of

sustaining complete knee ligament sprains than the male soccer

players (Yard et al 2008) This was supported by the result

of the research done by Ingram et al (2008) which showed

that complete ligament tears were more common in female soccer

than in male soccer It might due to that fact that there were

29

structural differences and neuromuscular differences between

female and male soccer players Yard et al also found that

the rate of complete knee ligament sprains requiring surgery

in female soccer players was higher than that in male soccer

players Female soccer players were found to be 13 times more

susceptible to knee ligament injuries that required surgery

The reasons for this high rate against male soccer players

included the shoe-surface interaction differences in

anthropometry and increased joint laxity

Ingram et al (2008) also showed that non-contact knee

injuries were more common in female soccer than in male soccer

The reasons for this result were suggested to be that the knee

joint of the female soccer players were more vulnerable to

the stress created by rapid acceleration deceleration and

cutting movement on the grass surfaces

Anterior Cruciate Ligament Injuries in Basketball and Soccer

According to Mihata Beutler amp Boden (2006) anterior

cruciate ligament (ACL) injuries were not uncommon in

30

collegiate sports The most common type of ACL injuries was

non-contact or minimal contact ACL injuries The actions of

cutting jumping sudden deceleration and checking with

another player were the high risk mechanisms for this kind

of ACL injuries Basketball players and soccer players were

found to be often exposing to these damaging forces because

they had to perform these actions repeatedly during practice

and competition

From the result shown by Dick et al (2007) 18 of the

total game injuries in male basketball were ACL injuries and

603 of these ACL injuries were non-contact ACL injuries

This result was supported by Mihata et al (2006) whose result

showed that ACL injuries accounted for 14 of all injuries

in male basketball from 1989 to 2004 For the female basketball

players they had a higher rate of ACL injuries than the male

players It was shown by Mihata et al that the ACL injuries

accounted for 52 of all injuries in female basketball from

1989 to 2004 which was about four times higher than in male

basketball

31

For the soccer players the female soccer players also had

higher rates of ACL injuries than the male soccer players

In between 1989 and 2004 39 of the total injuries in female

soccer were ACL injuries while only 16 of the total injuries

in male soccer were ACL injuries (Mihata et al 2006) The

rate of ACL injuries in female soccer was almost three times

higher than that in male soccer in that period of time A more

serious result was shown by Le Gall et al (2007) In their

result ACL injuries mainly ACL sprains or ruptures

accounted for 156 of all major injuries of the young elite

female soccer players

According to Mihata et al (2006) the reasons for the

female players having higher rates of ACL injuries than the

male players were that they had only participated in such

organized sports for a brief period of time they were less

fit and they received less training Another reason was a

disturbance in the neuromuscular patterns received by the

female players which protected the knee created by

incidental or minimal trauma

32

The rate of ACL injuries could be reduced effectively

Understanding the biomechanical risk factors and identifying

and changing those risk factors were the necessary steps to

decrease the long-term ACL injury rates (Mihata et al 2006)

Summary

Soccer and basketball are common sports all over the world

and they are generally regarded as kinds of contact sports

as there is direct contact between players Players are

required to have good muscular strength and power in order

to compete with others Collision and contacting with other

players would lead to imbalance and maybe fall which in turn

lead to injury

Knee was found to be one of the most common body sites

susceptible to injuries in basketball and soccer during both

practice and competition Different types of knee injuries

were sustained by the players such as contusion laceration

sprain ligament tear meniscus lesion and torn cartilage

According to Ingram et al (2008) 168 of all knee injuries

33

were surgery-requiring injuries Examples of these major

knee injuries were complete ligament tears torn cartilage

incomplete ligament tears and fractures

Female players no matter they were soccer players or

basketball players would have a higher chance of injuring

their knee especially the ACL than their male counterparts

It might due to both intrinsic factors such as muscular

strength and endurance and hormonal differences and

extrinsic factors such as game environment and sports

facilities

However knee injuries could be prevented Preventive

measures for knee injuries included lower-extremity landing

skills plyometrics (Le Gall et al 2007) neuromuscular

training programs added supervision (Dick et al 2007)

muscle strengthening and movement training (Ingram et al

2008)

34

Chapter 3

METHOD

The method of this study was divided into the following

sections 1) Participants 2) Development of questionnaire

3) Pilot study 4) Procedures and 5) Data analysis

Participants

The participants were both male and female local members

of university basketball or soccer team in Hong Kong in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team The total number of subjects was 197 with

48 male members of university basketball team 51 female

members of university basketball team 56 male members of

university soccer team and 42 female members of university

soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 4: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

4

ACKNOWLEDGEMENTS

I would like to express my deepest gratitude to my chief

adviser Dr Lobo LOUIE for his professional advice and

generous help on this project I would also like to thank Dr

Tom TONG for being my second reader of this project

Thanks must be given to all the participants involved in

this project Without their participation this project could

not be accomplished

Last but not least I would like to give special thanks

to my friends Mr HO Wing Tung Mr KO Chi Yuen Mr KWOK

Yin Hang Ms PONG Ka Man Mr TING Wai Ting and Mr WAN Siu

Ming Timothy and Mr YIU Wai Ming for their help and

encouragement during the entire project period

_______________

Li Kin Hei

Department of Physical Education

Hong Kong Baptist University

Date 30th April 2012

5

ABSTRACT

Basketball and soccer are two popular sports worldwide

However the players are at risk of injuries Basketball and

soccer competitions among the university teams in Hong Kong

are considered as competitions of high level As a result

the injuries are common among players especially knee

injuries The purpose of this study was to understand the

patterns of knee injuries among the university basketball and

soccer players in Hong Kong There were 197 university

basketball and soccer players being the participants in this

study The result showed that 147 of the players (746) have

suffered knee injuries during training or competition in the

past one year The most common types of knee injuries were

abrasion (n=87 592) contusion (n=81 551) and overuse

injury (n=58 395) The major causes of knee injuries were

collision with other players (n=111 755) venue problem

(n=56 381) poor fitness (n=55 374) being over-trained

(n=46 313) and inadequate warm up (n=44 299)

6

TABLE OF CONTENTS

CHAPTER Page

1 INTRODUCTION 10

Statement of Problem 13

Purpose of Study 13

Hypotheses 14

Definition of Terms 15

Delimitations 18

Limitations 19

Significance of Study 20

2 REVIEW OF LITERATURE 21

Knee Injuries in Basketball 21

Knee Injuries in Soccer 24

Gender Difference in the Knee Injuries

in Basketball 26

Gender Difference in the Knee Injuries

in Soccer 28

Anterior Cruciate Ligament Injuries in

Basketball and Soccer 29

7

Summary 32

3 METHOD 34

Participants 34

Development of Questionnaire 35

Pilot Study 36

Procedures 37

Data Analysis 37

4 ANALYSIS OF DATA 39

Results 40

Discussions 61

5 SUMMARY AND CONCLUSION 77

Summary of Results 77

Conclusion 82

Recommendations for Future Studies 83

REFERENCES 84

APPENDIX A

Knee Injury Questionnaire 88

8

LIST OF TABLES

TABLE Page

1 Demographic Information of the

Respondents (N=197) 41

2 Chi Square Test for Different Genders of the

Same Sport with the Rate of Knee Injuries 43

3 Chi Square Test for Different Sports of the

Same Gender with the Rate of Knee Injuries 43

4 Average Amount of Time per Week for Regular

Training of the Players (N=197) 45

5 Average Amount of Time per Training Session

for Fitness Training of the Players (N=197) 47

6 Chi Square Test for Fitness Training with

the Rate of Knee Injuries 47

7 Average Amount of Time for Warm Up (N=197) 49

8 Types of Warm Up of the Players (N=197) 50

9 Categories of Knee Injury of the

Injured Players (N=147) 51

10 Types of Knee Injury (N=147) 53

9

11 Causes of Knee Injuries (N=147) 55

12 Treatments for Knee Injuries (N=147) 57

13 Number of Knee Injuries Requiring

Surgery (N=147) 59

14 Major Knee Injuries Requiring Surgery 59

15 Recovery Time for the Injured

Players (N=147) 60

10

Chapter 1

INTRODUCTION

Basketball and soccer are two popular sports all over the

world According to Yard Schroeder Fields Collins amp

Comstock (2008) and Borowski Yard Fields amp Comstock (2008)

participation in basketball or soccer can lead to a number

of health benefits such as improved physical fitness weight

control increased strength and increased endurance As a

result many PE teachers in Hong Kong would include basketball

and soccer teaching in the syllabus of the PE classes Apart

from those health benefits students could also learn how to

cooperate and communicate with the others when they are

participating in basketball or soccer games due to the fact

that these two sports are kinds of team sports

Apart from having basketball and soccer classes in

schools there are also different levels of competitions in

basketball or soccer in Hong Kong For example there are

inter-primary schools sports competitions and

inter-secondary schools sports competitions organized by the

11

Hong Kong Schools Sports Federation (HKSSF) and inter-varsity

sports competitions organized by the University Sports

Federation of Hong Kong China (USFHK) When students are

representing their schools to compete with the other students

they usually have to be engaged in regular training and

competitions This may lead to an increased risk of injury

as they are participating in physically demanding sports

(Borowski et al 2008)

Among the three different levels of basketball and

soccer competitions mentioned above the inter-varsity

basketball and soccer competitions are expected to be the most

intense and most physically demanding competitions Borowski

et al (2008) found that the injury rate in high school

basketball was 194 per 1000 AEs and Yard et al (2008) found

that the injury rate in soccer in high school was 239 per

1000 AEs It was also found that knee was the second most

commonly injured body site in both basketball and soccer

(Borowski et al 2008 Yard et al 2008)

After getting a knee injury it usually takes the

12

injured player less than one week to return to the

participation but it may take some of them more than three

weeks for recovery (Ingram Fields Yard amp Comstock 2008)

It depends on the severity of the knee injury In order to

reduce the rate of injury especially knee injury and ensure

safe participation in basketball and soccer we have to first

understand the biomechanical risk factors of the injuries and

then identify the changes of the factors that would help to

reduce the injuries (Mihata Beutler amp Boden 2006)

13

Statement of Problem

The focus of this study was on the comparison of the rate

and types of knee injuries between the university basketball

team members and university soccer team members in Hong Kong

It also aimed at examining the relationship between the gender

and the patterns of knee injuries

Purpose of Study

The purpose of this study was to compare the rate and types

of knee injuries between the university basketball team

members and university soccer team members in Hong Kong The

result obtained could provide the coaches and players with

more information about the knee injuries in basketball and

soccer and could help them design preventive measures to

reduce the incidence of knee injuries

14

Hypotheses

The followings were the research hypotheses of this study

1 There would be a difference in the rate of knee injuries

between the university basketball team members and the

university soccer team members

2 There would be a difference in the rate of knee injuries

between the different genders in basketball

3 There would be a difference in the rate of knee injuries

between the different genders in soccer

4 There would be a difference in the rate of knee injuries

between the players who are regularly engaged in fitness

training and those who are not engaged in any fitness

training

5 There would be a difference in the rate of knee injuries

between the players who perform warm up prior to

trainingcompetition and those who do not

15

Definition of Terms

In order to understand this study more clearly the

operational definitions of terms were as follows

University Basketball Team Member

University basketball team member refers to the local

member of any university basketball team in Hong Kong in the

academic year 2011-2012 who has been participating in regular

training provided by the university basketball team

University Soccer Team Member

University soccer team member refers to the local member

of any university soccer team in Hong Kong in the academic

year 2011-2012 who has been participating in regular training

provided by the university soccer team

Knee Injury

Knee injury refers to any injury to the knee that occurs

during sports or exercise (Bellenir 2008) The Capsule

16

ligament synovium and cartilage in the knee are susceptible

to injuries in sports (Harris amp Varney 1977)

Case of Knee Injury

Case of knee injury refers to any reported case of knee

injury in basketball or soccer that occurred within the past

one year either in the training session or competition

Rate of Knee Injury

Rate of knee injury refers to the number of case of knee

injuries in the past one year divided by the number of players

Training Hour

Training hour refers to the time spent on training the

skills or tactics on the basketball court or soccer pitch

excluding the time spent on fitness training

17

Warm Up

Warm up refers to any exercise or activity performed before

the main exercise which aims at increasing the muscle

temperature and increasing the range of motion of the joints

and muscle tendons (Fevre 1998) It usually includes jogging

stretching or sometimes specific warm up

Specific Warm Up

Specific warm up refers to the exercise or activity that

prepares the body for the up-coming exercise using the

specific muscles which will be used mainly in the up-coming

exercise

Fitness Training

Fitness training refers to any kind of exercise that will

help to improve the fitness of the players both the

health-related fitness and skill-related fitness

18

Cool Down

Cool down refers to any light exercise or activity

performed after the main exercise that allows the body to

transit back from an excited state to a resting state It

usually includes slow jogging walking and stretching

Recovery Time

Recovery time refers to the amount of time spent on recovery

of the knee injury from the occurrence of the knee injury until

the player returns to regular training

Delimitations

The delimitations of this study were listed as follows

1 The participants were delimited to the local Hong Kong

members of university basketball or soccer team in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team

19

2 The period of data collection was delimited to March 2012

3 Cases of knee injury were delimited to the reported cases

of knee injury that occurred in either training or

competition in the past one year

Limitations

The following were the limitations that must be considered

when analyzing the results of this study

1 The content of the questionnaire might not provide enough

detailed information for analysis as it was self-designed

2 The questionnaire was not valid and reliable enough as it

was self-designed

3 It was assumed that the participants could correctly

identify the types of knee injuries that they suffered

4 It was assumed that the participants would honestly and

cautiously answer the questionnaire

20

Significance of Study

This study provided information about the pattern of knee

injuries of the local members of the university basketball

and soccer team in Hong Kong It also provided comparisons

of both the rate of knee injuries and types of injuries between

the members of university basketball team and that of

university soccer team Besides the relationship between the

gender and the patterns of knee injuries was examined

Understanding the patterns of knee injuries was important

because it was the primary step to prevent the occurrence of

knee injuries This provided much useful information for the

coaches as well as the players on how to reduce the occurrence

of knee injuries If coaches understood the knee injury

patterns of basketball or soccer they could be able to plan

a better and safer training program for the players For the

players if they understood more about the causes of knee

injuries they could focus more on the preventive measures

of knee injuries when they were engaged in the sports

21

Chapter 2

REVIEW OF LITERATURE

Some past literature focusing on the knee injuries in

basketball and soccer was reviewed in this chapter This

review of literature was divided into six sections (1) knee

injuries in basketball (2) knee injuries in soccer (3)

gender difference in the knee injuries in basketball (4)

gender difference in the knee injuries in soccer (5) anterior

cruciate ligament (ACL) injuries in basketball and soccer

and (6) summary

Knee Injuries in Basketball

Borowski Yard Fields amp Comstock (2008) said that

basketball was one of the most popular sports in the United

States Although basketball players could benefit a lot from

basketball activities such as improved self-esteem and

weight control they had an increased risk of injury as they

were participating in a physically demanding activity Dick

Hertel Agel Grossman amp Marshall (2007) defined collegiate

22

menrsquos basketball as ldquoa contact sport in which numerous

anatomical structures are susceptible to both acute and

overuse injuriesrdquo (p194) It was not uncommon for basketball

players to suffer from injuries

According to Borowski et al (2008) the knee was one of

the most commonly injured body parts in basketball practice

and competition For the female basketball players 172 and

195 of the injuries occurred in the knee during practice

and competition respectively Knee injuries in practice and

in competition accounted for 101 and 115 of the total

injuries respectively for in the male basketball

In 2004 Olympic Games there were seven knee injuries in

the basketball games (Junge et al 2006) There were two

ligament ruptures one meniscus lesion one sprain two

contusions and one laceration According to Dick et al

(2007) knee internal derangements and patellar injuries were

the common knee injuries happened during practice and

competition Borowski et al (2008) suggested that muscle or

tendon strains in knee were another common type of knee

23

injuries in basketball Soft tissue injuries were also common

knee injuries in basketball According to Ingram Fields Yard

amp Comstock (2008) torn cartilage injuries were common in both

male and female basketball players and complete ligament

tears were common in female basketball players

Ingram et al (2008) found that the knee injuries in

basketball for both male and female players were non-contact

injuries meaning that there was no contact between players

when the knee injuries happened However Borowski et al

(2008) found that 246 of the knee injuries in the United

States high school basketball were caused by collision with

other player But still there were some non-contact knee

injuries caused by either rotation around a planted foot or

inversion or jumping or landing

24

Knee Injuries in Soccer

According to Yard Schroeder Fields Collins amp Comstock

(2008) ldquosoccer is one of the most popular sports worldwiderdquo

(p1930) It explained why there have been more and more people

both youngsters and adults participating in different soccer

activities nowadays Upon participation in soccer the

players could get a number of benefits such as becoming

physically active increase in productivity and enhancement

in academic performance but there were still risks for

injuries (Yard et al 2008)

Le Gall Carling amp Reilly (2007) conducted a study on the

soccer injuries in young elite females According to the

result among all anatomical sites in the body the lower

extremities were the most common site for injuries in soccer

with 168 of those injuries affecting the knee It was also

supported by the result of the research conducted by Yard et

al (2008) which showed that 187 of the soccer injuries

occurred in the knee

Concerning the types of knee injuries Junge et al (2006)

25

did a research on the injuries in team sport tournaments during

the 2004 Olympic Games and found that there were totally 17

knee injuries in soccer Of these 17 knee injuries 1 was

meniscus lesion 7 were sprain and 9 were contusion Apart

from that ligament tears were common in soccer players too

Ingram et al (2008) showed that incomplete ligament tears

and complete ligament tears were common in male soccer players

and female soccer players respectively A similar result was

obtained by Yard et al (2008) It showed that incomplete knee

ligament sprains were common among both male and female soccer

players but complete knee ligament sprains were only common

in female soccer players Both Ingram et al and Yard et al

suggested that the both the complete and incomplete knee

ligament injuries in the male soccer players were caused by

contact with other players while the incomplete knee ligament

injuries in the female soccer players were not caused by any

contact with others

According to Le Gall et al (2007) serious injuries

usually occurred in the knee and those serious injuries

26

included ligament sprain or rupture meniscus lesion and

patellar tendinitis or bursitis Overuse injuries were also

commonly occurred in the knee Yard et al (2008) suggested

that ldquogirl soccer players sustained a larger proportion of

knee injuriesrdquo (p1932) Darrow Collins Yard amp Comstock

(2009) supported that more female soccer players suffered from

severe knee injuries than male soccer players did

Gender Difference in the Knee Injuries in Basketball

According to Borowski et al (2008) female high school

basketball players in the United States were more likely to

injure their knees during practice and competition than the

male players A similar result was also found in the study

done by Ingram et al (2008) which showed that female high

school basketball players had a higher rate of major knee

injuries than the male players Darrow et al (2009) further

showed that female high school basketball players in the

United States had a higher chance of suffering from severe

knee injuries than the male players

27

The reasons for the difference in the rate of knee injuries

in basketball among the female and male players could be

divided into two categories intrinsic factors and extrinsic

factors Borowski et al (2008) suggested that the intrinsic

factors were mainly physiological differences between boys

and girls Examples for these physiological differences were

anatomical differences in joint and bone structure

differences in flexibility and strength and differences in

hormone secretions Differences in equipment differences in

facilities and differences in competition environment were

the extrinsic factors for the difference in the rate of knee

injury

Ingram et al (2008) mentioned that the likeliness of

female basketball players to sustain major knee injuries in

basketball was due to the vulnerability of their knees It

was associated with various risk factors such as hormonal

difference neuromuscular difference and mechanical

difference These risk factors made the female basketball

players four to six times more susceptible to major knee

28

injuries than the male basketball players

Gender Difference in the Knee Injuries in Soccer

The result of the study conducted by Yard et al (2008)

showed that female soccer players sustained a higher rate of

knee injuries than the male soccer players Le Gall et al

(2007) suggested that the reasons for the higher rate in knee

injuries for the female soccer players included weaker

technical and tactical ability poorer muscular strength and

endurance and weaker coordination The rapid development of

the female soccer game which led to an increased in

aggressiveness of the players was another cause of the higher

knee injury rate

Specifically female soccer players had a higher rate of

sustaining complete knee ligament sprains than the male soccer

players (Yard et al 2008) This was supported by the result

of the research done by Ingram et al (2008) which showed

that complete ligament tears were more common in female soccer

than in male soccer It might due to that fact that there were

29

structural differences and neuromuscular differences between

female and male soccer players Yard et al also found that

the rate of complete knee ligament sprains requiring surgery

in female soccer players was higher than that in male soccer

players Female soccer players were found to be 13 times more

susceptible to knee ligament injuries that required surgery

The reasons for this high rate against male soccer players

included the shoe-surface interaction differences in

anthropometry and increased joint laxity

Ingram et al (2008) also showed that non-contact knee

injuries were more common in female soccer than in male soccer

The reasons for this result were suggested to be that the knee

joint of the female soccer players were more vulnerable to

the stress created by rapid acceleration deceleration and

cutting movement on the grass surfaces

Anterior Cruciate Ligament Injuries in Basketball and Soccer

According to Mihata Beutler amp Boden (2006) anterior

cruciate ligament (ACL) injuries were not uncommon in

30

collegiate sports The most common type of ACL injuries was

non-contact or minimal contact ACL injuries The actions of

cutting jumping sudden deceleration and checking with

another player were the high risk mechanisms for this kind

of ACL injuries Basketball players and soccer players were

found to be often exposing to these damaging forces because

they had to perform these actions repeatedly during practice

and competition

From the result shown by Dick et al (2007) 18 of the

total game injuries in male basketball were ACL injuries and

603 of these ACL injuries were non-contact ACL injuries

This result was supported by Mihata et al (2006) whose result

showed that ACL injuries accounted for 14 of all injuries

in male basketball from 1989 to 2004 For the female basketball

players they had a higher rate of ACL injuries than the male

players It was shown by Mihata et al that the ACL injuries

accounted for 52 of all injuries in female basketball from

1989 to 2004 which was about four times higher than in male

basketball

31

For the soccer players the female soccer players also had

higher rates of ACL injuries than the male soccer players

In between 1989 and 2004 39 of the total injuries in female

soccer were ACL injuries while only 16 of the total injuries

in male soccer were ACL injuries (Mihata et al 2006) The

rate of ACL injuries in female soccer was almost three times

higher than that in male soccer in that period of time A more

serious result was shown by Le Gall et al (2007) In their

result ACL injuries mainly ACL sprains or ruptures

accounted for 156 of all major injuries of the young elite

female soccer players

According to Mihata et al (2006) the reasons for the

female players having higher rates of ACL injuries than the

male players were that they had only participated in such

organized sports for a brief period of time they were less

fit and they received less training Another reason was a

disturbance in the neuromuscular patterns received by the

female players which protected the knee created by

incidental or minimal trauma

32

The rate of ACL injuries could be reduced effectively

Understanding the biomechanical risk factors and identifying

and changing those risk factors were the necessary steps to

decrease the long-term ACL injury rates (Mihata et al 2006)

Summary

Soccer and basketball are common sports all over the world

and they are generally regarded as kinds of contact sports

as there is direct contact between players Players are

required to have good muscular strength and power in order

to compete with others Collision and contacting with other

players would lead to imbalance and maybe fall which in turn

lead to injury

Knee was found to be one of the most common body sites

susceptible to injuries in basketball and soccer during both

practice and competition Different types of knee injuries

were sustained by the players such as contusion laceration

sprain ligament tear meniscus lesion and torn cartilage

According to Ingram et al (2008) 168 of all knee injuries

33

were surgery-requiring injuries Examples of these major

knee injuries were complete ligament tears torn cartilage

incomplete ligament tears and fractures

Female players no matter they were soccer players or

basketball players would have a higher chance of injuring

their knee especially the ACL than their male counterparts

It might due to both intrinsic factors such as muscular

strength and endurance and hormonal differences and

extrinsic factors such as game environment and sports

facilities

However knee injuries could be prevented Preventive

measures for knee injuries included lower-extremity landing

skills plyometrics (Le Gall et al 2007) neuromuscular

training programs added supervision (Dick et al 2007)

muscle strengthening and movement training (Ingram et al

2008)

34

Chapter 3

METHOD

The method of this study was divided into the following

sections 1) Participants 2) Development of questionnaire

3) Pilot study 4) Procedures and 5) Data analysis

Participants

The participants were both male and female local members

of university basketball or soccer team in Hong Kong in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team The total number of subjects was 197 with

48 male members of university basketball team 51 female

members of university basketball team 56 male members of

university soccer team and 42 female members of university

soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 5: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

5

ABSTRACT

Basketball and soccer are two popular sports worldwide

However the players are at risk of injuries Basketball and

soccer competitions among the university teams in Hong Kong

are considered as competitions of high level As a result

the injuries are common among players especially knee

injuries The purpose of this study was to understand the

patterns of knee injuries among the university basketball and

soccer players in Hong Kong There were 197 university

basketball and soccer players being the participants in this

study The result showed that 147 of the players (746) have

suffered knee injuries during training or competition in the

past one year The most common types of knee injuries were

abrasion (n=87 592) contusion (n=81 551) and overuse

injury (n=58 395) The major causes of knee injuries were

collision with other players (n=111 755) venue problem

(n=56 381) poor fitness (n=55 374) being over-trained

(n=46 313) and inadequate warm up (n=44 299)

6

TABLE OF CONTENTS

CHAPTER Page

1 INTRODUCTION 10

Statement of Problem 13

Purpose of Study 13

Hypotheses 14

Definition of Terms 15

Delimitations 18

Limitations 19

Significance of Study 20

2 REVIEW OF LITERATURE 21

Knee Injuries in Basketball 21

Knee Injuries in Soccer 24

Gender Difference in the Knee Injuries

in Basketball 26

Gender Difference in the Knee Injuries

in Soccer 28

Anterior Cruciate Ligament Injuries in

Basketball and Soccer 29

7

Summary 32

3 METHOD 34

Participants 34

Development of Questionnaire 35

Pilot Study 36

Procedures 37

Data Analysis 37

4 ANALYSIS OF DATA 39

Results 40

Discussions 61

5 SUMMARY AND CONCLUSION 77

Summary of Results 77

Conclusion 82

Recommendations for Future Studies 83

REFERENCES 84

APPENDIX A

Knee Injury Questionnaire 88

8

LIST OF TABLES

TABLE Page

1 Demographic Information of the

Respondents (N=197) 41

2 Chi Square Test for Different Genders of the

Same Sport with the Rate of Knee Injuries 43

3 Chi Square Test for Different Sports of the

Same Gender with the Rate of Knee Injuries 43

4 Average Amount of Time per Week for Regular

Training of the Players (N=197) 45

5 Average Amount of Time per Training Session

for Fitness Training of the Players (N=197) 47

6 Chi Square Test for Fitness Training with

the Rate of Knee Injuries 47

7 Average Amount of Time for Warm Up (N=197) 49

8 Types of Warm Up of the Players (N=197) 50

9 Categories of Knee Injury of the

Injured Players (N=147) 51

10 Types of Knee Injury (N=147) 53

9

11 Causes of Knee Injuries (N=147) 55

12 Treatments for Knee Injuries (N=147) 57

13 Number of Knee Injuries Requiring

Surgery (N=147) 59

14 Major Knee Injuries Requiring Surgery 59

15 Recovery Time for the Injured

Players (N=147) 60

10

Chapter 1

INTRODUCTION

Basketball and soccer are two popular sports all over the

world According to Yard Schroeder Fields Collins amp

Comstock (2008) and Borowski Yard Fields amp Comstock (2008)

participation in basketball or soccer can lead to a number

of health benefits such as improved physical fitness weight

control increased strength and increased endurance As a

result many PE teachers in Hong Kong would include basketball

and soccer teaching in the syllabus of the PE classes Apart

from those health benefits students could also learn how to

cooperate and communicate with the others when they are

participating in basketball or soccer games due to the fact

that these two sports are kinds of team sports

Apart from having basketball and soccer classes in

schools there are also different levels of competitions in

basketball or soccer in Hong Kong For example there are

inter-primary schools sports competitions and

inter-secondary schools sports competitions organized by the

11

Hong Kong Schools Sports Federation (HKSSF) and inter-varsity

sports competitions organized by the University Sports

Federation of Hong Kong China (USFHK) When students are

representing their schools to compete with the other students

they usually have to be engaged in regular training and

competitions This may lead to an increased risk of injury

as they are participating in physically demanding sports

(Borowski et al 2008)

Among the three different levels of basketball and

soccer competitions mentioned above the inter-varsity

basketball and soccer competitions are expected to be the most

intense and most physically demanding competitions Borowski

et al (2008) found that the injury rate in high school

basketball was 194 per 1000 AEs and Yard et al (2008) found

that the injury rate in soccer in high school was 239 per

1000 AEs It was also found that knee was the second most

commonly injured body site in both basketball and soccer

(Borowski et al 2008 Yard et al 2008)

After getting a knee injury it usually takes the

12

injured player less than one week to return to the

participation but it may take some of them more than three

weeks for recovery (Ingram Fields Yard amp Comstock 2008)

It depends on the severity of the knee injury In order to

reduce the rate of injury especially knee injury and ensure

safe participation in basketball and soccer we have to first

understand the biomechanical risk factors of the injuries and

then identify the changes of the factors that would help to

reduce the injuries (Mihata Beutler amp Boden 2006)

13

Statement of Problem

The focus of this study was on the comparison of the rate

and types of knee injuries between the university basketball

team members and university soccer team members in Hong Kong

It also aimed at examining the relationship between the gender

and the patterns of knee injuries

Purpose of Study

The purpose of this study was to compare the rate and types

of knee injuries between the university basketball team

members and university soccer team members in Hong Kong The

result obtained could provide the coaches and players with

more information about the knee injuries in basketball and

soccer and could help them design preventive measures to

reduce the incidence of knee injuries

14

Hypotheses

The followings were the research hypotheses of this study

1 There would be a difference in the rate of knee injuries

between the university basketball team members and the

university soccer team members

2 There would be a difference in the rate of knee injuries

between the different genders in basketball

3 There would be a difference in the rate of knee injuries

between the different genders in soccer

4 There would be a difference in the rate of knee injuries

between the players who are regularly engaged in fitness

training and those who are not engaged in any fitness

training

5 There would be a difference in the rate of knee injuries

between the players who perform warm up prior to

trainingcompetition and those who do not

15

Definition of Terms

In order to understand this study more clearly the

operational definitions of terms were as follows

University Basketball Team Member

University basketball team member refers to the local

member of any university basketball team in Hong Kong in the

academic year 2011-2012 who has been participating in regular

training provided by the university basketball team

University Soccer Team Member

University soccer team member refers to the local member

of any university soccer team in Hong Kong in the academic

year 2011-2012 who has been participating in regular training

provided by the university soccer team

Knee Injury

Knee injury refers to any injury to the knee that occurs

during sports or exercise (Bellenir 2008) The Capsule

16

ligament synovium and cartilage in the knee are susceptible

to injuries in sports (Harris amp Varney 1977)

Case of Knee Injury

Case of knee injury refers to any reported case of knee

injury in basketball or soccer that occurred within the past

one year either in the training session or competition

Rate of Knee Injury

Rate of knee injury refers to the number of case of knee

injuries in the past one year divided by the number of players

Training Hour

Training hour refers to the time spent on training the

skills or tactics on the basketball court or soccer pitch

excluding the time spent on fitness training

17

Warm Up

Warm up refers to any exercise or activity performed before

the main exercise which aims at increasing the muscle

temperature and increasing the range of motion of the joints

and muscle tendons (Fevre 1998) It usually includes jogging

stretching or sometimes specific warm up

Specific Warm Up

Specific warm up refers to the exercise or activity that

prepares the body for the up-coming exercise using the

specific muscles which will be used mainly in the up-coming

exercise

Fitness Training

Fitness training refers to any kind of exercise that will

help to improve the fitness of the players both the

health-related fitness and skill-related fitness

18

Cool Down

Cool down refers to any light exercise or activity

performed after the main exercise that allows the body to

transit back from an excited state to a resting state It

usually includes slow jogging walking and stretching

Recovery Time

Recovery time refers to the amount of time spent on recovery

of the knee injury from the occurrence of the knee injury until

the player returns to regular training

Delimitations

The delimitations of this study were listed as follows

1 The participants were delimited to the local Hong Kong

members of university basketball or soccer team in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team

19

2 The period of data collection was delimited to March 2012

3 Cases of knee injury were delimited to the reported cases

of knee injury that occurred in either training or

competition in the past one year

Limitations

The following were the limitations that must be considered

when analyzing the results of this study

1 The content of the questionnaire might not provide enough

detailed information for analysis as it was self-designed

2 The questionnaire was not valid and reliable enough as it

was self-designed

3 It was assumed that the participants could correctly

identify the types of knee injuries that they suffered

4 It was assumed that the participants would honestly and

cautiously answer the questionnaire

20

Significance of Study

This study provided information about the pattern of knee

injuries of the local members of the university basketball

and soccer team in Hong Kong It also provided comparisons

of both the rate of knee injuries and types of injuries between

the members of university basketball team and that of

university soccer team Besides the relationship between the

gender and the patterns of knee injuries was examined

Understanding the patterns of knee injuries was important

because it was the primary step to prevent the occurrence of

knee injuries This provided much useful information for the

coaches as well as the players on how to reduce the occurrence

of knee injuries If coaches understood the knee injury

patterns of basketball or soccer they could be able to plan

a better and safer training program for the players For the

players if they understood more about the causes of knee

injuries they could focus more on the preventive measures

of knee injuries when they were engaged in the sports

21

Chapter 2

REVIEW OF LITERATURE

Some past literature focusing on the knee injuries in

basketball and soccer was reviewed in this chapter This

review of literature was divided into six sections (1) knee

injuries in basketball (2) knee injuries in soccer (3)

gender difference in the knee injuries in basketball (4)

gender difference in the knee injuries in soccer (5) anterior

cruciate ligament (ACL) injuries in basketball and soccer

and (6) summary

Knee Injuries in Basketball

Borowski Yard Fields amp Comstock (2008) said that

basketball was one of the most popular sports in the United

States Although basketball players could benefit a lot from

basketball activities such as improved self-esteem and

weight control they had an increased risk of injury as they

were participating in a physically demanding activity Dick

Hertel Agel Grossman amp Marshall (2007) defined collegiate

22

menrsquos basketball as ldquoa contact sport in which numerous

anatomical structures are susceptible to both acute and

overuse injuriesrdquo (p194) It was not uncommon for basketball

players to suffer from injuries

According to Borowski et al (2008) the knee was one of

the most commonly injured body parts in basketball practice

and competition For the female basketball players 172 and

195 of the injuries occurred in the knee during practice

and competition respectively Knee injuries in practice and

in competition accounted for 101 and 115 of the total

injuries respectively for in the male basketball

In 2004 Olympic Games there were seven knee injuries in

the basketball games (Junge et al 2006) There were two

ligament ruptures one meniscus lesion one sprain two

contusions and one laceration According to Dick et al

(2007) knee internal derangements and patellar injuries were

the common knee injuries happened during practice and

competition Borowski et al (2008) suggested that muscle or

tendon strains in knee were another common type of knee

23

injuries in basketball Soft tissue injuries were also common

knee injuries in basketball According to Ingram Fields Yard

amp Comstock (2008) torn cartilage injuries were common in both

male and female basketball players and complete ligament

tears were common in female basketball players

Ingram et al (2008) found that the knee injuries in

basketball for both male and female players were non-contact

injuries meaning that there was no contact between players

when the knee injuries happened However Borowski et al

(2008) found that 246 of the knee injuries in the United

States high school basketball were caused by collision with

other player But still there were some non-contact knee

injuries caused by either rotation around a planted foot or

inversion or jumping or landing

24

Knee Injuries in Soccer

According to Yard Schroeder Fields Collins amp Comstock

(2008) ldquosoccer is one of the most popular sports worldwiderdquo

(p1930) It explained why there have been more and more people

both youngsters and adults participating in different soccer

activities nowadays Upon participation in soccer the

players could get a number of benefits such as becoming

physically active increase in productivity and enhancement

in academic performance but there were still risks for

injuries (Yard et al 2008)

Le Gall Carling amp Reilly (2007) conducted a study on the

soccer injuries in young elite females According to the

result among all anatomical sites in the body the lower

extremities were the most common site for injuries in soccer

with 168 of those injuries affecting the knee It was also

supported by the result of the research conducted by Yard et

al (2008) which showed that 187 of the soccer injuries

occurred in the knee

Concerning the types of knee injuries Junge et al (2006)

25

did a research on the injuries in team sport tournaments during

the 2004 Olympic Games and found that there were totally 17

knee injuries in soccer Of these 17 knee injuries 1 was

meniscus lesion 7 were sprain and 9 were contusion Apart

from that ligament tears were common in soccer players too

Ingram et al (2008) showed that incomplete ligament tears

and complete ligament tears were common in male soccer players

and female soccer players respectively A similar result was

obtained by Yard et al (2008) It showed that incomplete knee

ligament sprains were common among both male and female soccer

players but complete knee ligament sprains were only common

in female soccer players Both Ingram et al and Yard et al

suggested that the both the complete and incomplete knee

ligament injuries in the male soccer players were caused by

contact with other players while the incomplete knee ligament

injuries in the female soccer players were not caused by any

contact with others

According to Le Gall et al (2007) serious injuries

usually occurred in the knee and those serious injuries

26

included ligament sprain or rupture meniscus lesion and

patellar tendinitis or bursitis Overuse injuries were also

commonly occurred in the knee Yard et al (2008) suggested

that ldquogirl soccer players sustained a larger proportion of

knee injuriesrdquo (p1932) Darrow Collins Yard amp Comstock

(2009) supported that more female soccer players suffered from

severe knee injuries than male soccer players did

Gender Difference in the Knee Injuries in Basketball

According to Borowski et al (2008) female high school

basketball players in the United States were more likely to

injure their knees during practice and competition than the

male players A similar result was also found in the study

done by Ingram et al (2008) which showed that female high

school basketball players had a higher rate of major knee

injuries than the male players Darrow et al (2009) further

showed that female high school basketball players in the

United States had a higher chance of suffering from severe

knee injuries than the male players

27

The reasons for the difference in the rate of knee injuries

in basketball among the female and male players could be

divided into two categories intrinsic factors and extrinsic

factors Borowski et al (2008) suggested that the intrinsic

factors were mainly physiological differences between boys

and girls Examples for these physiological differences were

anatomical differences in joint and bone structure

differences in flexibility and strength and differences in

hormone secretions Differences in equipment differences in

facilities and differences in competition environment were

the extrinsic factors for the difference in the rate of knee

injury

Ingram et al (2008) mentioned that the likeliness of

female basketball players to sustain major knee injuries in

basketball was due to the vulnerability of their knees It

was associated with various risk factors such as hormonal

difference neuromuscular difference and mechanical

difference These risk factors made the female basketball

players four to six times more susceptible to major knee

28

injuries than the male basketball players

Gender Difference in the Knee Injuries in Soccer

The result of the study conducted by Yard et al (2008)

showed that female soccer players sustained a higher rate of

knee injuries than the male soccer players Le Gall et al

(2007) suggested that the reasons for the higher rate in knee

injuries for the female soccer players included weaker

technical and tactical ability poorer muscular strength and

endurance and weaker coordination The rapid development of

the female soccer game which led to an increased in

aggressiveness of the players was another cause of the higher

knee injury rate

Specifically female soccer players had a higher rate of

sustaining complete knee ligament sprains than the male soccer

players (Yard et al 2008) This was supported by the result

of the research done by Ingram et al (2008) which showed

that complete ligament tears were more common in female soccer

than in male soccer It might due to that fact that there were

29

structural differences and neuromuscular differences between

female and male soccer players Yard et al also found that

the rate of complete knee ligament sprains requiring surgery

in female soccer players was higher than that in male soccer

players Female soccer players were found to be 13 times more

susceptible to knee ligament injuries that required surgery

The reasons for this high rate against male soccer players

included the shoe-surface interaction differences in

anthropometry and increased joint laxity

Ingram et al (2008) also showed that non-contact knee

injuries were more common in female soccer than in male soccer

The reasons for this result were suggested to be that the knee

joint of the female soccer players were more vulnerable to

the stress created by rapid acceleration deceleration and

cutting movement on the grass surfaces

Anterior Cruciate Ligament Injuries in Basketball and Soccer

According to Mihata Beutler amp Boden (2006) anterior

cruciate ligament (ACL) injuries were not uncommon in

30

collegiate sports The most common type of ACL injuries was

non-contact or minimal contact ACL injuries The actions of

cutting jumping sudden deceleration and checking with

another player were the high risk mechanisms for this kind

of ACL injuries Basketball players and soccer players were

found to be often exposing to these damaging forces because

they had to perform these actions repeatedly during practice

and competition

From the result shown by Dick et al (2007) 18 of the

total game injuries in male basketball were ACL injuries and

603 of these ACL injuries were non-contact ACL injuries

This result was supported by Mihata et al (2006) whose result

showed that ACL injuries accounted for 14 of all injuries

in male basketball from 1989 to 2004 For the female basketball

players they had a higher rate of ACL injuries than the male

players It was shown by Mihata et al that the ACL injuries

accounted for 52 of all injuries in female basketball from

1989 to 2004 which was about four times higher than in male

basketball

31

For the soccer players the female soccer players also had

higher rates of ACL injuries than the male soccer players

In between 1989 and 2004 39 of the total injuries in female

soccer were ACL injuries while only 16 of the total injuries

in male soccer were ACL injuries (Mihata et al 2006) The

rate of ACL injuries in female soccer was almost three times

higher than that in male soccer in that period of time A more

serious result was shown by Le Gall et al (2007) In their

result ACL injuries mainly ACL sprains or ruptures

accounted for 156 of all major injuries of the young elite

female soccer players

According to Mihata et al (2006) the reasons for the

female players having higher rates of ACL injuries than the

male players were that they had only participated in such

organized sports for a brief period of time they were less

fit and they received less training Another reason was a

disturbance in the neuromuscular patterns received by the

female players which protected the knee created by

incidental or minimal trauma

32

The rate of ACL injuries could be reduced effectively

Understanding the biomechanical risk factors and identifying

and changing those risk factors were the necessary steps to

decrease the long-term ACL injury rates (Mihata et al 2006)

Summary

Soccer and basketball are common sports all over the world

and they are generally regarded as kinds of contact sports

as there is direct contact between players Players are

required to have good muscular strength and power in order

to compete with others Collision and contacting with other

players would lead to imbalance and maybe fall which in turn

lead to injury

Knee was found to be one of the most common body sites

susceptible to injuries in basketball and soccer during both

practice and competition Different types of knee injuries

were sustained by the players such as contusion laceration

sprain ligament tear meniscus lesion and torn cartilage

According to Ingram et al (2008) 168 of all knee injuries

33

were surgery-requiring injuries Examples of these major

knee injuries were complete ligament tears torn cartilage

incomplete ligament tears and fractures

Female players no matter they were soccer players or

basketball players would have a higher chance of injuring

their knee especially the ACL than their male counterparts

It might due to both intrinsic factors such as muscular

strength and endurance and hormonal differences and

extrinsic factors such as game environment and sports

facilities

However knee injuries could be prevented Preventive

measures for knee injuries included lower-extremity landing

skills plyometrics (Le Gall et al 2007) neuromuscular

training programs added supervision (Dick et al 2007)

muscle strengthening and movement training (Ingram et al

2008)

34

Chapter 3

METHOD

The method of this study was divided into the following

sections 1) Participants 2) Development of questionnaire

3) Pilot study 4) Procedures and 5) Data analysis

Participants

The participants were both male and female local members

of university basketball or soccer team in Hong Kong in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team The total number of subjects was 197 with

48 male members of university basketball team 51 female

members of university basketball team 56 male members of

university soccer team and 42 female members of university

soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 6: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

6

TABLE OF CONTENTS

CHAPTER Page

1 INTRODUCTION 10

Statement of Problem 13

Purpose of Study 13

Hypotheses 14

Definition of Terms 15

Delimitations 18

Limitations 19

Significance of Study 20

2 REVIEW OF LITERATURE 21

Knee Injuries in Basketball 21

Knee Injuries in Soccer 24

Gender Difference in the Knee Injuries

in Basketball 26

Gender Difference in the Knee Injuries

in Soccer 28

Anterior Cruciate Ligament Injuries in

Basketball and Soccer 29

7

Summary 32

3 METHOD 34

Participants 34

Development of Questionnaire 35

Pilot Study 36

Procedures 37

Data Analysis 37

4 ANALYSIS OF DATA 39

Results 40

Discussions 61

5 SUMMARY AND CONCLUSION 77

Summary of Results 77

Conclusion 82

Recommendations for Future Studies 83

REFERENCES 84

APPENDIX A

Knee Injury Questionnaire 88

8

LIST OF TABLES

TABLE Page

1 Demographic Information of the

Respondents (N=197) 41

2 Chi Square Test for Different Genders of the

Same Sport with the Rate of Knee Injuries 43

3 Chi Square Test for Different Sports of the

Same Gender with the Rate of Knee Injuries 43

4 Average Amount of Time per Week for Regular

Training of the Players (N=197) 45

5 Average Amount of Time per Training Session

for Fitness Training of the Players (N=197) 47

6 Chi Square Test for Fitness Training with

the Rate of Knee Injuries 47

7 Average Amount of Time for Warm Up (N=197) 49

8 Types of Warm Up of the Players (N=197) 50

9 Categories of Knee Injury of the

Injured Players (N=147) 51

10 Types of Knee Injury (N=147) 53

9

11 Causes of Knee Injuries (N=147) 55

12 Treatments for Knee Injuries (N=147) 57

13 Number of Knee Injuries Requiring

Surgery (N=147) 59

14 Major Knee Injuries Requiring Surgery 59

15 Recovery Time for the Injured

Players (N=147) 60

10

Chapter 1

INTRODUCTION

Basketball and soccer are two popular sports all over the

world According to Yard Schroeder Fields Collins amp

Comstock (2008) and Borowski Yard Fields amp Comstock (2008)

participation in basketball or soccer can lead to a number

of health benefits such as improved physical fitness weight

control increased strength and increased endurance As a

result many PE teachers in Hong Kong would include basketball

and soccer teaching in the syllabus of the PE classes Apart

from those health benefits students could also learn how to

cooperate and communicate with the others when they are

participating in basketball or soccer games due to the fact

that these two sports are kinds of team sports

Apart from having basketball and soccer classes in

schools there are also different levels of competitions in

basketball or soccer in Hong Kong For example there are

inter-primary schools sports competitions and

inter-secondary schools sports competitions organized by the

11

Hong Kong Schools Sports Federation (HKSSF) and inter-varsity

sports competitions organized by the University Sports

Federation of Hong Kong China (USFHK) When students are

representing their schools to compete with the other students

they usually have to be engaged in regular training and

competitions This may lead to an increased risk of injury

as they are participating in physically demanding sports

(Borowski et al 2008)

Among the three different levels of basketball and

soccer competitions mentioned above the inter-varsity

basketball and soccer competitions are expected to be the most

intense and most physically demanding competitions Borowski

et al (2008) found that the injury rate in high school

basketball was 194 per 1000 AEs and Yard et al (2008) found

that the injury rate in soccer in high school was 239 per

1000 AEs It was also found that knee was the second most

commonly injured body site in both basketball and soccer

(Borowski et al 2008 Yard et al 2008)

After getting a knee injury it usually takes the

12

injured player less than one week to return to the

participation but it may take some of them more than three

weeks for recovery (Ingram Fields Yard amp Comstock 2008)

It depends on the severity of the knee injury In order to

reduce the rate of injury especially knee injury and ensure

safe participation in basketball and soccer we have to first

understand the biomechanical risk factors of the injuries and

then identify the changes of the factors that would help to

reduce the injuries (Mihata Beutler amp Boden 2006)

13

Statement of Problem

The focus of this study was on the comparison of the rate

and types of knee injuries between the university basketball

team members and university soccer team members in Hong Kong

It also aimed at examining the relationship between the gender

and the patterns of knee injuries

Purpose of Study

The purpose of this study was to compare the rate and types

of knee injuries between the university basketball team

members and university soccer team members in Hong Kong The

result obtained could provide the coaches and players with

more information about the knee injuries in basketball and

soccer and could help them design preventive measures to

reduce the incidence of knee injuries

14

Hypotheses

The followings were the research hypotheses of this study

1 There would be a difference in the rate of knee injuries

between the university basketball team members and the

university soccer team members

2 There would be a difference in the rate of knee injuries

between the different genders in basketball

3 There would be a difference in the rate of knee injuries

between the different genders in soccer

4 There would be a difference in the rate of knee injuries

between the players who are regularly engaged in fitness

training and those who are not engaged in any fitness

training

5 There would be a difference in the rate of knee injuries

between the players who perform warm up prior to

trainingcompetition and those who do not

15

Definition of Terms

In order to understand this study more clearly the

operational definitions of terms were as follows

University Basketball Team Member

University basketball team member refers to the local

member of any university basketball team in Hong Kong in the

academic year 2011-2012 who has been participating in regular

training provided by the university basketball team

University Soccer Team Member

University soccer team member refers to the local member

of any university soccer team in Hong Kong in the academic

year 2011-2012 who has been participating in regular training

provided by the university soccer team

Knee Injury

Knee injury refers to any injury to the knee that occurs

during sports or exercise (Bellenir 2008) The Capsule

16

ligament synovium and cartilage in the knee are susceptible

to injuries in sports (Harris amp Varney 1977)

Case of Knee Injury

Case of knee injury refers to any reported case of knee

injury in basketball or soccer that occurred within the past

one year either in the training session or competition

Rate of Knee Injury

Rate of knee injury refers to the number of case of knee

injuries in the past one year divided by the number of players

Training Hour

Training hour refers to the time spent on training the

skills or tactics on the basketball court or soccer pitch

excluding the time spent on fitness training

17

Warm Up

Warm up refers to any exercise or activity performed before

the main exercise which aims at increasing the muscle

temperature and increasing the range of motion of the joints

and muscle tendons (Fevre 1998) It usually includes jogging

stretching or sometimes specific warm up

Specific Warm Up

Specific warm up refers to the exercise or activity that

prepares the body for the up-coming exercise using the

specific muscles which will be used mainly in the up-coming

exercise

Fitness Training

Fitness training refers to any kind of exercise that will

help to improve the fitness of the players both the

health-related fitness and skill-related fitness

18

Cool Down

Cool down refers to any light exercise or activity

performed after the main exercise that allows the body to

transit back from an excited state to a resting state It

usually includes slow jogging walking and stretching

Recovery Time

Recovery time refers to the amount of time spent on recovery

of the knee injury from the occurrence of the knee injury until

the player returns to regular training

Delimitations

The delimitations of this study were listed as follows

1 The participants were delimited to the local Hong Kong

members of university basketball or soccer team in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team

19

2 The period of data collection was delimited to March 2012

3 Cases of knee injury were delimited to the reported cases

of knee injury that occurred in either training or

competition in the past one year

Limitations

The following were the limitations that must be considered

when analyzing the results of this study

1 The content of the questionnaire might not provide enough

detailed information for analysis as it was self-designed

2 The questionnaire was not valid and reliable enough as it

was self-designed

3 It was assumed that the participants could correctly

identify the types of knee injuries that they suffered

4 It was assumed that the participants would honestly and

cautiously answer the questionnaire

20

Significance of Study

This study provided information about the pattern of knee

injuries of the local members of the university basketball

and soccer team in Hong Kong It also provided comparisons

of both the rate of knee injuries and types of injuries between

the members of university basketball team and that of

university soccer team Besides the relationship between the

gender and the patterns of knee injuries was examined

Understanding the patterns of knee injuries was important

because it was the primary step to prevent the occurrence of

knee injuries This provided much useful information for the

coaches as well as the players on how to reduce the occurrence

of knee injuries If coaches understood the knee injury

patterns of basketball or soccer they could be able to plan

a better and safer training program for the players For the

players if they understood more about the causes of knee

injuries they could focus more on the preventive measures

of knee injuries when they were engaged in the sports

21

Chapter 2

REVIEW OF LITERATURE

Some past literature focusing on the knee injuries in

basketball and soccer was reviewed in this chapter This

review of literature was divided into six sections (1) knee

injuries in basketball (2) knee injuries in soccer (3)

gender difference in the knee injuries in basketball (4)

gender difference in the knee injuries in soccer (5) anterior

cruciate ligament (ACL) injuries in basketball and soccer

and (6) summary

Knee Injuries in Basketball

Borowski Yard Fields amp Comstock (2008) said that

basketball was one of the most popular sports in the United

States Although basketball players could benefit a lot from

basketball activities such as improved self-esteem and

weight control they had an increased risk of injury as they

were participating in a physically demanding activity Dick

Hertel Agel Grossman amp Marshall (2007) defined collegiate

22

menrsquos basketball as ldquoa contact sport in which numerous

anatomical structures are susceptible to both acute and

overuse injuriesrdquo (p194) It was not uncommon for basketball

players to suffer from injuries

According to Borowski et al (2008) the knee was one of

the most commonly injured body parts in basketball practice

and competition For the female basketball players 172 and

195 of the injuries occurred in the knee during practice

and competition respectively Knee injuries in practice and

in competition accounted for 101 and 115 of the total

injuries respectively for in the male basketball

In 2004 Olympic Games there were seven knee injuries in

the basketball games (Junge et al 2006) There were two

ligament ruptures one meniscus lesion one sprain two

contusions and one laceration According to Dick et al

(2007) knee internal derangements and patellar injuries were

the common knee injuries happened during practice and

competition Borowski et al (2008) suggested that muscle or

tendon strains in knee were another common type of knee

23

injuries in basketball Soft tissue injuries were also common

knee injuries in basketball According to Ingram Fields Yard

amp Comstock (2008) torn cartilage injuries were common in both

male and female basketball players and complete ligament

tears were common in female basketball players

Ingram et al (2008) found that the knee injuries in

basketball for both male and female players were non-contact

injuries meaning that there was no contact between players

when the knee injuries happened However Borowski et al

(2008) found that 246 of the knee injuries in the United

States high school basketball were caused by collision with

other player But still there were some non-contact knee

injuries caused by either rotation around a planted foot or

inversion or jumping or landing

24

Knee Injuries in Soccer

According to Yard Schroeder Fields Collins amp Comstock

(2008) ldquosoccer is one of the most popular sports worldwiderdquo

(p1930) It explained why there have been more and more people

both youngsters and adults participating in different soccer

activities nowadays Upon participation in soccer the

players could get a number of benefits such as becoming

physically active increase in productivity and enhancement

in academic performance but there were still risks for

injuries (Yard et al 2008)

Le Gall Carling amp Reilly (2007) conducted a study on the

soccer injuries in young elite females According to the

result among all anatomical sites in the body the lower

extremities were the most common site for injuries in soccer

with 168 of those injuries affecting the knee It was also

supported by the result of the research conducted by Yard et

al (2008) which showed that 187 of the soccer injuries

occurred in the knee

Concerning the types of knee injuries Junge et al (2006)

25

did a research on the injuries in team sport tournaments during

the 2004 Olympic Games and found that there were totally 17

knee injuries in soccer Of these 17 knee injuries 1 was

meniscus lesion 7 were sprain and 9 were contusion Apart

from that ligament tears were common in soccer players too

Ingram et al (2008) showed that incomplete ligament tears

and complete ligament tears were common in male soccer players

and female soccer players respectively A similar result was

obtained by Yard et al (2008) It showed that incomplete knee

ligament sprains were common among both male and female soccer

players but complete knee ligament sprains were only common

in female soccer players Both Ingram et al and Yard et al

suggested that the both the complete and incomplete knee

ligament injuries in the male soccer players were caused by

contact with other players while the incomplete knee ligament

injuries in the female soccer players were not caused by any

contact with others

According to Le Gall et al (2007) serious injuries

usually occurred in the knee and those serious injuries

26

included ligament sprain or rupture meniscus lesion and

patellar tendinitis or bursitis Overuse injuries were also

commonly occurred in the knee Yard et al (2008) suggested

that ldquogirl soccer players sustained a larger proportion of

knee injuriesrdquo (p1932) Darrow Collins Yard amp Comstock

(2009) supported that more female soccer players suffered from

severe knee injuries than male soccer players did

Gender Difference in the Knee Injuries in Basketball

According to Borowski et al (2008) female high school

basketball players in the United States were more likely to

injure their knees during practice and competition than the

male players A similar result was also found in the study

done by Ingram et al (2008) which showed that female high

school basketball players had a higher rate of major knee

injuries than the male players Darrow et al (2009) further

showed that female high school basketball players in the

United States had a higher chance of suffering from severe

knee injuries than the male players

27

The reasons for the difference in the rate of knee injuries

in basketball among the female and male players could be

divided into two categories intrinsic factors and extrinsic

factors Borowski et al (2008) suggested that the intrinsic

factors were mainly physiological differences between boys

and girls Examples for these physiological differences were

anatomical differences in joint and bone structure

differences in flexibility and strength and differences in

hormone secretions Differences in equipment differences in

facilities and differences in competition environment were

the extrinsic factors for the difference in the rate of knee

injury

Ingram et al (2008) mentioned that the likeliness of

female basketball players to sustain major knee injuries in

basketball was due to the vulnerability of their knees It

was associated with various risk factors such as hormonal

difference neuromuscular difference and mechanical

difference These risk factors made the female basketball

players four to six times more susceptible to major knee

28

injuries than the male basketball players

Gender Difference in the Knee Injuries in Soccer

The result of the study conducted by Yard et al (2008)

showed that female soccer players sustained a higher rate of

knee injuries than the male soccer players Le Gall et al

(2007) suggested that the reasons for the higher rate in knee

injuries for the female soccer players included weaker

technical and tactical ability poorer muscular strength and

endurance and weaker coordination The rapid development of

the female soccer game which led to an increased in

aggressiveness of the players was another cause of the higher

knee injury rate

Specifically female soccer players had a higher rate of

sustaining complete knee ligament sprains than the male soccer

players (Yard et al 2008) This was supported by the result

of the research done by Ingram et al (2008) which showed

that complete ligament tears were more common in female soccer

than in male soccer It might due to that fact that there were

29

structural differences and neuromuscular differences between

female and male soccer players Yard et al also found that

the rate of complete knee ligament sprains requiring surgery

in female soccer players was higher than that in male soccer

players Female soccer players were found to be 13 times more

susceptible to knee ligament injuries that required surgery

The reasons for this high rate against male soccer players

included the shoe-surface interaction differences in

anthropometry and increased joint laxity

Ingram et al (2008) also showed that non-contact knee

injuries were more common in female soccer than in male soccer

The reasons for this result were suggested to be that the knee

joint of the female soccer players were more vulnerable to

the stress created by rapid acceleration deceleration and

cutting movement on the grass surfaces

Anterior Cruciate Ligament Injuries in Basketball and Soccer

According to Mihata Beutler amp Boden (2006) anterior

cruciate ligament (ACL) injuries were not uncommon in

30

collegiate sports The most common type of ACL injuries was

non-contact or minimal contact ACL injuries The actions of

cutting jumping sudden deceleration and checking with

another player were the high risk mechanisms for this kind

of ACL injuries Basketball players and soccer players were

found to be often exposing to these damaging forces because

they had to perform these actions repeatedly during practice

and competition

From the result shown by Dick et al (2007) 18 of the

total game injuries in male basketball were ACL injuries and

603 of these ACL injuries were non-contact ACL injuries

This result was supported by Mihata et al (2006) whose result

showed that ACL injuries accounted for 14 of all injuries

in male basketball from 1989 to 2004 For the female basketball

players they had a higher rate of ACL injuries than the male

players It was shown by Mihata et al that the ACL injuries

accounted for 52 of all injuries in female basketball from

1989 to 2004 which was about four times higher than in male

basketball

31

For the soccer players the female soccer players also had

higher rates of ACL injuries than the male soccer players

In between 1989 and 2004 39 of the total injuries in female

soccer were ACL injuries while only 16 of the total injuries

in male soccer were ACL injuries (Mihata et al 2006) The

rate of ACL injuries in female soccer was almost three times

higher than that in male soccer in that period of time A more

serious result was shown by Le Gall et al (2007) In their

result ACL injuries mainly ACL sprains or ruptures

accounted for 156 of all major injuries of the young elite

female soccer players

According to Mihata et al (2006) the reasons for the

female players having higher rates of ACL injuries than the

male players were that they had only participated in such

organized sports for a brief period of time they were less

fit and they received less training Another reason was a

disturbance in the neuromuscular patterns received by the

female players which protected the knee created by

incidental or minimal trauma

32

The rate of ACL injuries could be reduced effectively

Understanding the biomechanical risk factors and identifying

and changing those risk factors were the necessary steps to

decrease the long-term ACL injury rates (Mihata et al 2006)

Summary

Soccer and basketball are common sports all over the world

and they are generally regarded as kinds of contact sports

as there is direct contact between players Players are

required to have good muscular strength and power in order

to compete with others Collision and contacting with other

players would lead to imbalance and maybe fall which in turn

lead to injury

Knee was found to be one of the most common body sites

susceptible to injuries in basketball and soccer during both

practice and competition Different types of knee injuries

were sustained by the players such as contusion laceration

sprain ligament tear meniscus lesion and torn cartilage

According to Ingram et al (2008) 168 of all knee injuries

33

were surgery-requiring injuries Examples of these major

knee injuries were complete ligament tears torn cartilage

incomplete ligament tears and fractures

Female players no matter they were soccer players or

basketball players would have a higher chance of injuring

their knee especially the ACL than their male counterparts

It might due to both intrinsic factors such as muscular

strength and endurance and hormonal differences and

extrinsic factors such as game environment and sports

facilities

However knee injuries could be prevented Preventive

measures for knee injuries included lower-extremity landing

skills plyometrics (Le Gall et al 2007) neuromuscular

training programs added supervision (Dick et al 2007)

muscle strengthening and movement training (Ingram et al

2008)

34

Chapter 3

METHOD

The method of this study was divided into the following

sections 1) Participants 2) Development of questionnaire

3) Pilot study 4) Procedures and 5) Data analysis

Participants

The participants were both male and female local members

of university basketball or soccer team in Hong Kong in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team The total number of subjects was 197 with

48 male members of university basketball team 51 female

members of university basketball team 56 male members of

university soccer team and 42 female members of university

soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 7: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

7

Summary 32

3 METHOD 34

Participants 34

Development of Questionnaire 35

Pilot Study 36

Procedures 37

Data Analysis 37

4 ANALYSIS OF DATA 39

Results 40

Discussions 61

5 SUMMARY AND CONCLUSION 77

Summary of Results 77

Conclusion 82

Recommendations for Future Studies 83

REFERENCES 84

APPENDIX A

Knee Injury Questionnaire 88

8

LIST OF TABLES

TABLE Page

1 Demographic Information of the

Respondents (N=197) 41

2 Chi Square Test for Different Genders of the

Same Sport with the Rate of Knee Injuries 43

3 Chi Square Test for Different Sports of the

Same Gender with the Rate of Knee Injuries 43

4 Average Amount of Time per Week for Regular

Training of the Players (N=197) 45

5 Average Amount of Time per Training Session

for Fitness Training of the Players (N=197) 47

6 Chi Square Test for Fitness Training with

the Rate of Knee Injuries 47

7 Average Amount of Time for Warm Up (N=197) 49

8 Types of Warm Up of the Players (N=197) 50

9 Categories of Knee Injury of the

Injured Players (N=147) 51

10 Types of Knee Injury (N=147) 53

9

11 Causes of Knee Injuries (N=147) 55

12 Treatments for Knee Injuries (N=147) 57

13 Number of Knee Injuries Requiring

Surgery (N=147) 59

14 Major Knee Injuries Requiring Surgery 59

15 Recovery Time for the Injured

Players (N=147) 60

10

Chapter 1

INTRODUCTION

Basketball and soccer are two popular sports all over the

world According to Yard Schroeder Fields Collins amp

Comstock (2008) and Borowski Yard Fields amp Comstock (2008)

participation in basketball or soccer can lead to a number

of health benefits such as improved physical fitness weight

control increased strength and increased endurance As a

result many PE teachers in Hong Kong would include basketball

and soccer teaching in the syllabus of the PE classes Apart

from those health benefits students could also learn how to

cooperate and communicate with the others when they are

participating in basketball or soccer games due to the fact

that these two sports are kinds of team sports

Apart from having basketball and soccer classes in

schools there are also different levels of competitions in

basketball or soccer in Hong Kong For example there are

inter-primary schools sports competitions and

inter-secondary schools sports competitions organized by the

11

Hong Kong Schools Sports Federation (HKSSF) and inter-varsity

sports competitions organized by the University Sports

Federation of Hong Kong China (USFHK) When students are

representing their schools to compete with the other students

they usually have to be engaged in regular training and

competitions This may lead to an increased risk of injury

as they are participating in physically demanding sports

(Borowski et al 2008)

Among the three different levels of basketball and

soccer competitions mentioned above the inter-varsity

basketball and soccer competitions are expected to be the most

intense and most physically demanding competitions Borowski

et al (2008) found that the injury rate in high school

basketball was 194 per 1000 AEs and Yard et al (2008) found

that the injury rate in soccer in high school was 239 per

1000 AEs It was also found that knee was the second most

commonly injured body site in both basketball and soccer

(Borowski et al 2008 Yard et al 2008)

After getting a knee injury it usually takes the

12

injured player less than one week to return to the

participation but it may take some of them more than three

weeks for recovery (Ingram Fields Yard amp Comstock 2008)

It depends on the severity of the knee injury In order to

reduce the rate of injury especially knee injury and ensure

safe participation in basketball and soccer we have to first

understand the biomechanical risk factors of the injuries and

then identify the changes of the factors that would help to

reduce the injuries (Mihata Beutler amp Boden 2006)

13

Statement of Problem

The focus of this study was on the comparison of the rate

and types of knee injuries between the university basketball

team members and university soccer team members in Hong Kong

It also aimed at examining the relationship between the gender

and the patterns of knee injuries

Purpose of Study

The purpose of this study was to compare the rate and types

of knee injuries between the university basketball team

members and university soccer team members in Hong Kong The

result obtained could provide the coaches and players with

more information about the knee injuries in basketball and

soccer and could help them design preventive measures to

reduce the incidence of knee injuries

14

Hypotheses

The followings were the research hypotheses of this study

1 There would be a difference in the rate of knee injuries

between the university basketball team members and the

university soccer team members

2 There would be a difference in the rate of knee injuries

between the different genders in basketball

3 There would be a difference in the rate of knee injuries

between the different genders in soccer

4 There would be a difference in the rate of knee injuries

between the players who are regularly engaged in fitness

training and those who are not engaged in any fitness

training

5 There would be a difference in the rate of knee injuries

between the players who perform warm up prior to

trainingcompetition and those who do not

15

Definition of Terms

In order to understand this study more clearly the

operational definitions of terms were as follows

University Basketball Team Member

University basketball team member refers to the local

member of any university basketball team in Hong Kong in the

academic year 2011-2012 who has been participating in regular

training provided by the university basketball team

University Soccer Team Member

University soccer team member refers to the local member

of any university soccer team in Hong Kong in the academic

year 2011-2012 who has been participating in regular training

provided by the university soccer team

Knee Injury

Knee injury refers to any injury to the knee that occurs

during sports or exercise (Bellenir 2008) The Capsule

16

ligament synovium and cartilage in the knee are susceptible

to injuries in sports (Harris amp Varney 1977)

Case of Knee Injury

Case of knee injury refers to any reported case of knee

injury in basketball or soccer that occurred within the past

one year either in the training session or competition

Rate of Knee Injury

Rate of knee injury refers to the number of case of knee

injuries in the past one year divided by the number of players

Training Hour

Training hour refers to the time spent on training the

skills or tactics on the basketball court or soccer pitch

excluding the time spent on fitness training

17

Warm Up

Warm up refers to any exercise or activity performed before

the main exercise which aims at increasing the muscle

temperature and increasing the range of motion of the joints

and muscle tendons (Fevre 1998) It usually includes jogging

stretching or sometimes specific warm up

Specific Warm Up

Specific warm up refers to the exercise or activity that

prepares the body for the up-coming exercise using the

specific muscles which will be used mainly in the up-coming

exercise

Fitness Training

Fitness training refers to any kind of exercise that will

help to improve the fitness of the players both the

health-related fitness and skill-related fitness

18

Cool Down

Cool down refers to any light exercise or activity

performed after the main exercise that allows the body to

transit back from an excited state to a resting state It

usually includes slow jogging walking and stretching

Recovery Time

Recovery time refers to the amount of time spent on recovery

of the knee injury from the occurrence of the knee injury until

the player returns to regular training

Delimitations

The delimitations of this study were listed as follows

1 The participants were delimited to the local Hong Kong

members of university basketball or soccer team in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team

19

2 The period of data collection was delimited to March 2012

3 Cases of knee injury were delimited to the reported cases

of knee injury that occurred in either training or

competition in the past one year

Limitations

The following were the limitations that must be considered

when analyzing the results of this study

1 The content of the questionnaire might not provide enough

detailed information for analysis as it was self-designed

2 The questionnaire was not valid and reliable enough as it

was self-designed

3 It was assumed that the participants could correctly

identify the types of knee injuries that they suffered

4 It was assumed that the participants would honestly and

cautiously answer the questionnaire

20

Significance of Study

This study provided information about the pattern of knee

injuries of the local members of the university basketball

and soccer team in Hong Kong It also provided comparisons

of both the rate of knee injuries and types of injuries between

the members of university basketball team and that of

university soccer team Besides the relationship between the

gender and the patterns of knee injuries was examined

Understanding the patterns of knee injuries was important

because it was the primary step to prevent the occurrence of

knee injuries This provided much useful information for the

coaches as well as the players on how to reduce the occurrence

of knee injuries If coaches understood the knee injury

patterns of basketball or soccer they could be able to plan

a better and safer training program for the players For the

players if they understood more about the causes of knee

injuries they could focus more on the preventive measures

of knee injuries when they were engaged in the sports

21

Chapter 2

REVIEW OF LITERATURE

Some past literature focusing on the knee injuries in

basketball and soccer was reviewed in this chapter This

review of literature was divided into six sections (1) knee

injuries in basketball (2) knee injuries in soccer (3)

gender difference in the knee injuries in basketball (4)

gender difference in the knee injuries in soccer (5) anterior

cruciate ligament (ACL) injuries in basketball and soccer

and (6) summary

Knee Injuries in Basketball

Borowski Yard Fields amp Comstock (2008) said that

basketball was one of the most popular sports in the United

States Although basketball players could benefit a lot from

basketball activities such as improved self-esteem and

weight control they had an increased risk of injury as they

were participating in a physically demanding activity Dick

Hertel Agel Grossman amp Marshall (2007) defined collegiate

22

menrsquos basketball as ldquoa contact sport in which numerous

anatomical structures are susceptible to both acute and

overuse injuriesrdquo (p194) It was not uncommon for basketball

players to suffer from injuries

According to Borowski et al (2008) the knee was one of

the most commonly injured body parts in basketball practice

and competition For the female basketball players 172 and

195 of the injuries occurred in the knee during practice

and competition respectively Knee injuries in practice and

in competition accounted for 101 and 115 of the total

injuries respectively for in the male basketball

In 2004 Olympic Games there were seven knee injuries in

the basketball games (Junge et al 2006) There were two

ligament ruptures one meniscus lesion one sprain two

contusions and one laceration According to Dick et al

(2007) knee internal derangements and patellar injuries were

the common knee injuries happened during practice and

competition Borowski et al (2008) suggested that muscle or

tendon strains in knee were another common type of knee

23

injuries in basketball Soft tissue injuries were also common

knee injuries in basketball According to Ingram Fields Yard

amp Comstock (2008) torn cartilage injuries were common in both

male and female basketball players and complete ligament

tears were common in female basketball players

Ingram et al (2008) found that the knee injuries in

basketball for both male and female players were non-contact

injuries meaning that there was no contact between players

when the knee injuries happened However Borowski et al

(2008) found that 246 of the knee injuries in the United

States high school basketball were caused by collision with

other player But still there were some non-contact knee

injuries caused by either rotation around a planted foot or

inversion or jumping or landing

24

Knee Injuries in Soccer

According to Yard Schroeder Fields Collins amp Comstock

(2008) ldquosoccer is one of the most popular sports worldwiderdquo

(p1930) It explained why there have been more and more people

both youngsters and adults participating in different soccer

activities nowadays Upon participation in soccer the

players could get a number of benefits such as becoming

physically active increase in productivity and enhancement

in academic performance but there were still risks for

injuries (Yard et al 2008)

Le Gall Carling amp Reilly (2007) conducted a study on the

soccer injuries in young elite females According to the

result among all anatomical sites in the body the lower

extremities were the most common site for injuries in soccer

with 168 of those injuries affecting the knee It was also

supported by the result of the research conducted by Yard et

al (2008) which showed that 187 of the soccer injuries

occurred in the knee

Concerning the types of knee injuries Junge et al (2006)

25

did a research on the injuries in team sport tournaments during

the 2004 Olympic Games and found that there were totally 17

knee injuries in soccer Of these 17 knee injuries 1 was

meniscus lesion 7 were sprain and 9 were contusion Apart

from that ligament tears were common in soccer players too

Ingram et al (2008) showed that incomplete ligament tears

and complete ligament tears were common in male soccer players

and female soccer players respectively A similar result was

obtained by Yard et al (2008) It showed that incomplete knee

ligament sprains were common among both male and female soccer

players but complete knee ligament sprains were only common

in female soccer players Both Ingram et al and Yard et al

suggested that the both the complete and incomplete knee

ligament injuries in the male soccer players were caused by

contact with other players while the incomplete knee ligament

injuries in the female soccer players were not caused by any

contact with others

According to Le Gall et al (2007) serious injuries

usually occurred in the knee and those serious injuries

26

included ligament sprain or rupture meniscus lesion and

patellar tendinitis or bursitis Overuse injuries were also

commonly occurred in the knee Yard et al (2008) suggested

that ldquogirl soccer players sustained a larger proportion of

knee injuriesrdquo (p1932) Darrow Collins Yard amp Comstock

(2009) supported that more female soccer players suffered from

severe knee injuries than male soccer players did

Gender Difference in the Knee Injuries in Basketball

According to Borowski et al (2008) female high school

basketball players in the United States were more likely to

injure their knees during practice and competition than the

male players A similar result was also found in the study

done by Ingram et al (2008) which showed that female high

school basketball players had a higher rate of major knee

injuries than the male players Darrow et al (2009) further

showed that female high school basketball players in the

United States had a higher chance of suffering from severe

knee injuries than the male players

27

The reasons for the difference in the rate of knee injuries

in basketball among the female and male players could be

divided into two categories intrinsic factors and extrinsic

factors Borowski et al (2008) suggested that the intrinsic

factors were mainly physiological differences between boys

and girls Examples for these physiological differences were

anatomical differences in joint and bone structure

differences in flexibility and strength and differences in

hormone secretions Differences in equipment differences in

facilities and differences in competition environment were

the extrinsic factors for the difference in the rate of knee

injury

Ingram et al (2008) mentioned that the likeliness of

female basketball players to sustain major knee injuries in

basketball was due to the vulnerability of their knees It

was associated with various risk factors such as hormonal

difference neuromuscular difference and mechanical

difference These risk factors made the female basketball

players four to six times more susceptible to major knee

28

injuries than the male basketball players

Gender Difference in the Knee Injuries in Soccer

The result of the study conducted by Yard et al (2008)

showed that female soccer players sustained a higher rate of

knee injuries than the male soccer players Le Gall et al

(2007) suggested that the reasons for the higher rate in knee

injuries for the female soccer players included weaker

technical and tactical ability poorer muscular strength and

endurance and weaker coordination The rapid development of

the female soccer game which led to an increased in

aggressiveness of the players was another cause of the higher

knee injury rate

Specifically female soccer players had a higher rate of

sustaining complete knee ligament sprains than the male soccer

players (Yard et al 2008) This was supported by the result

of the research done by Ingram et al (2008) which showed

that complete ligament tears were more common in female soccer

than in male soccer It might due to that fact that there were

29

structural differences and neuromuscular differences between

female and male soccer players Yard et al also found that

the rate of complete knee ligament sprains requiring surgery

in female soccer players was higher than that in male soccer

players Female soccer players were found to be 13 times more

susceptible to knee ligament injuries that required surgery

The reasons for this high rate against male soccer players

included the shoe-surface interaction differences in

anthropometry and increased joint laxity

Ingram et al (2008) also showed that non-contact knee

injuries were more common in female soccer than in male soccer

The reasons for this result were suggested to be that the knee

joint of the female soccer players were more vulnerable to

the stress created by rapid acceleration deceleration and

cutting movement on the grass surfaces

Anterior Cruciate Ligament Injuries in Basketball and Soccer

According to Mihata Beutler amp Boden (2006) anterior

cruciate ligament (ACL) injuries were not uncommon in

30

collegiate sports The most common type of ACL injuries was

non-contact or minimal contact ACL injuries The actions of

cutting jumping sudden deceleration and checking with

another player were the high risk mechanisms for this kind

of ACL injuries Basketball players and soccer players were

found to be often exposing to these damaging forces because

they had to perform these actions repeatedly during practice

and competition

From the result shown by Dick et al (2007) 18 of the

total game injuries in male basketball were ACL injuries and

603 of these ACL injuries were non-contact ACL injuries

This result was supported by Mihata et al (2006) whose result

showed that ACL injuries accounted for 14 of all injuries

in male basketball from 1989 to 2004 For the female basketball

players they had a higher rate of ACL injuries than the male

players It was shown by Mihata et al that the ACL injuries

accounted for 52 of all injuries in female basketball from

1989 to 2004 which was about four times higher than in male

basketball

31

For the soccer players the female soccer players also had

higher rates of ACL injuries than the male soccer players

In between 1989 and 2004 39 of the total injuries in female

soccer were ACL injuries while only 16 of the total injuries

in male soccer were ACL injuries (Mihata et al 2006) The

rate of ACL injuries in female soccer was almost three times

higher than that in male soccer in that period of time A more

serious result was shown by Le Gall et al (2007) In their

result ACL injuries mainly ACL sprains or ruptures

accounted for 156 of all major injuries of the young elite

female soccer players

According to Mihata et al (2006) the reasons for the

female players having higher rates of ACL injuries than the

male players were that they had only participated in such

organized sports for a brief period of time they were less

fit and they received less training Another reason was a

disturbance in the neuromuscular patterns received by the

female players which protected the knee created by

incidental or minimal trauma

32

The rate of ACL injuries could be reduced effectively

Understanding the biomechanical risk factors and identifying

and changing those risk factors were the necessary steps to

decrease the long-term ACL injury rates (Mihata et al 2006)

Summary

Soccer and basketball are common sports all over the world

and they are generally regarded as kinds of contact sports

as there is direct contact between players Players are

required to have good muscular strength and power in order

to compete with others Collision and contacting with other

players would lead to imbalance and maybe fall which in turn

lead to injury

Knee was found to be one of the most common body sites

susceptible to injuries in basketball and soccer during both

practice and competition Different types of knee injuries

were sustained by the players such as contusion laceration

sprain ligament tear meniscus lesion and torn cartilage

According to Ingram et al (2008) 168 of all knee injuries

33

were surgery-requiring injuries Examples of these major

knee injuries were complete ligament tears torn cartilage

incomplete ligament tears and fractures

Female players no matter they were soccer players or

basketball players would have a higher chance of injuring

their knee especially the ACL than their male counterparts

It might due to both intrinsic factors such as muscular

strength and endurance and hormonal differences and

extrinsic factors such as game environment and sports

facilities

However knee injuries could be prevented Preventive

measures for knee injuries included lower-extremity landing

skills plyometrics (Le Gall et al 2007) neuromuscular

training programs added supervision (Dick et al 2007)

muscle strengthening and movement training (Ingram et al

2008)

34

Chapter 3

METHOD

The method of this study was divided into the following

sections 1) Participants 2) Development of questionnaire

3) Pilot study 4) Procedures and 5) Data analysis

Participants

The participants were both male and female local members

of university basketball or soccer team in Hong Kong in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team The total number of subjects was 197 with

48 male members of university basketball team 51 female

members of university basketball team 56 male members of

university soccer team and 42 female members of university

soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 8: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

8

LIST OF TABLES

TABLE Page

1 Demographic Information of the

Respondents (N=197) 41

2 Chi Square Test for Different Genders of the

Same Sport with the Rate of Knee Injuries 43

3 Chi Square Test for Different Sports of the

Same Gender with the Rate of Knee Injuries 43

4 Average Amount of Time per Week for Regular

Training of the Players (N=197) 45

5 Average Amount of Time per Training Session

for Fitness Training of the Players (N=197) 47

6 Chi Square Test for Fitness Training with

the Rate of Knee Injuries 47

7 Average Amount of Time for Warm Up (N=197) 49

8 Types of Warm Up of the Players (N=197) 50

9 Categories of Knee Injury of the

Injured Players (N=147) 51

10 Types of Knee Injury (N=147) 53

9

11 Causes of Knee Injuries (N=147) 55

12 Treatments for Knee Injuries (N=147) 57

13 Number of Knee Injuries Requiring

Surgery (N=147) 59

14 Major Knee Injuries Requiring Surgery 59

15 Recovery Time for the Injured

Players (N=147) 60

10

Chapter 1

INTRODUCTION

Basketball and soccer are two popular sports all over the

world According to Yard Schroeder Fields Collins amp

Comstock (2008) and Borowski Yard Fields amp Comstock (2008)

participation in basketball or soccer can lead to a number

of health benefits such as improved physical fitness weight

control increased strength and increased endurance As a

result many PE teachers in Hong Kong would include basketball

and soccer teaching in the syllabus of the PE classes Apart

from those health benefits students could also learn how to

cooperate and communicate with the others when they are

participating in basketball or soccer games due to the fact

that these two sports are kinds of team sports

Apart from having basketball and soccer classes in

schools there are also different levels of competitions in

basketball or soccer in Hong Kong For example there are

inter-primary schools sports competitions and

inter-secondary schools sports competitions organized by the

11

Hong Kong Schools Sports Federation (HKSSF) and inter-varsity

sports competitions organized by the University Sports

Federation of Hong Kong China (USFHK) When students are

representing their schools to compete with the other students

they usually have to be engaged in regular training and

competitions This may lead to an increased risk of injury

as they are participating in physically demanding sports

(Borowski et al 2008)

Among the three different levels of basketball and

soccer competitions mentioned above the inter-varsity

basketball and soccer competitions are expected to be the most

intense and most physically demanding competitions Borowski

et al (2008) found that the injury rate in high school

basketball was 194 per 1000 AEs and Yard et al (2008) found

that the injury rate in soccer in high school was 239 per

1000 AEs It was also found that knee was the second most

commonly injured body site in both basketball and soccer

(Borowski et al 2008 Yard et al 2008)

After getting a knee injury it usually takes the

12

injured player less than one week to return to the

participation but it may take some of them more than three

weeks for recovery (Ingram Fields Yard amp Comstock 2008)

It depends on the severity of the knee injury In order to

reduce the rate of injury especially knee injury and ensure

safe participation in basketball and soccer we have to first

understand the biomechanical risk factors of the injuries and

then identify the changes of the factors that would help to

reduce the injuries (Mihata Beutler amp Boden 2006)

13

Statement of Problem

The focus of this study was on the comparison of the rate

and types of knee injuries between the university basketball

team members and university soccer team members in Hong Kong

It also aimed at examining the relationship between the gender

and the patterns of knee injuries

Purpose of Study

The purpose of this study was to compare the rate and types

of knee injuries between the university basketball team

members and university soccer team members in Hong Kong The

result obtained could provide the coaches and players with

more information about the knee injuries in basketball and

soccer and could help them design preventive measures to

reduce the incidence of knee injuries

14

Hypotheses

The followings were the research hypotheses of this study

1 There would be a difference in the rate of knee injuries

between the university basketball team members and the

university soccer team members

2 There would be a difference in the rate of knee injuries

between the different genders in basketball

3 There would be a difference in the rate of knee injuries

between the different genders in soccer

4 There would be a difference in the rate of knee injuries

between the players who are regularly engaged in fitness

training and those who are not engaged in any fitness

training

5 There would be a difference in the rate of knee injuries

between the players who perform warm up prior to

trainingcompetition and those who do not

15

Definition of Terms

In order to understand this study more clearly the

operational definitions of terms were as follows

University Basketball Team Member

University basketball team member refers to the local

member of any university basketball team in Hong Kong in the

academic year 2011-2012 who has been participating in regular

training provided by the university basketball team

University Soccer Team Member

University soccer team member refers to the local member

of any university soccer team in Hong Kong in the academic

year 2011-2012 who has been participating in regular training

provided by the university soccer team

Knee Injury

Knee injury refers to any injury to the knee that occurs

during sports or exercise (Bellenir 2008) The Capsule

16

ligament synovium and cartilage in the knee are susceptible

to injuries in sports (Harris amp Varney 1977)

Case of Knee Injury

Case of knee injury refers to any reported case of knee

injury in basketball or soccer that occurred within the past

one year either in the training session or competition

Rate of Knee Injury

Rate of knee injury refers to the number of case of knee

injuries in the past one year divided by the number of players

Training Hour

Training hour refers to the time spent on training the

skills or tactics on the basketball court or soccer pitch

excluding the time spent on fitness training

17

Warm Up

Warm up refers to any exercise or activity performed before

the main exercise which aims at increasing the muscle

temperature and increasing the range of motion of the joints

and muscle tendons (Fevre 1998) It usually includes jogging

stretching or sometimes specific warm up

Specific Warm Up

Specific warm up refers to the exercise or activity that

prepares the body for the up-coming exercise using the

specific muscles which will be used mainly in the up-coming

exercise

Fitness Training

Fitness training refers to any kind of exercise that will

help to improve the fitness of the players both the

health-related fitness and skill-related fitness

18

Cool Down

Cool down refers to any light exercise or activity

performed after the main exercise that allows the body to

transit back from an excited state to a resting state It

usually includes slow jogging walking and stretching

Recovery Time

Recovery time refers to the amount of time spent on recovery

of the knee injury from the occurrence of the knee injury until

the player returns to regular training

Delimitations

The delimitations of this study were listed as follows

1 The participants were delimited to the local Hong Kong

members of university basketball or soccer team in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team

19

2 The period of data collection was delimited to March 2012

3 Cases of knee injury were delimited to the reported cases

of knee injury that occurred in either training or

competition in the past one year

Limitations

The following were the limitations that must be considered

when analyzing the results of this study

1 The content of the questionnaire might not provide enough

detailed information for analysis as it was self-designed

2 The questionnaire was not valid and reliable enough as it

was self-designed

3 It was assumed that the participants could correctly

identify the types of knee injuries that they suffered

4 It was assumed that the participants would honestly and

cautiously answer the questionnaire

20

Significance of Study

This study provided information about the pattern of knee

injuries of the local members of the university basketball

and soccer team in Hong Kong It also provided comparisons

of both the rate of knee injuries and types of injuries between

the members of university basketball team and that of

university soccer team Besides the relationship between the

gender and the patterns of knee injuries was examined

Understanding the patterns of knee injuries was important

because it was the primary step to prevent the occurrence of

knee injuries This provided much useful information for the

coaches as well as the players on how to reduce the occurrence

of knee injuries If coaches understood the knee injury

patterns of basketball or soccer they could be able to plan

a better and safer training program for the players For the

players if they understood more about the causes of knee

injuries they could focus more on the preventive measures

of knee injuries when they were engaged in the sports

21

Chapter 2

REVIEW OF LITERATURE

Some past literature focusing on the knee injuries in

basketball and soccer was reviewed in this chapter This

review of literature was divided into six sections (1) knee

injuries in basketball (2) knee injuries in soccer (3)

gender difference in the knee injuries in basketball (4)

gender difference in the knee injuries in soccer (5) anterior

cruciate ligament (ACL) injuries in basketball and soccer

and (6) summary

Knee Injuries in Basketball

Borowski Yard Fields amp Comstock (2008) said that

basketball was one of the most popular sports in the United

States Although basketball players could benefit a lot from

basketball activities such as improved self-esteem and

weight control they had an increased risk of injury as they

were participating in a physically demanding activity Dick

Hertel Agel Grossman amp Marshall (2007) defined collegiate

22

menrsquos basketball as ldquoa contact sport in which numerous

anatomical structures are susceptible to both acute and

overuse injuriesrdquo (p194) It was not uncommon for basketball

players to suffer from injuries

According to Borowski et al (2008) the knee was one of

the most commonly injured body parts in basketball practice

and competition For the female basketball players 172 and

195 of the injuries occurred in the knee during practice

and competition respectively Knee injuries in practice and

in competition accounted for 101 and 115 of the total

injuries respectively for in the male basketball

In 2004 Olympic Games there were seven knee injuries in

the basketball games (Junge et al 2006) There were two

ligament ruptures one meniscus lesion one sprain two

contusions and one laceration According to Dick et al

(2007) knee internal derangements and patellar injuries were

the common knee injuries happened during practice and

competition Borowski et al (2008) suggested that muscle or

tendon strains in knee were another common type of knee

23

injuries in basketball Soft tissue injuries were also common

knee injuries in basketball According to Ingram Fields Yard

amp Comstock (2008) torn cartilage injuries were common in both

male and female basketball players and complete ligament

tears were common in female basketball players

Ingram et al (2008) found that the knee injuries in

basketball for both male and female players were non-contact

injuries meaning that there was no contact between players

when the knee injuries happened However Borowski et al

(2008) found that 246 of the knee injuries in the United

States high school basketball were caused by collision with

other player But still there were some non-contact knee

injuries caused by either rotation around a planted foot or

inversion or jumping or landing

24

Knee Injuries in Soccer

According to Yard Schroeder Fields Collins amp Comstock

(2008) ldquosoccer is one of the most popular sports worldwiderdquo

(p1930) It explained why there have been more and more people

both youngsters and adults participating in different soccer

activities nowadays Upon participation in soccer the

players could get a number of benefits such as becoming

physically active increase in productivity and enhancement

in academic performance but there were still risks for

injuries (Yard et al 2008)

Le Gall Carling amp Reilly (2007) conducted a study on the

soccer injuries in young elite females According to the

result among all anatomical sites in the body the lower

extremities were the most common site for injuries in soccer

with 168 of those injuries affecting the knee It was also

supported by the result of the research conducted by Yard et

al (2008) which showed that 187 of the soccer injuries

occurred in the knee

Concerning the types of knee injuries Junge et al (2006)

25

did a research on the injuries in team sport tournaments during

the 2004 Olympic Games and found that there were totally 17

knee injuries in soccer Of these 17 knee injuries 1 was

meniscus lesion 7 were sprain and 9 were contusion Apart

from that ligament tears were common in soccer players too

Ingram et al (2008) showed that incomplete ligament tears

and complete ligament tears were common in male soccer players

and female soccer players respectively A similar result was

obtained by Yard et al (2008) It showed that incomplete knee

ligament sprains were common among both male and female soccer

players but complete knee ligament sprains were only common

in female soccer players Both Ingram et al and Yard et al

suggested that the both the complete and incomplete knee

ligament injuries in the male soccer players were caused by

contact with other players while the incomplete knee ligament

injuries in the female soccer players were not caused by any

contact with others

According to Le Gall et al (2007) serious injuries

usually occurred in the knee and those serious injuries

26

included ligament sprain or rupture meniscus lesion and

patellar tendinitis or bursitis Overuse injuries were also

commonly occurred in the knee Yard et al (2008) suggested

that ldquogirl soccer players sustained a larger proportion of

knee injuriesrdquo (p1932) Darrow Collins Yard amp Comstock

(2009) supported that more female soccer players suffered from

severe knee injuries than male soccer players did

Gender Difference in the Knee Injuries in Basketball

According to Borowski et al (2008) female high school

basketball players in the United States were more likely to

injure their knees during practice and competition than the

male players A similar result was also found in the study

done by Ingram et al (2008) which showed that female high

school basketball players had a higher rate of major knee

injuries than the male players Darrow et al (2009) further

showed that female high school basketball players in the

United States had a higher chance of suffering from severe

knee injuries than the male players

27

The reasons for the difference in the rate of knee injuries

in basketball among the female and male players could be

divided into two categories intrinsic factors and extrinsic

factors Borowski et al (2008) suggested that the intrinsic

factors were mainly physiological differences between boys

and girls Examples for these physiological differences were

anatomical differences in joint and bone structure

differences in flexibility and strength and differences in

hormone secretions Differences in equipment differences in

facilities and differences in competition environment were

the extrinsic factors for the difference in the rate of knee

injury

Ingram et al (2008) mentioned that the likeliness of

female basketball players to sustain major knee injuries in

basketball was due to the vulnerability of their knees It

was associated with various risk factors such as hormonal

difference neuromuscular difference and mechanical

difference These risk factors made the female basketball

players four to six times more susceptible to major knee

28

injuries than the male basketball players

Gender Difference in the Knee Injuries in Soccer

The result of the study conducted by Yard et al (2008)

showed that female soccer players sustained a higher rate of

knee injuries than the male soccer players Le Gall et al

(2007) suggested that the reasons for the higher rate in knee

injuries for the female soccer players included weaker

technical and tactical ability poorer muscular strength and

endurance and weaker coordination The rapid development of

the female soccer game which led to an increased in

aggressiveness of the players was another cause of the higher

knee injury rate

Specifically female soccer players had a higher rate of

sustaining complete knee ligament sprains than the male soccer

players (Yard et al 2008) This was supported by the result

of the research done by Ingram et al (2008) which showed

that complete ligament tears were more common in female soccer

than in male soccer It might due to that fact that there were

29

structural differences and neuromuscular differences between

female and male soccer players Yard et al also found that

the rate of complete knee ligament sprains requiring surgery

in female soccer players was higher than that in male soccer

players Female soccer players were found to be 13 times more

susceptible to knee ligament injuries that required surgery

The reasons for this high rate against male soccer players

included the shoe-surface interaction differences in

anthropometry and increased joint laxity

Ingram et al (2008) also showed that non-contact knee

injuries were more common in female soccer than in male soccer

The reasons for this result were suggested to be that the knee

joint of the female soccer players were more vulnerable to

the stress created by rapid acceleration deceleration and

cutting movement on the grass surfaces

Anterior Cruciate Ligament Injuries in Basketball and Soccer

According to Mihata Beutler amp Boden (2006) anterior

cruciate ligament (ACL) injuries were not uncommon in

30

collegiate sports The most common type of ACL injuries was

non-contact or minimal contact ACL injuries The actions of

cutting jumping sudden deceleration and checking with

another player were the high risk mechanisms for this kind

of ACL injuries Basketball players and soccer players were

found to be often exposing to these damaging forces because

they had to perform these actions repeatedly during practice

and competition

From the result shown by Dick et al (2007) 18 of the

total game injuries in male basketball were ACL injuries and

603 of these ACL injuries were non-contact ACL injuries

This result was supported by Mihata et al (2006) whose result

showed that ACL injuries accounted for 14 of all injuries

in male basketball from 1989 to 2004 For the female basketball

players they had a higher rate of ACL injuries than the male

players It was shown by Mihata et al that the ACL injuries

accounted for 52 of all injuries in female basketball from

1989 to 2004 which was about four times higher than in male

basketball

31

For the soccer players the female soccer players also had

higher rates of ACL injuries than the male soccer players

In between 1989 and 2004 39 of the total injuries in female

soccer were ACL injuries while only 16 of the total injuries

in male soccer were ACL injuries (Mihata et al 2006) The

rate of ACL injuries in female soccer was almost three times

higher than that in male soccer in that period of time A more

serious result was shown by Le Gall et al (2007) In their

result ACL injuries mainly ACL sprains or ruptures

accounted for 156 of all major injuries of the young elite

female soccer players

According to Mihata et al (2006) the reasons for the

female players having higher rates of ACL injuries than the

male players were that they had only participated in such

organized sports for a brief period of time they were less

fit and they received less training Another reason was a

disturbance in the neuromuscular patterns received by the

female players which protected the knee created by

incidental or minimal trauma

32

The rate of ACL injuries could be reduced effectively

Understanding the biomechanical risk factors and identifying

and changing those risk factors were the necessary steps to

decrease the long-term ACL injury rates (Mihata et al 2006)

Summary

Soccer and basketball are common sports all over the world

and they are generally regarded as kinds of contact sports

as there is direct contact between players Players are

required to have good muscular strength and power in order

to compete with others Collision and contacting with other

players would lead to imbalance and maybe fall which in turn

lead to injury

Knee was found to be one of the most common body sites

susceptible to injuries in basketball and soccer during both

practice and competition Different types of knee injuries

were sustained by the players such as contusion laceration

sprain ligament tear meniscus lesion and torn cartilage

According to Ingram et al (2008) 168 of all knee injuries

33

were surgery-requiring injuries Examples of these major

knee injuries were complete ligament tears torn cartilage

incomplete ligament tears and fractures

Female players no matter they were soccer players or

basketball players would have a higher chance of injuring

their knee especially the ACL than their male counterparts

It might due to both intrinsic factors such as muscular

strength and endurance and hormonal differences and

extrinsic factors such as game environment and sports

facilities

However knee injuries could be prevented Preventive

measures for knee injuries included lower-extremity landing

skills plyometrics (Le Gall et al 2007) neuromuscular

training programs added supervision (Dick et al 2007)

muscle strengthening and movement training (Ingram et al

2008)

34

Chapter 3

METHOD

The method of this study was divided into the following

sections 1) Participants 2) Development of questionnaire

3) Pilot study 4) Procedures and 5) Data analysis

Participants

The participants were both male and female local members

of university basketball or soccer team in Hong Kong in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team The total number of subjects was 197 with

48 male members of university basketball team 51 female

members of university basketball team 56 male members of

university soccer team and 42 female members of university

soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 9: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

9

11 Causes of Knee Injuries (N=147) 55

12 Treatments for Knee Injuries (N=147) 57

13 Number of Knee Injuries Requiring

Surgery (N=147) 59

14 Major Knee Injuries Requiring Surgery 59

15 Recovery Time for the Injured

Players (N=147) 60

10

Chapter 1

INTRODUCTION

Basketball and soccer are two popular sports all over the

world According to Yard Schroeder Fields Collins amp

Comstock (2008) and Borowski Yard Fields amp Comstock (2008)

participation in basketball or soccer can lead to a number

of health benefits such as improved physical fitness weight

control increased strength and increased endurance As a

result many PE teachers in Hong Kong would include basketball

and soccer teaching in the syllabus of the PE classes Apart

from those health benefits students could also learn how to

cooperate and communicate with the others when they are

participating in basketball or soccer games due to the fact

that these two sports are kinds of team sports

Apart from having basketball and soccer classes in

schools there are also different levels of competitions in

basketball or soccer in Hong Kong For example there are

inter-primary schools sports competitions and

inter-secondary schools sports competitions organized by the

11

Hong Kong Schools Sports Federation (HKSSF) and inter-varsity

sports competitions organized by the University Sports

Federation of Hong Kong China (USFHK) When students are

representing their schools to compete with the other students

they usually have to be engaged in regular training and

competitions This may lead to an increased risk of injury

as they are participating in physically demanding sports

(Borowski et al 2008)

Among the three different levels of basketball and

soccer competitions mentioned above the inter-varsity

basketball and soccer competitions are expected to be the most

intense and most physically demanding competitions Borowski

et al (2008) found that the injury rate in high school

basketball was 194 per 1000 AEs and Yard et al (2008) found

that the injury rate in soccer in high school was 239 per

1000 AEs It was also found that knee was the second most

commonly injured body site in both basketball and soccer

(Borowski et al 2008 Yard et al 2008)

After getting a knee injury it usually takes the

12

injured player less than one week to return to the

participation but it may take some of them more than three

weeks for recovery (Ingram Fields Yard amp Comstock 2008)

It depends on the severity of the knee injury In order to

reduce the rate of injury especially knee injury and ensure

safe participation in basketball and soccer we have to first

understand the biomechanical risk factors of the injuries and

then identify the changes of the factors that would help to

reduce the injuries (Mihata Beutler amp Boden 2006)

13

Statement of Problem

The focus of this study was on the comparison of the rate

and types of knee injuries between the university basketball

team members and university soccer team members in Hong Kong

It also aimed at examining the relationship between the gender

and the patterns of knee injuries

Purpose of Study

The purpose of this study was to compare the rate and types

of knee injuries between the university basketball team

members and university soccer team members in Hong Kong The

result obtained could provide the coaches and players with

more information about the knee injuries in basketball and

soccer and could help them design preventive measures to

reduce the incidence of knee injuries

14

Hypotheses

The followings were the research hypotheses of this study

1 There would be a difference in the rate of knee injuries

between the university basketball team members and the

university soccer team members

2 There would be a difference in the rate of knee injuries

between the different genders in basketball

3 There would be a difference in the rate of knee injuries

between the different genders in soccer

4 There would be a difference in the rate of knee injuries

between the players who are regularly engaged in fitness

training and those who are not engaged in any fitness

training

5 There would be a difference in the rate of knee injuries

between the players who perform warm up prior to

trainingcompetition and those who do not

15

Definition of Terms

In order to understand this study more clearly the

operational definitions of terms were as follows

University Basketball Team Member

University basketball team member refers to the local

member of any university basketball team in Hong Kong in the

academic year 2011-2012 who has been participating in regular

training provided by the university basketball team

University Soccer Team Member

University soccer team member refers to the local member

of any university soccer team in Hong Kong in the academic

year 2011-2012 who has been participating in regular training

provided by the university soccer team

Knee Injury

Knee injury refers to any injury to the knee that occurs

during sports or exercise (Bellenir 2008) The Capsule

16

ligament synovium and cartilage in the knee are susceptible

to injuries in sports (Harris amp Varney 1977)

Case of Knee Injury

Case of knee injury refers to any reported case of knee

injury in basketball or soccer that occurred within the past

one year either in the training session or competition

Rate of Knee Injury

Rate of knee injury refers to the number of case of knee

injuries in the past one year divided by the number of players

Training Hour

Training hour refers to the time spent on training the

skills or tactics on the basketball court or soccer pitch

excluding the time spent on fitness training

17

Warm Up

Warm up refers to any exercise or activity performed before

the main exercise which aims at increasing the muscle

temperature and increasing the range of motion of the joints

and muscle tendons (Fevre 1998) It usually includes jogging

stretching or sometimes specific warm up

Specific Warm Up

Specific warm up refers to the exercise or activity that

prepares the body for the up-coming exercise using the

specific muscles which will be used mainly in the up-coming

exercise

Fitness Training

Fitness training refers to any kind of exercise that will

help to improve the fitness of the players both the

health-related fitness and skill-related fitness

18

Cool Down

Cool down refers to any light exercise or activity

performed after the main exercise that allows the body to

transit back from an excited state to a resting state It

usually includes slow jogging walking and stretching

Recovery Time

Recovery time refers to the amount of time spent on recovery

of the knee injury from the occurrence of the knee injury until

the player returns to regular training

Delimitations

The delimitations of this study were listed as follows

1 The participants were delimited to the local Hong Kong

members of university basketball or soccer team in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team

19

2 The period of data collection was delimited to March 2012

3 Cases of knee injury were delimited to the reported cases

of knee injury that occurred in either training or

competition in the past one year

Limitations

The following were the limitations that must be considered

when analyzing the results of this study

1 The content of the questionnaire might not provide enough

detailed information for analysis as it was self-designed

2 The questionnaire was not valid and reliable enough as it

was self-designed

3 It was assumed that the participants could correctly

identify the types of knee injuries that they suffered

4 It was assumed that the participants would honestly and

cautiously answer the questionnaire

20

Significance of Study

This study provided information about the pattern of knee

injuries of the local members of the university basketball

and soccer team in Hong Kong It also provided comparisons

of both the rate of knee injuries and types of injuries between

the members of university basketball team and that of

university soccer team Besides the relationship between the

gender and the patterns of knee injuries was examined

Understanding the patterns of knee injuries was important

because it was the primary step to prevent the occurrence of

knee injuries This provided much useful information for the

coaches as well as the players on how to reduce the occurrence

of knee injuries If coaches understood the knee injury

patterns of basketball or soccer they could be able to plan

a better and safer training program for the players For the

players if they understood more about the causes of knee

injuries they could focus more on the preventive measures

of knee injuries when they were engaged in the sports

21

Chapter 2

REVIEW OF LITERATURE

Some past literature focusing on the knee injuries in

basketball and soccer was reviewed in this chapter This

review of literature was divided into six sections (1) knee

injuries in basketball (2) knee injuries in soccer (3)

gender difference in the knee injuries in basketball (4)

gender difference in the knee injuries in soccer (5) anterior

cruciate ligament (ACL) injuries in basketball and soccer

and (6) summary

Knee Injuries in Basketball

Borowski Yard Fields amp Comstock (2008) said that

basketball was one of the most popular sports in the United

States Although basketball players could benefit a lot from

basketball activities such as improved self-esteem and

weight control they had an increased risk of injury as they

were participating in a physically demanding activity Dick

Hertel Agel Grossman amp Marshall (2007) defined collegiate

22

menrsquos basketball as ldquoa contact sport in which numerous

anatomical structures are susceptible to both acute and

overuse injuriesrdquo (p194) It was not uncommon for basketball

players to suffer from injuries

According to Borowski et al (2008) the knee was one of

the most commonly injured body parts in basketball practice

and competition For the female basketball players 172 and

195 of the injuries occurred in the knee during practice

and competition respectively Knee injuries in practice and

in competition accounted for 101 and 115 of the total

injuries respectively for in the male basketball

In 2004 Olympic Games there were seven knee injuries in

the basketball games (Junge et al 2006) There were two

ligament ruptures one meniscus lesion one sprain two

contusions and one laceration According to Dick et al

(2007) knee internal derangements and patellar injuries were

the common knee injuries happened during practice and

competition Borowski et al (2008) suggested that muscle or

tendon strains in knee were another common type of knee

23

injuries in basketball Soft tissue injuries were also common

knee injuries in basketball According to Ingram Fields Yard

amp Comstock (2008) torn cartilage injuries were common in both

male and female basketball players and complete ligament

tears were common in female basketball players

Ingram et al (2008) found that the knee injuries in

basketball for both male and female players were non-contact

injuries meaning that there was no contact between players

when the knee injuries happened However Borowski et al

(2008) found that 246 of the knee injuries in the United

States high school basketball were caused by collision with

other player But still there were some non-contact knee

injuries caused by either rotation around a planted foot or

inversion or jumping or landing

24

Knee Injuries in Soccer

According to Yard Schroeder Fields Collins amp Comstock

(2008) ldquosoccer is one of the most popular sports worldwiderdquo

(p1930) It explained why there have been more and more people

both youngsters and adults participating in different soccer

activities nowadays Upon participation in soccer the

players could get a number of benefits such as becoming

physically active increase in productivity and enhancement

in academic performance but there were still risks for

injuries (Yard et al 2008)

Le Gall Carling amp Reilly (2007) conducted a study on the

soccer injuries in young elite females According to the

result among all anatomical sites in the body the lower

extremities were the most common site for injuries in soccer

with 168 of those injuries affecting the knee It was also

supported by the result of the research conducted by Yard et

al (2008) which showed that 187 of the soccer injuries

occurred in the knee

Concerning the types of knee injuries Junge et al (2006)

25

did a research on the injuries in team sport tournaments during

the 2004 Olympic Games and found that there were totally 17

knee injuries in soccer Of these 17 knee injuries 1 was

meniscus lesion 7 were sprain and 9 were contusion Apart

from that ligament tears were common in soccer players too

Ingram et al (2008) showed that incomplete ligament tears

and complete ligament tears were common in male soccer players

and female soccer players respectively A similar result was

obtained by Yard et al (2008) It showed that incomplete knee

ligament sprains were common among both male and female soccer

players but complete knee ligament sprains were only common

in female soccer players Both Ingram et al and Yard et al

suggested that the both the complete and incomplete knee

ligament injuries in the male soccer players were caused by

contact with other players while the incomplete knee ligament

injuries in the female soccer players were not caused by any

contact with others

According to Le Gall et al (2007) serious injuries

usually occurred in the knee and those serious injuries

26

included ligament sprain or rupture meniscus lesion and

patellar tendinitis or bursitis Overuse injuries were also

commonly occurred in the knee Yard et al (2008) suggested

that ldquogirl soccer players sustained a larger proportion of

knee injuriesrdquo (p1932) Darrow Collins Yard amp Comstock

(2009) supported that more female soccer players suffered from

severe knee injuries than male soccer players did

Gender Difference in the Knee Injuries in Basketball

According to Borowski et al (2008) female high school

basketball players in the United States were more likely to

injure their knees during practice and competition than the

male players A similar result was also found in the study

done by Ingram et al (2008) which showed that female high

school basketball players had a higher rate of major knee

injuries than the male players Darrow et al (2009) further

showed that female high school basketball players in the

United States had a higher chance of suffering from severe

knee injuries than the male players

27

The reasons for the difference in the rate of knee injuries

in basketball among the female and male players could be

divided into two categories intrinsic factors and extrinsic

factors Borowski et al (2008) suggested that the intrinsic

factors were mainly physiological differences between boys

and girls Examples for these physiological differences were

anatomical differences in joint and bone structure

differences in flexibility and strength and differences in

hormone secretions Differences in equipment differences in

facilities and differences in competition environment were

the extrinsic factors for the difference in the rate of knee

injury

Ingram et al (2008) mentioned that the likeliness of

female basketball players to sustain major knee injuries in

basketball was due to the vulnerability of their knees It

was associated with various risk factors such as hormonal

difference neuromuscular difference and mechanical

difference These risk factors made the female basketball

players four to six times more susceptible to major knee

28

injuries than the male basketball players

Gender Difference in the Knee Injuries in Soccer

The result of the study conducted by Yard et al (2008)

showed that female soccer players sustained a higher rate of

knee injuries than the male soccer players Le Gall et al

(2007) suggested that the reasons for the higher rate in knee

injuries for the female soccer players included weaker

technical and tactical ability poorer muscular strength and

endurance and weaker coordination The rapid development of

the female soccer game which led to an increased in

aggressiveness of the players was another cause of the higher

knee injury rate

Specifically female soccer players had a higher rate of

sustaining complete knee ligament sprains than the male soccer

players (Yard et al 2008) This was supported by the result

of the research done by Ingram et al (2008) which showed

that complete ligament tears were more common in female soccer

than in male soccer It might due to that fact that there were

29

structural differences and neuromuscular differences between

female and male soccer players Yard et al also found that

the rate of complete knee ligament sprains requiring surgery

in female soccer players was higher than that in male soccer

players Female soccer players were found to be 13 times more

susceptible to knee ligament injuries that required surgery

The reasons for this high rate against male soccer players

included the shoe-surface interaction differences in

anthropometry and increased joint laxity

Ingram et al (2008) also showed that non-contact knee

injuries were more common in female soccer than in male soccer

The reasons for this result were suggested to be that the knee

joint of the female soccer players were more vulnerable to

the stress created by rapid acceleration deceleration and

cutting movement on the grass surfaces

Anterior Cruciate Ligament Injuries in Basketball and Soccer

According to Mihata Beutler amp Boden (2006) anterior

cruciate ligament (ACL) injuries were not uncommon in

30

collegiate sports The most common type of ACL injuries was

non-contact or minimal contact ACL injuries The actions of

cutting jumping sudden deceleration and checking with

another player were the high risk mechanisms for this kind

of ACL injuries Basketball players and soccer players were

found to be often exposing to these damaging forces because

they had to perform these actions repeatedly during practice

and competition

From the result shown by Dick et al (2007) 18 of the

total game injuries in male basketball were ACL injuries and

603 of these ACL injuries were non-contact ACL injuries

This result was supported by Mihata et al (2006) whose result

showed that ACL injuries accounted for 14 of all injuries

in male basketball from 1989 to 2004 For the female basketball

players they had a higher rate of ACL injuries than the male

players It was shown by Mihata et al that the ACL injuries

accounted for 52 of all injuries in female basketball from

1989 to 2004 which was about four times higher than in male

basketball

31

For the soccer players the female soccer players also had

higher rates of ACL injuries than the male soccer players

In between 1989 and 2004 39 of the total injuries in female

soccer were ACL injuries while only 16 of the total injuries

in male soccer were ACL injuries (Mihata et al 2006) The

rate of ACL injuries in female soccer was almost three times

higher than that in male soccer in that period of time A more

serious result was shown by Le Gall et al (2007) In their

result ACL injuries mainly ACL sprains or ruptures

accounted for 156 of all major injuries of the young elite

female soccer players

According to Mihata et al (2006) the reasons for the

female players having higher rates of ACL injuries than the

male players were that they had only participated in such

organized sports for a brief period of time they were less

fit and they received less training Another reason was a

disturbance in the neuromuscular patterns received by the

female players which protected the knee created by

incidental or minimal trauma

32

The rate of ACL injuries could be reduced effectively

Understanding the biomechanical risk factors and identifying

and changing those risk factors were the necessary steps to

decrease the long-term ACL injury rates (Mihata et al 2006)

Summary

Soccer and basketball are common sports all over the world

and they are generally regarded as kinds of contact sports

as there is direct contact between players Players are

required to have good muscular strength and power in order

to compete with others Collision and contacting with other

players would lead to imbalance and maybe fall which in turn

lead to injury

Knee was found to be one of the most common body sites

susceptible to injuries in basketball and soccer during both

practice and competition Different types of knee injuries

were sustained by the players such as contusion laceration

sprain ligament tear meniscus lesion and torn cartilage

According to Ingram et al (2008) 168 of all knee injuries

33

were surgery-requiring injuries Examples of these major

knee injuries were complete ligament tears torn cartilage

incomplete ligament tears and fractures

Female players no matter they were soccer players or

basketball players would have a higher chance of injuring

their knee especially the ACL than their male counterparts

It might due to both intrinsic factors such as muscular

strength and endurance and hormonal differences and

extrinsic factors such as game environment and sports

facilities

However knee injuries could be prevented Preventive

measures for knee injuries included lower-extremity landing

skills plyometrics (Le Gall et al 2007) neuromuscular

training programs added supervision (Dick et al 2007)

muscle strengthening and movement training (Ingram et al

2008)

34

Chapter 3

METHOD

The method of this study was divided into the following

sections 1) Participants 2) Development of questionnaire

3) Pilot study 4) Procedures and 5) Data analysis

Participants

The participants were both male and female local members

of university basketball or soccer team in Hong Kong in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team The total number of subjects was 197 with

48 male members of university basketball team 51 female

members of university basketball team 56 male members of

university soccer team and 42 female members of university

soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

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Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

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sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

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The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 10: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

10

Chapter 1

INTRODUCTION

Basketball and soccer are two popular sports all over the

world According to Yard Schroeder Fields Collins amp

Comstock (2008) and Borowski Yard Fields amp Comstock (2008)

participation in basketball or soccer can lead to a number

of health benefits such as improved physical fitness weight

control increased strength and increased endurance As a

result many PE teachers in Hong Kong would include basketball

and soccer teaching in the syllabus of the PE classes Apart

from those health benefits students could also learn how to

cooperate and communicate with the others when they are

participating in basketball or soccer games due to the fact

that these two sports are kinds of team sports

Apart from having basketball and soccer classes in

schools there are also different levels of competitions in

basketball or soccer in Hong Kong For example there are

inter-primary schools sports competitions and

inter-secondary schools sports competitions organized by the

11

Hong Kong Schools Sports Federation (HKSSF) and inter-varsity

sports competitions organized by the University Sports

Federation of Hong Kong China (USFHK) When students are

representing their schools to compete with the other students

they usually have to be engaged in regular training and

competitions This may lead to an increased risk of injury

as they are participating in physically demanding sports

(Borowski et al 2008)

Among the three different levels of basketball and

soccer competitions mentioned above the inter-varsity

basketball and soccer competitions are expected to be the most

intense and most physically demanding competitions Borowski

et al (2008) found that the injury rate in high school

basketball was 194 per 1000 AEs and Yard et al (2008) found

that the injury rate in soccer in high school was 239 per

1000 AEs It was also found that knee was the second most

commonly injured body site in both basketball and soccer

(Borowski et al 2008 Yard et al 2008)

After getting a knee injury it usually takes the

12

injured player less than one week to return to the

participation but it may take some of them more than three

weeks for recovery (Ingram Fields Yard amp Comstock 2008)

It depends on the severity of the knee injury In order to

reduce the rate of injury especially knee injury and ensure

safe participation in basketball and soccer we have to first

understand the biomechanical risk factors of the injuries and

then identify the changes of the factors that would help to

reduce the injuries (Mihata Beutler amp Boden 2006)

13

Statement of Problem

The focus of this study was on the comparison of the rate

and types of knee injuries between the university basketball

team members and university soccer team members in Hong Kong

It also aimed at examining the relationship between the gender

and the patterns of knee injuries

Purpose of Study

The purpose of this study was to compare the rate and types

of knee injuries between the university basketball team

members and university soccer team members in Hong Kong The

result obtained could provide the coaches and players with

more information about the knee injuries in basketball and

soccer and could help them design preventive measures to

reduce the incidence of knee injuries

14

Hypotheses

The followings were the research hypotheses of this study

1 There would be a difference in the rate of knee injuries

between the university basketball team members and the

university soccer team members

2 There would be a difference in the rate of knee injuries

between the different genders in basketball

3 There would be a difference in the rate of knee injuries

between the different genders in soccer

4 There would be a difference in the rate of knee injuries

between the players who are regularly engaged in fitness

training and those who are not engaged in any fitness

training

5 There would be a difference in the rate of knee injuries

between the players who perform warm up prior to

trainingcompetition and those who do not

15

Definition of Terms

In order to understand this study more clearly the

operational definitions of terms were as follows

University Basketball Team Member

University basketball team member refers to the local

member of any university basketball team in Hong Kong in the

academic year 2011-2012 who has been participating in regular

training provided by the university basketball team

University Soccer Team Member

University soccer team member refers to the local member

of any university soccer team in Hong Kong in the academic

year 2011-2012 who has been participating in regular training

provided by the university soccer team

Knee Injury

Knee injury refers to any injury to the knee that occurs

during sports or exercise (Bellenir 2008) The Capsule

16

ligament synovium and cartilage in the knee are susceptible

to injuries in sports (Harris amp Varney 1977)

Case of Knee Injury

Case of knee injury refers to any reported case of knee

injury in basketball or soccer that occurred within the past

one year either in the training session or competition

Rate of Knee Injury

Rate of knee injury refers to the number of case of knee

injuries in the past one year divided by the number of players

Training Hour

Training hour refers to the time spent on training the

skills or tactics on the basketball court or soccer pitch

excluding the time spent on fitness training

17

Warm Up

Warm up refers to any exercise or activity performed before

the main exercise which aims at increasing the muscle

temperature and increasing the range of motion of the joints

and muscle tendons (Fevre 1998) It usually includes jogging

stretching or sometimes specific warm up

Specific Warm Up

Specific warm up refers to the exercise or activity that

prepares the body for the up-coming exercise using the

specific muscles which will be used mainly in the up-coming

exercise

Fitness Training

Fitness training refers to any kind of exercise that will

help to improve the fitness of the players both the

health-related fitness and skill-related fitness

18

Cool Down

Cool down refers to any light exercise or activity

performed after the main exercise that allows the body to

transit back from an excited state to a resting state It

usually includes slow jogging walking and stretching

Recovery Time

Recovery time refers to the amount of time spent on recovery

of the knee injury from the occurrence of the knee injury until

the player returns to regular training

Delimitations

The delimitations of this study were listed as follows

1 The participants were delimited to the local Hong Kong

members of university basketball or soccer team in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team

19

2 The period of data collection was delimited to March 2012

3 Cases of knee injury were delimited to the reported cases

of knee injury that occurred in either training or

competition in the past one year

Limitations

The following were the limitations that must be considered

when analyzing the results of this study

1 The content of the questionnaire might not provide enough

detailed information for analysis as it was self-designed

2 The questionnaire was not valid and reliable enough as it

was self-designed

3 It was assumed that the participants could correctly

identify the types of knee injuries that they suffered

4 It was assumed that the participants would honestly and

cautiously answer the questionnaire

20

Significance of Study

This study provided information about the pattern of knee

injuries of the local members of the university basketball

and soccer team in Hong Kong It also provided comparisons

of both the rate of knee injuries and types of injuries between

the members of university basketball team and that of

university soccer team Besides the relationship between the

gender and the patterns of knee injuries was examined

Understanding the patterns of knee injuries was important

because it was the primary step to prevent the occurrence of

knee injuries This provided much useful information for the

coaches as well as the players on how to reduce the occurrence

of knee injuries If coaches understood the knee injury

patterns of basketball or soccer they could be able to plan

a better and safer training program for the players For the

players if they understood more about the causes of knee

injuries they could focus more on the preventive measures

of knee injuries when they were engaged in the sports

21

Chapter 2

REVIEW OF LITERATURE

Some past literature focusing on the knee injuries in

basketball and soccer was reviewed in this chapter This

review of literature was divided into six sections (1) knee

injuries in basketball (2) knee injuries in soccer (3)

gender difference in the knee injuries in basketball (4)

gender difference in the knee injuries in soccer (5) anterior

cruciate ligament (ACL) injuries in basketball and soccer

and (6) summary

Knee Injuries in Basketball

Borowski Yard Fields amp Comstock (2008) said that

basketball was one of the most popular sports in the United

States Although basketball players could benefit a lot from

basketball activities such as improved self-esteem and

weight control they had an increased risk of injury as they

were participating in a physically demanding activity Dick

Hertel Agel Grossman amp Marshall (2007) defined collegiate

22

menrsquos basketball as ldquoa contact sport in which numerous

anatomical structures are susceptible to both acute and

overuse injuriesrdquo (p194) It was not uncommon for basketball

players to suffer from injuries

According to Borowski et al (2008) the knee was one of

the most commonly injured body parts in basketball practice

and competition For the female basketball players 172 and

195 of the injuries occurred in the knee during practice

and competition respectively Knee injuries in practice and

in competition accounted for 101 and 115 of the total

injuries respectively for in the male basketball

In 2004 Olympic Games there were seven knee injuries in

the basketball games (Junge et al 2006) There were two

ligament ruptures one meniscus lesion one sprain two

contusions and one laceration According to Dick et al

(2007) knee internal derangements and patellar injuries were

the common knee injuries happened during practice and

competition Borowski et al (2008) suggested that muscle or

tendon strains in knee were another common type of knee

23

injuries in basketball Soft tissue injuries were also common

knee injuries in basketball According to Ingram Fields Yard

amp Comstock (2008) torn cartilage injuries were common in both

male and female basketball players and complete ligament

tears were common in female basketball players

Ingram et al (2008) found that the knee injuries in

basketball for both male and female players were non-contact

injuries meaning that there was no contact between players

when the knee injuries happened However Borowski et al

(2008) found that 246 of the knee injuries in the United

States high school basketball were caused by collision with

other player But still there were some non-contact knee

injuries caused by either rotation around a planted foot or

inversion or jumping or landing

24

Knee Injuries in Soccer

According to Yard Schroeder Fields Collins amp Comstock

(2008) ldquosoccer is one of the most popular sports worldwiderdquo

(p1930) It explained why there have been more and more people

both youngsters and adults participating in different soccer

activities nowadays Upon participation in soccer the

players could get a number of benefits such as becoming

physically active increase in productivity and enhancement

in academic performance but there were still risks for

injuries (Yard et al 2008)

Le Gall Carling amp Reilly (2007) conducted a study on the

soccer injuries in young elite females According to the

result among all anatomical sites in the body the lower

extremities were the most common site for injuries in soccer

with 168 of those injuries affecting the knee It was also

supported by the result of the research conducted by Yard et

al (2008) which showed that 187 of the soccer injuries

occurred in the knee

Concerning the types of knee injuries Junge et al (2006)

25

did a research on the injuries in team sport tournaments during

the 2004 Olympic Games and found that there were totally 17

knee injuries in soccer Of these 17 knee injuries 1 was

meniscus lesion 7 were sprain and 9 were contusion Apart

from that ligament tears were common in soccer players too

Ingram et al (2008) showed that incomplete ligament tears

and complete ligament tears were common in male soccer players

and female soccer players respectively A similar result was

obtained by Yard et al (2008) It showed that incomplete knee

ligament sprains were common among both male and female soccer

players but complete knee ligament sprains were only common

in female soccer players Both Ingram et al and Yard et al

suggested that the both the complete and incomplete knee

ligament injuries in the male soccer players were caused by

contact with other players while the incomplete knee ligament

injuries in the female soccer players were not caused by any

contact with others

According to Le Gall et al (2007) serious injuries

usually occurred in the knee and those serious injuries

26

included ligament sprain or rupture meniscus lesion and

patellar tendinitis or bursitis Overuse injuries were also

commonly occurred in the knee Yard et al (2008) suggested

that ldquogirl soccer players sustained a larger proportion of

knee injuriesrdquo (p1932) Darrow Collins Yard amp Comstock

(2009) supported that more female soccer players suffered from

severe knee injuries than male soccer players did

Gender Difference in the Knee Injuries in Basketball

According to Borowski et al (2008) female high school

basketball players in the United States were more likely to

injure their knees during practice and competition than the

male players A similar result was also found in the study

done by Ingram et al (2008) which showed that female high

school basketball players had a higher rate of major knee

injuries than the male players Darrow et al (2009) further

showed that female high school basketball players in the

United States had a higher chance of suffering from severe

knee injuries than the male players

27

The reasons for the difference in the rate of knee injuries

in basketball among the female and male players could be

divided into two categories intrinsic factors and extrinsic

factors Borowski et al (2008) suggested that the intrinsic

factors were mainly physiological differences between boys

and girls Examples for these physiological differences were

anatomical differences in joint and bone structure

differences in flexibility and strength and differences in

hormone secretions Differences in equipment differences in

facilities and differences in competition environment were

the extrinsic factors for the difference in the rate of knee

injury

Ingram et al (2008) mentioned that the likeliness of

female basketball players to sustain major knee injuries in

basketball was due to the vulnerability of their knees It

was associated with various risk factors such as hormonal

difference neuromuscular difference and mechanical

difference These risk factors made the female basketball

players four to six times more susceptible to major knee

28

injuries than the male basketball players

Gender Difference in the Knee Injuries in Soccer

The result of the study conducted by Yard et al (2008)

showed that female soccer players sustained a higher rate of

knee injuries than the male soccer players Le Gall et al

(2007) suggested that the reasons for the higher rate in knee

injuries for the female soccer players included weaker

technical and tactical ability poorer muscular strength and

endurance and weaker coordination The rapid development of

the female soccer game which led to an increased in

aggressiveness of the players was another cause of the higher

knee injury rate

Specifically female soccer players had a higher rate of

sustaining complete knee ligament sprains than the male soccer

players (Yard et al 2008) This was supported by the result

of the research done by Ingram et al (2008) which showed

that complete ligament tears were more common in female soccer

than in male soccer It might due to that fact that there were

29

structural differences and neuromuscular differences between

female and male soccer players Yard et al also found that

the rate of complete knee ligament sprains requiring surgery

in female soccer players was higher than that in male soccer

players Female soccer players were found to be 13 times more

susceptible to knee ligament injuries that required surgery

The reasons for this high rate against male soccer players

included the shoe-surface interaction differences in

anthropometry and increased joint laxity

Ingram et al (2008) also showed that non-contact knee

injuries were more common in female soccer than in male soccer

The reasons for this result were suggested to be that the knee

joint of the female soccer players were more vulnerable to

the stress created by rapid acceleration deceleration and

cutting movement on the grass surfaces

Anterior Cruciate Ligament Injuries in Basketball and Soccer

According to Mihata Beutler amp Boden (2006) anterior

cruciate ligament (ACL) injuries were not uncommon in

30

collegiate sports The most common type of ACL injuries was

non-contact or minimal contact ACL injuries The actions of

cutting jumping sudden deceleration and checking with

another player were the high risk mechanisms for this kind

of ACL injuries Basketball players and soccer players were

found to be often exposing to these damaging forces because

they had to perform these actions repeatedly during practice

and competition

From the result shown by Dick et al (2007) 18 of the

total game injuries in male basketball were ACL injuries and

603 of these ACL injuries were non-contact ACL injuries

This result was supported by Mihata et al (2006) whose result

showed that ACL injuries accounted for 14 of all injuries

in male basketball from 1989 to 2004 For the female basketball

players they had a higher rate of ACL injuries than the male

players It was shown by Mihata et al that the ACL injuries

accounted for 52 of all injuries in female basketball from

1989 to 2004 which was about four times higher than in male

basketball

31

For the soccer players the female soccer players also had

higher rates of ACL injuries than the male soccer players

In between 1989 and 2004 39 of the total injuries in female

soccer were ACL injuries while only 16 of the total injuries

in male soccer were ACL injuries (Mihata et al 2006) The

rate of ACL injuries in female soccer was almost three times

higher than that in male soccer in that period of time A more

serious result was shown by Le Gall et al (2007) In their

result ACL injuries mainly ACL sprains or ruptures

accounted for 156 of all major injuries of the young elite

female soccer players

According to Mihata et al (2006) the reasons for the

female players having higher rates of ACL injuries than the

male players were that they had only participated in such

organized sports for a brief period of time they were less

fit and they received less training Another reason was a

disturbance in the neuromuscular patterns received by the

female players which protected the knee created by

incidental or minimal trauma

32

The rate of ACL injuries could be reduced effectively

Understanding the biomechanical risk factors and identifying

and changing those risk factors were the necessary steps to

decrease the long-term ACL injury rates (Mihata et al 2006)

Summary

Soccer and basketball are common sports all over the world

and they are generally regarded as kinds of contact sports

as there is direct contact between players Players are

required to have good muscular strength and power in order

to compete with others Collision and contacting with other

players would lead to imbalance and maybe fall which in turn

lead to injury

Knee was found to be one of the most common body sites

susceptible to injuries in basketball and soccer during both

practice and competition Different types of knee injuries

were sustained by the players such as contusion laceration

sprain ligament tear meniscus lesion and torn cartilage

According to Ingram et al (2008) 168 of all knee injuries

33

were surgery-requiring injuries Examples of these major

knee injuries were complete ligament tears torn cartilage

incomplete ligament tears and fractures

Female players no matter they were soccer players or

basketball players would have a higher chance of injuring

their knee especially the ACL than their male counterparts

It might due to both intrinsic factors such as muscular

strength and endurance and hormonal differences and

extrinsic factors such as game environment and sports

facilities

However knee injuries could be prevented Preventive

measures for knee injuries included lower-extremity landing

skills plyometrics (Le Gall et al 2007) neuromuscular

training programs added supervision (Dick et al 2007)

muscle strengthening and movement training (Ingram et al

2008)

34

Chapter 3

METHOD

The method of this study was divided into the following

sections 1) Participants 2) Development of questionnaire

3) Pilot study 4) Procedures and 5) Data analysis

Participants

The participants were both male and female local members

of university basketball or soccer team in Hong Kong in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team The total number of subjects was 197 with

48 male members of university basketball team 51 female

members of university basketball team 56 male members of

university soccer team and 42 female members of university

soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 11: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

11

Hong Kong Schools Sports Federation (HKSSF) and inter-varsity

sports competitions organized by the University Sports

Federation of Hong Kong China (USFHK) When students are

representing their schools to compete with the other students

they usually have to be engaged in regular training and

competitions This may lead to an increased risk of injury

as they are participating in physically demanding sports

(Borowski et al 2008)

Among the three different levels of basketball and

soccer competitions mentioned above the inter-varsity

basketball and soccer competitions are expected to be the most

intense and most physically demanding competitions Borowski

et al (2008) found that the injury rate in high school

basketball was 194 per 1000 AEs and Yard et al (2008) found

that the injury rate in soccer in high school was 239 per

1000 AEs It was also found that knee was the second most

commonly injured body site in both basketball and soccer

(Borowski et al 2008 Yard et al 2008)

After getting a knee injury it usually takes the

12

injured player less than one week to return to the

participation but it may take some of them more than three

weeks for recovery (Ingram Fields Yard amp Comstock 2008)

It depends on the severity of the knee injury In order to

reduce the rate of injury especially knee injury and ensure

safe participation in basketball and soccer we have to first

understand the biomechanical risk factors of the injuries and

then identify the changes of the factors that would help to

reduce the injuries (Mihata Beutler amp Boden 2006)

13

Statement of Problem

The focus of this study was on the comparison of the rate

and types of knee injuries between the university basketball

team members and university soccer team members in Hong Kong

It also aimed at examining the relationship between the gender

and the patterns of knee injuries

Purpose of Study

The purpose of this study was to compare the rate and types

of knee injuries between the university basketball team

members and university soccer team members in Hong Kong The

result obtained could provide the coaches and players with

more information about the knee injuries in basketball and

soccer and could help them design preventive measures to

reduce the incidence of knee injuries

14

Hypotheses

The followings were the research hypotheses of this study

1 There would be a difference in the rate of knee injuries

between the university basketball team members and the

university soccer team members

2 There would be a difference in the rate of knee injuries

between the different genders in basketball

3 There would be a difference in the rate of knee injuries

between the different genders in soccer

4 There would be a difference in the rate of knee injuries

between the players who are regularly engaged in fitness

training and those who are not engaged in any fitness

training

5 There would be a difference in the rate of knee injuries

between the players who perform warm up prior to

trainingcompetition and those who do not

15

Definition of Terms

In order to understand this study more clearly the

operational definitions of terms were as follows

University Basketball Team Member

University basketball team member refers to the local

member of any university basketball team in Hong Kong in the

academic year 2011-2012 who has been participating in regular

training provided by the university basketball team

University Soccer Team Member

University soccer team member refers to the local member

of any university soccer team in Hong Kong in the academic

year 2011-2012 who has been participating in regular training

provided by the university soccer team

Knee Injury

Knee injury refers to any injury to the knee that occurs

during sports or exercise (Bellenir 2008) The Capsule

16

ligament synovium and cartilage in the knee are susceptible

to injuries in sports (Harris amp Varney 1977)

Case of Knee Injury

Case of knee injury refers to any reported case of knee

injury in basketball or soccer that occurred within the past

one year either in the training session or competition

Rate of Knee Injury

Rate of knee injury refers to the number of case of knee

injuries in the past one year divided by the number of players

Training Hour

Training hour refers to the time spent on training the

skills or tactics on the basketball court or soccer pitch

excluding the time spent on fitness training

17

Warm Up

Warm up refers to any exercise or activity performed before

the main exercise which aims at increasing the muscle

temperature and increasing the range of motion of the joints

and muscle tendons (Fevre 1998) It usually includes jogging

stretching or sometimes specific warm up

Specific Warm Up

Specific warm up refers to the exercise or activity that

prepares the body for the up-coming exercise using the

specific muscles which will be used mainly in the up-coming

exercise

Fitness Training

Fitness training refers to any kind of exercise that will

help to improve the fitness of the players both the

health-related fitness and skill-related fitness

18

Cool Down

Cool down refers to any light exercise or activity

performed after the main exercise that allows the body to

transit back from an excited state to a resting state It

usually includes slow jogging walking and stretching

Recovery Time

Recovery time refers to the amount of time spent on recovery

of the knee injury from the occurrence of the knee injury until

the player returns to regular training

Delimitations

The delimitations of this study were listed as follows

1 The participants were delimited to the local Hong Kong

members of university basketball or soccer team in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team

19

2 The period of data collection was delimited to March 2012

3 Cases of knee injury were delimited to the reported cases

of knee injury that occurred in either training or

competition in the past one year

Limitations

The following were the limitations that must be considered

when analyzing the results of this study

1 The content of the questionnaire might not provide enough

detailed information for analysis as it was self-designed

2 The questionnaire was not valid and reliable enough as it

was self-designed

3 It was assumed that the participants could correctly

identify the types of knee injuries that they suffered

4 It was assumed that the participants would honestly and

cautiously answer the questionnaire

20

Significance of Study

This study provided information about the pattern of knee

injuries of the local members of the university basketball

and soccer team in Hong Kong It also provided comparisons

of both the rate of knee injuries and types of injuries between

the members of university basketball team and that of

university soccer team Besides the relationship between the

gender and the patterns of knee injuries was examined

Understanding the patterns of knee injuries was important

because it was the primary step to prevent the occurrence of

knee injuries This provided much useful information for the

coaches as well as the players on how to reduce the occurrence

of knee injuries If coaches understood the knee injury

patterns of basketball or soccer they could be able to plan

a better and safer training program for the players For the

players if they understood more about the causes of knee

injuries they could focus more on the preventive measures

of knee injuries when they were engaged in the sports

21

Chapter 2

REVIEW OF LITERATURE

Some past literature focusing on the knee injuries in

basketball and soccer was reviewed in this chapter This

review of literature was divided into six sections (1) knee

injuries in basketball (2) knee injuries in soccer (3)

gender difference in the knee injuries in basketball (4)

gender difference in the knee injuries in soccer (5) anterior

cruciate ligament (ACL) injuries in basketball and soccer

and (6) summary

Knee Injuries in Basketball

Borowski Yard Fields amp Comstock (2008) said that

basketball was one of the most popular sports in the United

States Although basketball players could benefit a lot from

basketball activities such as improved self-esteem and

weight control they had an increased risk of injury as they

were participating in a physically demanding activity Dick

Hertel Agel Grossman amp Marshall (2007) defined collegiate

22

menrsquos basketball as ldquoa contact sport in which numerous

anatomical structures are susceptible to both acute and

overuse injuriesrdquo (p194) It was not uncommon for basketball

players to suffer from injuries

According to Borowski et al (2008) the knee was one of

the most commonly injured body parts in basketball practice

and competition For the female basketball players 172 and

195 of the injuries occurred in the knee during practice

and competition respectively Knee injuries in practice and

in competition accounted for 101 and 115 of the total

injuries respectively for in the male basketball

In 2004 Olympic Games there were seven knee injuries in

the basketball games (Junge et al 2006) There were two

ligament ruptures one meniscus lesion one sprain two

contusions and one laceration According to Dick et al

(2007) knee internal derangements and patellar injuries were

the common knee injuries happened during practice and

competition Borowski et al (2008) suggested that muscle or

tendon strains in knee were another common type of knee

23

injuries in basketball Soft tissue injuries were also common

knee injuries in basketball According to Ingram Fields Yard

amp Comstock (2008) torn cartilage injuries were common in both

male and female basketball players and complete ligament

tears were common in female basketball players

Ingram et al (2008) found that the knee injuries in

basketball for both male and female players were non-contact

injuries meaning that there was no contact between players

when the knee injuries happened However Borowski et al

(2008) found that 246 of the knee injuries in the United

States high school basketball were caused by collision with

other player But still there were some non-contact knee

injuries caused by either rotation around a planted foot or

inversion or jumping or landing

24

Knee Injuries in Soccer

According to Yard Schroeder Fields Collins amp Comstock

(2008) ldquosoccer is one of the most popular sports worldwiderdquo

(p1930) It explained why there have been more and more people

both youngsters and adults participating in different soccer

activities nowadays Upon participation in soccer the

players could get a number of benefits such as becoming

physically active increase in productivity and enhancement

in academic performance but there were still risks for

injuries (Yard et al 2008)

Le Gall Carling amp Reilly (2007) conducted a study on the

soccer injuries in young elite females According to the

result among all anatomical sites in the body the lower

extremities were the most common site for injuries in soccer

with 168 of those injuries affecting the knee It was also

supported by the result of the research conducted by Yard et

al (2008) which showed that 187 of the soccer injuries

occurred in the knee

Concerning the types of knee injuries Junge et al (2006)

25

did a research on the injuries in team sport tournaments during

the 2004 Olympic Games and found that there were totally 17

knee injuries in soccer Of these 17 knee injuries 1 was

meniscus lesion 7 were sprain and 9 were contusion Apart

from that ligament tears were common in soccer players too

Ingram et al (2008) showed that incomplete ligament tears

and complete ligament tears were common in male soccer players

and female soccer players respectively A similar result was

obtained by Yard et al (2008) It showed that incomplete knee

ligament sprains were common among both male and female soccer

players but complete knee ligament sprains were only common

in female soccer players Both Ingram et al and Yard et al

suggested that the both the complete and incomplete knee

ligament injuries in the male soccer players were caused by

contact with other players while the incomplete knee ligament

injuries in the female soccer players were not caused by any

contact with others

According to Le Gall et al (2007) serious injuries

usually occurred in the knee and those serious injuries

26

included ligament sprain or rupture meniscus lesion and

patellar tendinitis or bursitis Overuse injuries were also

commonly occurred in the knee Yard et al (2008) suggested

that ldquogirl soccer players sustained a larger proportion of

knee injuriesrdquo (p1932) Darrow Collins Yard amp Comstock

(2009) supported that more female soccer players suffered from

severe knee injuries than male soccer players did

Gender Difference in the Knee Injuries in Basketball

According to Borowski et al (2008) female high school

basketball players in the United States were more likely to

injure their knees during practice and competition than the

male players A similar result was also found in the study

done by Ingram et al (2008) which showed that female high

school basketball players had a higher rate of major knee

injuries than the male players Darrow et al (2009) further

showed that female high school basketball players in the

United States had a higher chance of suffering from severe

knee injuries than the male players

27

The reasons for the difference in the rate of knee injuries

in basketball among the female and male players could be

divided into two categories intrinsic factors and extrinsic

factors Borowski et al (2008) suggested that the intrinsic

factors were mainly physiological differences between boys

and girls Examples for these physiological differences were

anatomical differences in joint and bone structure

differences in flexibility and strength and differences in

hormone secretions Differences in equipment differences in

facilities and differences in competition environment were

the extrinsic factors for the difference in the rate of knee

injury

Ingram et al (2008) mentioned that the likeliness of

female basketball players to sustain major knee injuries in

basketball was due to the vulnerability of their knees It

was associated with various risk factors such as hormonal

difference neuromuscular difference and mechanical

difference These risk factors made the female basketball

players four to six times more susceptible to major knee

28

injuries than the male basketball players

Gender Difference in the Knee Injuries in Soccer

The result of the study conducted by Yard et al (2008)

showed that female soccer players sustained a higher rate of

knee injuries than the male soccer players Le Gall et al

(2007) suggested that the reasons for the higher rate in knee

injuries for the female soccer players included weaker

technical and tactical ability poorer muscular strength and

endurance and weaker coordination The rapid development of

the female soccer game which led to an increased in

aggressiveness of the players was another cause of the higher

knee injury rate

Specifically female soccer players had a higher rate of

sustaining complete knee ligament sprains than the male soccer

players (Yard et al 2008) This was supported by the result

of the research done by Ingram et al (2008) which showed

that complete ligament tears were more common in female soccer

than in male soccer It might due to that fact that there were

29

structural differences and neuromuscular differences between

female and male soccer players Yard et al also found that

the rate of complete knee ligament sprains requiring surgery

in female soccer players was higher than that in male soccer

players Female soccer players were found to be 13 times more

susceptible to knee ligament injuries that required surgery

The reasons for this high rate against male soccer players

included the shoe-surface interaction differences in

anthropometry and increased joint laxity

Ingram et al (2008) also showed that non-contact knee

injuries were more common in female soccer than in male soccer

The reasons for this result were suggested to be that the knee

joint of the female soccer players were more vulnerable to

the stress created by rapid acceleration deceleration and

cutting movement on the grass surfaces

Anterior Cruciate Ligament Injuries in Basketball and Soccer

According to Mihata Beutler amp Boden (2006) anterior

cruciate ligament (ACL) injuries were not uncommon in

30

collegiate sports The most common type of ACL injuries was

non-contact or minimal contact ACL injuries The actions of

cutting jumping sudden deceleration and checking with

another player were the high risk mechanisms for this kind

of ACL injuries Basketball players and soccer players were

found to be often exposing to these damaging forces because

they had to perform these actions repeatedly during practice

and competition

From the result shown by Dick et al (2007) 18 of the

total game injuries in male basketball were ACL injuries and

603 of these ACL injuries were non-contact ACL injuries

This result was supported by Mihata et al (2006) whose result

showed that ACL injuries accounted for 14 of all injuries

in male basketball from 1989 to 2004 For the female basketball

players they had a higher rate of ACL injuries than the male

players It was shown by Mihata et al that the ACL injuries

accounted for 52 of all injuries in female basketball from

1989 to 2004 which was about four times higher than in male

basketball

31

For the soccer players the female soccer players also had

higher rates of ACL injuries than the male soccer players

In between 1989 and 2004 39 of the total injuries in female

soccer were ACL injuries while only 16 of the total injuries

in male soccer were ACL injuries (Mihata et al 2006) The

rate of ACL injuries in female soccer was almost three times

higher than that in male soccer in that period of time A more

serious result was shown by Le Gall et al (2007) In their

result ACL injuries mainly ACL sprains or ruptures

accounted for 156 of all major injuries of the young elite

female soccer players

According to Mihata et al (2006) the reasons for the

female players having higher rates of ACL injuries than the

male players were that they had only participated in such

organized sports for a brief period of time they were less

fit and they received less training Another reason was a

disturbance in the neuromuscular patterns received by the

female players which protected the knee created by

incidental or minimal trauma

32

The rate of ACL injuries could be reduced effectively

Understanding the biomechanical risk factors and identifying

and changing those risk factors were the necessary steps to

decrease the long-term ACL injury rates (Mihata et al 2006)

Summary

Soccer and basketball are common sports all over the world

and they are generally regarded as kinds of contact sports

as there is direct contact between players Players are

required to have good muscular strength and power in order

to compete with others Collision and contacting with other

players would lead to imbalance and maybe fall which in turn

lead to injury

Knee was found to be one of the most common body sites

susceptible to injuries in basketball and soccer during both

practice and competition Different types of knee injuries

were sustained by the players such as contusion laceration

sprain ligament tear meniscus lesion and torn cartilage

According to Ingram et al (2008) 168 of all knee injuries

33

were surgery-requiring injuries Examples of these major

knee injuries were complete ligament tears torn cartilage

incomplete ligament tears and fractures

Female players no matter they were soccer players or

basketball players would have a higher chance of injuring

their knee especially the ACL than their male counterparts

It might due to both intrinsic factors such as muscular

strength and endurance and hormonal differences and

extrinsic factors such as game environment and sports

facilities

However knee injuries could be prevented Preventive

measures for knee injuries included lower-extremity landing

skills plyometrics (Le Gall et al 2007) neuromuscular

training programs added supervision (Dick et al 2007)

muscle strengthening and movement training (Ingram et al

2008)

34

Chapter 3

METHOD

The method of this study was divided into the following

sections 1) Participants 2) Development of questionnaire

3) Pilot study 4) Procedures and 5) Data analysis

Participants

The participants were both male and female local members

of university basketball or soccer team in Hong Kong in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team The total number of subjects was 197 with

48 male members of university basketball team 51 female

members of university basketball team 56 male members of

university soccer team and 42 female members of university

soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 12: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

12

injured player less than one week to return to the

participation but it may take some of them more than three

weeks for recovery (Ingram Fields Yard amp Comstock 2008)

It depends on the severity of the knee injury In order to

reduce the rate of injury especially knee injury and ensure

safe participation in basketball and soccer we have to first

understand the biomechanical risk factors of the injuries and

then identify the changes of the factors that would help to

reduce the injuries (Mihata Beutler amp Boden 2006)

13

Statement of Problem

The focus of this study was on the comparison of the rate

and types of knee injuries between the university basketball

team members and university soccer team members in Hong Kong

It also aimed at examining the relationship between the gender

and the patterns of knee injuries

Purpose of Study

The purpose of this study was to compare the rate and types

of knee injuries between the university basketball team

members and university soccer team members in Hong Kong The

result obtained could provide the coaches and players with

more information about the knee injuries in basketball and

soccer and could help them design preventive measures to

reduce the incidence of knee injuries

14

Hypotheses

The followings were the research hypotheses of this study

1 There would be a difference in the rate of knee injuries

between the university basketball team members and the

university soccer team members

2 There would be a difference in the rate of knee injuries

between the different genders in basketball

3 There would be a difference in the rate of knee injuries

between the different genders in soccer

4 There would be a difference in the rate of knee injuries

between the players who are regularly engaged in fitness

training and those who are not engaged in any fitness

training

5 There would be a difference in the rate of knee injuries

between the players who perform warm up prior to

trainingcompetition and those who do not

15

Definition of Terms

In order to understand this study more clearly the

operational definitions of terms were as follows

University Basketball Team Member

University basketball team member refers to the local

member of any university basketball team in Hong Kong in the

academic year 2011-2012 who has been participating in regular

training provided by the university basketball team

University Soccer Team Member

University soccer team member refers to the local member

of any university soccer team in Hong Kong in the academic

year 2011-2012 who has been participating in regular training

provided by the university soccer team

Knee Injury

Knee injury refers to any injury to the knee that occurs

during sports or exercise (Bellenir 2008) The Capsule

16

ligament synovium and cartilage in the knee are susceptible

to injuries in sports (Harris amp Varney 1977)

Case of Knee Injury

Case of knee injury refers to any reported case of knee

injury in basketball or soccer that occurred within the past

one year either in the training session or competition

Rate of Knee Injury

Rate of knee injury refers to the number of case of knee

injuries in the past one year divided by the number of players

Training Hour

Training hour refers to the time spent on training the

skills or tactics on the basketball court or soccer pitch

excluding the time spent on fitness training

17

Warm Up

Warm up refers to any exercise or activity performed before

the main exercise which aims at increasing the muscle

temperature and increasing the range of motion of the joints

and muscle tendons (Fevre 1998) It usually includes jogging

stretching or sometimes specific warm up

Specific Warm Up

Specific warm up refers to the exercise or activity that

prepares the body for the up-coming exercise using the

specific muscles which will be used mainly in the up-coming

exercise

Fitness Training

Fitness training refers to any kind of exercise that will

help to improve the fitness of the players both the

health-related fitness and skill-related fitness

18

Cool Down

Cool down refers to any light exercise or activity

performed after the main exercise that allows the body to

transit back from an excited state to a resting state It

usually includes slow jogging walking and stretching

Recovery Time

Recovery time refers to the amount of time spent on recovery

of the knee injury from the occurrence of the knee injury until

the player returns to regular training

Delimitations

The delimitations of this study were listed as follows

1 The participants were delimited to the local Hong Kong

members of university basketball or soccer team in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team

19

2 The period of data collection was delimited to March 2012

3 Cases of knee injury were delimited to the reported cases

of knee injury that occurred in either training or

competition in the past one year

Limitations

The following were the limitations that must be considered

when analyzing the results of this study

1 The content of the questionnaire might not provide enough

detailed information for analysis as it was self-designed

2 The questionnaire was not valid and reliable enough as it

was self-designed

3 It was assumed that the participants could correctly

identify the types of knee injuries that they suffered

4 It was assumed that the participants would honestly and

cautiously answer the questionnaire

20

Significance of Study

This study provided information about the pattern of knee

injuries of the local members of the university basketball

and soccer team in Hong Kong It also provided comparisons

of both the rate of knee injuries and types of injuries between

the members of university basketball team and that of

university soccer team Besides the relationship between the

gender and the patterns of knee injuries was examined

Understanding the patterns of knee injuries was important

because it was the primary step to prevent the occurrence of

knee injuries This provided much useful information for the

coaches as well as the players on how to reduce the occurrence

of knee injuries If coaches understood the knee injury

patterns of basketball or soccer they could be able to plan

a better and safer training program for the players For the

players if they understood more about the causes of knee

injuries they could focus more on the preventive measures

of knee injuries when they were engaged in the sports

21

Chapter 2

REVIEW OF LITERATURE

Some past literature focusing on the knee injuries in

basketball and soccer was reviewed in this chapter This

review of literature was divided into six sections (1) knee

injuries in basketball (2) knee injuries in soccer (3)

gender difference in the knee injuries in basketball (4)

gender difference in the knee injuries in soccer (5) anterior

cruciate ligament (ACL) injuries in basketball and soccer

and (6) summary

Knee Injuries in Basketball

Borowski Yard Fields amp Comstock (2008) said that

basketball was one of the most popular sports in the United

States Although basketball players could benefit a lot from

basketball activities such as improved self-esteem and

weight control they had an increased risk of injury as they

were participating in a physically demanding activity Dick

Hertel Agel Grossman amp Marshall (2007) defined collegiate

22

menrsquos basketball as ldquoa contact sport in which numerous

anatomical structures are susceptible to both acute and

overuse injuriesrdquo (p194) It was not uncommon for basketball

players to suffer from injuries

According to Borowski et al (2008) the knee was one of

the most commonly injured body parts in basketball practice

and competition For the female basketball players 172 and

195 of the injuries occurred in the knee during practice

and competition respectively Knee injuries in practice and

in competition accounted for 101 and 115 of the total

injuries respectively for in the male basketball

In 2004 Olympic Games there were seven knee injuries in

the basketball games (Junge et al 2006) There were two

ligament ruptures one meniscus lesion one sprain two

contusions and one laceration According to Dick et al

(2007) knee internal derangements and patellar injuries were

the common knee injuries happened during practice and

competition Borowski et al (2008) suggested that muscle or

tendon strains in knee were another common type of knee

23

injuries in basketball Soft tissue injuries were also common

knee injuries in basketball According to Ingram Fields Yard

amp Comstock (2008) torn cartilage injuries were common in both

male and female basketball players and complete ligament

tears were common in female basketball players

Ingram et al (2008) found that the knee injuries in

basketball for both male and female players were non-contact

injuries meaning that there was no contact between players

when the knee injuries happened However Borowski et al

(2008) found that 246 of the knee injuries in the United

States high school basketball were caused by collision with

other player But still there were some non-contact knee

injuries caused by either rotation around a planted foot or

inversion or jumping or landing

24

Knee Injuries in Soccer

According to Yard Schroeder Fields Collins amp Comstock

(2008) ldquosoccer is one of the most popular sports worldwiderdquo

(p1930) It explained why there have been more and more people

both youngsters and adults participating in different soccer

activities nowadays Upon participation in soccer the

players could get a number of benefits such as becoming

physically active increase in productivity and enhancement

in academic performance but there were still risks for

injuries (Yard et al 2008)

Le Gall Carling amp Reilly (2007) conducted a study on the

soccer injuries in young elite females According to the

result among all anatomical sites in the body the lower

extremities were the most common site for injuries in soccer

with 168 of those injuries affecting the knee It was also

supported by the result of the research conducted by Yard et

al (2008) which showed that 187 of the soccer injuries

occurred in the knee

Concerning the types of knee injuries Junge et al (2006)

25

did a research on the injuries in team sport tournaments during

the 2004 Olympic Games and found that there were totally 17

knee injuries in soccer Of these 17 knee injuries 1 was

meniscus lesion 7 were sprain and 9 were contusion Apart

from that ligament tears were common in soccer players too

Ingram et al (2008) showed that incomplete ligament tears

and complete ligament tears were common in male soccer players

and female soccer players respectively A similar result was

obtained by Yard et al (2008) It showed that incomplete knee

ligament sprains were common among both male and female soccer

players but complete knee ligament sprains were only common

in female soccer players Both Ingram et al and Yard et al

suggested that the both the complete and incomplete knee

ligament injuries in the male soccer players were caused by

contact with other players while the incomplete knee ligament

injuries in the female soccer players were not caused by any

contact with others

According to Le Gall et al (2007) serious injuries

usually occurred in the knee and those serious injuries

26

included ligament sprain or rupture meniscus lesion and

patellar tendinitis or bursitis Overuse injuries were also

commonly occurred in the knee Yard et al (2008) suggested

that ldquogirl soccer players sustained a larger proportion of

knee injuriesrdquo (p1932) Darrow Collins Yard amp Comstock

(2009) supported that more female soccer players suffered from

severe knee injuries than male soccer players did

Gender Difference in the Knee Injuries in Basketball

According to Borowski et al (2008) female high school

basketball players in the United States were more likely to

injure their knees during practice and competition than the

male players A similar result was also found in the study

done by Ingram et al (2008) which showed that female high

school basketball players had a higher rate of major knee

injuries than the male players Darrow et al (2009) further

showed that female high school basketball players in the

United States had a higher chance of suffering from severe

knee injuries than the male players

27

The reasons for the difference in the rate of knee injuries

in basketball among the female and male players could be

divided into two categories intrinsic factors and extrinsic

factors Borowski et al (2008) suggested that the intrinsic

factors were mainly physiological differences between boys

and girls Examples for these physiological differences were

anatomical differences in joint and bone structure

differences in flexibility and strength and differences in

hormone secretions Differences in equipment differences in

facilities and differences in competition environment were

the extrinsic factors for the difference in the rate of knee

injury

Ingram et al (2008) mentioned that the likeliness of

female basketball players to sustain major knee injuries in

basketball was due to the vulnerability of their knees It

was associated with various risk factors such as hormonal

difference neuromuscular difference and mechanical

difference These risk factors made the female basketball

players four to six times more susceptible to major knee

28

injuries than the male basketball players

Gender Difference in the Knee Injuries in Soccer

The result of the study conducted by Yard et al (2008)

showed that female soccer players sustained a higher rate of

knee injuries than the male soccer players Le Gall et al

(2007) suggested that the reasons for the higher rate in knee

injuries for the female soccer players included weaker

technical and tactical ability poorer muscular strength and

endurance and weaker coordination The rapid development of

the female soccer game which led to an increased in

aggressiveness of the players was another cause of the higher

knee injury rate

Specifically female soccer players had a higher rate of

sustaining complete knee ligament sprains than the male soccer

players (Yard et al 2008) This was supported by the result

of the research done by Ingram et al (2008) which showed

that complete ligament tears were more common in female soccer

than in male soccer It might due to that fact that there were

29

structural differences and neuromuscular differences between

female and male soccer players Yard et al also found that

the rate of complete knee ligament sprains requiring surgery

in female soccer players was higher than that in male soccer

players Female soccer players were found to be 13 times more

susceptible to knee ligament injuries that required surgery

The reasons for this high rate against male soccer players

included the shoe-surface interaction differences in

anthropometry and increased joint laxity

Ingram et al (2008) also showed that non-contact knee

injuries were more common in female soccer than in male soccer

The reasons for this result were suggested to be that the knee

joint of the female soccer players were more vulnerable to

the stress created by rapid acceleration deceleration and

cutting movement on the grass surfaces

Anterior Cruciate Ligament Injuries in Basketball and Soccer

According to Mihata Beutler amp Boden (2006) anterior

cruciate ligament (ACL) injuries were not uncommon in

30

collegiate sports The most common type of ACL injuries was

non-contact or minimal contact ACL injuries The actions of

cutting jumping sudden deceleration and checking with

another player were the high risk mechanisms for this kind

of ACL injuries Basketball players and soccer players were

found to be often exposing to these damaging forces because

they had to perform these actions repeatedly during practice

and competition

From the result shown by Dick et al (2007) 18 of the

total game injuries in male basketball were ACL injuries and

603 of these ACL injuries were non-contact ACL injuries

This result was supported by Mihata et al (2006) whose result

showed that ACL injuries accounted for 14 of all injuries

in male basketball from 1989 to 2004 For the female basketball

players they had a higher rate of ACL injuries than the male

players It was shown by Mihata et al that the ACL injuries

accounted for 52 of all injuries in female basketball from

1989 to 2004 which was about four times higher than in male

basketball

31

For the soccer players the female soccer players also had

higher rates of ACL injuries than the male soccer players

In between 1989 and 2004 39 of the total injuries in female

soccer were ACL injuries while only 16 of the total injuries

in male soccer were ACL injuries (Mihata et al 2006) The

rate of ACL injuries in female soccer was almost three times

higher than that in male soccer in that period of time A more

serious result was shown by Le Gall et al (2007) In their

result ACL injuries mainly ACL sprains or ruptures

accounted for 156 of all major injuries of the young elite

female soccer players

According to Mihata et al (2006) the reasons for the

female players having higher rates of ACL injuries than the

male players were that they had only participated in such

organized sports for a brief period of time they were less

fit and they received less training Another reason was a

disturbance in the neuromuscular patterns received by the

female players which protected the knee created by

incidental or minimal trauma

32

The rate of ACL injuries could be reduced effectively

Understanding the biomechanical risk factors and identifying

and changing those risk factors were the necessary steps to

decrease the long-term ACL injury rates (Mihata et al 2006)

Summary

Soccer and basketball are common sports all over the world

and they are generally regarded as kinds of contact sports

as there is direct contact between players Players are

required to have good muscular strength and power in order

to compete with others Collision and contacting with other

players would lead to imbalance and maybe fall which in turn

lead to injury

Knee was found to be one of the most common body sites

susceptible to injuries in basketball and soccer during both

practice and competition Different types of knee injuries

were sustained by the players such as contusion laceration

sprain ligament tear meniscus lesion and torn cartilage

According to Ingram et al (2008) 168 of all knee injuries

33

were surgery-requiring injuries Examples of these major

knee injuries were complete ligament tears torn cartilage

incomplete ligament tears and fractures

Female players no matter they were soccer players or

basketball players would have a higher chance of injuring

their knee especially the ACL than their male counterparts

It might due to both intrinsic factors such as muscular

strength and endurance and hormonal differences and

extrinsic factors such as game environment and sports

facilities

However knee injuries could be prevented Preventive

measures for knee injuries included lower-extremity landing

skills plyometrics (Le Gall et al 2007) neuromuscular

training programs added supervision (Dick et al 2007)

muscle strengthening and movement training (Ingram et al

2008)

34

Chapter 3

METHOD

The method of this study was divided into the following

sections 1) Participants 2) Development of questionnaire

3) Pilot study 4) Procedures and 5) Data analysis

Participants

The participants were both male and female local members

of university basketball or soccer team in Hong Kong in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team The total number of subjects was 197 with

48 male members of university basketball team 51 female

members of university basketball team 56 male members of

university soccer team and 42 female members of university

soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

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Bellenir K (2008) Sports injuries information for teens

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Griffith H W (1986) Complete guide to sports injuries

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amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 13: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

13

Statement of Problem

The focus of this study was on the comparison of the rate

and types of knee injuries between the university basketball

team members and university soccer team members in Hong Kong

It also aimed at examining the relationship between the gender

and the patterns of knee injuries

Purpose of Study

The purpose of this study was to compare the rate and types

of knee injuries between the university basketball team

members and university soccer team members in Hong Kong The

result obtained could provide the coaches and players with

more information about the knee injuries in basketball and

soccer and could help them design preventive measures to

reduce the incidence of knee injuries

14

Hypotheses

The followings were the research hypotheses of this study

1 There would be a difference in the rate of knee injuries

between the university basketball team members and the

university soccer team members

2 There would be a difference in the rate of knee injuries

between the different genders in basketball

3 There would be a difference in the rate of knee injuries

between the different genders in soccer

4 There would be a difference in the rate of knee injuries

between the players who are regularly engaged in fitness

training and those who are not engaged in any fitness

training

5 There would be a difference in the rate of knee injuries

between the players who perform warm up prior to

trainingcompetition and those who do not

15

Definition of Terms

In order to understand this study more clearly the

operational definitions of terms were as follows

University Basketball Team Member

University basketball team member refers to the local

member of any university basketball team in Hong Kong in the

academic year 2011-2012 who has been participating in regular

training provided by the university basketball team

University Soccer Team Member

University soccer team member refers to the local member

of any university soccer team in Hong Kong in the academic

year 2011-2012 who has been participating in regular training

provided by the university soccer team

Knee Injury

Knee injury refers to any injury to the knee that occurs

during sports or exercise (Bellenir 2008) The Capsule

16

ligament synovium and cartilage in the knee are susceptible

to injuries in sports (Harris amp Varney 1977)

Case of Knee Injury

Case of knee injury refers to any reported case of knee

injury in basketball or soccer that occurred within the past

one year either in the training session or competition

Rate of Knee Injury

Rate of knee injury refers to the number of case of knee

injuries in the past one year divided by the number of players

Training Hour

Training hour refers to the time spent on training the

skills or tactics on the basketball court or soccer pitch

excluding the time spent on fitness training

17

Warm Up

Warm up refers to any exercise or activity performed before

the main exercise which aims at increasing the muscle

temperature and increasing the range of motion of the joints

and muscle tendons (Fevre 1998) It usually includes jogging

stretching or sometimes specific warm up

Specific Warm Up

Specific warm up refers to the exercise or activity that

prepares the body for the up-coming exercise using the

specific muscles which will be used mainly in the up-coming

exercise

Fitness Training

Fitness training refers to any kind of exercise that will

help to improve the fitness of the players both the

health-related fitness and skill-related fitness

18

Cool Down

Cool down refers to any light exercise or activity

performed after the main exercise that allows the body to

transit back from an excited state to a resting state It

usually includes slow jogging walking and stretching

Recovery Time

Recovery time refers to the amount of time spent on recovery

of the knee injury from the occurrence of the knee injury until

the player returns to regular training

Delimitations

The delimitations of this study were listed as follows

1 The participants were delimited to the local Hong Kong

members of university basketball or soccer team in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team

19

2 The period of data collection was delimited to March 2012

3 Cases of knee injury were delimited to the reported cases

of knee injury that occurred in either training or

competition in the past one year

Limitations

The following were the limitations that must be considered

when analyzing the results of this study

1 The content of the questionnaire might not provide enough

detailed information for analysis as it was self-designed

2 The questionnaire was not valid and reliable enough as it

was self-designed

3 It was assumed that the participants could correctly

identify the types of knee injuries that they suffered

4 It was assumed that the participants would honestly and

cautiously answer the questionnaire

20

Significance of Study

This study provided information about the pattern of knee

injuries of the local members of the university basketball

and soccer team in Hong Kong It also provided comparisons

of both the rate of knee injuries and types of injuries between

the members of university basketball team and that of

university soccer team Besides the relationship between the

gender and the patterns of knee injuries was examined

Understanding the patterns of knee injuries was important

because it was the primary step to prevent the occurrence of

knee injuries This provided much useful information for the

coaches as well as the players on how to reduce the occurrence

of knee injuries If coaches understood the knee injury

patterns of basketball or soccer they could be able to plan

a better and safer training program for the players For the

players if they understood more about the causes of knee

injuries they could focus more on the preventive measures

of knee injuries when they were engaged in the sports

21

Chapter 2

REVIEW OF LITERATURE

Some past literature focusing on the knee injuries in

basketball and soccer was reviewed in this chapter This

review of literature was divided into six sections (1) knee

injuries in basketball (2) knee injuries in soccer (3)

gender difference in the knee injuries in basketball (4)

gender difference in the knee injuries in soccer (5) anterior

cruciate ligament (ACL) injuries in basketball and soccer

and (6) summary

Knee Injuries in Basketball

Borowski Yard Fields amp Comstock (2008) said that

basketball was one of the most popular sports in the United

States Although basketball players could benefit a lot from

basketball activities such as improved self-esteem and

weight control they had an increased risk of injury as they

were participating in a physically demanding activity Dick

Hertel Agel Grossman amp Marshall (2007) defined collegiate

22

menrsquos basketball as ldquoa contact sport in which numerous

anatomical structures are susceptible to both acute and

overuse injuriesrdquo (p194) It was not uncommon for basketball

players to suffer from injuries

According to Borowski et al (2008) the knee was one of

the most commonly injured body parts in basketball practice

and competition For the female basketball players 172 and

195 of the injuries occurred in the knee during practice

and competition respectively Knee injuries in practice and

in competition accounted for 101 and 115 of the total

injuries respectively for in the male basketball

In 2004 Olympic Games there were seven knee injuries in

the basketball games (Junge et al 2006) There were two

ligament ruptures one meniscus lesion one sprain two

contusions and one laceration According to Dick et al

(2007) knee internal derangements and patellar injuries were

the common knee injuries happened during practice and

competition Borowski et al (2008) suggested that muscle or

tendon strains in knee were another common type of knee

23

injuries in basketball Soft tissue injuries were also common

knee injuries in basketball According to Ingram Fields Yard

amp Comstock (2008) torn cartilage injuries were common in both

male and female basketball players and complete ligament

tears were common in female basketball players

Ingram et al (2008) found that the knee injuries in

basketball for both male and female players were non-contact

injuries meaning that there was no contact between players

when the knee injuries happened However Borowski et al

(2008) found that 246 of the knee injuries in the United

States high school basketball were caused by collision with

other player But still there were some non-contact knee

injuries caused by either rotation around a planted foot or

inversion or jumping or landing

24

Knee Injuries in Soccer

According to Yard Schroeder Fields Collins amp Comstock

(2008) ldquosoccer is one of the most popular sports worldwiderdquo

(p1930) It explained why there have been more and more people

both youngsters and adults participating in different soccer

activities nowadays Upon participation in soccer the

players could get a number of benefits such as becoming

physically active increase in productivity and enhancement

in academic performance but there were still risks for

injuries (Yard et al 2008)

Le Gall Carling amp Reilly (2007) conducted a study on the

soccer injuries in young elite females According to the

result among all anatomical sites in the body the lower

extremities were the most common site for injuries in soccer

with 168 of those injuries affecting the knee It was also

supported by the result of the research conducted by Yard et

al (2008) which showed that 187 of the soccer injuries

occurred in the knee

Concerning the types of knee injuries Junge et al (2006)

25

did a research on the injuries in team sport tournaments during

the 2004 Olympic Games and found that there were totally 17

knee injuries in soccer Of these 17 knee injuries 1 was

meniscus lesion 7 were sprain and 9 were contusion Apart

from that ligament tears were common in soccer players too

Ingram et al (2008) showed that incomplete ligament tears

and complete ligament tears were common in male soccer players

and female soccer players respectively A similar result was

obtained by Yard et al (2008) It showed that incomplete knee

ligament sprains were common among both male and female soccer

players but complete knee ligament sprains were only common

in female soccer players Both Ingram et al and Yard et al

suggested that the both the complete and incomplete knee

ligament injuries in the male soccer players were caused by

contact with other players while the incomplete knee ligament

injuries in the female soccer players were not caused by any

contact with others

According to Le Gall et al (2007) serious injuries

usually occurred in the knee and those serious injuries

26

included ligament sprain or rupture meniscus lesion and

patellar tendinitis or bursitis Overuse injuries were also

commonly occurred in the knee Yard et al (2008) suggested

that ldquogirl soccer players sustained a larger proportion of

knee injuriesrdquo (p1932) Darrow Collins Yard amp Comstock

(2009) supported that more female soccer players suffered from

severe knee injuries than male soccer players did

Gender Difference in the Knee Injuries in Basketball

According to Borowski et al (2008) female high school

basketball players in the United States were more likely to

injure their knees during practice and competition than the

male players A similar result was also found in the study

done by Ingram et al (2008) which showed that female high

school basketball players had a higher rate of major knee

injuries than the male players Darrow et al (2009) further

showed that female high school basketball players in the

United States had a higher chance of suffering from severe

knee injuries than the male players

27

The reasons for the difference in the rate of knee injuries

in basketball among the female and male players could be

divided into two categories intrinsic factors and extrinsic

factors Borowski et al (2008) suggested that the intrinsic

factors were mainly physiological differences between boys

and girls Examples for these physiological differences were

anatomical differences in joint and bone structure

differences in flexibility and strength and differences in

hormone secretions Differences in equipment differences in

facilities and differences in competition environment were

the extrinsic factors for the difference in the rate of knee

injury

Ingram et al (2008) mentioned that the likeliness of

female basketball players to sustain major knee injuries in

basketball was due to the vulnerability of their knees It

was associated with various risk factors such as hormonal

difference neuromuscular difference and mechanical

difference These risk factors made the female basketball

players four to six times more susceptible to major knee

28

injuries than the male basketball players

Gender Difference in the Knee Injuries in Soccer

The result of the study conducted by Yard et al (2008)

showed that female soccer players sustained a higher rate of

knee injuries than the male soccer players Le Gall et al

(2007) suggested that the reasons for the higher rate in knee

injuries for the female soccer players included weaker

technical and tactical ability poorer muscular strength and

endurance and weaker coordination The rapid development of

the female soccer game which led to an increased in

aggressiveness of the players was another cause of the higher

knee injury rate

Specifically female soccer players had a higher rate of

sustaining complete knee ligament sprains than the male soccer

players (Yard et al 2008) This was supported by the result

of the research done by Ingram et al (2008) which showed

that complete ligament tears were more common in female soccer

than in male soccer It might due to that fact that there were

29

structural differences and neuromuscular differences between

female and male soccer players Yard et al also found that

the rate of complete knee ligament sprains requiring surgery

in female soccer players was higher than that in male soccer

players Female soccer players were found to be 13 times more

susceptible to knee ligament injuries that required surgery

The reasons for this high rate against male soccer players

included the shoe-surface interaction differences in

anthropometry and increased joint laxity

Ingram et al (2008) also showed that non-contact knee

injuries were more common in female soccer than in male soccer

The reasons for this result were suggested to be that the knee

joint of the female soccer players were more vulnerable to

the stress created by rapid acceleration deceleration and

cutting movement on the grass surfaces

Anterior Cruciate Ligament Injuries in Basketball and Soccer

According to Mihata Beutler amp Boden (2006) anterior

cruciate ligament (ACL) injuries were not uncommon in

30

collegiate sports The most common type of ACL injuries was

non-contact or minimal contact ACL injuries The actions of

cutting jumping sudden deceleration and checking with

another player were the high risk mechanisms for this kind

of ACL injuries Basketball players and soccer players were

found to be often exposing to these damaging forces because

they had to perform these actions repeatedly during practice

and competition

From the result shown by Dick et al (2007) 18 of the

total game injuries in male basketball were ACL injuries and

603 of these ACL injuries were non-contact ACL injuries

This result was supported by Mihata et al (2006) whose result

showed that ACL injuries accounted for 14 of all injuries

in male basketball from 1989 to 2004 For the female basketball

players they had a higher rate of ACL injuries than the male

players It was shown by Mihata et al that the ACL injuries

accounted for 52 of all injuries in female basketball from

1989 to 2004 which was about four times higher than in male

basketball

31

For the soccer players the female soccer players also had

higher rates of ACL injuries than the male soccer players

In between 1989 and 2004 39 of the total injuries in female

soccer were ACL injuries while only 16 of the total injuries

in male soccer were ACL injuries (Mihata et al 2006) The

rate of ACL injuries in female soccer was almost three times

higher than that in male soccer in that period of time A more

serious result was shown by Le Gall et al (2007) In their

result ACL injuries mainly ACL sprains or ruptures

accounted for 156 of all major injuries of the young elite

female soccer players

According to Mihata et al (2006) the reasons for the

female players having higher rates of ACL injuries than the

male players were that they had only participated in such

organized sports for a brief period of time they were less

fit and they received less training Another reason was a

disturbance in the neuromuscular patterns received by the

female players which protected the knee created by

incidental or minimal trauma

32

The rate of ACL injuries could be reduced effectively

Understanding the biomechanical risk factors and identifying

and changing those risk factors were the necessary steps to

decrease the long-term ACL injury rates (Mihata et al 2006)

Summary

Soccer and basketball are common sports all over the world

and they are generally regarded as kinds of contact sports

as there is direct contact between players Players are

required to have good muscular strength and power in order

to compete with others Collision and contacting with other

players would lead to imbalance and maybe fall which in turn

lead to injury

Knee was found to be one of the most common body sites

susceptible to injuries in basketball and soccer during both

practice and competition Different types of knee injuries

were sustained by the players such as contusion laceration

sprain ligament tear meniscus lesion and torn cartilage

According to Ingram et al (2008) 168 of all knee injuries

33

were surgery-requiring injuries Examples of these major

knee injuries were complete ligament tears torn cartilage

incomplete ligament tears and fractures

Female players no matter they were soccer players or

basketball players would have a higher chance of injuring

their knee especially the ACL than their male counterparts

It might due to both intrinsic factors such as muscular

strength and endurance and hormonal differences and

extrinsic factors such as game environment and sports

facilities

However knee injuries could be prevented Preventive

measures for knee injuries included lower-extremity landing

skills plyometrics (Le Gall et al 2007) neuromuscular

training programs added supervision (Dick et al 2007)

muscle strengthening and movement training (Ingram et al

2008)

34

Chapter 3

METHOD

The method of this study was divided into the following

sections 1) Participants 2) Development of questionnaire

3) Pilot study 4) Procedures and 5) Data analysis

Participants

The participants were both male and female local members

of university basketball or soccer team in Hong Kong in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team The total number of subjects was 197 with

48 male members of university basketball team 51 female

members of university basketball team 56 male members of

university soccer team and 42 female members of university

soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 14: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

14

Hypotheses

The followings were the research hypotheses of this study

1 There would be a difference in the rate of knee injuries

between the university basketball team members and the

university soccer team members

2 There would be a difference in the rate of knee injuries

between the different genders in basketball

3 There would be a difference in the rate of knee injuries

between the different genders in soccer

4 There would be a difference in the rate of knee injuries

between the players who are regularly engaged in fitness

training and those who are not engaged in any fitness

training

5 There would be a difference in the rate of knee injuries

between the players who perform warm up prior to

trainingcompetition and those who do not

15

Definition of Terms

In order to understand this study more clearly the

operational definitions of terms were as follows

University Basketball Team Member

University basketball team member refers to the local

member of any university basketball team in Hong Kong in the

academic year 2011-2012 who has been participating in regular

training provided by the university basketball team

University Soccer Team Member

University soccer team member refers to the local member

of any university soccer team in Hong Kong in the academic

year 2011-2012 who has been participating in regular training

provided by the university soccer team

Knee Injury

Knee injury refers to any injury to the knee that occurs

during sports or exercise (Bellenir 2008) The Capsule

16

ligament synovium and cartilage in the knee are susceptible

to injuries in sports (Harris amp Varney 1977)

Case of Knee Injury

Case of knee injury refers to any reported case of knee

injury in basketball or soccer that occurred within the past

one year either in the training session or competition

Rate of Knee Injury

Rate of knee injury refers to the number of case of knee

injuries in the past one year divided by the number of players

Training Hour

Training hour refers to the time spent on training the

skills or tactics on the basketball court or soccer pitch

excluding the time spent on fitness training

17

Warm Up

Warm up refers to any exercise or activity performed before

the main exercise which aims at increasing the muscle

temperature and increasing the range of motion of the joints

and muscle tendons (Fevre 1998) It usually includes jogging

stretching or sometimes specific warm up

Specific Warm Up

Specific warm up refers to the exercise or activity that

prepares the body for the up-coming exercise using the

specific muscles which will be used mainly in the up-coming

exercise

Fitness Training

Fitness training refers to any kind of exercise that will

help to improve the fitness of the players both the

health-related fitness and skill-related fitness

18

Cool Down

Cool down refers to any light exercise or activity

performed after the main exercise that allows the body to

transit back from an excited state to a resting state It

usually includes slow jogging walking and stretching

Recovery Time

Recovery time refers to the amount of time spent on recovery

of the knee injury from the occurrence of the knee injury until

the player returns to regular training

Delimitations

The delimitations of this study were listed as follows

1 The participants were delimited to the local Hong Kong

members of university basketball or soccer team in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team

19

2 The period of data collection was delimited to March 2012

3 Cases of knee injury were delimited to the reported cases

of knee injury that occurred in either training or

competition in the past one year

Limitations

The following were the limitations that must be considered

when analyzing the results of this study

1 The content of the questionnaire might not provide enough

detailed information for analysis as it was self-designed

2 The questionnaire was not valid and reliable enough as it

was self-designed

3 It was assumed that the participants could correctly

identify the types of knee injuries that they suffered

4 It was assumed that the participants would honestly and

cautiously answer the questionnaire

20

Significance of Study

This study provided information about the pattern of knee

injuries of the local members of the university basketball

and soccer team in Hong Kong It also provided comparisons

of both the rate of knee injuries and types of injuries between

the members of university basketball team and that of

university soccer team Besides the relationship between the

gender and the patterns of knee injuries was examined

Understanding the patterns of knee injuries was important

because it was the primary step to prevent the occurrence of

knee injuries This provided much useful information for the

coaches as well as the players on how to reduce the occurrence

of knee injuries If coaches understood the knee injury

patterns of basketball or soccer they could be able to plan

a better and safer training program for the players For the

players if they understood more about the causes of knee

injuries they could focus more on the preventive measures

of knee injuries when they were engaged in the sports

21

Chapter 2

REVIEW OF LITERATURE

Some past literature focusing on the knee injuries in

basketball and soccer was reviewed in this chapter This

review of literature was divided into six sections (1) knee

injuries in basketball (2) knee injuries in soccer (3)

gender difference in the knee injuries in basketball (4)

gender difference in the knee injuries in soccer (5) anterior

cruciate ligament (ACL) injuries in basketball and soccer

and (6) summary

Knee Injuries in Basketball

Borowski Yard Fields amp Comstock (2008) said that

basketball was one of the most popular sports in the United

States Although basketball players could benefit a lot from

basketball activities such as improved self-esteem and

weight control they had an increased risk of injury as they

were participating in a physically demanding activity Dick

Hertel Agel Grossman amp Marshall (2007) defined collegiate

22

menrsquos basketball as ldquoa contact sport in which numerous

anatomical structures are susceptible to both acute and

overuse injuriesrdquo (p194) It was not uncommon for basketball

players to suffer from injuries

According to Borowski et al (2008) the knee was one of

the most commonly injured body parts in basketball practice

and competition For the female basketball players 172 and

195 of the injuries occurred in the knee during practice

and competition respectively Knee injuries in practice and

in competition accounted for 101 and 115 of the total

injuries respectively for in the male basketball

In 2004 Olympic Games there were seven knee injuries in

the basketball games (Junge et al 2006) There were two

ligament ruptures one meniscus lesion one sprain two

contusions and one laceration According to Dick et al

(2007) knee internal derangements and patellar injuries were

the common knee injuries happened during practice and

competition Borowski et al (2008) suggested that muscle or

tendon strains in knee were another common type of knee

23

injuries in basketball Soft tissue injuries were also common

knee injuries in basketball According to Ingram Fields Yard

amp Comstock (2008) torn cartilage injuries were common in both

male and female basketball players and complete ligament

tears were common in female basketball players

Ingram et al (2008) found that the knee injuries in

basketball for both male and female players were non-contact

injuries meaning that there was no contact between players

when the knee injuries happened However Borowski et al

(2008) found that 246 of the knee injuries in the United

States high school basketball were caused by collision with

other player But still there were some non-contact knee

injuries caused by either rotation around a planted foot or

inversion or jumping or landing

24

Knee Injuries in Soccer

According to Yard Schroeder Fields Collins amp Comstock

(2008) ldquosoccer is one of the most popular sports worldwiderdquo

(p1930) It explained why there have been more and more people

both youngsters and adults participating in different soccer

activities nowadays Upon participation in soccer the

players could get a number of benefits such as becoming

physically active increase in productivity and enhancement

in academic performance but there were still risks for

injuries (Yard et al 2008)

Le Gall Carling amp Reilly (2007) conducted a study on the

soccer injuries in young elite females According to the

result among all anatomical sites in the body the lower

extremities were the most common site for injuries in soccer

with 168 of those injuries affecting the knee It was also

supported by the result of the research conducted by Yard et

al (2008) which showed that 187 of the soccer injuries

occurred in the knee

Concerning the types of knee injuries Junge et al (2006)

25

did a research on the injuries in team sport tournaments during

the 2004 Olympic Games and found that there were totally 17

knee injuries in soccer Of these 17 knee injuries 1 was

meniscus lesion 7 were sprain and 9 were contusion Apart

from that ligament tears were common in soccer players too

Ingram et al (2008) showed that incomplete ligament tears

and complete ligament tears were common in male soccer players

and female soccer players respectively A similar result was

obtained by Yard et al (2008) It showed that incomplete knee

ligament sprains were common among both male and female soccer

players but complete knee ligament sprains were only common

in female soccer players Both Ingram et al and Yard et al

suggested that the both the complete and incomplete knee

ligament injuries in the male soccer players were caused by

contact with other players while the incomplete knee ligament

injuries in the female soccer players were not caused by any

contact with others

According to Le Gall et al (2007) serious injuries

usually occurred in the knee and those serious injuries

26

included ligament sprain or rupture meniscus lesion and

patellar tendinitis or bursitis Overuse injuries were also

commonly occurred in the knee Yard et al (2008) suggested

that ldquogirl soccer players sustained a larger proportion of

knee injuriesrdquo (p1932) Darrow Collins Yard amp Comstock

(2009) supported that more female soccer players suffered from

severe knee injuries than male soccer players did

Gender Difference in the Knee Injuries in Basketball

According to Borowski et al (2008) female high school

basketball players in the United States were more likely to

injure their knees during practice and competition than the

male players A similar result was also found in the study

done by Ingram et al (2008) which showed that female high

school basketball players had a higher rate of major knee

injuries than the male players Darrow et al (2009) further

showed that female high school basketball players in the

United States had a higher chance of suffering from severe

knee injuries than the male players

27

The reasons for the difference in the rate of knee injuries

in basketball among the female and male players could be

divided into two categories intrinsic factors and extrinsic

factors Borowski et al (2008) suggested that the intrinsic

factors were mainly physiological differences between boys

and girls Examples for these physiological differences were

anatomical differences in joint and bone structure

differences in flexibility and strength and differences in

hormone secretions Differences in equipment differences in

facilities and differences in competition environment were

the extrinsic factors for the difference in the rate of knee

injury

Ingram et al (2008) mentioned that the likeliness of

female basketball players to sustain major knee injuries in

basketball was due to the vulnerability of their knees It

was associated with various risk factors such as hormonal

difference neuromuscular difference and mechanical

difference These risk factors made the female basketball

players four to six times more susceptible to major knee

28

injuries than the male basketball players

Gender Difference in the Knee Injuries in Soccer

The result of the study conducted by Yard et al (2008)

showed that female soccer players sustained a higher rate of

knee injuries than the male soccer players Le Gall et al

(2007) suggested that the reasons for the higher rate in knee

injuries for the female soccer players included weaker

technical and tactical ability poorer muscular strength and

endurance and weaker coordination The rapid development of

the female soccer game which led to an increased in

aggressiveness of the players was another cause of the higher

knee injury rate

Specifically female soccer players had a higher rate of

sustaining complete knee ligament sprains than the male soccer

players (Yard et al 2008) This was supported by the result

of the research done by Ingram et al (2008) which showed

that complete ligament tears were more common in female soccer

than in male soccer It might due to that fact that there were

29

structural differences and neuromuscular differences between

female and male soccer players Yard et al also found that

the rate of complete knee ligament sprains requiring surgery

in female soccer players was higher than that in male soccer

players Female soccer players were found to be 13 times more

susceptible to knee ligament injuries that required surgery

The reasons for this high rate against male soccer players

included the shoe-surface interaction differences in

anthropometry and increased joint laxity

Ingram et al (2008) also showed that non-contact knee

injuries were more common in female soccer than in male soccer

The reasons for this result were suggested to be that the knee

joint of the female soccer players were more vulnerable to

the stress created by rapid acceleration deceleration and

cutting movement on the grass surfaces

Anterior Cruciate Ligament Injuries in Basketball and Soccer

According to Mihata Beutler amp Boden (2006) anterior

cruciate ligament (ACL) injuries were not uncommon in

30

collegiate sports The most common type of ACL injuries was

non-contact or minimal contact ACL injuries The actions of

cutting jumping sudden deceleration and checking with

another player were the high risk mechanisms for this kind

of ACL injuries Basketball players and soccer players were

found to be often exposing to these damaging forces because

they had to perform these actions repeatedly during practice

and competition

From the result shown by Dick et al (2007) 18 of the

total game injuries in male basketball were ACL injuries and

603 of these ACL injuries were non-contact ACL injuries

This result was supported by Mihata et al (2006) whose result

showed that ACL injuries accounted for 14 of all injuries

in male basketball from 1989 to 2004 For the female basketball

players they had a higher rate of ACL injuries than the male

players It was shown by Mihata et al that the ACL injuries

accounted for 52 of all injuries in female basketball from

1989 to 2004 which was about four times higher than in male

basketball

31

For the soccer players the female soccer players also had

higher rates of ACL injuries than the male soccer players

In between 1989 and 2004 39 of the total injuries in female

soccer were ACL injuries while only 16 of the total injuries

in male soccer were ACL injuries (Mihata et al 2006) The

rate of ACL injuries in female soccer was almost three times

higher than that in male soccer in that period of time A more

serious result was shown by Le Gall et al (2007) In their

result ACL injuries mainly ACL sprains or ruptures

accounted for 156 of all major injuries of the young elite

female soccer players

According to Mihata et al (2006) the reasons for the

female players having higher rates of ACL injuries than the

male players were that they had only participated in such

organized sports for a brief period of time they were less

fit and they received less training Another reason was a

disturbance in the neuromuscular patterns received by the

female players which protected the knee created by

incidental or minimal trauma

32

The rate of ACL injuries could be reduced effectively

Understanding the biomechanical risk factors and identifying

and changing those risk factors were the necessary steps to

decrease the long-term ACL injury rates (Mihata et al 2006)

Summary

Soccer and basketball are common sports all over the world

and they are generally regarded as kinds of contact sports

as there is direct contact between players Players are

required to have good muscular strength and power in order

to compete with others Collision and contacting with other

players would lead to imbalance and maybe fall which in turn

lead to injury

Knee was found to be one of the most common body sites

susceptible to injuries in basketball and soccer during both

practice and competition Different types of knee injuries

were sustained by the players such as contusion laceration

sprain ligament tear meniscus lesion and torn cartilage

According to Ingram et al (2008) 168 of all knee injuries

33

were surgery-requiring injuries Examples of these major

knee injuries were complete ligament tears torn cartilage

incomplete ligament tears and fractures

Female players no matter they were soccer players or

basketball players would have a higher chance of injuring

their knee especially the ACL than their male counterparts

It might due to both intrinsic factors such as muscular

strength and endurance and hormonal differences and

extrinsic factors such as game environment and sports

facilities

However knee injuries could be prevented Preventive

measures for knee injuries included lower-extremity landing

skills plyometrics (Le Gall et al 2007) neuromuscular

training programs added supervision (Dick et al 2007)

muscle strengthening and movement training (Ingram et al

2008)

34

Chapter 3

METHOD

The method of this study was divided into the following

sections 1) Participants 2) Development of questionnaire

3) Pilot study 4) Procedures and 5) Data analysis

Participants

The participants were both male and female local members

of university basketball or soccer team in Hong Kong in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team The total number of subjects was 197 with

48 male members of university basketball team 51 female

members of university basketball team 56 male members of

university soccer team and 42 female members of university

soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 15: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

15

Definition of Terms

In order to understand this study more clearly the

operational definitions of terms were as follows

University Basketball Team Member

University basketball team member refers to the local

member of any university basketball team in Hong Kong in the

academic year 2011-2012 who has been participating in regular

training provided by the university basketball team

University Soccer Team Member

University soccer team member refers to the local member

of any university soccer team in Hong Kong in the academic

year 2011-2012 who has been participating in regular training

provided by the university soccer team

Knee Injury

Knee injury refers to any injury to the knee that occurs

during sports or exercise (Bellenir 2008) The Capsule

16

ligament synovium and cartilage in the knee are susceptible

to injuries in sports (Harris amp Varney 1977)

Case of Knee Injury

Case of knee injury refers to any reported case of knee

injury in basketball or soccer that occurred within the past

one year either in the training session or competition

Rate of Knee Injury

Rate of knee injury refers to the number of case of knee

injuries in the past one year divided by the number of players

Training Hour

Training hour refers to the time spent on training the

skills or tactics on the basketball court or soccer pitch

excluding the time spent on fitness training

17

Warm Up

Warm up refers to any exercise or activity performed before

the main exercise which aims at increasing the muscle

temperature and increasing the range of motion of the joints

and muscle tendons (Fevre 1998) It usually includes jogging

stretching or sometimes specific warm up

Specific Warm Up

Specific warm up refers to the exercise or activity that

prepares the body for the up-coming exercise using the

specific muscles which will be used mainly in the up-coming

exercise

Fitness Training

Fitness training refers to any kind of exercise that will

help to improve the fitness of the players both the

health-related fitness and skill-related fitness

18

Cool Down

Cool down refers to any light exercise or activity

performed after the main exercise that allows the body to

transit back from an excited state to a resting state It

usually includes slow jogging walking and stretching

Recovery Time

Recovery time refers to the amount of time spent on recovery

of the knee injury from the occurrence of the knee injury until

the player returns to regular training

Delimitations

The delimitations of this study were listed as follows

1 The participants were delimited to the local Hong Kong

members of university basketball or soccer team in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team

19

2 The period of data collection was delimited to March 2012

3 Cases of knee injury were delimited to the reported cases

of knee injury that occurred in either training or

competition in the past one year

Limitations

The following were the limitations that must be considered

when analyzing the results of this study

1 The content of the questionnaire might not provide enough

detailed information for analysis as it was self-designed

2 The questionnaire was not valid and reliable enough as it

was self-designed

3 It was assumed that the participants could correctly

identify the types of knee injuries that they suffered

4 It was assumed that the participants would honestly and

cautiously answer the questionnaire

20

Significance of Study

This study provided information about the pattern of knee

injuries of the local members of the university basketball

and soccer team in Hong Kong It also provided comparisons

of both the rate of knee injuries and types of injuries between

the members of university basketball team and that of

university soccer team Besides the relationship between the

gender and the patterns of knee injuries was examined

Understanding the patterns of knee injuries was important

because it was the primary step to prevent the occurrence of

knee injuries This provided much useful information for the

coaches as well as the players on how to reduce the occurrence

of knee injuries If coaches understood the knee injury

patterns of basketball or soccer they could be able to plan

a better and safer training program for the players For the

players if they understood more about the causes of knee

injuries they could focus more on the preventive measures

of knee injuries when they were engaged in the sports

21

Chapter 2

REVIEW OF LITERATURE

Some past literature focusing on the knee injuries in

basketball and soccer was reviewed in this chapter This

review of literature was divided into six sections (1) knee

injuries in basketball (2) knee injuries in soccer (3)

gender difference in the knee injuries in basketball (4)

gender difference in the knee injuries in soccer (5) anterior

cruciate ligament (ACL) injuries in basketball and soccer

and (6) summary

Knee Injuries in Basketball

Borowski Yard Fields amp Comstock (2008) said that

basketball was one of the most popular sports in the United

States Although basketball players could benefit a lot from

basketball activities such as improved self-esteem and

weight control they had an increased risk of injury as they

were participating in a physically demanding activity Dick

Hertel Agel Grossman amp Marshall (2007) defined collegiate

22

menrsquos basketball as ldquoa contact sport in which numerous

anatomical structures are susceptible to both acute and

overuse injuriesrdquo (p194) It was not uncommon for basketball

players to suffer from injuries

According to Borowski et al (2008) the knee was one of

the most commonly injured body parts in basketball practice

and competition For the female basketball players 172 and

195 of the injuries occurred in the knee during practice

and competition respectively Knee injuries in practice and

in competition accounted for 101 and 115 of the total

injuries respectively for in the male basketball

In 2004 Olympic Games there were seven knee injuries in

the basketball games (Junge et al 2006) There were two

ligament ruptures one meniscus lesion one sprain two

contusions and one laceration According to Dick et al

(2007) knee internal derangements and patellar injuries were

the common knee injuries happened during practice and

competition Borowski et al (2008) suggested that muscle or

tendon strains in knee were another common type of knee

23

injuries in basketball Soft tissue injuries were also common

knee injuries in basketball According to Ingram Fields Yard

amp Comstock (2008) torn cartilage injuries were common in both

male and female basketball players and complete ligament

tears were common in female basketball players

Ingram et al (2008) found that the knee injuries in

basketball for both male and female players were non-contact

injuries meaning that there was no contact between players

when the knee injuries happened However Borowski et al

(2008) found that 246 of the knee injuries in the United

States high school basketball were caused by collision with

other player But still there were some non-contact knee

injuries caused by either rotation around a planted foot or

inversion or jumping or landing

24

Knee Injuries in Soccer

According to Yard Schroeder Fields Collins amp Comstock

(2008) ldquosoccer is one of the most popular sports worldwiderdquo

(p1930) It explained why there have been more and more people

both youngsters and adults participating in different soccer

activities nowadays Upon participation in soccer the

players could get a number of benefits such as becoming

physically active increase in productivity and enhancement

in academic performance but there were still risks for

injuries (Yard et al 2008)

Le Gall Carling amp Reilly (2007) conducted a study on the

soccer injuries in young elite females According to the

result among all anatomical sites in the body the lower

extremities were the most common site for injuries in soccer

with 168 of those injuries affecting the knee It was also

supported by the result of the research conducted by Yard et

al (2008) which showed that 187 of the soccer injuries

occurred in the knee

Concerning the types of knee injuries Junge et al (2006)

25

did a research on the injuries in team sport tournaments during

the 2004 Olympic Games and found that there were totally 17

knee injuries in soccer Of these 17 knee injuries 1 was

meniscus lesion 7 were sprain and 9 were contusion Apart

from that ligament tears were common in soccer players too

Ingram et al (2008) showed that incomplete ligament tears

and complete ligament tears were common in male soccer players

and female soccer players respectively A similar result was

obtained by Yard et al (2008) It showed that incomplete knee

ligament sprains were common among both male and female soccer

players but complete knee ligament sprains were only common

in female soccer players Both Ingram et al and Yard et al

suggested that the both the complete and incomplete knee

ligament injuries in the male soccer players were caused by

contact with other players while the incomplete knee ligament

injuries in the female soccer players were not caused by any

contact with others

According to Le Gall et al (2007) serious injuries

usually occurred in the knee and those serious injuries

26

included ligament sprain or rupture meniscus lesion and

patellar tendinitis or bursitis Overuse injuries were also

commonly occurred in the knee Yard et al (2008) suggested

that ldquogirl soccer players sustained a larger proportion of

knee injuriesrdquo (p1932) Darrow Collins Yard amp Comstock

(2009) supported that more female soccer players suffered from

severe knee injuries than male soccer players did

Gender Difference in the Knee Injuries in Basketball

According to Borowski et al (2008) female high school

basketball players in the United States were more likely to

injure their knees during practice and competition than the

male players A similar result was also found in the study

done by Ingram et al (2008) which showed that female high

school basketball players had a higher rate of major knee

injuries than the male players Darrow et al (2009) further

showed that female high school basketball players in the

United States had a higher chance of suffering from severe

knee injuries than the male players

27

The reasons for the difference in the rate of knee injuries

in basketball among the female and male players could be

divided into two categories intrinsic factors and extrinsic

factors Borowski et al (2008) suggested that the intrinsic

factors were mainly physiological differences between boys

and girls Examples for these physiological differences were

anatomical differences in joint and bone structure

differences in flexibility and strength and differences in

hormone secretions Differences in equipment differences in

facilities and differences in competition environment were

the extrinsic factors for the difference in the rate of knee

injury

Ingram et al (2008) mentioned that the likeliness of

female basketball players to sustain major knee injuries in

basketball was due to the vulnerability of their knees It

was associated with various risk factors such as hormonal

difference neuromuscular difference and mechanical

difference These risk factors made the female basketball

players four to six times more susceptible to major knee

28

injuries than the male basketball players

Gender Difference in the Knee Injuries in Soccer

The result of the study conducted by Yard et al (2008)

showed that female soccer players sustained a higher rate of

knee injuries than the male soccer players Le Gall et al

(2007) suggested that the reasons for the higher rate in knee

injuries for the female soccer players included weaker

technical and tactical ability poorer muscular strength and

endurance and weaker coordination The rapid development of

the female soccer game which led to an increased in

aggressiveness of the players was another cause of the higher

knee injury rate

Specifically female soccer players had a higher rate of

sustaining complete knee ligament sprains than the male soccer

players (Yard et al 2008) This was supported by the result

of the research done by Ingram et al (2008) which showed

that complete ligament tears were more common in female soccer

than in male soccer It might due to that fact that there were

29

structural differences and neuromuscular differences between

female and male soccer players Yard et al also found that

the rate of complete knee ligament sprains requiring surgery

in female soccer players was higher than that in male soccer

players Female soccer players were found to be 13 times more

susceptible to knee ligament injuries that required surgery

The reasons for this high rate against male soccer players

included the shoe-surface interaction differences in

anthropometry and increased joint laxity

Ingram et al (2008) also showed that non-contact knee

injuries were more common in female soccer than in male soccer

The reasons for this result were suggested to be that the knee

joint of the female soccer players were more vulnerable to

the stress created by rapid acceleration deceleration and

cutting movement on the grass surfaces

Anterior Cruciate Ligament Injuries in Basketball and Soccer

According to Mihata Beutler amp Boden (2006) anterior

cruciate ligament (ACL) injuries were not uncommon in

30

collegiate sports The most common type of ACL injuries was

non-contact or minimal contact ACL injuries The actions of

cutting jumping sudden deceleration and checking with

another player were the high risk mechanisms for this kind

of ACL injuries Basketball players and soccer players were

found to be often exposing to these damaging forces because

they had to perform these actions repeatedly during practice

and competition

From the result shown by Dick et al (2007) 18 of the

total game injuries in male basketball were ACL injuries and

603 of these ACL injuries were non-contact ACL injuries

This result was supported by Mihata et al (2006) whose result

showed that ACL injuries accounted for 14 of all injuries

in male basketball from 1989 to 2004 For the female basketball

players they had a higher rate of ACL injuries than the male

players It was shown by Mihata et al that the ACL injuries

accounted for 52 of all injuries in female basketball from

1989 to 2004 which was about four times higher than in male

basketball

31

For the soccer players the female soccer players also had

higher rates of ACL injuries than the male soccer players

In between 1989 and 2004 39 of the total injuries in female

soccer were ACL injuries while only 16 of the total injuries

in male soccer were ACL injuries (Mihata et al 2006) The

rate of ACL injuries in female soccer was almost three times

higher than that in male soccer in that period of time A more

serious result was shown by Le Gall et al (2007) In their

result ACL injuries mainly ACL sprains or ruptures

accounted for 156 of all major injuries of the young elite

female soccer players

According to Mihata et al (2006) the reasons for the

female players having higher rates of ACL injuries than the

male players were that they had only participated in such

organized sports for a brief period of time they were less

fit and they received less training Another reason was a

disturbance in the neuromuscular patterns received by the

female players which protected the knee created by

incidental or minimal trauma

32

The rate of ACL injuries could be reduced effectively

Understanding the biomechanical risk factors and identifying

and changing those risk factors were the necessary steps to

decrease the long-term ACL injury rates (Mihata et al 2006)

Summary

Soccer and basketball are common sports all over the world

and they are generally regarded as kinds of contact sports

as there is direct contact between players Players are

required to have good muscular strength and power in order

to compete with others Collision and contacting with other

players would lead to imbalance and maybe fall which in turn

lead to injury

Knee was found to be one of the most common body sites

susceptible to injuries in basketball and soccer during both

practice and competition Different types of knee injuries

were sustained by the players such as contusion laceration

sprain ligament tear meniscus lesion and torn cartilage

According to Ingram et al (2008) 168 of all knee injuries

33

were surgery-requiring injuries Examples of these major

knee injuries were complete ligament tears torn cartilage

incomplete ligament tears and fractures

Female players no matter they were soccer players or

basketball players would have a higher chance of injuring

their knee especially the ACL than their male counterparts

It might due to both intrinsic factors such as muscular

strength and endurance and hormonal differences and

extrinsic factors such as game environment and sports

facilities

However knee injuries could be prevented Preventive

measures for knee injuries included lower-extremity landing

skills plyometrics (Le Gall et al 2007) neuromuscular

training programs added supervision (Dick et al 2007)

muscle strengthening and movement training (Ingram et al

2008)

34

Chapter 3

METHOD

The method of this study was divided into the following

sections 1) Participants 2) Development of questionnaire

3) Pilot study 4) Procedures and 5) Data analysis

Participants

The participants were both male and female local members

of university basketball or soccer team in Hong Kong in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team The total number of subjects was 197 with

48 male members of university basketball team 51 female

members of university basketball team 56 male members of

university soccer team and 42 female members of university

soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 16: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

16

ligament synovium and cartilage in the knee are susceptible

to injuries in sports (Harris amp Varney 1977)

Case of Knee Injury

Case of knee injury refers to any reported case of knee

injury in basketball or soccer that occurred within the past

one year either in the training session or competition

Rate of Knee Injury

Rate of knee injury refers to the number of case of knee

injuries in the past one year divided by the number of players

Training Hour

Training hour refers to the time spent on training the

skills or tactics on the basketball court or soccer pitch

excluding the time spent on fitness training

17

Warm Up

Warm up refers to any exercise or activity performed before

the main exercise which aims at increasing the muscle

temperature and increasing the range of motion of the joints

and muscle tendons (Fevre 1998) It usually includes jogging

stretching or sometimes specific warm up

Specific Warm Up

Specific warm up refers to the exercise or activity that

prepares the body for the up-coming exercise using the

specific muscles which will be used mainly in the up-coming

exercise

Fitness Training

Fitness training refers to any kind of exercise that will

help to improve the fitness of the players both the

health-related fitness and skill-related fitness

18

Cool Down

Cool down refers to any light exercise or activity

performed after the main exercise that allows the body to

transit back from an excited state to a resting state It

usually includes slow jogging walking and stretching

Recovery Time

Recovery time refers to the amount of time spent on recovery

of the knee injury from the occurrence of the knee injury until

the player returns to regular training

Delimitations

The delimitations of this study were listed as follows

1 The participants were delimited to the local Hong Kong

members of university basketball or soccer team in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team

19

2 The period of data collection was delimited to March 2012

3 Cases of knee injury were delimited to the reported cases

of knee injury that occurred in either training or

competition in the past one year

Limitations

The following were the limitations that must be considered

when analyzing the results of this study

1 The content of the questionnaire might not provide enough

detailed information for analysis as it was self-designed

2 The questionnaire was not valid and reliable enough as it

was self-designed

3 It was assumed that the participants could correctly

identify the types of knee injuries that they suffered

4 It was assumed that the participants would honestly and

cautiously answer the questionnaire

20

Significance of Study

This study provided information about the pattern of knee

injuries of the local members of the university basketball

and soccer team in Hong Kong It also provided comparisons

of both the rate of knee injuries and types of injuries between

the members of university basketball team and that of

university soccer team Besides the relationship between the

gender and the patterns of knee injuries was examined

Understanding the patterns of knee injuries was important

because it was the primary step to prevent the occurrence of

knee injuries This provided much useful information for the

coaches as well as the players on how to reduce the occurrence

of knee injuries If coaches understood the knee injury

patterns of basketball or soccer they could be able to plan

a better and safer training program for the players For the

players if they understood more about the causes of knee

injuries they could focus more on the preventive measures

of knee injuries when they were engaged in the sports

21

Chapter 2

REVIEW OF LITERATURE

Some past literature focusing on the knee injuries in

basketball and soccer was reviewed in this chapter This

review of literature was divided into six sections (1) knee

injuries in basketball (2) knee injuries in soccer (3)

gender difference in the knee injuries in basketball (4)

gender difference in the knee injuries in soccer (5) anterior

cruciate ligament (ACL) injuries in basketball and soccer

and (6) summary

Knee Injuries in Basketball

Borowski Yard Fields amp Comstock (2008) said that

basketball was one of the most popular sports in the United

States Although basketball players could benefit a lot from

basketball activities such as improved self-esteem and

weight control they had an increased risk of injury as they

were participating in a physically demanding activity Dick

Hertel Agel Grossman amp Marshall (2007) defined collegiate

22

menrsquos basketball as ldquoa contact sport in which numerous

anatomical structures are susceptible to both acute and

overuse injuriesrdquo (p194) It was not uncommon for basketball

players to suffer from injuries

According to Borowski et al (2008) the knee was one of

the most commonly injured body parts in basketball practice

and competition For the female basketball players 172 and

195 of the injuries occurred in the knee during practice

and competition respectively Knee injuries in practice and

in competition accounted for 101 and 115 of the total

injuries respectively for in the male basketball

In 2004 Olympic Games there were seven knee injuries in

the basketball games (Junge et al 2006) There were two

ligament ruptures one meniscus lesion one sprain two

contusions and one laceration According to Dick et al

(2007) knee internal derangements and patellar injuries were

the common knee injuries happened during practice and

competition Borowski et al (2008) suggested that muscle or

tendon strains in knee were another common type of knee

23

injuries in basketball Soft tissue injuries were also common

knee injuries in basketball According to Ingram Fields Yard

amp Comstock (2008) torn cartilage injuries were common in both

male and female basketball players and complete ligament

tears were common in female basketball players

Ingram et al (2008) found that the knee injuries in

basketball for both male and female players were non-contact

injuries meaning that there was no contact between players

when the knee injuries happened However Borowski et al

(2008) found that 246 of the knee injuries in the United

States high school basketball were caused by collision with

other player But still there were some non-contact knee

injuries caused by either rotation around a planted foot or

inversion or jumping or landing

24

Knee Injuries in Soccer

According to Yard Schroeder Fields Collins amp Comstock

(2008) ldquosoccer is one of the most popular sports worldwiderdquo

(p1930) It explained why there have been more and more people

both youngsters and adults participating in different soccer

activities nowadays Upon participation in soccer the

players could get a number of benefits such as becoming

physically active increase in productivity and enhancement

in academic performance but there were still risks for

injuries (Yard et al 2008)

Le Gall Carling amp Reilly (2007) conducted a study on the

soccer injuries in young elite females According to the

result among all anatomical sites in the body the lower

extremities were the most common site for injuries in soccer

with 168 of those injuries affecting the knee It was also

supported by the result of the research conducted by Yard et

al (2008) which showed that 187 of the soccer injuries

occurred in the knee

Concerning the types of knee injuries Junge et al (2006)

25

did a research on the injuries in team sport tournaments during

the 2004 Olympic Games and found that there were totally 17

knee injuries in soccer Of these 17 knee injuries 1 was

meniscus lesion 7 were sprain and 9 were contusion Apart

from that ligament tears were common in soccer players too

Ingram et al (2008) showed that incomplete ligament tears

and complete ligament tears were common in male soccer players

and female soccer players respectively A similar result was

obtained by Yard et al (2008) It showed that incomplete knee

ligament sprains were common among both male and female soccer

players but complete knee ligament sprains were only common

in female soccer players Both Ingram et al and Yard et al

suggested that the both the complete and incomplete knee

ligament injuries in the male soccer players were caused by

contact with other players while the incomplete knee ligament

injuries in the female soccer players were not caused by any

contact with others

According to Le Gall et al (2007) serious injuries

usually occurred in the knee and those serious injuries

26

included ligament sprain or rupture meniscus lesion and

patellar tendinitis or bursitis Overuse injuries were also

commonly occurred in the knee Yard et al (2008) suggested

that ldquogirl soccer players sustained a larger proportion of

knee injuriesrdquo (p1932) Darrow Collins Yard amp Comstock

(2009) supported that more female soccer players suffered from

severe knee injuries than male soccer players did

Gender Difference in the Knee Injuries in Basketball

According to Borowski et al (2008) female high school

basketball players in the United States were more likely to

injure their knees during practice and competition than the

male players A similar result was also found in the study

done by Ingram et al (2008) which showed that female high

school basketball players had a higher rate of major knee

injuries than the male players Darrow et al (2009) further

showed that female high school basketball players in the

United States had a higher chance of suffering from severe

knee injuries than the male players

27

The reasons for the difference in the rate of knee injuries

in basketball among the female and male players could be

divided into two categories intrinsic factors and extrinsic

factors Borowski et al (2008) suggested that the intrinsic

factors were mainly physiological differences between boys

and girls Examples for these physiological differences were

anatomical differences in joint and bone structure

differences in flexibility and strength and differences in

hormone secretions Differences in equipment differences in

facilities and differences in competition environment were

the extrinsic factors for the difference in the rate of knee

injury

Ingram et al (2008) mentioned that the likeliness of

female basketball players to sustain major knee injuries in

basketball was due to the vulnerability of their knees It

was associated with various risk factors such as hormonal

difference neuromuscular difference and mechanical

difference These risk factors made the female basketball

players four to six times more susceptible to major knee

28

injuries than the male basketball players

Gender Difference in the Knee Injuries in Soccer

The result of the study conducted by Yard et al (2008)

showed that female soccer players sustained a higher rate of

knee injuries than the male soccer players Le Gall et al

(2007) suggested that the reasons for the higher rate in knee

injuries for the female soccer players included weaker

technical and tactical ability poorer muscular strength and

endurance and weaker coordination The rapid development of

the female soccer game which led to an increased in

aggressiveness of the players was another cause of the higher

knee injury rate

Specifically female soccer players had a higher rate of

sustaining complete knee ligament sprains than the male soccer

players (Yard et al 2008) This was supported by the result

of the research done by Ingram et al (2008) which showed

that complete ligament tears were more common in female soccer

than in male soccer It might due to that fact that there were

29

structural differences and neuromuscular differences between

female and male soccer players Yard et al also found that

the rate of complete knee ligament sprains requiring surgery

in female soccer players was higher than that in male soccer

players Female soccer players were found to be 13 times more

susceptible to knee ligament injuries that required surgery

The reasons for this high rate against male soccer players

included the shoe-surface interaction differences in

anthropometry and increased joint laxity

Ingram et al (2008) also showed that non-contact knee

injuries were more common in female soccer than in male soccer

The reasons for this result were suggested to be that the knee

joint of the female soccer players were more vulnerable to

the stress created by rapid acceleration deceleration and

cutting movement on the grass surfaces

Anterior Cruciate Ligament Injuries in Basketball and Soccer

According to Mihata Beutler amp Boden (2006) anterior

cruciate ligament (ACL) injuries were not uncommon in

30

collegiate sports The most common type of ACL injuries was

non-contact or minimal contact ACL injuries The actions of

cutting jumping sudden deceleration and checking with

another player were the high risk mechanisms for this kind

of ACL injuries Basketball players and soccer players were

found to be often exposing to these damaging forces because

they had to perform these actions repeatedly during practice

and competition

From the result shown by Dick et al (2007) 18 of the

total game injuries in male basketball were ACL injuries and

603 of these ACL injuries were non-contact ACL injuries

This result was supported by Mihata et al (2006) whose result

showed that ACL injuries accounted for 14 of all injuries

in male basketball from 1989 to 2004 For the female basketball

players they had a higher rate of ACL injuries than the male

players It was shown by Mihata et al that the ACL injuries

accounted for 52 of all injuries in female basketball from

1989 to 2004 which was about four times higher than in male

basketball

31

For the soccer players the female soccer players also had

higher rates of ACL injuries than the male soccer players

In between 1989 and 2004 39 of the total injuries in female

soccer were ACL injuries while only 16 of the total injuries

in male soccer were ACL injuries (Mihata et al 2006) The

rate of ACL injuries in female soccer was almost three times

higher than that in male soccer in that period of time A more

serious result was shown by Le Gall et al (2007) In their

result ACL injuries mainly ACL sprains or ruptures

accounted for 156 of all major injuries of the young elite

female soccer players

According to Mihata et al (2006) the reasons for the

female players having higher rates of ACL injuries than the

male players were that they had only participated in such

organized sports for a brief period of time they were less

fit and they received less training Another reason was a

disturbance in the neuromuscular patterns received by the

female players which protected the knee created by

incidental or minimal trauma

32

The rate of ACL injuries could be reduced effectively

Understanding the biomechanical risk factors and identifying

and changing those risk factors were the necessary steps to

decrease the long-term ACL injury rates (Mihata et al 2006)

Summary

Soccer and basketball are common sports all over the world

and they are generally regarded as kinds of contact sports

as there is direct contact between players Players are

required to have good muscular strength and power in order

to compete with others Collision and contacting with other

players would lead to imbalance and maybe fall which in turn

lead to injury

Knee was found to be one of the most common body sites

susceptible to injuries in basketball and soccer during both

practice and competition Different types of knee injuries

were sustained by the players such as contusion laceration

sprain ligament tear meniscus lesion and torn cartilage

According to Ingram et al (2008) 168 of all knee injuries

33

were surgery-requiring injuries Examples of these major

knee injuries were complete ligament tears torn cartilage

incomplete ligament tears and fractures

Female players no matter they were soccer players or

basketball players would have a higher chance of injuring

their knee especially the ACL than their male counterparts

It might due to both intrinsic factors such as muscular

strength and endurance and hormonal differences and

extrinsic factors such as game environment and sports

facilities

However knee injuries could be prevented Preventive

measures for knee injuries included lower-extremity landing

skills plyometrics (Le Gall et al 2007) neuromuscular

training programs added supervision (Dick et al 2007)

muscle strengthening and movement training (Ingram et al

2008)

34

Chapter 3

METHOD

The method of this study was divided into the following

sections 1) Participants 2) Development of questionnaire

3) Pilot study 4) Procedures and 5) Data analysis

Participants

The participants were both male and female local members

of university basketball or soccer team in Hong Kong in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team The total number of subjects was 197 with

48 male members of university basketball team 51 female

members of university basketball team 56 male members of

university soccer team and 42 female members of university

soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

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Bellenir K (2008) Sports injuries information for teens

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Borowski L A Yard E E Fields S K amp Comstock R

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Darrow C J Collins C L Yard E E amp Comstock R

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Griffith H W (1986) Complete guide to sports injuries

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Le Gall F CarIing C amp Reilly T (2008) Injuries in

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doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 17: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

17

Warm Up

Warm up refers to any exercise or activity performed before

the main exercise which aims at increasing the muscle

temperature and increasing the range of motion of the joints

and muscle tendons (Fevre 1998) It usually includes jogging

stretching or sometimes specific warm up

Specific Warm Up

Specific warm up refers to the exercise or activity that

prepares the body for the up-coming exercise using the

specific muscles which will be used mainly in the up-coming

exercise

Fitness Training

Fitness training refers to any kind of exercise that will

help to improve the fitness of the players both the

health-related fitness and skill-related fitness

18

Cool Down

Cool down refers to any light exercise or activity

performed after the main exercise that allows the body to

transit back from an excited state to a resting state It

usually includes slow jogging walking and stretching

Recovery Time

Recovery time refers to the amount of time spent on recovery

of the knee injury from the occurrence of the knee injury until

the player returns to regular training

Delimitations

The delimitations of this study were listed as follows

1 The participants were delimited to the local Hong Kong

members of university basketball or soccer team in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team

19

2 The period of data collection was delimited to March 2012

3 Cases of knee injury were delimited to the reported cases

of knee injury that occurred in either training or

competition in the past one year

Limitations

The following were the limitations that must be considered

when analyzing the results of this study

1 The content of the questionnaire might not provide enough

detailed information for analysis as it was self-designed

2 The questionnaire was not valid and reliable enough as it

was self-designed

3 It was assumed that the participants could correctly

identify the types of knee injuries that they suffered

4 It was assumed that the participants would honestly and

cautiously answer the questionnaire

20

Significance of Study

This study provided information about the pattern of knee

injuries of the local members of the university basketball

and soccer team in Hong Kong It also provided comparisons

of both the rate of knee injuries and types of injuries between

the members of university basketball team and that of

university soccer team Besides the relationship between the

gender and the patterns of knee injuries was examined

Understanding the patterns of knee injuries was important

because it was the primary step to prevent the occurrence of

knee injuries This provided much useful information for the

coaches as well as the players on how to reduce the occurrence

of knee injuries If coaches understood the knee injury

patterns of basketball or soccer they could be able to plan

a better and safer training program for the players For the

players if they understood more about the causes of knee

injuries they could focus more on the preventive measures

of knee injuries when they were engaged in the sports

21

Chapter 2

REVIEW OF LITERATURE

Some past literature focusing on the knee injuries in

basketball and soccer was reviewed in this chapter This

review of literature was divided into six sections (1) knee

injuries in basketball (2) knee injuries in soccer (3)

gender difference in the knee injuries in basketball (4)

gender difference in the knee injuries in soccer (5) anterior

cruciate ligament (ACL) injuries in basketball and soccer

and (6) summary

Knee Injuries in Basketball

Borowski Yard Fields amp Comstock (2008) said that

basketball was one of the most popular sports in the United

States Although basketball players could benefit a lot from

basketball activities such as improved self-esteem and

weight control they had an increased risk of injury as they

were participating in a physically demanding activity Dick

Hertel Agel Grossman amp Marshall (2007) defined collegiate

22

menrsquos basketball as ldquoa contact sport in which numerous

anatomical structures are susceptible to both acute and

overuse injuriesrdquo (p194) It was not uncommon for basketball

players to suffer from injuries

According to Borowski et al (2008) the knee was one of

the most commonly injured body parts in basketball practice

and competition For the female basketball players 172 and

195 of the injuries occurred in the knee during practice

and competition respectively Knee injuries in practice and

in competition accounted for 101 and 115 of the total

injuries respectively for in the male basketball

In 2004 Olympic Games there were seven knee injuries in

the basketball games (Junge et al 2006) There were two

ligament ruptures one meniscus lesion one sprain two

contusions and one laceration According to Dick et al

(2007) knee internal derangements and patellar injuries were

the common knee injuries happened during practice and

competition Borowski et al (2008) suggested that muscle or

tendon strains in knee were another common type of knee

23

injuries in basketball Soft tissue injuries were also common

knee injuries in basketball According to Ingram Fields Yard

amp Comstock (2008) torn cartilage injuries were common in both

male and female basketball players and complete ligament

tears were common in female basketball players

Ingram et al (2008) found that the knee injuries in

basketball for both male and female players were non-contact

injuries meaning that there was no contact between players

when the knee injuries happened However Borowski et al

(2008) found that 246 of the knee injuries in the United

States high school basketball were caused by collision with

other player But still there were some non-contact knee

injuries caused by either rotation around a planted foot or

inversion or jumping or landing

24

Knee Injuries in Soccer

According to Yard Schroeder Fields Collins amp Comstock

(2008) ldquosoccer is one of the most popular sports worldwiderdquo

(p1930) It explained why there have been more and more people

both youngsters and adults participating in different soccer

activities nowadays Upon participation in soccer the

players could get a number of benefits such as becoming

physically active increase in productivity and enhancement

in academic performance but there were still risks for

injuries (Yard et al 2008)

Le Gall Carling amp Reilly (2007) conducted a study on the

soccer injuries in young elite females According to the

result among all anatomical sites in the body the lower

extremities were the most common site for injuries in soccer

with 168 of those injuries affecting the knee It was also

supported by the result of the research conducted by Yard et

al (2008) which showed that 187 of the soccer injuries

occurred in the knee

Concerning the types of knee injuries Junge et al (2006)

25

did a research on the injuries in team sport tournaments during

the 2004 Olympic Games and found that there were totally 17

knee injuries in soccer Of these 17 knee injuries 1 was

meniscus lesion 7 were sprain and 9 were contusion Apart

from that ligament tears were common in soccer players too

Ingram et al (2008) showed that incomplete ligament tears

and complete ligament tears were common in male soccer players

and female soccer players respectively A similar result was

obtained by Yard et al (2008) It showed that incomplete knee

ligament sprains were common among both male and female soccer

players but complete knee ligament sprains were only common

in female soccer players Both Ingram et al and Yard et al

suggested that the both the complete and incomplete knee

ligament injuries in the male soccer players were caused by

contact with other players while the incomplete knee ligament

injuries in the female soccer players were not caused by any

contact with others

According to Le Gall et al (2007) serious injuries

usually occurred in the knee and those serious injuries

26

included ligament sprain or rupture meniscus lesion and

patellar tendinitis or bursitis Overuse injuries were also

commonly occurred in the knee Yard et al (2008) suggested

that ldquogirl soccer players sustained a larger proportion of

knee injuriesrdquo (p1932) Darrow Collins Yard amp Comstock

(2009) supported that more female soccer players suffered from

severe knee injuries than male soccer players did

Gender Difference in the Knee Injuries in Basketball

According to Borowski et al (2008) female high school

basketball players in the United States were more likely to

injure their knees during practice and competition than the

male players A similar result was also found in the study

done by Ingram et al (2008) which showed that female high

school basketball players had a higher rate of major knee

injuries than the male players Darrow et al (2009) further

showed that female high school basketball players in the

United States had a higher chance of suffering from severe

knee injuries than the male players

27

The reasons for the difference in the rate of knee injuries

in basketball among the female and male players could be

divided into two categories intrinsic factors and extrinsic

factors Borowski et al (2008) suggested that the intrinsic

factors were mainly physiological differences between boys

and girls Examples for these physiological differences were

anatomical differences in joint and bone structure

differences in flexibility and strength and differences in

hormone secretions Differences in equipment differences in

facilities and differences in competition environment were

the extrinsic factors for the difference in the rate of knee

injury

Ingram et al (2008) mentioned that the likeliness of

female basketball players to sustain major knee injuries in

basketball was due to the vulnerability of their knees It

was associated with various risk factors such as hormonal

difference neuromuscular difference and mechanical

difference These risk factors made the female basketball

players four to six times more susceptible to major knee

28

injuries than the male basketball players

Gender Difference in the Knee Injuries in Soccer

The result of the study conducted by Yard et al (2008)

showed that female soccer players sustained a higher rate of

knee injuries than the male soccer players Le Gall et al

(2007) suggested that the reasons for the higher rate in knee

injuries for the female soccer players included weaker

technical and tactical ability poorer muscular strength and

endurance and weaker coordination The rapid development of

the female soccer game which led to an increased in

aggressiveness of the players was another cause of the higher

knee injury rate

Specifically female soccer players had a higher rate of

sustaining complete knee ligament sprains than the male soccer

players (Yard et al 2008) This was supported by the result

of the research done by Ingram et al (2008) which showed

that complete ligament tears were more common in female soccer

than in male soccer It might due to that fact that there were

29

structural differences and neuromuscular differences between

female and male soccer players Yard et al also found that

the rate of complete knee ligament sprains requiring surgery

in female soccer players was higher than that in male soccer

players Female soccer players were found to be 13 times more

susceptible to knee ligament injuries that required surgery

The reasons for this high rate against male soccer players

included the shoe-surface interaction differences in

anthropometry and increased joint laxity

Ingram et al (2008) also showed that non-contact knee

injuries were more common in female soccer than in male soccer

The reasons for this result were suggested to be that the knee

joint of the female soccer players were more vulnerable to

the stress created by rapid acceleration deceleration and

cutting movement on the grass surfaces

Anterior Cruciate Ligament Injuries in Basketball and Soccer

According to Mihata Beutler amp Boden (2006) anterior

cruciate ligament (ACL) injuries were not uncommon in

30

collegiate sports The most common type of ACL injuries was

non-contact or minimal contact ACL injuries The actions of

cutting jumping sudden deceleration and checking with

another player were the high risk mechanisms for this kind

of ACL injuries Basketball players and soccer players were

found to be often exposing to these damaging forces because

they had to perform these actions repeatedly during practice

and competition

From the result shown by Dick et al (2007) 18 of the

total game injuries in male basketball were ACL injuries and

603 of these ACL injuries were non-contact ACL injuries

This result was supported by Mihata et al (2006) whose result

showed that ACL injuries accounted for 14 of all injuries

in male basketball from 1989 to 2004 For the female basketball

players they had a higher rate of ACL injuries than the male

players It was shown by Mihata et al that the ACL injuries

accounted for 52 of all injuries in female basketball from

1989 to 2004 which was about four times higher than in male

basketball

31

For the soccer players the female soccer players also had

higher rates of ACL injuries than the male soccer players

In between 1989 and 2004 39 of the total injuries in female

soccer were ACL injuries while only 16 of the total injuries

in male soccer were ACL injuries (Mihata et al 2006) The

rate of ACL injuries in female soccer was almost three times

higher than that in male soccer in that period of time A more

serious result was shown by Le Gall et al (2007) In their

result ACL injuries mainly ACL sprains or ruptures

accounted for 156 of all major injuries of the young elite

female soccer players

According to Mihata et al (2006) the reasons for the

female players having higher rates of ACL injuries than the

male players were that they had only participated in such

organized sports for a brief period of time they were less

fit and they received less training Another reason was a

disturbance in the neuromuscular patterns received by the

female players which protected the knee created by

incidental or minimal trauma

32

The rate of ACL injuries could be reduced effectively

Understanding the biomechanical risk factors and identifying

and changing those risk factors were the necessary steps to

decrease the long-term ACL injury rates (Mihata et al 2006)

Summary

Soccer and basketball are common sports all over the world

and they are generally regarded as kinds of contact sports

as there is direct contact between players Players are

required to have good muscular strength and power in order

to compete with others Collision and contacting with other

players would lead to imbalance and maybe fall which in turn

lead to injury

Knee was found to be one of the most common body sites

susceptible to injuries in basketball and soccer during both

practice and competition Different types of knee injuries

were sustained by the players such as contusion laceration

sprain ligament tear meniscus lesion and torn cartilage

According to Ingram et al (2008) 168 of all knee injuries

33

were surgery-requiring injuries Examples of these major

knee injuries were complete ligament tears torn cartilage

incomplete ligament tears and fractures

Female players no matter they were soccer players or

basketball players would have a higher chance of injuring

their knee especially the ACL than their male counterparts

It might due to both intrinsic factors such as muscular

strength and endurance and hormonal differences and

extrinsic factors such as game environment and sports

facilities

However knee injuries could be prevented Preventive

measures for knee injuries included lower-extremity landing

skills plyometrics (Le Gall et al 2007) neuromuscular

training programs added supervision (Dick et al 2007)

muscle strengthening and movement training (Ingram et al

2008)

34

Chapter 3

METHOD

The method of this study was divided into the following

sections 1) Participants 2) Development of questionnaire

3) Pilot study 4) Procedures and 5) Data analysis

Participants

The participants were both male and female local members

of university basketball or soccer team in Hong Kong in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team The total number of subjects was 197 with

48 male members of university basketball team 51 female

members of university basketball team 56 male members of

university soccer team and 42 female members of university

soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 18: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

18

Cool Down

Cool down refers to any light exercise or activity

performed after the main exercise that allows the body to

transit back from an excited state to a resting state It

usually includes slow jogging walking and stretching

Recovery Time

Recovery time refers to the amount of time spent on recovery

of the knee injury from the occurrence of the knee injury until

the player returns to regular training

Delimitations

The delimitations of this study were listed as follows

1 The participants were delimited to the local Hong Kong

members of university basketball or soccer team in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team

19

2 The period of data collection was delimited to March 2012

3 Cases of knee injury were delimited to the reported cases

of knee injury that occurred in either training or

competition in the past one year

Limitations

The following were the limitations that must be considered

when analyzing the results of this study

1 The content of the questionnaire might not provide enough

detailed information for analysis as it was self-designed

2 The questionnaire was not valid and reliable enough as it

was self-designed

3 It was assumed that the participants could correctly

identify the types of knee injuries that they suffered

4 It was assumed that the participants would honestly and

cautiously answer the questionnaire

20

Significance of Study

This study provided information about the pattern of knee

injuries of the local members of the university basketball

and soccer team in Hong Kong It also provided comparisons

of both the rate of knee injuries and types of injuries between

the members of university basketball team and that of

university soccer team Besides the relationship between the

gender and the patterns of knee injuries was examined

Understanding the patterns of knee injuries was important

because it was the primary step to prevent the occurrence of

knee injuries This provided much useful information for the

coaches as well as the players on how to reduce the occurrence

of knee injuries If coaches understood the knee injury

patterns of basketball or soccer they could be able to plan

a better and safer training program for the players For the

players if they understood more about the causes of knee

injuries they could focus more on the preventive measures

of knee injuries when they were engaged in the sports

21

Chapter 2

REVIEW OF LITERATURE

Some past literature focusing on the knee injuries in

basketball and soccer was reviewed in this chapter This

review of literature was divided into six sections (1) knee

injuries in basketball (2) knee injuries in soccer (3)

gender difference in the knee injuries in basketball (4)

gender difference in the knee injuries in soccer (5) anterior

cruciate ligament (ACL) injuries in basketball and soccer

and (6) summary

Knee Injuries in Basketball

Borowski Yard Fields amp Comstock (2008) said that

basketball was one of the most popular sports in the United

States Although basketball players could benefit a lot from

basketball activities such as improved self-esteem and

weight control they had an increased risk of injury as they

were participating in a physically demanding activity Dick

Hertel Agel Grossman amp Marshall (2007) defined collegiate

22

menrsquos basketball as ldquoa contact sport in which numerous

anatomical structures are susceptible to both acute and

overuse injuriesrdquo (p194) It was not uncommon for basketball

players to suffer from injuries

According to Borowski et al (2008) the knee was one of

the most commonly injured body parts in basketball practice

and competition For the female basketball players 172 and

195 of the injuries occurred in the knee during practice

and competition respectively Knee injuries in practice and

in competition accounted for 101 and 115 of the total

injuries respectively for in the male basketball

In 2004 Olympic Games there were seven knee injuries in

the basketball games (Junge et al 2006) There were two

ligament ruptures one meniscus lesion one sprain two

contusions and one laceration According to Dick et al

(2007) knee internal derangements and patellar injuries were

the common knee injuries happened during practice and

competition Borowski et al (2008) suggested that muscle or

tendon strains in knee were another common type of knee

23

injuries in basketball Soft tissue injuries were also common

knee injuries in basketball According to Ingram Fields Yard

amp Comstock (2008) torn cartilage injuries were common in both

male and female basketball players and complete ligament

tears were common in female basketball players

Ingram et al (2008) found that the knee injuries in

basketball for both male and female players were non-contact

injuries meaning that there was no contact between players

when the knee injuries happened However Borowski et al

(2008) found that 246 of the knee injuries in the United

States high school basketball were caused by collision with

other player But still there were some non-contact knee

injuries caused by either rotation around a planted foot or

inversion or jumping or landing

24

Knee Injuries in Soccer

According to Yard Schroeder Fields Collins amp Comstock

(2008) ldquosoccer is one of the most popular sports worldwiderdquo

(p1930) It explained why there have been more and more people

both youngsters and adults participating in different soccer

activities nowadays Upon participation in soccer the

players could get a number of benefits such as becoming

physically active increase in productivity and enhancement

in academic performance but there were still risks for

injuries (Yard et al 2008)

Le Gall Carling amp Reilly (2007) conducted a study on the

soccer injuries in young elite females According to the

result among all anatomical sites in the body the lower

extremities were the most common site for injuries in soccer

with 168 of those injuries affecting the knee It was also

supported by the result of the research conducted by Yard et

al (2008) which showed that 187 of the soccer injuries

occurred in the knee

Concerning the types of knee injuries Junge et al (2006)

25

did a research on the injuries in team sport tournaments during

the 2004 Olympic Games and found that there were totally 17

knee injuries in soccer Of these 17 knee injuries 1 was

meniscus lesion 7 were sprain and 9 were contusion Apart

from that ligament tears were common in soccer players too

Ingram et al (2008) showed that incomplete ligament tears

and complete ligament tears were common in male soccer players

and female soccer players respectively A similar result was

obtained by Yard et al (2008) It showed that incomplete knee

ligament sprains were common among both male and female soccer

players but complete knee ligament sprains were only common

in female soccer players Both Ingram et al and Yard et al

suggested that the both the complete and incomplete knee

ligament injuries in the male soccer players were caused by

contact with other players while the incomplete knee ligament

injuries in the female soccer players were not caused by any

contact with others

According to Le Gall et al (2007) serious injuries

usually occurred in the knee and those serious injuries

26

included ligament sprain or rupture meniscus lesion and

patellar tendinitis or bursitis Overuse injuries were also

commonly occurred in the knee Yard et al (2008) suggested

that ldquogirl soccer players sustained a larger proportion of

knee injuriesrdquo (p1932) Darrow Collins Yard amp Comstock

(2009) supported that more female soccer players suffered from

severe knee injuries than male soccer players did

Gender Difference in the Knee Injuries in Basketball

According to Borowski et al (2008) female high school

basketball players in the United States were more likely to

injure their knees during practice and competition than the

male players A similar result was also found in the study

done by Ingram et al (2008) which showed that female high

school basketball players had a higher rate of major knee

injuries than the male players Darrow et al (2009) further

showed that female high school basketball players in the

United States had a higher chance of suffering from severe

knee injuries than the male players

27

The reasons for the difference in the rate of knee injuries

in basketball among the female and male players could be

divided into two categories intrinsic factors and extrinsic

factors Borowski et al (2008) suggested that the intrinsic

factors were mainly physiological differences between boys

and girls Examples for these physiological differences were

anatomical differences in joint and bone structure

differences in flexibility and strength and differences in

hormone secretions Differences in equipment differences in

facilities and differences in competition environment were

the extrinsic factors for the difference in the rate of knee

injury

Ingram et al (2008) mentioned that the likeliness of

female basketball players to sustain major knee injuries in

basketball was due to the vulnerability of their knees It

was associated with various risk factors such as hormonal

difference neuromuscular difference and mechanical

difference These risk factors made the female basketball

players four to six times more susceptible to major knee

28

injuries than the male basketball players

Gender Difference in the Knee Injuries in Soccer

The result of the study conducted by Yard et al (2008)

showed that female soccer players sustained a higher rate of

knee injuries than the male soccer players Le Gall et al

(2007) suggested that the reasons for the higher rate in knee

injuries for the female soccer players included weaker

technical and tactical ability poorer muscular strength and

endurance and weaker coordination The rapid development of

the female soccer game which led to an increased in

aggressiveness of the players was another cause of the higher

knee injury rate

Specifically female soccer players had a higher rate of

sustaining complete knee ligament sprains than the male soccer

players (Yard et al 2008) This was supported by the result

of the research done by Ingram et al (2008) which showed

that complete ligament tears were more common in female soccer

than in male soccer It might due to that fact that there were

29

structural differences and neuromuscular differences between

female and male soccer players Yard et al also found that

the rate of complete knee ligament sprains requiring surgery

in female soccer players was higher than that in male soccer

players Female soccer players were found to be 13 times more

susceptible to knee ligament injuries that required surgery

The reasons for this high rate against male soccer players

included the shoe-surface interaction differences in

anthropometry and increased joint laxity

Ingram et al (2008) also showed that non-contact knee

injuries were more common in female soccer than in male soccer

The reasons for this result were suggested to be that the knee

joint of the female soccer players were more vulnerable to

the stress created by rapid acceleration deceleration and

cutting movement on the grass surfaces

Anterior Cruciate Ligament Injuries in Basketball and Soccer

According to Mihata Beutler amp Boden (2006) anterior

cruciate ligament (ACL) injuries were not uncommon in

30

collegiate sports The most common type of ACL injuries was

non-contact or minimal contact ACL injuries The actions of

cutting jumping sudden deceleration and checking with

another player were the high risk mechanisms for this kind

of ACL injuries Basketball players and soccer players were

found to be often exposing to these damaging forces because

they had to perform these actions repeatedly during practice

and competition

From the result shown by Dick et al (2007) 18 of the

total game injuries in male basketball were ACL injuries and

603 of these ACL injuries were non-contact ACL injuries

This result was supported by Mihata et al (2006) whose result

showed that ACL injuries accounted for 14 of all injuries

in male basketball from 1989 to 2004 For the female basketball

players they had a higher rate of ACL injuries than the male

players It was shown by Mihata et al that the ACL injuries

accounted for 52 of all injuries in female basketball from

1989 to 2004 which was about four times higher than in male

basketball

31

For the soccer players the female soccer players also had

higher rates of ACL injuries than the male soccer players

In between 1989 and 2004 39 of the total injuries in female

soccer were ACL injuries while only 16 of the total injuries

in male soccer were ACL injuries (Mihata et al 2006) The

rate of ACL injuries in female soccer was almost three times

higher than that in male soccer in that period of time A more

serious result was shown by Le Gall et al (2007) In their

result ACL injuries mainly ACL sprains or ruptures

accounted for 156 of all major injuries of the young elite

female soccer players

According to Mihata et al (2006) the reasons for the

female players having higher rates of ACL injuries than the

male players were that they had only participated in such

organized sports for a brief period of time they were less

fit and they received less training Another reason was a

disturbance in the neuromuscular patterns received by the

female players which protected the knee created by

incidental or minimal trauma

32

The rate of ACL injuries could be reduced effectively

Understanding the biomechanical risk factors and identifying

and changing those risk factors were the necessary steps to

decrease the long-term ACL injury rates (Mihata et al 2006)

Summary

Soccer and basketball are common sports all over the world

and they are generally regarded as kinds of contact sports

as there is direct contact between players Players are

required to have good muscular strength and power in order

to compete with others Collision and contacting with other

players would lead to imbalance and maybe fall which in turn

lead to injury

Knee was found to be one of the most common body sites

susceptible to injuries in basketball and soccer during both

practice and competition Different types of knee injuries

were sustained by the players such as contusion laceration

sprain ligament tear meniscus lesion and torn cartilage

According to Ingram et al (2008) 168 of all knee injuries

33

were surgery-requiring injuries Examples of these major

knee injuries were complete ligament tears torn cartilage

incomplete ligament tears and fractures

Female players no matter they were soccer players or

basketball players would have a higher chance of injuring

their knee especially the ACL than their male counterparts

It might due to both intrinsic factors such as muscular

strength and endurance and hormonal differences and

extrinsic factors such as game environment and sports

facilities

However knee injuries could be prevented Preventive

measures for knee injuries included lower-extremity landing

skills plyometrics (Le Gall et al 2007) neuromuscular

training programs added supervision (Dick et al 2007)

muscle strengthening and movement training (Ingram et al

2008)

34

Chapter 3

METHOD

The method of this study was divided into the following

sections 1) Participants 2) Development of questionnaire

3) Pilot study 4) Procedures and 5) Data analysis

Participants

The participants were both male and female local members

of university basketball or soccer team in Hong Kong in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team The total number of subjects was 197 with

48 male members of university basketball team 51 female

members of university basketball team 56 male members of

university soccer team and 42 female members of university

soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 19: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

19

2 The period of data collection was delimited to March 2012

3 Cases of knee injury were delimited to the reported cases

of knee injury that occurred in either training or

competition in the past one year

Limitations

The following were the limitations that must be considered

when analyzing the results of this study

1 The content of the questionnaire might not provide enough

detailed information for analysis as it was self-designed

2 The questionnaire was not valid and reliable enough as it

was self-designed

3 It was assumed that the participants could correctly

identify the types of knee injuries that they suffered

4 It was assumed that the participants would honestly and

cautiously answer the questionnaire

20

Significance of Study

This study provided information about the pattern of knee

injuries of the local members of the university basketball

and soccer team in Hong Kong It also provided comparisons

of both the rate of knee injuries and types of injuries between

the members of university basketball team and that of

university soccer team Besides the relationship between the

gender and the patterns of knee injuries was examined

Understanding the patterns of knee injuries was important

because it was the primary step to prevent the occurrence of

knee injuries This provided much useful information for the

coaches as well as the players on how to reduce the occurrence

of knee injuries If coaches understood the knee injury

patterns of basketball or soccer they could be able to plan

a better and safer training program for the players For the

players if they understood more about the causes of knee

injuries they could focus more on the preventive measures

of knee injuries when they were engaged in the sports

21

Chapter 2

REVIEW OF LITERATURE

Some past literature focusing on the knee injuries in

basketball and soccer was reviewed in this chapter This

review of literature was divided into six sections (1) knee

injuries in basketball (2) knee injuries in soccer (3)

gender difference in the knee injuries in basketball (4)

gender difference in the knee injuries in soccer (5) anterior

cruciate ligament (ACL) injuries in basketball and soccer

and (6) summary

Knee Injuries in Basketball

Borowski Yard Fields amp Comstock (2008) said that

basketball was one of the most popular sports in the United

States Although basketball players could benefit a lot from

basketball activities such as improved self-esteem and

weight control they had an increased risk of injury as they

were participating in a physically demanding activity Dick

Hertel Agel Grossman amp Marshall (2007) defined collegiate

22

menrsquos basketball as ldquoa contact sport in which numerous

anatomical structures are susceptible to both acute and

overuse injuriesrdquo (p194) It was not uncommon for basketball

players to suffer from injuries

According to Borowski et al (2008) the knee was one of

the most commonly injured body parts in basketball practice

and competition For the female basketball players 172 and

195 of the injuries occurred in the knee during practice

and competition respectively Knee injuries in practice and

in competition accounted for 101 and 115 of the total

injuries respectively for in the male basketball

In 2004 Olympic Games there were seven knee injuries in

the basketball games (Junge et al 2006) There were two

ligament ruptures one meniscus lesion one sprain two

contusions and one laceration According to Dick et al

(2007) knee internal derangements and patellar injuries were

the common knee injuries happened during practice and

competition Borowski et al (2008) suggested that muscle or

tendon strains in knee were another common type of knee

23

injuries in basketball Soft tissue injuries were also common

knee injuries in basketball According to Ingram Fields Yard

amp Comstock (2008) torn cartilage injuries were common in both

male and female basketball players and complete ligament

tears were common in female basketball players

Ingram et al (2008) found that the knee injuries in

basketball for both male and female players were non-contact

injuries meaning that there was no contact between players

when the knee injuries happened However Borowski et al

(2008) found that 246 of the knee injuries in the United

States high school basketball were caused by collision with

other player But still there were some non-contact knee

injuries caused by either rotation around a planted foot or

inversion or jumping or landing

24

Knee Injuries in Soccer

According to Yard Schroeder Fields Collins amp Comstock

(2008) ldquosoccer is one of the most popular sports worldwiderdquo

(p1930) It explained why there have been more and more people

both youngsters and adults participating in different soccer

activities nowadays Upon participation in soccer the

players could get a number of benefits such as becoming

physically active increase in productivity and enhancement

in academic performance but there were still risks for

injuries (Yard et al 2008)

Le Gall Carling amp Reilly (2007) conducted a study on the

soccer injuries in young elite females According to the

result among all anatomical sites in the body the lower

extremities were the most common site for injuries in soccer

with 168 of those injuries affecting the knee It was also

supported by the result of the research conducted by Yard et

al (2008) which showed that 187 of the soccer injuries

occurred in the knee

Concerning the types of knee injuries Junge et al (2006)

25

did a research on the injuries in team sport tournaments during

the 2004 Olympic Games and found that there were totally 17

knee injuries in soccer Of these 17 knee injuries 1 was

meniscus lesion 7 were sprain and 9 were contusion Apart

from that ligament tears were common in soccer players too

Ingram et al (2008) showed that incomplete ligament tears

and complete ligament tears were common in male soccer players

and female soccer players respectively A similar result was

obtained by Yard et al (2008) It showed that incomplete knee

ligament sprains were common among both male and female soccer

players but complete knee ligament sprains were only common

in female soccer players Both Ingram et al and Yard et al

suggested that the both the complete and incomplete knee

ligament injuries in the male soccer players were caused by

contact with other players while the incomplete knee ligament

injuries in the female soccer players were not caused by any

contact with others

According to Le Gall et al (2007) serious injuries

usually occurred in the knee and those serious injuries

26

included ligament sprain or rupture meniscus lesion and

patellar tendinitis or bursitis Overuse injuries were also

commonly occurred in the knee Yard et al (2008) suggested

that ldquogirl soccer players sustained a larger proportion of

knee injuriesrdquo (p1932) Darrow Collins Yard amp Comstock

(2009) supported that more female soccer players suffered from

severe knee injuries than male soccer players did

Gender Difference in the Knee Injuries in Basketball

According to Borowski et al (2008) female high school

basketball players in the United States were more likely to

injure their knees during practice and competition than the

male players A similar result was also found in the study

done by Ingram et al (2008) which showed that female high

school basketball players had a higher rate of major knee

injuries than the male players Darrow et al (2009) further

showed that female high school basketball players in the

United States had a higher chance of suffering from severe

knee injuries than the male players

27

The reasons for the difference in the rate of knee injuries

in basketball among the female and male players could be

divided into two categories intrinsic factors and extrinsic

factors Borowski et al (2008) suggested that the intrinsic

factors were mainly physiological differences between boys

and girls Examples for these physiological differences were

anatomical differences in joint and bone structure

differences in flexibility and strength and differences in

hormone secretions Differences in equipment differences in

facilities and differences in competition environment were

the extrinsic factors for the difference in the rate of knee

injury

Ingram et al (2008) mentioned that the likeliness of

female basketball players to sustain major knee injuries in

basketball was due to the vulnerability of their knees It

was associated with various risk factors such as hormonal

difference neuromuscular difference and mechanical

difference These risk factors made the female basketball

players four to six times more susceptible to major knee

28

injuries than the male basketball players

Gender Difference in the Knee Injuries in Soccer

The result of the study conducted by Yard et al (2008)

showed that female soccer players sustained a higher rate of

knee injuries than the male soccer players Le Gall et al

(2007) suggested that the reasons for the higher rate in knee

injuries for the female soccer players included weaker

technical and tactical ability poorer muscular strength and

endurance and weaker coordination The rapid development of

the female soccer game which led to an increased in

aggressiveness of the players was another cause of the higher

knee injury rate

Specifically female soccer players had a higher rate of

sustaining complete knee ligament sprains than the male soccer

players (Yard et al 2008) This was supported by the result

of the research done by Ingram et al (2008) which showed

that complete ligament tears were more common in female soccer

than in male soccer It might due to that fact that there were

29

structural differences and neuromuscular differences between

female and male soccer players Yard et al also found that

the rate of complete knee ligament sprains requiring surgery

in female soccer players was higher than that in male soccer

players Female soccer players were found to be 13 times more

susceptible to knee ligament injuries that required surgery

The reasons for this high rate against male soccer players

included the shoe-surface interaction differences in

anthropometry and increased joint laxity

Ingram et al (2008) also showed that non-contact knee

injuries were more common in female soccer than in male soccer

The reasons for this result were suggested to be that the knee

joint of the female soccer players were more vulnerable to

the stress created by rapid acceleration deceleration and

cutting movement on the grass surfaces

Anterior Cruciate Ligament Injuries in Basketball and Soccer

According to Mihata Beutler amp Boden (2006) anterior

cruciate ligament (ACL) injuries were not uncommon in

30

collegiate sports The most common type of ACL injuries was

non-contact or minimal contact ACL injuries The actions of

cutting jumping sudden deceleration and checking with

another player were the high risk mechanisms for this kind

of ACL injuries Basketball players and soccer players were

found to be often exposing to these damaging forces because

they had to perform these actions repeatedly during practice

and competition

From the result shown by Dick et al (2007) 18 of the

total game injuries in male basketball were ACL injuries and

603 of these ACL injuries were non-contact ACL injuries

This result was supported by Mihata et al (2006) whose result

showed that ACL injuries accounted for 14 of all injuries

in male basketball from 1989 to 2004 For the female basketball

players they had a higher rate of ACL injuries than the male

players It was shown by Mihata et al that the ACL injuries

accounted for 52 of all injuries in female basketball from

1989 to 2004 which was about four times higher than in male

basketball

31

For the soccer players the female soccer players also had

higher rates of ACL injuries than the male soccer players

In between 1989 and 2004 39 of the total injuries in female

soccer were ACL injuries while only 16 of the total injuries

in male soccer were ACL injuries (Mihata et al 2006) The

rate of ACL injuries in female soccer was almost three times

higher than that in male soccer in that period of time A more

serious result was shown by Le Gall et al (2007) In their

result ACL injuries mainly ACL sprains or ruptures

accounted for 156 of all major injuries of the young elite

female soccer players

According to Mihata et al (2006) the reasons for the

female players having higher rates of ACL injuries than the

male players were that they had only participated in such

organized sports for a brief period of time they were less

fit and they received less training Another reason was a

disturbance in the neuromuscular patterns received by the

female players which protected the knee created by

incidental or minimal trauma

32

The rate of ACL injuries could be reduced effectively

Understanding the biomechanical risk factors and identifying

and changing those risk factors were the necessary steps to

decrease the long-term ACL injury rates (Mihata et al 2006)

Summary

Soccer and basketball are common sports all over the world

and they are generally regarded as kinds of contact sports

as there is direct contact between players Players are

required to have good muscular strength and power in order

to compete with others Collision and contacting with other

players would lead to imbalance and maybe fall which in turn

lead to injury

Knee was found to be one of the most common body sites

susceptible to injuries in basketball and soccer during both

practice and competition Different types of knee injuries

were sustained by the players such as contusion laceration

sprain ligament tear meniscus lesion and torn cartilage

According to Ingram et al (2008) 168 of all knee injuries

33

were surgery-requiring injuries Examples of these major

knee injuries were complete ligament tears torn cartilage

incomplete ligament tears and fractures

Female players no matter they were soccer players or

basketball players would have a higher chance of injuring

their knee especially the ACL than their male counterparts

It might due to both intrinsic factors such as muscular

strength and endurance and hormonal differences and

extrinsic factors such as game environment and sports

facilities

However knee injuries could be prevented Preventive

measures for knee injuries included lower-extremity landing

skills plyometrics (Le Gall et al 2007) neuromuscular

training programs added supervision (Dick et al 2007)

muscle strengthening and movement training (Ingram et al

2008)

34

Chapter 3

METHOD

The method of this study was divided into the following

sections 1) Participants 2) Development of questionnaire

3) Pilot study 4) Procedures and 5) Data analysis

Participants

The participants were both male and female local members

of university basketball or soccer team in Hong Kong in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team The total number of subjects was 197 with

48 male members of university basketball team 51 female

members of university basketball team 56 male members of

university soccer team and 42 female members of university

soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 20: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

20

Significance of Study

This study provided information about the pattern of knee

injuries of the local members of the university basketball

and soccer team in Hong Kong It also provided comparisons

of both the rate of knee injuries and types of injuries between

the members of university basketball team and that of

university soccer team Besides the relationship between the

gender and the patterns of knee injuries was examined

Understanding the patterns of knee injuries was important

because it was the primary step to prevent the occurrence of

knee injuries This provided much useful information for the

coaches as well as the players on how to reduce the occurrence

of knee injuries If coaches understood the knee injury

patterns of basketball or soccer they could be able to plan

a better and safer training program for the players For the

players if they understood more about the causes of knee

injuries they could focus more on the preventive measures

of knee injuries when they were engaged in the sports

21

Chapter 2

REVIEW OF LITERATURE

Some past literature focusing on the knee injuries in

basketball and soccer was reviewed in this chapter This

review of literature was divided into six sections (1) knee

injuries in basketball (2) knee injuries in soccer (3)

gender difference in the knee injuries in basketball (4)

gender difference in the knee injuries in soccer (5) anterior

cruciate ligament (ACL) injuries in basketball and soccer

and (6) summary

Knee Injuries in Basketball

Borowski Yard Fields amp Comstock (2008) said that

basketball was one of the most popular sports in the United

States Although basketball players could benefit a lot from

basketball activities such as improved self-esteem and

weight control they had an increased risk of injury as they

were participating in a physically demanding activity Dick

Hertel Agel Grossman amp Marshall (2007) defined collegiate

22

menrsquos basketball as ldquoa contact sport in which numerous

anatomical structures are susceptible to both acute and

overuse injuriesrdquo (p194) It was not uncommon for basketball

players to suffer from injuries

According to Borowski et al (2008) the knee was one of

the most commonly injured body parts in basketball practice

and competition For the female basketball players 172 and

195 of the injuries occurred in the knee during practice

and competition respectively Knee injuries in practice and

in competition accounted for 101 and 115 of the total

injuries respectively for in the male basketball

In 2004 Olympic Games there were seven knee injuries in

the basketball games (Junge et al 2006) There were two

ligament ruptures one meniscus lesion one sprain two

contusions and one laceration According to Dick et al

(2007) knee internal derangements and patellar injuries were

the common knee injuries happened during practice and

competition Borowski et al (2008) suggested that muscle or

tendon strains in knee were another common type of knee

23

injuries in basketball Soft tissue injuries were also common

knee injuries in basketball According to Ingram Fields Yard

amp Comstock (2008) torn cartilage injuries were common in both

male and female basketball players and complete ligament

tears were common in female basketball players

Ingram et al (2008) found that the knee injuries in

basketball for both male and female players were non-contact

injuries meaning that there was no contact between players

when the knee injuries happened However Borowski et al

(2008) found that 246 of the knee injuries in the United

States high school basketball were caused by collision with

other player But still there were some non-contact knee

injuries caused by either rotation around a planted foot or

inversion or jumping or landing

24

Knee Injuries in Soccer

According to Yard Schroeder Fields Collins amp Comstock

(2008) ldquosoccer is one of the most popular sports worldwiderdquo

(p1930) It explained why there have been more and more people

both youngsters and adults participating in different soccer

activities nowadays Upon participation in soccer the

players could get a number of benefits such as becoming

physically active increase in productivity and enhancement

in academic performance but there were still risks for

injuries (Yard et al 2008)

Le Gall Carling amp Reilly (2007) conducted a study on the

soccer injuries in young elite females According to the

result among all anatomical sites in the body the lower

extremities were the most common site for injuries in soccer

with 168 of those injuries affecting the knee It was also

supported by the result of the research conducted by Yard et

al (2008) which showed that 187 of the soccer injuries

occurred in the knee

Concerning the types of knee injuries Junge et al (2006)

25

did a research on the injuries in team sport tournaments during

the 2004 Olympic Games and found that there were totally 17

knee injuries in soccer Of these 17 knee injuries 1 was

meniscus lesion 7 were sprain and 9 were contusion Apart

from that ligament tears were common in soccer players too

Ingram et al (2008) showed that incomplete ligament tears

and complete ligament tears were common in male soccer players

and female soccer players respectively A similar result was

obtained by Yard et al (2008) It showed that incomplete knee

ligament sprains were common among both male and female soccer

players but complete knee ligament sprains were only common

in female soccer players Both Ingram et al and Yard et al

suggested that the both the complete and incomplete knee

ligament injuries in the male soccer players were caused by

contact with other players while the incomplete knee ligament

injuries in the female soccer players were not caused by any

contact with others

According to Le Gall et al (2007) serious injuries

usually occurred in the knee and those serious injuries

26

included ligament sprain or rupture meniscus lesion and

patellar tendinitis or bursitis Overuse injuries were also

commonly occurred in the knee Yard et al (2008) suggested

that ldquogirl soccer players sustained a larger proportion of

knee injuriesrdquo (p1932) Darrow Collins Yard amp Comstock

(2009) supported that more female soccer players suffered from

severe knee injuries than male soccer players did

Gender Difference in the Knee Injuries in Basketball

According to Borowski et al (2008) female high school

basketball players in the United States were more likely to

injure their knees during practice and competition than the

male players A similar result was also found in the study

done by Ingram et al (2008) which showed that female high

school basketball players had a higher rate of major knee

injuries than the male players Darrow et al (2009) further

showed that female high school basketball players in the

United States had a higher chance of suffering from severe

knee injuries than the male players

27

The reasons for the difference in the rate of knee injuries

in basketball among the female and male players could be

divided into two categories intrinsic factors and extrinsic

factors Borowski et al (2008) suggested that the intrinsic

factors were mainly physiological differences between boys

and girls Examples for these physiological differences were

anatomical differences in joint and bone structure

differences in flexibility and strength and differences in

hormone secretions Differences in equipment differences in

facilities and differences in competition environment were

the extrinsic factors for the difference in the rate of knee

injury

Ingram et al (2008) mentioned that the likeliness of

female basketball players to sustain major knee injuries in

basketball was due to the vulnerability of their knees It

was associated with various risk factors such as hormonal

difference neuromuscular difference and mechanical

difference These risk factors made the female basketball

players four to six times more susceptible to major knee

28

injuries than the male basketball players

Gender Difference in the Knee Injuries in Soccer

The result of the study conducted by Yard et al (2008)

showed that female soccer players sustained a higher rate of

knee injuries than the male soccer players Le Gall et al

(2007) suggested that the reasons for the higher rate in knee

injuries for the female soccer players included weaker

technical and tactical ability poorer muscular strength and

endurance and weaker coordination The rapid development of

the female soccer game which led to an increased in

aggressiveness of the players was another cause of the higher

knee injury rate

Specifically female soccer players had a higher rate of

sustaining complete knee ligament sprains than the male soccer

players (Yard et al 2008) This was supported by the result

of the research done by Ingram et al (2008) which showed

that complete ligament tears were more common in female soccer

than in male soccer It might due to that fact that there were

29

structural differences and neuromuscular differences between

female and male soccer players Yard et al also found that

the rate of complete knee ligament sprains requiring surgery

in female soccer players was higher than that in male soccer

players Female soccer players were found to be 13 times more

susceptible to knee ligament injuries that required surgery

The reasons for this high rate against male soccer players

included the shoe-surface interaction differences in

anthropometry and increased joint laxity

Ingram et al (2008) also showed that non-contact knee

injuries were more common in female soccer than in male soccer

The reasons for this result were suggested to be that the knee

joint of the female soccer players were more vulnerable to

the stress created by rapid acceleration deceleration and

cutting movement on the grass surfaces

Anterior Cruciate Ligament Injuries in Basketball and Soccer

According to Mihata Beutler amp Boden (2006) anterior

cruciate ligament (ACL) injuries were not uncommon in

30

collegiate sports The most common type of ACL injuries was

non-contact or minimal contact ACL injuries The actions of

cutting jumping sudden deceleration and checking with

another player were the high risk mechanisms for this kind

of ACL injuries Basketball players and soccer players were

found to be often exposing to these damaging forces because

they had to perform these actions repeatedly during practice

and competition

From the result shown by Dick et al (2007) 18 of the

total game injuries in male basketball were ACL injuries and

603 of these ACL injuries were non-contact ACL injuries

This result was supported by Mihata et al (2006) whose result

showed that ACL injuries accounted for 14 of all injuries

in male basketball from 1989 to 2004 For the female basketball

players they had a higher rate of ACL injuries than the male

players It was shown by Mihata et al that the ACL injuries

accounted for 52 of all injuries in female basketball from

1989 to 2004 which was about four times higher than in male

basketball

31

For the soccer players the female soccer players also had

higher rates of ACL injuries than the male soccer players

In between 1989 and 2004 39 of the total injuries in female

soccer were ACL injuries while only 16 of the total injuries

in male soccer were ACL injuries (Mihata et al 2006) The

rate of ACL injuries in female soccer was almost three times

higher than that in male soccer in that period of time A more

serious result was shown by Le Gall et al (2007) In their

result ACL injuries mainly ACL sprains or ruptures

accounted for 156 of all major injuries of the young elite

female soccer players

According to Mihata et al (2006) the reasons for the

female players having higher rates of ACL injuries than the

male players were that they had only participated in such

organized sports for a brief period of time they were less

fit and they received less training Another reason was a

disturbance in the neuromuscular patterns received by the

female players which protected the knee created by

incidental or minimal trauma

32

The rate of ACL injuries could be reduced effectively

Understanding the biomechanical risk factors and identifying

and changing those risk factors were the necessary steps to

decrease the long-term ACL injury rates (Mihata et al 2006)

Summary

Soccer and basketball are common sports all over the world

and they are generally regarded as kinds of contact sports

as there is direct contact between players Players are

required to have good muscular strength and power in order

to compete with others Collision and contacting with other

players would lead to imbalance and maybe fall which in turn

lead to injury

Knee was found to be one of the most common body sites

susceptible to injuries in basketball and soccer during both

practice and competition Different types of knee injuries

were sustained by the players such as contusion laceration

sprain ligament tear meniscus lesion and torn cartilage

According to Ingram et al (2008) 168 of all knee injuries

33

were surgery-requiring injuries Examples of these major

knee injuries were complete ligament tears torn cartilage

incomplete ligament tears and fractures

Female players no matter they were soccer players or

basketball players would have a higher chance of injuring

their knee especially the ACL than their male counterparts

It might due to both intrinsic factors such as muscular

strength and endurance and hormonal differences and

extrinsic factors such as game environment and sports

facilities

However knee injuries could be prevented Preventive

measures for knee injuries included lower-extremity landing

skills plyometrics (Le Gall et al 2007) neuromuscular

training programs added supervision (Dick et al 2007)

muscle strengthening and movement training (Ingram et al

2008)

34

Chapter 3

METHOD

The method of this study was divided into the following

sections 1) Participants 2) Development of questionnaire

3) Pilot study 4) Procedures and 5) Data analysis

Participants

The participants were both male and female local members

of university basketball or soccer team in Hong Kong in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team The total number of subjects was 197 with

48 male members of university basketball team 51 female

members of university basketball team 56 male members of

university soccer team and 42 female members of university

soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 21: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

21

Chapter 2

REVIEW OF LITERATURE

Some past literature focusing on the knee injuries in

basketball and soccer was reviewed in this chapter This

review of literature was divided into six sections (1) knee

injuries in basketball (2) knee injuries in soccer (3)

gender difference in the knee injuries in basketball (4)

gender difference in the knee injuries in soccer (5) anterior

cruciate ligament (ACL) injuries in basketball and soccer

and (6) summary

Knee Injuries in Basketball

Borowski Yard Fields amp Comstock (2008) said that

basketball was one of the most popular sports in the United

States Although basketball players could benefit a lot from

basketball activities such as improved self-esteem and

weight control they had an increased risk of injury as they

were participating in a physically demanding activity Dick

Hertel Agel Grossman amp Marshall (2007) defined collegiate

22

menrsquos basketball as ldquoa contact sport in which numerous

anatomical structures are susceptible to both acute and

overuse injuriesrdquo (p194) It was not uncommon for basketball

players to suffer from injuries

According to Borowski et al (2008) the knee was one of

the most commonly injured body parts in basketball practice

and competition For the female basketball players 172 and

195 of the injuries occurred in the knee during practice

and competition respectively Knee injuries in practice and

in competition accounted for 101 and 115 of the total

injuries respectively for in the male basketball

In 2004 Olympic Games there were seven knee injuries in

the basketball games (Junge et al 2006) There were two

ligament ruptures one meniscus lesion one sprain two

contusions and one laceration According to Dick et al

(2007) knee internal derangements and patellar injuries were

the common knee injuries happened during practice and

competition Borowski et al (2008) suggested that muscle or

tendon strains in knee were another common type of knee

23

injuries in basketball Soft tissue injuries were also common

knee injuries in basketball According to Ingram Fields Yard

amp Comstock (2008) torn cartilage injuries were common in both

male and female basketball players and complete ligament

tears were common in female basketball players

Ingram et al (2008) found that the knee injuries in

basketball for both male and female players were non-contact

injuries meaning that there was no contact between players

when the knee injuries happened However Borowski et al

(2008) found that 246 of the knee injuries in the United

States high school basketball were caused by collision with

other player But still there were some non-contact knee

injuries caused by either rotation around a planted foot or

inversion or jumping or landing

24

Knee Injuries in Soccer

According to Yard Schroeder Fields Collins amp Comstock

(2008) ldquosoccer is one of the most popular sports worldwiderdquo

(p1930) It explained why there have been more and more people

both youngsters and adults participating in different soccer

activities nowadays Upon participation in soccer the

players could get a number of benefits such as becoming

physically active increase in productivity and enhancement

in academic performance but there were still risks for

injuries (Yard et al 2008)

Le Gall Carling amp Reilly (2007) conducted a study on the

soccer injuries in young elite females According to the

result among all anatomical sites in the body the lower

extremities were the most common site for injuries in soccer

with 168 of those injuries affecting the knee It was also

supported by the result of the research conducted by Yard et

al (2008) which showed that 187 of the soccer injuries

occurred in the knee

Concerning the types of knee injuries Junge et al (2006)

25

did a research on the injuries in team sport tournaments during

the 2004 Olympic Games and found that there were totally 17

knee injuries in soccer Of these 17 knee injuries 1 was

meniscus lesion 7 were sprain and 9 were contusion Apart

from that ligament tears were common in soccer players too

Ingram et al (2008) showed that incomplete ligament tears

and complete ligament tears were common in male soccer players

and female soccer players respectively A similar result was

obtained by Yard et al (2008) It showed that incomplete knee

ligament sprains were common among both male and female soccer

players but complete knee ligament sprains were only common

in female soccer players Both Ingram et al and Yard et al

suggested that the both the complete and incomplete knee

ligament injuries in the male soccer players were caused by

contact with other players while the incomplete knee ligament

injuries in the female soccer players were not caused by any

contact with others

According to Le Gall et al (2007) serious injuries

usually occurred in the knee and those serious injuries

26

included ligament sprain or rupture meniscus lesion and

patellar tendinitis or bursitis Overuse injuries were also

commonly occurred in the knee Yard et al (2008) suggested

that ldquogirl soccer players sustained a larger proportion of

knee injuriesrdquo (p1932) Darrow Collins Yard amp Comstock

(2009) supported that more female soccer players suffered from

severe knee injuries than male soccer players did

Gender Difference in the Knee Injuries in Basketball

According to Borowski et al (2008) female high school

basketball players in the United States were more likely to

injure their knees during practice and competition than the

male players A similar result was also found in the study

done by Ingram et al (2008) which showed that female high

school basketball players had a higher rate of major knee

injuries than the male players Darrow et al (2009) further

showed that female high school basketball players in the

United States had a higher chance of suffering from severe

knee injuries than the male players

27

The reasons for the difference in the rate of knee injuries

in basketball among the female and male players could be

divided into two categories intrinsic factors and extrinsic

factors Borowski et al (2008) suggested that the intrinsic

factors were mainly physiological differences between boys

and girls Examples for these physiological differences were

anatomical differences in joint and bone structure

differences in flexibility and strength and differences in

hormone secretions Differences in equipment differences in

facilities and differences in competition environment were

the extrinsic factors for the difference in the rate of knee

injury

Ingram et al (2008) mentioned that the likeliness of

female basketball players to sustain major knee injuries in

basketball was due to the vulnerability of their knees It

was associated with various risk factors such as hormonal

difference neuromuscular difference and mechanical

difference These risk factors made the female basketball

players four to six times more susceptible to major knee

28

injuries than the male basketball players

Gender Difference in the Knee Injuries in Soccer

The result of the study conducted by Yard et al (2008)

showed that female soccer players sustained a higher rate of

knee injuries than the male soccer players Le Gall et al

(2007) suggested that the reasons for the higher rate in knee

injuries for the female soccer players included weaker

technical and tactical ability poorer muscular strength and

endurance and weaker coordination The rapid development of

the female soccer game which led to an increased in

aggressiveness of the players was another cause of the higher

knee injury rate

Specifically female soccer players had a higher rate of

sustaining complete knee ligament sprains than the male soccer

players (Yard et al 2008) This was supported by the result

of the research done by Ingram et al (2008) which showed

that complete ligament tears were more common in female soccer

than in male soccer It might due to that fact that there were

29

structural differences and neuromuscular differences between

female and male soccer players Yard et al also found that

the rate of complete knee ligament sprains requiring surgery

in female soccer players was higher than that in male soccer

players Female soccer players were found to be 13 times more

susceptible to knee ligament injuries that required surgery

The reasons for this high rate against male soccer players

included the shoe-surface interaction differences in

anthropometry and increased joint laxity

Ingram et al (2008) also showed that non-contact knee

injuries were more common in female soccer than in male soccer

The reasons for this result were suggested to be that the knee

joint of the female soccer players were more vulnerable to

the stress created by rapid acceleration deceleration and

cutting movement on the grass surfaces

Anterior Cruciate Ligament Injuries in Basketball and Soccer

According to Mihata Beutler amp Boden (2006) anterior

cruciate ligament (ACL) injuries were not uncommon in

30

collegiate sports The most common type of ACL injuries was

non-contact or minimal contact ACL injuries The actions of

cutting jumping sudden deceleration and checking with

another player were the high risk mechanisms for this kind

of ACL injuries Basketball players and soccer players were

found to be often exposing to these damaging forces because

they had to perform these actions repeatedly during practice

and competition

From the result shown by Dick et al (2007) 18 of the

total game injuries in male basketball were ACL injuries and

603 of these ACL injuries were non-contact ACL injuries

This result was supported by Mihata et al (2006) whose result

showed that ACL injuries accounted for 14 of all injuries

in male basketball from 1989 to 2004 For the female basketball

players they had a higher rate of ACL injuries than the male

players It was shown by Mihata et al that the ACL injuries

accounted for 52 of all injuries in female basketball from

1989 to 2004 which was about four times higher than in male

basketball

31

For the soccer players the female soccer players also had

higher rates of ACL injuries than the male soccer players

In between 1989 and 2004 39 of the total injuries in female

soccer were ACL injuries while only 16 of the total injuries

in male soccer were ACL injuries (Mihata et al 2006) The

rate of ACL injuries in female soccer was almost three times

higher than that in male soccer in that period of time A more

serious result was shown by Le Gall et al (2007) In their

result ACL injuries mainly ACL sprains or ruptures

accounted for 156 of all major injuries of the young elite

female soccer players

According to Mihata et al (2006) the reasons for the

female players having higher rates of ACL injuries than the

male players were that they had only participated in such

organized sports for a brief period of time they were less

fit and they received less training Another reason was a

disturbance in the neuromuscular patterns received by the

female players which protected the knee created by

incidental or minimal trauma

32

The rate of ACL injuries could be reduced effectively

Understanding the biomechanical risk factors and identifying

and changing those risk factors were the necessary steps to

decrease the long-term ACL injury rates (Mihata et al 2006)

Summary

Soccer and basketball are common sports all over the world

and they are generally regarded as kinds of contact sports

as there is direct contact between players Players are

required to have good muscular strength and power in order

to compete with others Collision and contacting with other

players would lead to imbalance and maybe fall which in turn

lead to injury

Knee was found to be one of the most common body sites

susceptible to injuries in basketball and soccer during both

practice and competition Different types of knee injuries

were sustained by the players such as contusion laceration

sprain ligament tear meniscus lesion and torn cartilage

According to Ingram et al (2008) 168 of all knee injuries

33

were surgery-requiring injuries Examples of these major

knee injuries were complete ligament tears torn cartilage

incomplete ligament tears and fractures

Female players no matter they were soccer players or

basketball players would have a higher chance of injuring

their knee especially the ACL than their male counterparts

It might due to both intrinsic factors such as muscular

strength and endurance and hormonal differences and

extrinsic factors such as game environment and sports

facilities

However knee injuries could be prevented Preventive

measures for knee injuries included lower-extremity landing

skills plyometrics (Le Gall et al 2007) neuromuscular

training programs added supervision (Dick et al 2007)

muscle strengthening and movement training (Ingram et al

2008)

34

Chapter 3

METHOD

The method of this study was divided into the following

sections 1) Participants 2) Development of questionnaire

3) Pilot study 4) Procedures and 5) Data analysis

Participants

The participants were both male and female local members

of university basketball or soccer team in Hong Kong in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team The total number of subjects was 197 with

48 male members of university basketball team 51 female

members of university basketball team 56 male members of

university soccer team and 42 female members of university

soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 22: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

22

menrsquos basketball as ldquoa contact sport in which numerous

anatomical structures are susceptible to both acute and

overuse injuriesrdquo (p194) It was not uncommon for basketball

players to suffer from injuries

According to Borowski et al (2008) the knee was one of

the most commonly injured body parts in basketball practice

and competition For the female basketball players 172 and

195 of the injuries occurred in the knee during practice

and competition respectively Knee injuries in practice and

in competition accounted for 101 and 115 of the total

injuries respectively for in the male basketball

In 2004 Olympic Games there were seven knee injuries in

the basketball games (Junge et al 2006) There were two

ligament ruptures one meniscus lesion one sprain two

contusions and one laceration According to Dick et al

(2007) knee internal derangements and patellar injuries were

the common knee injuries happened during practice and

competition Borowski et al (2008) suggested that muscle or

tendon strains in knee were another common type of knee

23

injuries in basketball Soft tissue injuries were also common

knee injuries in basketball According to Ingram Fields Yard

amp Comstock (2008) torn cartilage injuries were common in both

male and female basketball players and complete ligament

tears were common in female basketball players

Ingram et al (2008) found that the knee injuries in

basketball for both male and female players were non-contact

injuries meaning that there was no contact between players

when the knee injuries happened However Borowski et al

(2008) found that 246 of the knee injuries in the United

States high school basketball were caused by collision with

other player But still there were some non-contact knee

injuries caused by either rotation around a planted foot or

inversion or jumping or landing

24

Knee Injuries in Soccer

According to Yard Schroeder Fields Collins amp Comstock

(2008) ldquosoccer is one of the most popular sports worldwiderdquo

(p1930) It explained why there have been more and more people

both youngsters and adults participating in different soccer

activities nowadays Upon participation in soccer the

players could get a number of benefits such as becoming

physically active increase in productivity and enhancement

in academic performance but there were still risks for

injuries (Yard et al 2008)

Le Gall Carling amp Reilly (2007) conducted a study on the

soccer injuries in young elite females According to the

result among all anatomical sites in the body the lower

extremities were the most common site for injuries in soccer

with 168 of those injuries affecting the knee It was also

supported by the result of the research conducted by Yard et

al (2008) which showed that 187 of the soccer injuries

occurred in the knee

Concerning the types of knee injuries Junge et al (2006)

25

did a research on the injuries in team sport tournaments during

the 2004 Olympic Games and found that there were totally 17

knee injuries in soccer Of these 17 knee injuries 1 was

meniscus lesion 7 were sprain and 9 were contusion Apart

from that ligament tears were common in soccer players too

Ingram et al (2008) showed that incomplete ligament tears

and complete ligament tears were common in male soccer players

and female soccer players respectively A similar result was

obtained by Yard et al (2008) It showed that incomplete knee

ligament sprains were common among both male and female soccer

players but complete knee ligament sprains were only common

in female soccer players Both Ingram et al and Yard et al

suggested that the both the complete and incomplete knee

ligament injuries in the male soccer players were caused by

contact with other players while the incomplete knee ligament

injuries in the female soccer players were not caused by any

contact with others

According to Le Gall et al (2007) serious injuries

usually occurred in the knee and those serious injuries

26

included ligament sprain or rupture meniscus lesion and

patellar tendinitis or bursitis Overuse injuries were also

commonly occurred in the knee Yard et al (2008) suggested

that ldquogirl soccer players sustained a larger proportion of

knee injuriesrdquo (p1932) Darrow Collins Yard amp Comstock

(2009) supported that more female soccer players suffered from

severe knee injuries than male soccer players did

Gender Difference in the Knee Injuries in Basketball

According to Borowski et al (2008) female high school

basketball players in the United States were more likely to

injure their knees during practice and competition than the

male players A similar result was also found in the study

done by Ingram et al (2008) which showed that female high

school basketball players had a higher rate of major knee

injuries than the male players Darrow et al (2009) further

showed that female high school basketball players in the

United States had a higher chance of suffering from severe

knee injuries than the male players

27

The reasons for the difference in the rate of knee injuries

in basketball among the female and male players could be

divided into two categories intrinsic factors and extrinsic

factors Borowski et al (2008) suggested that the intrinsic

factors were mainly physiological differences between boys

and girls Examples for these physiological differences were

anatomical differences in joint and bone structure

differences in flexibility and strength and differences in

hormone secretions Differences in equipment differences in

facilities and differences in competition environment were

the extrinsic factors for the difference in the rate of knee

injury

Ingram et al (2008) mentioned that the likeliness of

female basketball players to sustain major knee injuries in

basketball was due to the vulnerability of their knees It

was associated with various risk factors such as hormonal

difference neuromuscular difference and mechanical

difference These risk factors made the female basketball

players four to six times more susceptible to major knee

28

injuries than the male basketball players

Gender Difference in the Knee Injuries in Soccer

The result of the study conducted by Yard et al (2008)

showed that female soccer players sustained a higher rate of

knee injuries than the male soccer players Le Gall et al

(2007) suggested that the reasons for the higher rate in knee

injuries for the female soccer players included weaker

technical and tactical ability poorer muscular strength and

endurance and weaker coordination The rapid development of

the female soccer game which led to an increased in

aggressiveness of the players was another cause of the higher

knee injury rate

Specifically female soccer players had a higher rate of

sustaining complete knee ligament sprains than the male soccer

players (Yard et al 2008) This was supported by the result

of the research done by Ingram et al (2008) which showed

that complete ligament tears were more common in female soccer

than in male soccer It might due to that fact that there were

29

structural differences and neuromuscular differences between

female and male soccer players Yard et al also found that

the rate of complete knee ligament sprains requiring surgery

in female soccer players was higher than that in male soccer

players Female soccer players were found to be 13 times more

susceptible to knee ligament injuries that required surgery

The reasons for this high rate against male soccer players

included the shoe-surface interaction differences in

anthropometry and increased joint laxity

Ingram et al (2008) also showed that non-contact knee

injuries were more common in female soccer than in male soccer

The reasons for this result were suggested to be that the knee

joint of the female soccer players were more vulnerable to

the stress created by rapid acceleration deceleration and

cutting movement on the grass surfaces

Anterior Cruciate Ligament Injuries in Basketball and Soccer

According to Mihata Beutler amp Boden (2006) anterior

cruciate ligament (ACL) injuries were not uncommon in

30

collegiate sports The most common type of ACL injuries was

non-contact or minimal contact ACL injuries The actions of

cutting jumping sudden deceleration and checking with

another player were the high risk mechanisms for this kind

of ACL injuries Basketball players and soccer players were

found to be often exposing to these damaging forces because

they had to perform these actions repeatedly during practice

and competition

From the result shown by Dick et al (2007) 18 of the

total game injuries in male basketball were ACL injuries and

603 of these ACL injuries were non-contact ACL injuries

This result was supported by Mihata et al (2006) whose result

showed that ACL injuries accounted for 14 of all injuries

in male basketball from 1989 to 2004 For the female basketball

players they had a higher rate of ACL injuries than the male

players It was shown by Mihata et al that the ACL injuries

accounted for 52 of all injuries in female basketball from

1989 to 2004 which was about four times higher than in male

basketball

31

For the soccer players the female soccer players also had

higher rates of ACL injuries than the male soccer players

In between 1989 and 2004 39 of the total injuries in female

soccer were ACL injuries while only 16 of the total injuries

in male soccer were ACL injuries (Mihata et al 2006) The

rate of ACL injuries in female soccer was almost three times

higher than that in male soccer in that period of time A more

serious result was shown by Le Gall et al (2007) In their

result ACL injuries mainly ACL sprains or ruptures

accounted for 156 of all major injuries of the young elite

female soccer players

According to Mihata et al (2006) the reasons for the

female players having higher rates of ACL injuries than the

male players were that they had only participated in such

organized sports for a brief period of time they were less

fit and they received less training Another reason was a

disturbance in the neuromuscular patterns received by the

female players which protected the knee created by

incidental or minimal trauma

32

The rate of ACL injuries could be reduced effectively

Understanding the biomechanical risk factors and identifying

and changing those risk factors were the necessary steps to

decrease the long-term ACL injury rates (Mihata et al 2006)

Summary

Soccer and basketball are common sports all over the world

and they are generally regarded as kinds of contact sports

as there is direct contact between players Players are

required to have good muscular strength and power in order

to compete with others Collision and contacting with other

players would lead to imbalance and maybe fall which in turn

lead to injury

Knee was found to be one of the most common body sites

susceptible to injuries in basketball and soccer during both

practice and competition Different types of knee injuries

were sustained by the players such as contusion laceration

sprain ligament tear meniscus lesion and torn cartilage

According to Ingram et al (2008) 168 of all knee injuries

33

were surgery-requiring injuries Examples of these major

knee injuries were complete ligament tears torn cartilage

incomplete ligament tears and fractures

Female players no matter they were soccer players or

basketball players would have a higher chance of injuring

their knee especially the ACL than their male counterparts

It might due to both intrinsic factors such as muscular

strength and endurance and hormonal differences and

extrinsic factors such as game environment and sports

facilities

However knee injuries could be prevented Preventive

measures for knee injuries included lower-extremity landing

skills plyometrics (Le Gall et al 2007) neuromuscular

training programs added supervision (Dick et al 2007)

muscle strengthening and movement training (Ingram et al

2008)

34

Chapter 3

METHOD

The method of this study was divided into the following

sections 1) Participants 2) Development of questionnaire

3) Pilot study 4) Procedures and 5) Data analysis

Participants

The participants were both male and female local members

of university basketball or soccer team in Hong Kong in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team The total number of subjects was 197 with

48 male members of university basketball team 51 female

members of university basketball team 56 male members of

university soccer team and 42 female members of university

soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

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Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

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The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 23: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

23

injuries in basketball Soft tissue injuries were also common

knee injuries in basketball According to Ingram Fields Yard

amp Comstock (2008) torn cartilage injuries were common in both

male and female basketball players and complete ligament

tears were common in female basketball players

Ingram et al (2008) found that the knee injuries in

basketball for both male and female players were non-contact

injuries meaning that there was no contact between players

when the knee injuries happened However Borowski et al

(2008) found that 246 of the knee injuries in the United

States high school basketball were caused by collision with

other player But still there were some non-contact knee

injuries caused by either rotation around a planted foot or

inversion or jumping or landing

24

Knee Injuries in Soccer

According to Yard Schroeder Fields Collins amp Comstock

(2008) ldquosoccer is one of the most popular sports worldwiderdquo

(p1930) It explained why there have been more and more people

both youngsters and adults participating in different soccer

activities nowadays Upon participation in soccer the

players could get a number of benefits such as becoming

physically active increase in productivity and enhancement

in academic performance but there were still risks for

injuries (Yard et al 2008)

Le Gall Carling amp Reilly (2007) conducted a study on the

soccer injuries in young elite females According to the

result among all anatomical sites in the body the lower

extremities were the most common site for injuries in soccer

with 168 of those injuries affecting the knee It was also

supported by the result of the research conducted by Yard et

al (2008) which showed that 187 of the soccer injuries

occurred in the knee

Concerning the types of knee injuries Junge et al (2006)

25

did a research on the injuries in team sport tournaments during

the 2004 Olympic Games and found that there were totally 17

knee injuries in soccer Of these 17 knee injuries 1 was

meniscus lesion 7 were sprain and 9 were contusion Apart

from that ligament tears were common in soccer players too

Ingram et al (2008) showed that incomplete ligament tears

and complete ligament tears were common in male soccer players

and female soccer players respectively A similar result was

obtained by Yard et al (2008) It showed that incomplete knee

ligament sprains were common among both male and female soccer

players but complete knee ligament sprains were only common

in female soccer players Both Ingram et al and Yard et al

suggested that the both the complete and incomplete knee

ligament injuries in the male soccer players were caused by

contact with other players while the incomplete knee ligament

injuries in the female soccer players were not caused by any

contact with others

According to Le Gall et al (2007) serious injuries

usually occurred in the knee and those serious injuries

26

included ligament sprain or rupture meniscus lesion and

patellar tendinitis or bursitis Overuse injuries were also

commonly occurred in the knee Yard et al (2008) suggested

that ldquogirl soccer players sustained a larger proportion of

knee injuriesrdquo (p1932) Darrow Collins Yard amp Comstock

(2009) supported that more female soccer players suffered from

severe knee injuries than male soccer players did

Gender Difference in the Knee Injuries in Basketball

According to Borowski et al (2008) female high school

basketball players in the United States were more likely to

injure their knees during practice and competition than the

male players A similar result was also found in the study

done by Ingram et al (2008) which showed that female high

school basketball players had a higher rate of major knee

injuries than the male players Darrow et al (2009) further

showed that female high school basketball players in the

United States had a higher chance of suffering from severe

knee injuries than the male players

27

The reasons for the difference in the rate of knee injuries

in basketball among the female and male players could be

divided into two categories intrinsic factors and extrinsic

factors Borowski et al (2008) suggested that the intrinsic

factors were mainly physiological differences between boys

and girls Examples for these physiological differences were

anatomical differences in joint and bone structure

differences in flexibility and strength and differences in

hormone secretions Differences in equipment differences in

facilities and differences in competition environment were

the extrinsic factors for the difference in the rate of knee

injury

Ingram et al (2008) mentioned that the likeliness of

female basketball players to sustain major knee injuries in

basketball was due to the vulnerability of their knees It

was associated with various risk factors such as hormonal

difference neuromuscular difference and mechanical

difference These risk factors made the female basketball

players four to six times more susceptible to major knee

28

injuries than the male basketball players

Gender Difference in the Knee Injuries in Soccer

The result of the study conducted by Yard et al (2008)

showed that female soccer players sustained a higher rate of

knee injuries than the male soccer players Le Gall et al

(2007) suggested that the reasons for the higher rate in knee

injuries for the female soccer players included weaker

technical and tactical ability poorer muscular strength and

endurance and weaker coordination The rapid development of

the female soccer game which led to an increased in

aggressiveness of the players was another cause of the higher

knee injury rate

Specifically female soccer players had a higher rate of

sustaining complete knee ligament sprains than the male soccer

players (Yard et al 2008) This was supported by the result

of the research done by Ingram et al (2008) which showed

that complete ligament tears were more common in female soccer

than in male soccer It might due to that fact that there were

29

structural differences and neuromuscular differences between

female and male soccer players Yard et al also found that

the rate of complete knee ligament sprains requiring surgery

in female soccer players was higher than that in male soccer

players Female soccer players were found to be 13 times more

susceptible to knee ligament injuries that required surgery

The reasons for this high rate against male soccer players

included the shoe-surface interaction differences in

anthropometry and increased joint laxity

Ingram et al (2008) also showed that non-contact knee

injuries were more common in female soccer than in male soccer

The reasons for this result were suggested to be that the knee

joint of the female soccer players were more vulnerable to

the stress created by rapid acceleration deceleration and

cutting movement on the grass surfaces

Anterior Cruciate Ligament Injuries in Basketball and Soccer

According to Mihata Beutler amp Boden (2006) anterior

cruciate ligament (ACL) injuries were not uncommon in

30

collegiate sports The most common type of ACL injuries was

non-contact or minimal contact ACL injuries The actions of

cutting jumping sudden deceleration and checking with

another player were the high risk mechanisms for this kind

of ACL injuries Basketball players and soccer players were

found to be often exposing to these damaging forces because

they had to perform these actions repeatedly during practice

and competition

From the result shown by Dick et al (2007) 18 of the

total game injuries in male basketball were ACL injuries and

603 of these ACL injuries were non-contact ACL injuries

This result was supported by Mihata et al (2006) whose result

showed that ACL injuries accounted for 14 of all injuries

in male basketball from 1989 to 2004 For the female basketball

players they had a higher rate of ACL injuries than the male

players It was shown by Mihata et al that the ACL injuries

accounted for 52 of all injuries in female basketball from

1989 to 2004 which was about four times higher than in male

basketball

31

For the soccer players the female soccer players also had

higher rates of ACL injuries than the male soccer players

In between 1989 and 2004 39 of the total injuries in female

soccer were ACL injuries while only 16 of the total injuries

in male soccer were ACL injuries (Mihata et al 2006) The

rate of ACL injuries in female soccer was almost three times

higher than that in male soccer in that period of time A more

serious result was shown by Le Gall et al (2007) In their

result ACL injuries mainly ACL sprains or ruptures

accounted for 156 of all major injuries of the young elite

female soccer players

According to Mihata et al (2006) the reasons for the

female players having higher rates of ACL injuries than the

male players were that they had only participated in such

organized sports for a brief period of time they were less

fit and they received less training Another reason was a

disturbance in the neuromuscular patterns received by the

female players which protected the knee created by

incidental or minimal trauma

32

The rate of ACL injuries could be reduced effectively

Understanding the biomechanical risk factors and identifying

and changing those risk factors were the necessary steps to

decrease the long-term ACL injury rates (Mihata et al 2006)

Summary

Soccer and basketball are common sports all over the world

and they are generally regarded as kinds of contact sports

as there is direct contact between players Players are

required to have good muscular strength and power in order

to compete with others Collision and contacting with other

players would lead to imbalance and maybe fall which in turn

lead to injury

Knee was found to be one of the most common body sites

susceptible to injuries in basketball and soccer during both

practice and competition Different types of knee injuries

were sustained by the players such as contusion laceration

sprain ligament tear meniscus lesion and torn cartilage

According to Ingram et al (2008) 168 of all knee injuries

33

were surgery-requiring injuries Examples of these major

knee injuries were complete ligament tears torn cartilage

incomplete ligament tears and fractures

Female players no matter they were soccer players or

basketball players would have a higher chance of injuring

their knee especially the ACL than their male counterparts

It might due to both intrinsic factors such as muscular

strength and endurance and hormonal differences and

extrinsic factors such as game environment and sports

facilities

However knee injuries could be prevented Preventive

measures for knee injuries included lower-extremity landing

skills plyometrics (Le Gall et al 2007) neuromuscular

training programs added supervision (Dick et al 2007)

muscle strengthening and movement training (Ingram et al

2008)

34

Chapter 3

METHOD

The method of this study was divided into the following

sections 1) Participants 2) Development of questionnaire

3) Pilot study 4) Procedures and 5) Data analysis

Participants

The participants were both male and female local members

of university basketball or soccer team in Hong Kong in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team The total number of subjects was 197 with

48 male members of university basketball team 51 female

members of university basketball team 56 male members of

university soccer team and 42 female members of university

soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

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Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

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Borowski L A Yard E E Fields S K amp Comstock R

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Cailliet R (1992) Knee pain and disability (3rd ed)

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Darrow C J Collins C L Yard E E amp Comstock R

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Dick R Hertel J Agel J Grossman J amp Marshall S

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Griffith H W (1986) Complete guide to sports injuries

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Harris H amp Varney M (1977) The treatment of football

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Ingram J G Fields S K Yard E E amp Comstock R D

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amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 24: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

24

Knee Injuries in Soccer

According to Yard Schroeder Fields Collins amp Comstock

(2008) ldquosoccer is one of the most popular sports worldwiderdquo

(p1930) It explained why there have been more and more people

both youngsters and adults participating in different soccer

activities nowadays Upon participation in soccer the

players could get a number of benefits such as becoming

physically active increase in productivity and enhancement

in academic performance but there were still risks for

injuries (Yard et al 2008)

Le Gall Carling amp Reilly (2007) conducted a study on the

soccer injuries in young elite females According to the

result among all anatomical sites in the body the lower

extremities were the most common site for injuries in soccer

with 168 of those injuries affecting the knee It was also

supported by the result of the research conducted by Yard et

al (2008) which showed that 187 of the soccer injuries

occurred in the knee

Concerning the types of knee injuries Junge et al (2006)

25

did a research on the injuries in team sport tournaments during

the 2004 Olympic Games and found that there were totally 17

knee injuries in soccer Of these 17 knee injuries 1 was

meniscus lesion 7 were sprain and 9 were contusion Apart

from that ligament tears were common in soccer players too

Ingram et al (2008) showed that incomplete ligament tears

and complete ligament tears were common in male soccer players

and female soccer players respectively A similar result was

obtained by Yard et al (2008) It showed that incomplete knee

ligament sprains were common among both male and female soccer

players but complete knee ligament sprains were only common

in female soccer players Both Ingram et al and Yard et al

suggested that the both the complete and incomplete knee

ligament injuries in the male soccer players were caused by

contact with other players while the incomplete knee ligament

injuries in the female soccer players were not caused by any

contact with others

According to Le Gall et al (2007) serious injuries

usually occurred in the knee and those serious injuries

26

included ligament sprain or rupture meniscus lesion and

patellar tendinitis or bursitis Overuse injuries were also

commonly occurred in the knee Yard et al (2008) suggested

that ldquogirl soccer players sustained a larger proportion of

knee injuriesrdquo (p1932) Darrow Collins Yard amp Comstock

(2009) supported that more female soccer players suffered from

severe knee injuries than male soccer players did

Gender Difference in the Knee Injuries in Basketball

According to Borowski et al (2008) female high school

basketball players in the United States were more likely to

injure their knees during practice and competition than the

male players A similar result was also found in the study

done by Ingram et al (2008) which showed that female high

school basketball players had a higher rate of major knee

injuries than the male players Darrow et al (2009) further

showed that female high school basketball players in the

United States had a higher chance of suffering from severe

knee injuries than the male players

27

The reasons for the difference in the rate of knee injuries

in basketball among the female and male players could be

divided into two categories intrinsic factors and extrinsic

factors Borowski et al (2008) suggested that the intrinsic

factors were mainly physiological differences between boys

and girls Examples for these physiological differences were

anatomical differences in joint and bone structure

differences in flexibility and strength and differences in

hormone secretions Differences in equipment differences in

facilities and differences in competition environment were

the extrinsic factors for the difference in the rate of knee

injury

Ingram et al (2008) mentioned that the likeliness of

female basketball players to sustain major knee injuries in

basketball was due to the vulnerability of their knees It

was associated with various risk factors such as hormonal

difference neuromuscular difference and mechanical

difference These risk factors made the female basketball

players four to six times more susceptible to major knee

28

injuries than the male basketball players

Gender Difference in the Knee Injuries in Soccer

The result of the study conducted by Yard et al (2008)

showed that female soccer players sustained a higher rate of

knee injuries than the male soccer players Le Gall et al

(2007) suggested that the reasons for the higher rate in knee

injuries for the female soccer players included weaker

technical and tactical ability poorer muscular strength and

endurance and weaker coordination The rapid development of

the female soccer game which led to an increased in

aggressiveness of the players was another cause of the higher

knee injury rate

Specifically female soccer players had a higher rate of

sustaining complete knee ligament sprains than the male soccer

players (Yard et al 2008) This was supported by the result

of the research done by Ingram et al (2008) which showed

that complete ligament tears were more common in female soccer

than in male soccer It might due to that fact that there were

29

structural differences and neuromuscular differences between

female and male soccer players Yard et al also found that

the rate of complete knee ligament sprains requiring surgery

in female soccer players was higher than that in male soccer

players Female soccer players were found to be 13 times more

susceptible to knee ligament injuries that required surgery

The reasons for this high rate against male soccer players

included the shoe-surface interaction differences in

anthropometry and increased joint laxity

Ingram et al (2008) also showed that non-contact knee

injuries were more common in female soccer than in male soccer

The reasons for this result were suggested to be that the knee

joint of the female soccer players were more vulnerable to

the stress created by rapid acceleration deceleration and

cutting movement on the grass surfaces

Anterior Cruciate Ligament Injuries in Basketball and Soccer

According to Mihata Beutler amp Boden (2006) anterior

cruciate ligament (ACL) injuries were not uncommon in

30

collegiate sports The most common type of ACL injuries was

non-contact or minimal contact ACL injuries The actions of

cutting jumping sudden deceleration and checking with

another player were the high risk mechanisms for this kind

of ACL injuries Basketball players and soccer players were

found to be often exposing to these damaging forces because

they had to perform these actions repeatedly during practice

and competition

From the result shown by Dick et al (2007) 18 of the

total game injuries in male basketball were ACL injuries and

603 of these ACL injuries were non-contact ACL injuries

This result was supported by Mihata et al (2006) whose result

showed that ACL injuries accounted for 14 of all injuries

in male basketball from 1989 to 2004 For the female basketball

players they had a higher rate of ACL injuries than the male

players It was shown by Mihata et al that the ACL injuries

accounted for 52 of all injuries in female basketball from

1989 to 2004 which was about four times higher than in male

basketball

31

For the soccer players the female soccer players also had

higher rates of ACL injuries than the male soccer players

In between 1989 and 2004 39 of the total injuries in female

soccer were ACL injuries while only 16 of the total injuries

in male soccer were ACL injuries (Mihata et al 2006) The

rate of ACL injuries in female soccer was almost three times

higher than that in male soccer in that period of time A more

serious result was shown by Le Gall et al (2007) In their

result ACL injuries mainly ACL sprains or ruptures

accounted for 156 of all major injuries of the young elite

female soccer players

According to Mihata et al (2006) the reasons for the

female players having higher rates of ACL injuries than the

male players were that they had only participated in such

organized sports for a brief period of time they were less

fit and they received less training Another reason was a

disturbance in the neuromuscular patterns received by the

female players which protected the knee created by

incidental or minimal trauma

32

The rate of ACL injuries could be reduced effectively

Understanding the biomechanical risk factors and identifying

and changing those risk factors were the necessary steps to

decrease the long-term ACL injury rates (Mihata et al 2006)

Summary

Soccer and basketball are common sports all over the world

and they are generally regarded as kinds of contact sports

as there is direct contact between players Players are

required to have good muscular strength and power in order

to compete with others Collision and contacting with other

players would lead to imbalance and maybe fall which in turn

lead to injury

Knee was found to be one of the most common body sites

susceptible to injuries in basketball and soccer during both

practice and competition Different types of knee injuries

were sustained by the players such as contusion laceration

sprain ligament tear meniscus lesion and torn cartilage

According to Ingram et al (2008) 168 of all knee injuries

33

were surgery-requiring injuries Examples of these major

knee injuries were complete ligament tears torn cartilage

incomplete ligament tears and fractures

Female players no matter they were soccer players or

basketball players would have a higher chance of injuring

their knee especially the ACL than their male counterparts

It might due to both intrinsic factors such as muscular

strength and endurance and hormonal differences and

extrinsic factors such as game environment and sports

facilities

However knee injuries could be prevented Preventive

measures for knee injuries included lower-extremity landing

skills plyometrics (Le Gall et al 2007) neuromuscular

training programs added supervision (Dick et al 2007)

muscle strengthening and movement training (Ingram et al

2008)

34

Chapter 3

METHOD

The method of this study was divided into the following

sections 1) Participants 2) Development of questionnaire

3) Pilot study 4) Procedures and 5) Data analysis

Participants

The participants were both male and female local members

of university basketball or soccer team in Hong Kong in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team The total number of subjects was 197 with

48 male members of university basketball team 51 female

members of university basketball team 56 male members of

university soccer team and 42 female members of university

soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

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Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 25: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

25

did a research on the injuries in team sport tournaments during

the 2004 Olympic Games and found that there were totally 17

knee injuries in soccer Of these 17 knee injuries 1 was

meniscus lesion 7 were sprain and 9 were contusion Apart

from that ligament tears were common in soccer players too

Ingram et al (2008) showed that incomplete ligament tears

and complete ligament tears were common in male soccer players

and female soccer players respectively A similar result was

obtained by Yard et al (2008) It showed that incomplete knee

ligament sprains were common among both male and female soccer

players but complete knee ligament sprains were only common

in female soccer players Both Ingram et al and Yard et al

suggested that the both the complete and incomplete knee

ligament injuries in the male soccer players were caused by

contact with other players while the incomplete knee ligament

injuries in the female soccer players were not caused by any

contact with others

According to Le Gall et al (2007) serious injuries

usually occurred in the knee and those serious injuries

26

included ligament sprain or rupture meniscus lesion and

patellar tendinitis or bursitis Overuse injuries were also

commonly occurred in the knee Yard et al (2008) suggested

that ldquogirl soccer players sustained a larger proportion of

knee injuriesrdquo (p1932) Darrow Collins Yard amp Comstock

(2009) supported that more female soccer players suffered from

severe knee injuries than male soccer players did

Gender Difference in the Knee Injuries in Basketball

According to Borowski et al (2008) female high school

basketball players in the United States were more likely to

injure their knees during practice and competition than the

male players A similar result was also found in the study

done by Ingram et al (2008) which showed that female high

school basketball players had a higher rate of major knee

injuries than the male players Darrow et al (2009) further

showed that female high school basketball players in the

United States had a higher chance of suffering from severe

knee injuries than the male players

27

The reasons for the difference in the rate of knee injuries

in basketball among the female and male players could be

divided into two categories intrinsic factors and extrinsic

factors Borowski et al (2008) suggested that the intrinsic

factors were mainly physiological differences between boys

and girls Examples for these physiological differences were

anatomical differences in joint and bone structure

differences in flexibility and strength and differences in

hormone secretions Differences in equipment differences in

facilities and differences in competition environment were

the extrinsic factors for the difference in the rate of knee

injury

Ingram et al (2008) mentioned that the likeliness of

female basketball players to sustain major knee injuries in

basketball was due to the vulnerability of their knees It

was associated with various risk factors such as hormonal

difference neuromuscular difference and mechanical

difference These risk factors made the female basketball

players four to six times more susceptible to major knee

28

injuries than the male basketball players

Gender Difference in the Knee Injuries in Soccer

The result of the study conducted by Yard et al (2008)

showed that female soccer players sustained a higher rate of

knee injuries than the male soccer players Le Gall et al

(2007) suggested that the reasons for the higher rate in knee

injuries for the female soccer players included weaker

technical and tactical ability poorer muscular strength and

endurance and weaker coordination The rapid development of

the female soccer game which led to an increased in

aggressiveness of the players was another cause of the higher

knee injury rate

Specifically female soccer players had a higher rate of

sustaining complete knee ligament sprains than the male soccer

players (Yard et al 2008) This was supported by the result

of the research done by Ingram et al (2008) which showed

that complete ligament tears were more common in female soccer

than in male soccer It might due to that fact that there were

29

structural differences and neuromuscular differences between

female and male soccer players Yard et al also found that

the rate of complete knee ligament sprains requiring surgery

in female soccer players was higher than that in male soccer

players Female soccer players were found to be 13 times more

susceptible to knee ligament injuries that required surgery

The reasons for this high rate against male soccer players

included the shoe-surface interaction differences in

anthropometry and increased joint laxity

Ingram et al (2008) also showed that non-contact knee

injuries were more common in female soccer than in male soccer

The reasons for this result were suggested to be that the knee

joint of the female soccer players were more vulnerable to

the stress created by rapid acceleration deceleration and

cutting movement on the grass surfaces

Anterior Cruciate Ligament Injuries in Basketball and Soccer

According to Mihata Beutler amp Boden (2006) anterior

cruciate ligament (ACL) injuries were not uncommon in

30

collegiate sports The most common type of ACL injuries was

non-contact or minimal contact ACL injuries The actions of

cutting jumping sudden deceleration and checking with

another player were the high risk mechanisms for this kind

of ACL injuries Basketball players and soccer players were

found to be often exposing to these damaging forces because

they had to perform these actions repeatedly during practice

and competition

From the result shown by Dick et al (2007) 18 of the

total game injuries in male basketball were ACL injuries and

603 of these ACL injuries were non-contact ACL injuries

This result was supported by Mihata et al (2006) whose result

showed that ACL injuries accounted for 14 of all injuries

in male basketball from 1989 to 2004 For the female basketball

players they had a higher rate of ACL injuries than the male

players It was shown by Mihata et al that the ACL injuries

accounted for 52 of all injuries in female basketball from

1989 to 2004 which was about four times higher than in male

basketball

31

For the soccer players the female soccer players also had

higher rates of ACL injuries than the male soccer players

In between 1989 and 2004 39 of the total injuries in female

soccer were ACL injuries while only 16 of the total injuries

in male soccer were ACL injuries (Mihata et al 2006) The

rate of ACL injuries in female soccer was almost three times

higher than that in male soccer in that period of time A more

serious result was shown by Le Gall et al (2007) In their

result ACL injuries mainly ACL sprains or ruptures

accounted for 156 of all major injuries of the young elite

female soccer players

According to Mihata et al (2006) the reasons for the

female players having higher rates of ACL injuries than the

male players were that they had only participated in such

organized sports for a brief period of time they were less

fit and they received less training Another reason was a

disturbance in the neuromuscular patterns received by the

female players which protected the knee created by

incidental or minimal trauma

32

The rate of ACL injuries could be reduced effectively

Understanding the biomechanical risk factors and identifying

and changing those risk factors were the necessary steps to

decrease the long-term ACL injury rates (Mihata et al 2006)

Summary

Soccer and basketball are common sports all over the world

and they are generally regarded as kinds of contact sports

as there is direct contact between players Players are

required to have good muscular strength and power in order

to compete with others Collision and contacting with other

players would lead to imbalance and maybe fall which in turn

lead to injury

Knee was found to be one of the most common body sites

susceptible to injuries in basketball and soccer during both

practice and competition Different types of knee injuries

were sustained by the players such as contusion laceration

sprain ligament tear meniscus lesion and torn cartilage

According to Ingram et al (2008) 168 of all knee injuries

33

were surgery-requiring injuries Examples of these major

knee injuries were complete ligament tears torn cartilage

incomplete ligament tears and fractures

Female players no matter they were soccer players or

basketball players would have a higher chance of injuring

their knee especially the ACL than their male counterparts

It might due to both intrinsic factors such as muscular

strength and endurance and hormonal differences and

extrinsic factors such as game environment and sports

facilities

However knee injuries could be prevented Preventive

measures for knee injuries included lower-extremity landing

skills plyometrics (Le Gall et al 2007) neuromuscular

training programs added supervision (Dick et al 2007)

muscle strengthening and movement training (Ingram et al

2008)

34

Chapter 3

METHOD

The method of this study was divided into the following

sections 1) Participants 2) Development of questionnaire

3) Pilot study 4) Procedures and 5) Data analysis

Participants

The participants were both male and female local members

of university basketball or soccer team in Hong Kong in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team The total number of subjects was 197 with

48 male members of university basketball team 51 female

members of university basketball team 56 male members of

university soccer team and 42 female members of university

soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

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Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 26: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

26

included ligament sprain or rupture meniscus lesion and

patellar tendinitis or bursitis Overuse injuries were also

commonly occurred in the knee Yard et al (2008) suggested

that ldquogirl soccer players sustained a larger proportion of

knee injuriesrdquo (p1932) Darrow Collins Yard amp Comstock

(2009) supported that more female soccer players suffered from

severe knee injuries than male soccer players did

Gender Difference in the Knee Injuries in Basketball

According to Borowski et al (2008) female high school

basketball players in the United States were more likely to

injure their knees during practice and competition than the

male players A similar result was also found in the study

done by Ingram et al (2008) which showed that female high

school basketball players had a higher rate of major knee

injuries than the male players Darrow et al (2009) further

showed that female high school basketball players in the

United States had a higher chance of suffering from severe

knee injuries than the male players

27

The reasons for the difference in the rate of knee injuries

in basketball among the female and male players could be

divided into two categories intrinsic factors and extrinsic

factors Borowski et al (2008) suggested that the intrinsic

factors were mainly physiological differences between boys

and girls Examples for these physiological differences were

anatomical differences in joint and bone structure

differences in flexibility and strength and differences in

hormone secretions Differences in equipment differences in

facilities and differences in competition environment were

the extrinsic factors for the difference in the rate of knee

injury

Ingram et al (2008) mentioned that the likeliness of

female basketball players to sustain major knee injuries in

basketball was due to the vulnerability of their knees It

was associated with various risk factors such as hormonal

difference neuromuscular difference and mechanical

difference These risk factors made the female basketball

players four to six times more susceptible to major knee

28

injuries than the male basketball players

Gender Difference in the Knee Injuries in Soccer

The result of the study conducted by Yard et al (2008)

showed that female soccer players sustained a higher rate of

knee injuries than the male soccer players Le Gall et al

(2007) suggested that the reasons for the higher rate in knee

injuries for the female soccer players included weaker

technical and tactical ability poorer muscular strength and

endurance and weaker coordination The rapid development of

the female soccer game which led to an increased in

aggressiveness of the players was another cause of the higher

knee injury rate

Specifically female soccer players had a higher rate of

sustaining complete knee ligament sprains than the male soccer

players (Yard et al 2008) This was supported by the result

of the research done by Ingram et al (2008) which showed

that complete ligament tears were more common in female soccer

than in male soccer It might due to that fact that there were

29

structural differences and neuromuscular differences between

female and male soccer players Yard et al also found that

the rate of complete knee ligament sprains requiring surgery

in female soccer players was higher than that in male soccer

players Female soccer players were found to be 13 times more

susceptible to knee ligament injuries that required surgery

The reasons for this high rate against male soccer players

included the shoe-surface interaction differences in

anthropometry and increased joint laxity

Ingram et al (2008) also showed that non-contact knee

injuries were more common in female soccer than in male soccer

The reasons for this result were suggested to be that the knee

joint of the female soccer players were more vulnerable to

the stress created by rapid acceleration deceleration and

cutting movement on the grass surfaces

Anterior Cruciate Ligament Injuries in Basketball and Soccer

According to Mihata Beutler amp Boden (2006) anterior

cruciate ligament (ACL) injuries were not uncommon in

30

collegiate sports The most common type of ACL injuries was

non-contact or minimal contact ACL injuries The actions of

cutting jumping sudden deceleration and checking with

another player were the high risk mechanisms for this kind

of ACL injuries Basketball players and soccer players were

found to be often exposing to these damaging forces because

they had to perform these actions repeatedly during practice

and competition

From the result shown by Dick et al (2007) 18 of the

total game injuries in male basketball were ACL injuries and

603 of these ACL injuries were non-contact ACL injuries

This result was supported by Mihata et al (2006) whose result

showed that ACL injuries accounted for 14 of all injuries

in male basketball from 1989 to 2004 For the female basketball

players they had a higher rate of ACL injuries than the male

players It was shown by Mihata et al that the ACL injuries

accounted for 52 of all injuries in female basketball from

1989 to 2004 which was about four times higher than in male

basketball

31

For the soccer players the female soccer players also had

higher rates of ACL injuries than the male soccer players

In between 1989 and 2004 39 of the total injuries in female

soccer were ACL injuries while only 16 of the total injuries

in male soccer were ACL injuries (Mihata et al 2006) The

rate of ACL injuries in female soccer was almost three times

higher than that in male soccer in that period of time A more

serious result was shown by Le Gall et al (2007) In their

result ACL injuries mainly ACL sprains or ruptures

accounted for 156 of all major injuries of the young elite

female soccer players

According to Mihata et al (2006) the reasons for the

female players having higher rates of ACL injuries than the

male players were that they had only participated in such

organized sports for a brief period of time they were less

fit and they received less training Another reason was a

disturbance in the neuromuscular patterns received by the

female players which protected the knee created by

incidental or minimal trauma

32

The rate of ACL injuries could be reduced effectively

Understanding the biomechanical risk factors and identifying

and changing those risk factors were the necessary steps to

decrease the long-term ACL injury rates (Mihata et al 2006)

Summary

Soccer and basketball are common sports all over the world

and they are generally regarded as kinds of contact sports

as there is direct contact between players Players are

required to have good muscular strength and power in order

to compete with others Collision and contacting with other

players would lead to imbalance and maybe fall which in turn

lead to injury

Knee was found to be one of the most common body sites

susceptible to injuries in basketball and soccer during both

practice and competition Different types of knee injuries

were sustained by the players such as contusion laceration

sprain ligament tear meniscus lesion and torn cartilage

According to Ingram et al (2008) 168 of all knee injuries

33

were surgery-requiring injuries Examples of these major

knee injuries were complete ligament tears torn cartilage

incomplete ligament tears and fractures

Female players no matter they were soccer players or

basketball players would have a higher chance of injuring

their knee especially the ACL than their male counterparts

It might due to both intrinsic factors such as muscular

strength and endurance and hormonal differences and

extrinsic factors such as game environment and sports

facilities

However knee injuries could be prevented Preventive

measures for knee injuries included lower-extremity landing

skills plyometrics (Le Gall et al 2007) neuromuscular

training programs added supervision (Dick et al 2007)

muscle strengthening and movement training (Ingram et al

2008)

34

Chapter 3

METHOD

The method of this study was divided into the following

sections 1) Participants 2) Development of questionnaire

3) Pilot study 4) Procedures and 5) Data analysis

Participants

The participants were both male and female local members

of university basketball or soccer team in Hong Kong in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team The total number of subjects was 197 with

48 male members of university basketball team 51 female

members of university basketball team 56 male members of

university soccer team and 42 female members of university

soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

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Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 27: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

27

The reasons for the difference in the rate of knee injuries

in basketball among the female and male players could be

divided into two categories intrinsic factors and extrinsic

factors Borowski et al (2008) suggested that the intrinsic

factors were mainly physiological differences between boys

and girls Examples for these physiological differences were

anatomical differences in joint and bone structure

differences in flexibility and strength and differences in

hormone secretions Differences in equipment differences in

facilities and differences in competition environment were

the extrinsic factors for the difference in the rate of knee

injury

Ingram et al (2008) mentioned that the likeliness of

female basketball players to sustain major knee injuries in

basketball was due to the vulnerability of their knees It

was associated with various risk factors such as hormonal

difference neuromuscular difference and mechanical

difference These risk factors made the female basketball

players four to six times more susceptible to major knee

28

injuries than the male basketball players

Gender Difference in the Knee Injuries in Soccer

The result of the study conducted by Yard et al (2008)

showed that female soccer players sustained a higher rate of

knee injuries than the male soccer players Le Gall et al

(2007) suggested that the reasons for the higher rate in knee

injuries for the female soccer players included weaker

technical and tactical ability poorer muscular strength and

endurance and weaker coordination The rapid development of

the female soccer game which led to an increased in

aggressiveness of the players was another cause of the higher

knee injury rate

Specifically female soccer players had a higher rate of

sustaining complete knee ligament sprains than the male soccer

players (Yard et al 2008) This was supported by the result

of the research done by Ingram et al (2008) which showed

that complete ligament tears were more common in female soccer

than in male soccer It might due to that fact that there were

29

structural differences and neuromuscular differences between

female and male soccer players Yard et al also found that

the rate of complete knee ligament sprains requiring surgery

in female soccer players was higher than that in male soccer

players Female soccer players were found to be 13 times more

susceptible to knee ligament injuries that required surgery

The reasons for this high rate against male soccer players

included the shoe-surface interaction differences in

anthropometry and increased joint laxity

Ingram et al (2008) also showed that non-contact knee

injuries were more common in female soccer than in male soccer

The reasons for this result were suggested to be that the knee

joint of the female soccer players were more vulnerable to

the stress created by rapid acceleration deceleration and

cutting movement on the grass surfaces

Anterior Cruciate Ligament Injuries in Basketball and Soccer

According to Mihata Beutler amp Boden (2006) anterior

cruciate ligament (ACL) injuries were not uncommon in

30

collegiate sports The most common type of ACL injuries was

non-contact or minimal contact ACL injuries The actions of

cutting jumping sudden deceleration and checking with

another player were the high risk mechanisms for this kind

of ACL injuries Basketball players and soccer players were

found to be often exposing to these damaging forces because

they had to perform these actions repeatedly during practice

and competition

From the result shown by Dick et al (2007) 18 of the

total game injuries in male basketball were ACL injuries and

603 of these ACL injuries were non-contact ACL injuries

This result was supported by Mihata et al (2006) whose result

showed that ACL injuries accounted for 14 of all injuries

in male basketball from 1989 to 2004 For the female basketball

players they had a higher rate of ACL injuries than the male

players It was shown by Mihata et al that the ACL injuries

accounted for 52 of all injuries in female basketball from

1989 to 2004 which was about four times higher than in male

basketball

31

For the soccer players the female soccer players also had

higher rates of ACL injuries than the male soccer players

In between 1989 and 2004 39 of the total injuries in female

soccer were ACL injuries while only 16 of the total injuries

in male soccer were ACL injuries (Mihata et al 2006) The

rate of ACL injuries in female soccer was almost three times

higher than that in male soccer in that period of time A more

serious result was shown by Le Gall et al (2007) In their

result ACL injuries mainly ACL sprains or ruptures

accounted for 156 of all major injuries of the young elite

female soccer players

According to Mihata et al (2006) the reasons for the

female players having higher rates of ACL injuries than the

male players were that they had only participated in such

organized sports for a brief period of time they were less

fit and they received less training Another reason was a

disturbance in the neuromuscular patterns received by the

female players which protected the knee created by

incidental or minimal trauma

32

The rate of ACL injuries could be reduced effectively

Understanding the biomechanical risk factors and identifying

and changing those risk factors were the necessary steps to

decrease the long-term ACL injury rates (Mihata et al 2006)

Summary

Soccer and basketball are common sports all over the world

and they are generally regarded as kinds of contact sports

as there is direct contact between players Players are

required to have good muscular strength and power in order

to compete with others Collision and contacting with other

players would lead to imbalance and maybe fall which in turn

lead to injury

Knee was found to be one of the most common body sites

susceptible to injuries in basketball and soccer during both

practice and competition Different types of knee injuries

were sustained by the players such as contusion laceration

sprain ligament tear meniscus lesion and torn cartilage

According to Ingram et al (2008) 168 of all knee injuries

33

were surgery-requiring injuries Examples of these major

knee injuries were complete ligament tears torn cartilage

incomplete ligament tears and fractures

Female players no matter they were soccer players or

basketball players would have a higher chance of injuring

their knee especially the ACL than their male counterparts

It might due to both intrinsic factors such as muscular

strength and endurance and hormonal differences and

extrinsic factors such as game environment and sports

facilities

However knee injuries could be prevented Preventive

measures for knee injuries included lower-extremity landing

skills plyometrics (Le Gall et al 2007) neuromuscular

training programs added supervision (Dick et al 2007)

muscle strengthening and movement training (Ingram et al

2008)

34

Chapter 3

METHOD

The method of this study was divided into the following

sections 1) Participants 2) Development of questionnaire

3) Pilot study 4) Procedures and 5) Data analysis

Participants

The participants were both male and female local members

of university basketball or soccer team in Hong Kong in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team The total number of subjects was 197 with

48 male members of university basketball team 51 female

members of university basketball team 56 male members of

university soccer team and 42 female members of university

soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

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Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

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Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

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Cailliet R (1992) Knee pain and disability (3rd ed)

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Darrow C J Collins C L Yard E E amp Comstock R

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Dick R Hertel J Agel J Grossman J amp Marshall S

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Grenier R (1999) Soccer injuries In R C Bull (Ed)

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Griffith H W (1986) Complete guide to sports injuries

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Grisogono V (1988) Knee health Problems prevention and

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Harmer P A (2005) Basketball injuries In N Maffulli

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injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

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Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

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in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 28: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

28

injuries than the male basketball players

Gender Difference in the Knee Injuries in Soccer

The result of the study conducted by Yard et al (2008)

showed that female soccer players sustained a higher rate of

knee injuries than the male soccer players Le Gall et al

(2007) suggested that the reasons for the higher rate in knee

injuries for the female soccer players included weaker

technical and tactical ability poorer muscular strength and

endurance and weaker coordination The rapid development of

the female soccer game which led to an increased in

aggressiveness of the players was another cause of the higher

knee injury rate

Specifically female soccer players had a higher rate of

sustaining complete knee ligament sprains than the male soccer

players (Yard et al 2008) This was supported by the result

of the research done by Ingram et al (2008) which showed

that complete ligament tears were more common in female soccer

than in male soccer It might due to that fact that there were

29

structural differences and neuromuscular differences between

female and male soccer players Yard et al also found that

the rate of complete knee ligament sprains requiring surgery

in female soccer players was higher than that in male soccer

players Female soccer players were found to be 13 times more

susceptible to knee ligament injuries that required surgery

The reasons for this high rate against male soccer players

included the shoe-surface interaction differences in

anthropometry and increased joint laxity

Ingram et al (2008) also showed that non-contact knee

injuries were more common in female soccer than in male soccer

The reasons for this result were suggested to be that the knee

joint of the female soccer players were more vulnerable to

the stress created by rapid acceleration deceleration and

cutting movement on the grass surfaces

Anterior Cruciate Ligament Injuries in Basketball and Soccer

According to Mihata Beutler amp Boden (2006) anterior

cruciate ligament (ACL) injuries were not uncommon in

30

collegiate sports The most common type of ACL injuries was

non-contact or minimal contact ACL injuries The actions of

cutting jumping sudden deceleration and checking with

another player were the high risk mechanisms for this kind

of ACL injuries Basketball players and soccer players were

found to be often exposing to these damaging forces because

they had to perform these actions repeatedly during practice

and competition

From the result shown by Dick et al (2007) 18 of the

total game injuries in male basketball were ACL injuries and

603 of these ACL injuries were non-contact ACL injuries

This result was supported by Mihata et al (2006) whose result

showed that ACL injuries accounted for 14 of all injuries

in male basketball from 1989 to 2004 For the female basketball

players they had a higher rate of ACL injuries than the male

players It was shown by Mihata et al that the ACL injuries

accounted for 52 of all injuries in female basketball from

1989 to 2004 which was about four times higher than in male

basketball

31

For the soccer players the female soccer players also had

higher rates of ACL injuries than the male soccer players

In between 1989 and 2004 39 of the total injuries in female

soccer were ACL injuries while only 16 of the total injuries

in male soccer were ACL injuries (Mihata et al 2006) The

rate of ACL injuries in female soccer was almost three times

higher than that in male soccer in that period of time A more

serious result was shown by Le Gall et al (2007) In their

result ACL injuries mainly ACL sprains or ruptures

accounted for 156 of all major injuries of the young elite

female soccer players

According to Mihata et al (2006) the reasons for the

female players having higher rates of ACL injuries than the

male players were that they had only participated in such

organized sports for a brief period of time they were less

fit and they received less training Another reason was a

disturbance in the neuromuscular patterns received by the

female players which protected the knee created by

incidental or minimal trauma

32

The rate of ACL injuries could be reduced effectively

Understanding the biomechanical risk factors and identifying

and changing those risk factors were the necessary steps to

decrease the long-term ACL injury rates (Mihata et al 2006)

Summary

Soccer and basketball are common sports all over the world

and they are generally regarded as kinds of contact sports

as there is direct contact between players Players are

required to have good muscular strength and power in order

to compete with others Collision and contacting with other

players would lead to imbalance and maybe fall which in turn

lead to injury

Knee was found to be one of the most common body sites

susceptible to injuries in basketball and soccer during both

practice and competition Different types of knee injuries

were sustained by the players such as contusion laceration

sprain ligament tear meniscus lesion and torn cartilage

According to Ingram et al (2008) 168 of all knee injuries

33

were surgery-requiring injuries Examples of these major

knee injuries were complete ligament tears torn cartilage

incomplete ligament tears and fractures

Female players no matter they were soccer players or

basketball players would have a higher chance of injuring

their knee especially the ACL than their male counterparts

It might due to both intrinsic factors such as muscular

strength and endurance and hormonal differences and

extrinsic factors such as game environment and sports

facilities

However knee injuries could be prevented Preventive

measures for knee injuries included lower-extremity landing

skills plyometrics (Le Gall et al 2007) neuromuscular

training programs added supervision (Dick et al 2007)

muscle strengthening and movement training (Ingram et al

2008)

34

Chapter 3

METHOD

The method of this study was divided into the following

sections 1) Participants 2) Development of questionnaire

3) Pilot study 4) Procedures and 5) Data analysis

Participants

The participants were both male and female local members

of university basketball or soccer team in Hong Kong in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team The total number of subjects was 197 with

48 male members of university basketball team 51 female

members of university basketball team 56 male members of

university soccer team and 42 female members of university

soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

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Bellenir K (2008) Sports injuries information for teens

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Borowski L A Yard E E Fields S K amp Comstock R

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Griffith H W (1986) Complete guide to sports injuries

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Yard E E Shcroeder M J Fields S K Collins C L

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high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 29: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

29

structural differences and neuromuscular differences between

female and male soccer players Yard et al also found that

the rate of complete knee ligament sprains requiring surgery

in female soccer players was higher than that in male soccer

players Female soccer players were found to be 13 times more

susceptible to knee ligament injuries that required surgery

The reasons for this high rate against male soccer players

included the shoe-surface interaction differences in

anthropometry and increased joint laxity

Ingram et al (2008) also showed that non-contact knee

injuries were more common in female soccer than in male soccer

The reasons for this result were suggested to be that the knee

joint of the female soccer players were more vulnerable to

the stress created by rapid acceleration deceleration and

cutting movement on the grass surfaces

Anterior Cruciate Ligament Injuries in Basketball and Soccer

According to Mihata Beutler amp Boden (2006) anterior

cruciate ligament (ACL) injuries were not uncommon in

30

collegiate sports The most common type of ACL injuries was

non-contact or minimal contact ACL injuries The actions of

cutting jumping sudden deceleration and checking with

another player were the high risk mechanisms for this kind

of ACL injuries Basketball players and soccer players were

found to be often exposing to these damaging forces because

they had to perform these actions repeatedly during practice

and competition

From the result shown by Dick et al (2007) 18 of the

total game injuries in male basketball were ACL injuries and

603 of these ACL injuries were non-contact ACL injuries

This result was supported by Mihata et al (2006) whose result

showed that ACL injuries accounted for 14 of all injuries

in male basketball from 1989 to 2004 For the female basketball

players they had a higher rate of ACL injuries than the male

players It was shown by Mihata et al that the ACL injuries

accounted for 52 of all injuries in female basketball from

1989 to 2004 which was about four times higher than in male

basketball

31

For the soccer players the female soccer players also had

higher rates of ACL injuries than the male soccer players

In between 1989 and 2004 39 of the total injuries in female

soccer were ACL injuries while only 16 of the total injuries

in male soccer were ACL injuries (Mihata et al 2006) The

rate of ACL injuries in female soccer was almost three times

higher than that in male soccer in that period of time A more

serious result was shown by Le Gall et al (2007) In their

result ACL injuries mainly ACL sprains or ruptures

accounted for 156 of all major injuries of the young elite

female soccer players

According to Mihata et al (2006) the reasons for the

female players having higher rates of ACL injuries than the

male players were that they had only participated in such

organized sports for a brief period of time they were less

fit and they received less training Another reason was a

disturbance in the neuromuscular patterns received by the

female players which protected the knee created by

incidental or minimal trauma

32

The rate of ACL injuries could be reduced effectively

Understanding the biomechanical risk factors and identifying

and changing those risk factors were the necessary steps to

decrease the long-term ACL injury rates (Mihata et al 2006)

Summary

Soccer and basketball are common sports all over the world

and they are generally regarded as kinds of contact sports

as there is direct contact between players Players are

required to have good muscular strength and power in order

to compete with others Collision and contacting with other

players would lead to imbalance and maybe fall which in turn

lead to injury

Knee was found to be one of the most common body sites

susceptible to injuries in basketball and soccer during both

practice and competition Different types of knee injuries

were sustained by the players such as contusion laceration

sprain ligament tear meniscus lesion and torn cartilage

According to Ingram et al (2008) 168 of all knee injuries

33

were surgery-requiring injuries Examples of these major

knee injuries were complete ligament tears torn cartilage

incomplete ligament tears and fractures

Female players no matter they were soccer players or

basketball players would have a higher chance of injuring

their knee especially the ACL than their male counterparts

It might due to both intrinsic factors such as muscular

strength and endurance and hormonal differences and

extrinsic factors such as game environment and sports

facilities

However knee injuries could be prevented Preventive

measures for knee injuries included lower-extremity landing

skills plyometrics (Le Gall et al 2007) neuromuscular

training programs added supervision (Dick et al 2007)

muscle strengthening and movement training (Ingram et al

2008)

34

Chapter 3

METHOD

The method of this study was divided into the following

sections 1) Participants 2) Development of questionnaire

3) Pilot study 4) Procedures and 5) Data analysis

Participants

The participants were both male and female local members

of university basketball or soccer team in Hong Kong in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team The total number of subjects was 197 with

48 male members of university basketball team 51 female

members of university basketball team 56 male members of

university soccer team and 42 female members of university

soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 30: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

30

collegiate sports The most common type of ACL injuries was

non-contact or minimal contact ACL injuries The actions of

cutting jumping sudden deceleration and checking with

another player were the high risk mechanisms for this kind

of ACL injuries Basketball players and soccer players were

found to be often exposing to these damaging forces because

they had to perform these actions repeatedly during practice

and competition

From the result shown by Dick et al (2007) 18 of the

total game injuries in male basketball were ACL injuries and

603 of these ACL injuries were non-contact ACL injuries

This result was supported by Mihata et al (2006) whose result

showed that ACL injuries accounted for 14 of all injuries

in male basketball from 1989 to 2004 For the female basketball

players they had a higher rate of ACL injuries than the male

players It was shown by Mihata et al that the ACL injuries

accounted for 52 of all injuries in female basketball from

1989 to 2004 which was about four times higher than in male

basketball

31

For the soccer players the female soccer players also had

higher rates of ACL injuries than the male soccer players

In between 1989 and 2004 39 of the total injuries in female

soccer were ACL injuries while only 16 of the total injuries

in male soccer were ACL injuries (Mihata et al 2006) The

rate of ACL injuries in female soccer was almost three times

higher than that in male soccer in that period of time A more

serious result was shown by Le Gall et al (2007) In their

result ACL injuries mainly ACL sprains or ruptures

accounted for 156 of all major injuries of the young elite

female soccer players

According to Mihata et al (2006) the reasons for the

female players having higher rates of ACL injuries than the

male players were that they had only participated in such

organized sports for a brief period of time they were less

fit and they received less training Another reason was a

disturbance in the neuromuscular patterns received by the

female players which protected the knee created by

incidental or minimal trauma

32

The rate of ACL injuries could be reduced effectively

Understanding the biomechanical risk factors and identifying

and changing those risk factors were the necessary steps to

decrease the long-term ACL injury rates (Mihata et al 2006)

Summary

Soccer and basketball are common sports all over the world

and they are generally regarded as kinds of contact sports

as there is direct contact between players Players are

required to have good muscular strength and power in order

to compete with others Collision and contacting with other

players would lead to imbalance and maybe fall which in turn

lead to injury

Knee was found to be one of the most common body sites

susceptible to injuries in basketball and soccer during both

practice and competition Different types of knee injuries

were sustained by the players such as contusion laceration

sprain ligament tear meniscus lesion and torn cartilage

According to Ingram et al (2008) 168 of all knee injuries

33

were surgery-requiring injuries Examples of these major

knee injuries were complete ligament tears torn cartilage

incomplete ligament tears and fractures

Female players no matter they were soccer players or

basketball players would have a higher chance of injuring

their knee especially the ACL than their male counterparts

It might due to both intrinsic factors such as muscular

strength and endurance and hormonal differences and

extrinsic factors such as game environment and sports

facilities

However knee injuries could be prevented Preventive

measures for knee injuries included lower-extremity landing

skills plyometrics (Le Gall et al 2007) neuromuscular

training programs added supervision (Dick et al 2007)

muscle strengthening and movement training (Ingram et al

2008)

34

Chapter 3

METHOD

The method of this study was divided into the following

sections 1) Participants 2) Development of questionnaire

3) Pilot study 4) Procedures and 5) Data analysis

Participants

The participants were both male and female local members

of university basketball or soccer team in Hong Kong in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team The total number of subjects was 197 with

48 male members of university basketball team 51 female

members of university basketball team 56 male members of

university soccer team and 42 female members of university

soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 31: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

31

For the soccer players the female soccer players also had

higher rates of ACL injuries than the male soccer players

In between 1989 and 2004 39 of the total injuries in female

soccer were ACL injuries while only 16 of the total injuries

in male soccer were ACL injuries (Mihata et al 2006) The

rate of ACL injuries in female soccer was almost three times

higher than that in male soccer in that period of time A more

serious result was shown by Le Gall et al (2007) In their

result ACL injuries mainly ACL sprains or ruptures

accounted for 156 of all major injuries of the young elite

female soccer players

According to Mihata et al (2006) the reasons for the

female players having higher rates of ACL injuries than the

male players were that they had only participated in such

organized sports for a brief period of time they were less

fit and they received less training Another reason was a

disturbance in the neuromuscular patterns received by the

female players which protected the knee created by

incidental or minimal trauma

32

The rate of ACL injuries could be reduced effectively

Understanding the biomechanical risk factors and identifying

and changing those risk factors were the necessary steps to

decrease the long-term ACL injury rates (Mihata et al 2006)

Summary

Soccer and basketball are common sports all over the world

and they are generally regarded as kinds of contact sports

as there is direct contact between players Players are

required to have good muscular strength and power in order

to compete with others Collision and contacting with other

players would lead to imbalance and maybe fall which in turn

lead to injury

Knee was found to be one of the most common body sites

susceptible to injuries in basketball and soccer during both

practice and competition Different types of knee injuries

were sustained by the players such as contusion laceration

sprain ligament tear meniscus lesion and torn cartilage

According to Ingram et al (2008) 168 of all knee injuries

33

were surgery-requiring injuries Examples of these major

knee injuries were complete ligament tears torn cartilage

incomplete ligament tears and fractures

Female players no matter they were soccer players or

basketball players would have a higher chance of injuring

their knee especially the ACL than their male counterparts

It might due to both intrinsic factors such as muscular

strength and endurance and hormonal differences and

extrinsic factors such as game environment and sports

facilities

However knee injuries could be prevented Preventive

measures for knee injuries included lower-extremity landing

skills plyometrics (Le Gall et al 2007) neuromuscular

training programs added supervision (Dick et al 2007)

muscle strengthening and movement training (Ingram et al

2008)

34

Chapter 3

METHOD

The method of this study was divided into the following

sections 1) Participants 2) Development of questionnaire

3) Pilot study 4) Procedures and 5) Data analysis

Participants

The participants were both male and female local members

of university basketball or soccer team in Hong Kong in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team The total number of subjects was 197 with

48 male members of university basketball team 51 female

members of university basketball team 56 male members of

university soccer team and 42 female members of university

soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 32: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

32

The rate of ACL injuries could be reduced effectively

Understanding the biomechanical risk factors and identifying

and changing those risk factors were the necessary steps to

decrease the long-term ACL injury rates (Mihata et al 2006)

Summary

Soccer and basketball are common sports all over the world

and they are generally regarded as kinds of contact sports

as there is direct contact between players Players are

required to have good muscular strength and power in order

to compete with others Collision and contacting with other

players would lead to imbalance and maybe fall which in turn

lead to injury

Knee was found to be one of the most common body sites

susceptible to injuries in basketball and soccer during both

practice and competition Different types of knee injuries

were sustained by the players such as contusion laceration

sprain ligament tear meniscus lesion and torn cartilage

According to Ingram et al (2008) 168 of all knee injuries

33

were surgery-requiring injuries Examples of these major

knee injuries were complete ligament tears torn cartilage

incomplete ligament tears and fractures

Female players no matter they were soccer players or

basketball players would have a higher chance of injuring

their knee especially the ACL than their male counterparts

It might due to both intrinsic factors such as muscular

strength and endurance and hormonal differences and

extrinsic factors such as game environment and sports

facilities

However knee injuries could be prevented Preventive

measures for knee injuries included lower-extremity landing

skills plyometrics (Le Gall et al 2007) neuromuscular

training programs added supervision (Dick et al 2007)

muscle strengthening and movement training (Ingram et al

2008)

34

Chapter 3

METHOD

The method of this study was divided into the following

sections 1) Participants 2) Development of questionnaire

3) Pilot study 4) Procedures and 5) Data analysis

Participants

The participants were both male and female local members

of university basketball or soccer team in Hong Kong in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team The total number of subjects was 197 with

48 male members of university basketball team 51 female

members of university basketball team 56 male members of

university soccer team and 42 female members of university

soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 33: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

33

were surgery-requiring injuries Examples of these major

knee injuries were complete ligament tears torn cartilage

incomplete ligament tears and fractures

Female players no matter they were soccer players or

basketball players would have a higher chance of injuring

their knee especially the ACL than their male counterparts

It might due to both intrinsic factors such as muscular

strength and endurance and hormonal differences and

extrinsic factors such as game environment and sports

facilities

However knee injuries could be prevented Preventive

measures for knee injuries included lower-extremity landing

skills plyometrics (Le Gall et al 2007) neuromuscular

training programs added supervision (Dick et al 2007)

muscle strengthening and movement training (Ingram et al

2008)

34

Chapter 3

METHOD

The method of this study was divided into the following

sections 1) Participants 2) Development of questionnaire

3) Pilot study 4) Procedures and 5) Data analysis

Participants

The participants were both male and female local members

of university basketball or soccer team in Hong Kong in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team The total number of subjects was 197 with

48 male members of university basketball team 51 female

members of university basketball team 56 male members of

university soccer team and 42 female members of university

soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 34: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

34

Chapter 3

METHOD

The method of this study was divided into the following

sections 1) Participants 2) Development of questionnaire

3) Pilot study 4) Procedures and 5) Data analysis

Participants

The participants were both male and female local members

of university basketball or soccer team in Hong Kong in the

academic year 2011-2012 who have been participating in

regular training in basketball or soccer provided by the

university team The total number of subjects was 197 with

48 male members of university basketball team 51 female

members of university basketball team 56 male members of

university soccer team and 42 female members of university

soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

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Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

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sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

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The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 35: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

35

Development of Questionnaire

A self-designed questionnaire was used as there was no

previous relevant questionnaire available for this study The

questionnaire consisted of two parts and there were totally

19 questions (See Appendix A)

In the first part there were mainly demographic questions

such as gender age height weight and the type of sport

played (basketball or soccer) Some information about the

training was also collected in this part such as the average

number of training hours spent on basketball or soccer per

week the amount of time spent on fitness training (if any)

the amount of time spent on warm up (if any) and the types

of warm up activities (if any) Lastly the participants were

asked if they had done any cool down exercise after training

In the second part focuses were put on the information

of knee injuries occurred during basketball or soccer training

or competition within the past one year Questions like the

categories of knee injuries the types of knee injuries the

causes of knee injuries the types of medical treatment the

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 36: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

36

need for surgery and the length of recovery time were included

in this part The participants were also asked if they were

re-engaged in regular training

Pilot Study

Before distributing the self-designed questionnaires to

the participants a pilot study was carried out in order to

make sure that the questionnaire was understandable and

comprehensible

In the pilot study 10 male and 10 female university

students were asked to complete the questionnaire After the

completion of questionnaires they were asked if they could

easily understand the questions and fill in the questionnaire

smoothly without any problems

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 37: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

37

Procedures

The questionnaires together with pens were distributed

to the participants directly by the coaches after a training

session The purpose of the study and the instructions of

filling up the questionnaire were explained clearly to the

participants before they started The participants were given

ten minutes to complete the questionnaire The participants

were reminded not to write their names in the questionnaire

and that the information would be kept confidential and solely

for the use of this study

Data Analysis

All the data collected were inputted into the Statistical

Package for Social Science 180 for Windows (SPSS 180) and

being analyzed The level of significance was set at 005 for

all statistical analyses

Descriptive statistics such as mean percentage and

standard deviation were used to describe the demographic

information of the participants for example the average

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 38: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

38

number of training hours per week the amount of time spent

in fitness training and the types of warm up activities

In order to determine if there was any mean difference in

the rate of knee injury between different genders and that

between different types of sports chi square was used

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 39: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

39

Chapter 4

ANALYSIS OF DATA

The purpose of this study was to compare the rate and

types of knee injuries among the university basketball and

soccer players in Hong Kong The effect of demography on the

rate of knee injuries was also investigated

The descriptive and Chi square were mainly used to analyze

the data obtained The analyses of the data were presented

in the following aspects

1 Demographic information of the players

2 Rate of knee injuries of the players

3 Amount of time for regular training of the players

4 Amount of time for fitness training of the players

5 Warm up patterns of the players

6 Categories of knee injuries

7 Types of knee injuries suffered by the players

8 Causes of knee injuries

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 40: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

40

9 Treatment for knee injuries

10 Severity of Knee Injuries

Results

1 Demographic information of the players

In this study there were 197 respondents including

university basketball and university soccer players The data

consisted of 104 males (528) and 93 females (472) The

age range of the respondents was 18 to 25 and the overall

mean age was 213

Among the respondents 99 were basketball players

consisting of 48 male basketball players (244) and 51 female

basketball players (259) and the other 98 were soccer

players consisting of 56 male soccer players (284) and 42

female soccer players (213) Table 1 shows the details in

the demographic information of the respondents

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 41: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

41

Table 1

Demographic Information of the Respondents (N=197)

Sport Gender Number of

Players

Mean Age

Basketball Male 48 (244) 22

Female 51 (259) 21

Soccer Male 56 (284) 21

Female 42 (213) 21

Total 197 213

2 Rate of knee injuries of the players

Concerning knee injuries 147 of the respondents have

suffered different types of knee injuries during training or

competition in the past one year (746) Among all the

knee-injured respondents 41 were male basketball players

(279) 37 were female basketball players (252) 41 were

male soccer players (279) and 28 were female soccer players

(19) Table 2 shows the details on the rate of knee injuries

of different type of players during training or competition

in the past one year

In order to determine if there was any significant

difference in the rate of knee injuries between different

genders of the same sport and that in the rate of knee injuries

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 42: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

42

between different sports of the same gender chi square tests

were performed

According to the result shown in Table 2 there was no

significant difference (p=0118) in the rate of knee injuries

between the male basketball players and the female basketball

players Moreover there was no significant difference

(p=0482) in the rate of knee injuries between the male soccer

players and the female soccer players

It was also found that there was no significant difference

in the rate of knee injuries between basketball and soccer

for both genders The p-value in the rate of knee injuries

between the male basketball players and male soccer players

was found to be 0129 and that between the female basketball

players and female soccer players was found to be 0538 This

result was shown in Table 3

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 43: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

43

Table 2

Chi Square Test for Different Genders of the Same Sport with

the Rate of Knee Injuries

Sport Gender Knee Injury

Yes No Chi

Square

P

Basketball Male

(n=48)

41

(854)

7 (146)

Female

(n=51)

37

(725)

14

(275)

245 0118

Soccer Male

(n=56)

41

(732)

15

(268)

Female

(n=42)

28

(667)

14

(333)

0494 0482

Total

(N=197)

147

(746)

50

(254)

Table 3

Chi Square Test for Different Sports of the Same Gender with

the Rate of Knee Injuries

Gender Sport Knee Injury

Yes No Chi

Square

P

Male Basketball

(n=48)

41

(854)

7 (146)

Soccer

(n=56)

41

(732)

15

(268)

2307 0129

Female Basketball

(n=51)

37

(725)

14

(275)

Soccer

(n=42)

28

(667)

14

(333)

0379 0538

Total

(N=197)

147

(746)

50

(254)

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

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Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

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sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

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The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 44: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

44

3 Amount of time for regular training of the players

All of the respondents were regularly involved in either

basketball or soccer training in their own university team

44 of the respondents (223) spent an average of 1 to 5 hours

in training per week 110 of the respondents (558) spent

an average of 6 to 10 hours in training per week 36 of the

respondents (183) spent an average of 11 to 15 hours in

training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

Table 4 shows the average amount of time spent on regular

training by the respondents per week in the past one year

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 45: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

45

Table 4

Average Amount of Time per Week for Regular Training of the

Players (N=197)

Sport Gender Regular Training (Hours)

1-5 6-10 11-15 ge16

Basketball Male

(n=48)

5 21 20 2

Female

(n=51)

9 30 8 4

Soccer Male

(n=56)

19 36 1 0

Female

(n=42)

11 23 7 1

Total

(N=197)

44

(223)

110

(558)

36

(183)

7

(36)

4 Amount of time for fitness training of the players

Apart from the regular training 149 of the respondents

(756) were involved in fitness training after regular

practice session

Of those who participated in fitness training 33 (221)

spent an average of less than 15 minutes in fitness training

after regular practice session 90 (604) spent an average

of 16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes in

fitness training after regular practice session and the

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

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Bellenir K (2008) Sports injuries information for teens

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Borowski L A Yard E E Fields S K amp Comstock R

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Cailliet R (1992) Knee pain and disability (3rd ed)

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Darrow C J Collins C L Yard E E amp Comstock R

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Dick R Hertel J Agel J Grossman J amp Marshall S

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Griffith H W (1986) Complete guide to sports injuries

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Le Gall F CarIing C amp Reilly T (2008) Injuries in

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doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 46: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

46

remaining 4(27) spent an average of more than 46 minutes

in fitness training after regular practice session Table 5

shows the average amount of time spent on fitness training

by the players if any after each regular training session

Chi square test was performed to see if there was any

significant difference in the rate of knee injuries between

the players who were engaged in regular fitness training and

those who were not The result of the chi square test was shown

in Table 6 The p-values were found to be 0602 in basketball

and 0329 in soccer Therefore there was no significant

difference (pgt005) in the rate of knee injuries between the

players for both basketball and soccer who were engaged in

regular fitness training and those who were not

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 47: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

47

Table 5

Average Amount of Time per Training Session for Fitness

Training of the Players (N=197)

Sport Gender Fitness

Training

Amount of Time for Fitness Training

(Minutes)

le15 16-30 31-45 ge46

Basketball Male

(n=48)

39

(813)

5 24 9 1

Female

(n=51)

36

(706)

8 22 4 2

Soccer Male

(n=56)

41

(732)

12 26 3 0

Female

(n=42)

33

(786)

8 18 6 1

Total

(N=197)

149

(756)

33

(221)

90

(604)

22

(148)

4

(27)

Table 6

Chi Square Test for Fitness Training with the Rate of Knee

Injuries

Sport Knee Injury Chi

Square

P

Yes No

Basketball Fitness

Training

Yes 60 15 0272 0602

No 18 6

Soccer Fitness

Training

Yes 54 20 0954 0329

No 15 9

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

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Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

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Dick R Hertel J Agel J Grossman J amp Marshall S

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Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

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Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

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injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

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Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

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Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

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D T Kirkendall (Eds) Praeger handbook of sports

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Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

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Sports Medicine 36(2) 276-284

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Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

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Pecina M M amp Bojanic I (1993) Overuse injuries of the

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Prentice W E (2008) Essentials of athletic injury

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Reilly T (1992) Strength training for injury prevention

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Richards D W Sekyi-Out A amp Marks P H (1999)

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McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

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Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

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doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 48: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

48

5 Warm up patterns of the players

All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 of the respondents spent

an average of 31 minutes or more in warm up activities

Most of the male basketball players (563) spent an average

of 11 to 20 minutes in warm up activities while most of the

female basketball players (608) spent an average of 10

minutes or less in warm up activities For the soccer players

most of the male (607) and female players (571) spent an

average of 11 to 20 minutes in warm up activities Table 7

shows the average amount of time spent on warm up activities

by the players

Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up Table 8 shows the details

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 49: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

49

about the types of warm up activities done by each type of

players

Table 7

Average Amount of Time for Warm Up (N=197)

Sport Gender Warm Up Amount of Time for Warm Up (Minutes)

le10 11-20 21-30 ge31

Basketball Male

(n=48)

48

(100)

15

(313)

27

(563)

6

(125)

0 (0)

Female

(n=51)

51

(100)

31

(608)

17

(333)

2

(39)

1 (2)

Soccer Male

(n=56)

56

(100)

17

(304)

34

(607)

5

(89)

0 (0)

Female

(n=42)

42

(100)

12

(286)

24

(571)

6

(143)

0 (0)

Total

(N=197)

75

(381)

102

(518)

19

(96)

1

(05)

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 50: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

50

Table 8

Types of Warm Up of the Players (N=197)

Sport Gender Types of Warm Up

Jogging Stretching Specific Warm

Up

Basketball Male

(n=48)

44 (917) 47 (979) 25 (521)

Female

(n=51)

51 (100) 50 (98) 16 (314)

Soccer Male

(n=56)

53 (946) 54 (964) 29 (518)

Female

(n=42)

41 (976) 38 (905) 25 (595)

Total

(N=197)

189 (959) 189 (959) 95 (482)

6 Categories of knee injuries

There are two main categories of knee injury acute injury

and chronic injury A player could suffer more than one knee

injuries in the past one year and the injuries could be of

different categories

There were 128 players suffering acute knee injuries (871)

and 57 players suffering chronic knee injuries (388) Of

those who suffered acute knee injuries 34 were male

basketball players (829) 32 were female basketball players

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 51: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

51

(865) 39 were male soccer player (951) and 23 were female

soccer players (821) Of those who suffered chronic knee

injuries 18 were male basketball players (439) 15 were

female basketball players (405) 10 were male soccer players

(244) and 14 were female soccer players (50) Table 9 shows

the categories of knee injury of the players who have suffered

knee injuries in the past one year

Table 9

Categories of Knee Injury of the Injured Players (N=147)

Sport Gender Knee Injury Category

Acute No

Acute

Chronic No

Chronic

Basketball Male

(n=41)

34

(829)

7

(171)

18

(439)

23

(561)

Female

(n=37)

32

(865)

5

(135)

15

(405)

22

(595)

Soccer Male

(n=41)

39

(951)

2

(49)

10

(244)

31

(756)

Female

(n=28)

23

(821)

5

(179)

14

(50)

14

(50)

Total

(N=147)

128

(871)

19

(129)

57

(388)

90

(612)

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 52: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

52

7 Types of knee injuries suffered by the players

There were mainly nine types of knee injuries ie abrasion

contusion sprain overuse injury meniscus tear ACL tear

PCL tear MCL tear and LCL tear Respondents were asked if

they have suffered any of these knee injuries in the past one

year during training or competition Each respondent could

suffer more than one types of knee injury

There were 87 abrasions (592) 81 contusions (551) 40

sprains (272) 58 overuse injuries (395) 9 meniscus tears

(61) 8 ACL tears (54) 2 PCL tears (14) 2 MCL tears

(14) and no LCL tear Table 10 shows the details of the

types of knee injuries suffered by each type of players in

the past one year during training or competition

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 53: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

53

Table 10

Types of Knee Injury (N=147)

Types of Players

Knee Injury Types Basketball Soccer Total

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Abrasion 18

(439)

23

(622)

34

(829)

12

(429)

87

(592)

Contusion 24

(585)

20

(541)

22

(537)

15

(536)

81

(551)

Sprain 15

(366)

7

(189)

13

(317)

5

(179)

40

(272)

Overuse Injury 19

(463)

14

(378)

11

(268)

14

(50)

58

(395)

Meniscus Tear 3

(73)

3

(81)

1

(24)

2

(71)

9

(61)

ACL Tear 3

(73)

3

(81)

0

(0)

2

(71)

8

(54)

PCL Tear 0

(0)

1

(27)

1

(24)

0

(0)

2

(14)

MCL Tear 2

(49)

0

(0)

0

(0)

0

(0)

2

(14)

LCL Tear 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

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Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

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Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

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2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

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players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

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McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

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The Scottish Sports Council St Andrewrsquos Ambulance

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Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

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doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 54: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

54

8 Causes of knee injuries

There were different reasons for the knee injuries ie

inadequate warm up poor fitness over-trained not

concentrated collision with others venue problem

unsuitable equipment and others Respondents were asked

about their opinion on the reasons for their knee injuries

suffered in the past one year There might be more than one

reason for the injuries

The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299) Table 11 shows the

details of the causes of knee injuries suffered by each type

of players during training or competition during the past one

year

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 55: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

55

Table 11

Causes of Knee Injuries (N=147)

Reason

Type of Players

Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Inadequate

Warm Up

9

(22)

12

(324)

12

(293)

11

(393)

44

(299)

Poor Fitness 14

(341)

15

(405)

16

(39)

10

(357)

55

(374)

Over-trained 20

(488)

10

(27)

8

(195)

8

(286)

46

(313)

Not

Concentrated

7

(177)

10

(27)

5

(122)

5

(179)

27

(184)

Collision

with others

30

(732)

26

(703)

37

(902)

18

(643)

111

(755)

Venue problem 10

(244)

8

(216)

27

(659)

11

(393)

56

(381)

Unsuitable

Equipment

2

(49)

2

(54)

2

(49)

1

(36)

7

(48)

Others 0

(0)

1

(27)

0

(0)

0

(0)

1

(07)

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 56: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

56

9 Treatment for knee injuries

There were different treatments for knee injuries with

different severities Treatments included rest accident amp

emergency general doctor family doctor orthopaedic doctor

physiotherapy Chinese bone setting acupuncture and others

The most common treatment was rest (782) followed by

physiotherapy (252) Acupuncture (143) Chinese bone

setting (129) accident amp emergency (102) were some other

common treatments employed Orthopaedic doctor (95) and

general doctor (48) were uncommon treatments None of the

respondents went to a family doctor for treatment of knee

injuries Table 12 shows the details of treatments for the

knee injuries suffered by each type of players during training

or competition in the past one year

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 57: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

57

Table 12

Treatments for Knee Injuries (N=147)

Type of Players

Treatment Basketball Soccer Total

(N=147)

Male

(n=41)

Female

(n=37)

Male

(n=41)

Female

(n=28)

Rest 32

(78)

26

(703)

38

(927)

19

(679)

115

(782)

Accident amp

Emergency

5

(122)

5

(135)

1

(24)

4

(143)

15

(102)

General Doctor 2

(49)

0

(0)

2

(49)

3

(107)

7

(48)

Family doctor 0

(0)

0

(0)

0

(0)

0

(0)

0

(0)

Orthopaedic

Doctor

3

(73)

4

(108)

2

(49)

5

(179)

14

(95)

Physiotherapy 15

(366)

10

(27)

3

(73)

9

(321)

37

(252)

Chinese Bone

Setting

7

(171)

6

(162)

3

(73)

3

(107)

19

(129)

Acupuncture 8

(195)

6

(162)

6

(146)

1

(36)

21

(143)

Others 1

(24)

0

(0)

0

(0)

0

(0)

1

(07)

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 58: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

58

10 Severity of Knee Injuries

For some serious knee injuries such as ligament tears and

meniscus teas surgery was required as a treatment to help

the process of recovery

According to the result 5 of the injured male basketball

players (122) 5 of the injured female basketball players

(135) 2 of the injured male soccer players (49) and 4

of the injured female soccer players (143) had undergone

surgery because of their serious knee injuries Table 13 shows

the number of knee injuries that required surgery

Concerning the major knee injuries surgery was required

for 905 of all major knee injuries such as meniscus tears

and ligament tears Details were shown in Table 14

Due to the different levels of severity of the knee injuries

the injured players needed different time for recovery 361

and 333 of the injured players needed less than one week

and two to three weeks for recovery respectively 17 of the

injured players needed a recovery period of 4 to 5 weeks Only

136 of the injured players required more than 6 weeks for

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 59: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

59

recovery All of the injured players (100) have returned to

the regular training after the recovery period Table 15 shows

the details on the time for recovery of each type of injured

players

Table 13

Number of Knee Injuries Requiring Surgery (N=147)

Sport Gender Surgery

Yes NO

Basketball Male

(n=41)

5 (122) 36 (878)

Female

(n=37)

5 (135) 32 (865)

Soccer Male

(n=41)

2 (49) 39 (951)

Female

(n=28)

4 (143) 14 (857)

Total (N=147) 16 (109) 131 (891)

Table 14

Major Knee Injuries Requiring Surgery

Major Knee Injury Surgery

Yes No

Meniscus Tear 7 2

ACL Tear 8 0

PCL Tear 2 0

MCL Tear 2 0

LCL Tear 0 0

Total 19 (905) 2 (95)

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 60: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

60

Table 15

Recovery Time for the Injured Players (N=147)

Sport Gender Recovery Time Re-training

le1 week 2-3

weeks

4-5

weeks

ge6

weeks

Yes No

Basketball Male

(n=41)

11

(268)

12

(293)

12

(293)

6

(146)

41

(100)

0

(0)

Female

(n=37)

18

(486)

11

(297)

2

(54)

6

(162)

37

(100)

0

(0)

Soccer Male

(n=41)

16

(415)

16

(39)

5

(122)

3

(73)

41

(100)

0

(0)

Female

(n=28)

7

(25)

10

(357)

6

(214)

5

(179)

28

(100)

0

(0)

Total (N=147) 53

(361)

49

(333)

25

(17)

20

(136)

147

(100)

0

(0)

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 61: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

61

Discussions

The results of this study were used to give a better

understanding on the demographic effects on knee injuries

patterns of knee injuries causes of knee injuries of the

university basketball and soccer players in Hong Kong

Although the target group and the sample size of this

study were different from that of the similar studies done

before in other countries the result may still be worth

discussing as it reflected the situation in Hong Kong to a

certain extent

1 Knee injuries of the players of different genders

The researcher thought that the male players might have

a higher chance of getting a knee injury than their female

counterparts as a result of the higher game intensity and more

vigorous collision from the opponents However as shown by

the result of this study there was no significant difference

(pgt005) in the rate of knee injury between the male basketball

players and female soccer players (p=0118) and between the

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 62: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

62

male soccer players and female soccer players (p=0482)

Although Harmer (2005) showed that more female

basketball players had suffered a higher rate of knee injuries

than the male basketball players and Fevre (1998) showed that

female soccer players had suffered a higher rate of knee

injuries than the male soccer players Ingram et al (2008)

showed that male players had a higher rate of knee injuries

than the female players

Most of the knee injuries in the male players were found

in soccer and basketball as the speed and intensity of the

game were much more vigorous (Ingram et al 2008) However

a number of knee injuries were also found in female basketball

and female soccer These knee injuries were mainly due to lower

level of skill poorer technique and lower degree of physical

fitness of the female players (Fevre 1998)

Another reason for the comparably higher rate of knee

injury of the female players to the male players is that the

female players are usually lack of game experience and weak

in tactical ability (Le Gall et al 2007) When the female

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 63: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

63

players are exposed to aggressive behaviors they have no idea

on how to avoid collisions or foul plays from the other players

As a result they are easily bumped by the others and then

fall down Collision from others and contact with the playing

surface will cause knee injuries easily

2 Knee injuries of the players in different types of sports

The researcher thought that the basketball players would

have a higher chance of getting a knee injury due to the sport

nature of basketball In a basketball game there would be

more collision between players since there is a close contact

between the offensive player and the defensive player Also

there are a lot of jumping actions and landing actions such

as lay-ups and jump shots so more pressure would be placed

on the knee of the players

However the result of this study showed that there was

no significant difference (pgt005) in the rate of knee injury

between the male basketball players and male soccer players

(p=0129) and between the female basketball players and

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 64: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

64

female soccer players (p=0538)

Although the knee injuries rates per 10000 athletic

exposures in male soccer (36) and female soccer (508) were

higher than that in male basketball (203) and female

basketball (38) respectively (Ingram et al 2008) there was

no evident showing that there was a significant difference

in the rate of knee injuries between these two sports

In basketball the knee was affected by both acute and

chronic injuries (Richards Sekyi-Out amp Marks 1999) They

found that the anterior cruciate ligament (ACL) was

susceptible to injury as there was frequent acceleration

deceleration tibial rotation and pivoting Richards et al

also mentioned that overuse injuries in knee such as patellar

derangement were common The major cause of these injuries

was eccentric contraction caused by repeated actions of

jumping

Grenier (1999) analyzed that injuries to the knee joint

in soccer were caused by sudden uncontrolled changes in the

body rotation and flexion during passing running or

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 65: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

65

collision with the others These changes were caused by the

cleats of the shoes that might fix the legs of the players

in the playing surface Repeated pivoting with high velocities

and deceleration would place a lot of stress on the articular

cartilage in the knee joint and cause chondral injuries

3 Fitness training

Although the result showed that there was no significant

difference in the rate of knee injuries between the players

for both basketball (p=0602) and soccer (p=0329) who were

engaged in regular fitness training and those who were not

many of the researchers found that fitness training could help

reduce the incidence and severity of sport injuries

According to Reilly (1992) the stability of a joint could

be increased by muscles that crossed the joint The stability

of the knee joint could therefore be increased by

strengthening the quadriceps which secures the joint together

with the cruciate ligaments and collateral ligaments This

was also supported by Cailliet (1992) Cailliet mentioned that

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 66: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

66

the quadriceps hamstrings medial adductor and lateral

abductor were the major muscles that helped stabilize the knee

joint by crossing it from the anterior side and posterior side

Hence strengthening these muscles could help further

stabilize the knee joint and reduce the incidence of knee

injuries

Apart from strengthening the muscles across the knee joint

Prentice (2008) also suggested that improving the body

conditioning such as flexibility cardiovascular endurance

muscular endurance agility speed and balance could help

to prevent knee injuries Improving the strength of

gastrocnemius could also help to provide more stability to

the knee joint

4 Warm up patterns of the players

It was not surprised to find that all of the respondents

participated in warm up activities before the training or

competition The reason is that being the team members of the

university team they are engaged in a systematic training

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 67: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

67

with high intensity Warm up could help them prepare for the

training and reduce the rate of injury by rising the muscle

temperature and increasing the range of motion of the joints

and muscle tendons at the same time (Fevre 1998) The

musculotendinous unit would be stretched during warm up

leading to an increase in length of the muscles at a given

load (Fevre 1998)

According to the result 959 of the players would do

jogging and stretching as warm up exercise This high

percentage agreed with what The Scottish Sports Council (1991)

suggested about the activities included in warm up The first

activity was body exercise involving both arms and legs

basically jogging which aimed at increasing the body

temperature and the blood flow The second activity was

stretching of muscles tendons and joints Stretching

prepared the muscles tendons and joints to work under

stress

However less than half (482) of the players would do

specific warm up Specific warm up is a newer way of warm up

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 68: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

68

It is more dynamic and close to the game situation Not many

of the players understand the principle and the ways of doing

specific warm up As a result they would choose to do the

traditional warm up exercise which is more well-known and

familiar to them

5 Patterns of knee injuries of the players

The result showed that the incidence of acute knee injuries

(n=128) was more than that of chronic knee injuries (n=57)

An acute injury is an ldquoinjury with rapid onset due to traumatic

episode but with short durationrdquo (Anderson Hall amp Martin

2000 p667) and the injured player could clearly remember

the cause and process of the injury (Ritter amp Albohm 2000)

while a chronic injury is an ldquoinjury with long onset and long

durationrdquo (Anderson et al p668) In other words an acute

knee injury is more immediate and sudden than a chronic knee

injury and it could occur at anytime and anywhere during the

training or competition On the other hand chronic knee

injury is the result of long term training and a continuous

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 69: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

69

placement of pressure upon the knee joint As a result the

occurrence of acute knee injuries would be more frequent than

that of chronic knee injuries

Among all types of knee injuries in the study abrasion

(n=87 592) and contusion (n=81 551) were found to be

the two most frequent knee injuries However sprains were

found to be the most common type of knee injuries in basketball

(Harmer 2005) and in soccer (Le Gall et al 2007) in the

past studies Harmer found that contusions and abrasions were

the next most common types of injuries in basketball but not

the most common types

Overuse injury was found to be the third highest knee injury

(n=58 395) Overuse injuries were common in the knee joint

because the knee joint was involved in most of the sport

activities such as jumping running and landing (Pecina amp

Bojanic 1993) Due to the high intensity and high frequency

of the university team training the players would experience

a lot of pressure in their knees As they keep on training

in order to strike for the best result in the inter-varsity

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 70: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

70

competition they would develop overuse injury in their knees

6 Causes of knee injuries

The result showed that majority of the injured players

thought that collision with the other players (n=111 755)

was the cause of their knee injuries This result could be

explained by the types of knee injuries the players suffered

As discussed above contusion was the second most common knee

injuries in basketball and soccer and contusion was caused

by the direct blow to the knee resulted from collision

(Griffith 1986) Hence it was not surprised to have

collision with the other players as the most common cause of

knee injuries

The second most common cause of knee injuries was the venue

problem (n=56 381) This was the main cause of abrasion

which was mentioned above being the most common type of knee

injuries in basketball and soccer According to Griffith

(1986) abrasion was caused when someone fell on a rough

surface especially during athletic activity Once the player

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 71: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

71

has contact with the playing surface from a high position

(standing position) at a high speed (usually in dynamic state)

especially on a rough playing surface such as the grass soccer

pitch he or she would probably suffer abrasion or maybe

contusion Falling onto the playing surface could result from

being collided or loss of balance

Poor fitness was the third common cause of knee injuries

(n=55 374) According to Hoffman (2003) and Gray (1980)

muscular fitness could reduce the probability and severity

of injuries It was because the strength of tendon-muscle

complex and bone mineral density would be increased with good

muscular fitness On the other hand poor fitness would easily

lead to fatigue which increases the stress on the

musculoskeletal system (Hoffman 2003) Once the leg muscles

of the players are fatigued the protection to the knee joint

would be reduced and the players would easily suffer knee

injuries if being collided or falling down

The least common cause of knee injuries was unsuitable

equipment (n=7 48) It was close to the expectation of the

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 72: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

72

researcher Being a member of the university team who receives

systematic training the player is probably an experienced

player and has a serious attitude towards the sport Therefore

the player would normally have a set of sport gears such as

appropriate basketball shoes or soccer boots knee brace

ankle supporter and shin guard Prentice (2008) mentioned

that suitable shoe type and functional knee brace could help

prevent the probability or reduce the severity of knee

injuries These gears would only be worn by the players if

they are comfortable and suitable for them so that their

performance would not be affected by these gears Hence

unsuitable equipment was not a common cause of knee injuries

7 Treatments of knee injuries

The researcher thought that the injured players being

experienced and serious players would seek help from

professionals or specialists such as physiotherapists once

they got injured However the result of this study showed

that the majority of the injured players (n=115 782) would

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 73: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

73

rest on their own rather than seeking professional medical

assistance from physiotherapists (n=37 252) or orthopaedic

doctors (n=14 95)

This could be explained by the types of knee injuries the

players suffered According to the result of this study the

majority of the players suffered minor injuries such as

abrasion (n=87 592) and contusion (n=81 551) The

severity of minor injuries was low and the players could

probably treat their own injuries by applying principles like

RICE ie rest ice compression and elevation

On the other hand 15 of the injured players (102) had

received medical assistance from the Accident amp Emergency

Department in the hospitals These players were those who had

an accident during training or competition (Grisogono 1988)

Under normal circumstances those players had to receive

surgery afterwards From the result 16 of the injured players

(109) had received surgery The number of injured players

(n=15) who went to Accident amp Emergency Department was similar

to that (n=16) who had a surgery

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 74: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

74

Ingram et al (2008) found that complete ligament tears

torn cartilage incomplete ligament tears and fracture were

the common knee injuries that require surgery It supported

the result of this study which showed that 19 out of the 21

meniscus tears and ligament tears (905) required surgery

8 Recovery time

According to the result shown in Table 9 more than half

of the injured players had suffered abrasion (n=87 592)

and contusion (n=81 551) and 40 of them suffered sprain

(272) These types of knee injuries are considered as minor

injuries This result was supported by Hoffman (2003) showing

that minor injuries accounted for most of the injuries in male

(755) and female (721) high school basketball As most

of the injured players suffered minor injuries the time loss

and recovery time would not be long The result showed that

361 of the injured players would take a week or less for

recovery Ingram et al (2008) showed that 431 of the

knee-injured players suffered a time loss of less than one

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 75: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

75

week

According to the result only 25 of the injured players (17)

required a recovery time of 4 to 5 weeks and 20 of the injured

players (136) required a recovery time of 6 weeks or more

The injured players who suffered major knee injuries such

as meniscus tear or ligament tear would be the one requiring

such a long period of recovery time According to Darrow et

al (2009) missing more than 21 days in training or

competition would make the players miss a large part of that

particular season

9 Prevention of knee injuries

In order to reduce the incidence and severity of knee

injuries in basketball and soccer some preventive measure

should be done

As mentioned above improving the level of fitness could

help reduce the rate of knee injuries (Prentice 2008) The

fitness program could include core strength training lower

extremity strength training balance training coordination

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 76: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

76

training proprioception training and agility training

(Kirkendall amp Garrett 2011) Apart from it the use of proper

and protective equipment such as knee braces could help

further protect the knee joint (Prentice)

In order to reduce the risk of developing overuse injuries

the players and the coach should make sure the training

activities are suitable to the age and abilities of the players

(Pecina amp Bojanic 1993) Stretching and strengthening

exercise could also help reduce the amount of stress placed

on the bones and joints

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 77: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

77

Chapter 5

SUMMARY AND CONCLUSION

There are three parts in this chapter (1) Summary of

Results (2) Conclusion and (3) Recommendations for Future

Studies

Summary of Results

The results of the study were summarized as follows

1 Among 197 respondents there were 48 male basketball

players 51 female basketball players 56 male soccer

players and 42 female soccer players They were either the

team member of their university basketball or soccer team

2 147 of the respondents (746) have suffered different

types of knee injuries during training or competition in

the past one year 41 were male basketball players (279)

37 were female basketball players (252) 41 were male

soccer players (279) and 28 were female soccer players

(19) All of the respondents returned to training after

their recovery

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 78: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

78

3 There were no significant differences in the rate of knee

injuries between different genders in basketball (p=0118)

and between different genders in soccer (p=0482)

4 There were no significant differences in the rate of knee

injuries between basketball and soccer in males (p=0129)

and between basketball and soccer in females (p=0538)

5 44 of the respondents (223) spent an average of 1 to 5

hours in training per week 110 of the respondents (558)

spent an average of 6 to 10 hours in training per week 36

of the respondents (183) spent an average of 11 to 15 hours

in training per week and the remaining 7 respondents (36)

spent an average of more than 16 hours in training per week

6 149 of the respondents (756) were involved in fitness

training after regular practice session 33 (221) spent

an average of less than 15 minutes in fitness training after

regular practice session 90 (604) spent an average of

16 to 30 minutes in fitness training after regular practice

session 22 (148) spent an average of 31 to 45 minutes

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 79: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

79

in fitness training after regular practice session and the

remaining 4 (27) spent an average of more than 46 minutes

in fitness training after regular practice session

7 There were no significant differences in the rate of knee

injuries between the players who were engaged in regular

fitness training and those who were not in both basketball

(p=0602) and soccer (p=0329)

8 All of the respondents participated in warm up activities

before the training started 381 of the respondents spent

an average of 10 minutes or less in warm up activities 518

of them spent an average of 11 to 20 minutes in warm up

activities 96 of them spent an average of 21 to 30 minutes

in warm up activities and only 05 respondent spent an

average of 31 minutes or more in warm up activities

9 Concerning the types of warm up activities 189 (959) of

the players would do jogging and stretching and 95 of them

(482) would do specific warm up

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 80: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

80

10 There were 128 players (871) who suffered acute knee

injuries in the past one year 34 (829) were male

basketball players 32 were female basketball players

(865) 39 were male soccer player (951) and 23 were

female soccer players (821)

11 There were 57 players (388) who suffered chronic knee

injuries in the past one year 18 were male basketball

players (439) 15 were female basketball players (405)

10 were male soccer players(244) and 14 were female

soccer players (50)

12 Concerning the types of injuries there were 87 abrasions

(592) 81 contusions (551) 40 sprains (272) 58

overuse injuries (395) 9 meniscus tears (61) 8 ACL

tears (54) 2 PCL tears (14) 2 MCL tears (14) and

no LCL tear

13 The five most common causes of knee injuries were found

to be collision with the other player(s) (755) venue

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 81: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

81

problem (381) poor fitness (374) being over-trained

(313) and inadequate warm up (299)

14 The most common treatment was rest (782) followed by

physiotherapy (252) acupuncture (143) Chinese bone

setting (129) and accident amp emergency (102)

Orthopaedic doctor (95) and general doctor (48) were

some uncommon treatments

15 5 injured male basketball players (122) 5 injured female

basketball players (135) 2 injured male soccer players

(49) and 4 injured female soccer players (143) had

undergone surgery for the knee injuries

16 361 of the injured players needed less than one week for

recovery 333 needed 2 to 3 weeks for recovery while only

17 of the injured players needed a recovery period of 4

to 6 weeks and 136 needed more than 6 weeks for recovery

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 82: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

82

Conclusion

This study provided some information about the patterns

or knee injuries of the members of the university basketball

and soccer teams in Hong Kong Knowing the causes of knee injury

could help to reduce and prevent the occurrence of knee injury

in the future This may further improve the performance of

the players

Although many of the respondents have suffered knee

injuries in the past one year most of the injuries were

unserious injuries such as abrasion and contusion This could

be hardly prevented due to the sport nature of basketball and

soccer

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 83: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

83

Recommendations for Future Studies

The following recommendations are made based on this

study for future studies

1 The types of knee injuries listed in the questionnaire were

limited which may not reflect all the problems the players

had

2 Study may focus on a specific type of knee injury which

may provide more detailed information for setting up

prevention measures

3 Distribution of the questionnaires could be done in the

middle of the season so that more questionnaires would be

collected

4 The psychological impact of the injury could be included

5 The preventive measures that the players would use could

be included

6 The steps of returning to sports of the players after knee

injuries could be included

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 84: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

84

REFERENCES

Anderson M K Hall S J amp Martin M (2000) Sports injury

management (2nd ed) Philadelphia PA Lippincott

Williams amp Wilkins

Bellenir K (2008) Sports injuries information for teens

Health tips about acute traumatic and chronic injuries

in adolescent athletes (2nd ed) Detroit MI

Omnigraphics Inc

Borowski L A Yard E E Fields S K amp Comstock R

D (2008) The epidemiology of US high school basketball

injuries 2005-2007 American Journal of Sports Medicine

36(12) 2328-2335 doi1011770363546508322893

Cailliet R (1992) Knee pain and disability (3rd ed)

Philadelphia PA FA Davis

Darrow C J Collins C L Yard E E amp Comstock R

D (2009) Epidemiology of severe injuries among united

states high school athletes American Journal of Sports

Medicine 37(9) 1798-1805 doi1011770363546509333015

Dick R Hertel J Agel J Grossman J amp Marshall S

W (2007) Descriptive epidemiology of collegiate mens

basketball injuries National collegiate athletic

association injury surveillance system 1988-1989 through

2003-2004 Journal of Athletic Training 42(2) 194-201

Fevre D (1998) Collision sports Injury and repair Oxford

Butterworth-Heinemann

Gray M (1980) Football injuries Oxford Offox Press

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 85: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

85

Grenier R (1999) Soccer injuries In R C Bull (Ed)

Handbook of sports injuries (pp 398) New York

McGraw-Hill

Griffith H W (1986) Complete guide to sports injuries

Los Angeles CA Price Stern Sloan Inc

Grisogono V (1988) Knee health Problems prevention and

cure London John Murray Ltd

Harmer P A (2005) Basketball injuries In N Maffulli

amp D J Caine (Eds) Epidemiology of pediatric sports

injuries Team sports (pp 44) Basel NY Karger

Harris H amp Varney M (1977) The treatment of football

injuries London Macdonald and Janersquos Publishers

Hoffman JR (2003) Epidemiology of basketball injuries

In D B McKeag (Ed) Basketball (pp 79) Malden MA

Blackwell Science Ltd

Ingram J G Fields S K Yard E E amp Comstock R D

(2008) Epidemiology of knee injuries among boys and girls

in US high school athletics American Journal of Sports

Medicine 36(6) 1116-1122 doi1011770363546508314400

Junge A Langevoort G Pipe A Peytavin A Wong F

amp Mountjoy M et al (2006) Injuries in team sport

tournaments during the 2004 olympic games American

Journal of Sports Medicine 34(4) 565-576

doi1011770363546505281807

Kirkendall D T amp Garrett Jr W E (2011) Common soccer

injuries and their prevention In C T Moorman III amp

D T Kirkendall (Eds) Praeger handbook of sports

medicine and athlete health (pp 337) Santa Barbara

Ca Praeger

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 86: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

86

Le Gall F CarIing C amp Reilly T (2008) Injuries in

young elite female soccer players American Journal of

Sports Medicine 36(2) 276-284

doi1011770363546507307866

Mihata L C S Beutier A I amp Boden B P (2006)

Comparing the incidence of anterior cruciate ligament

injury in collegiate lacrosse soccer and basketball

players American Journal of Sports Medicine 34(6)

899-904 doi1011770363546505285582

Pecina M M amp Bojanic I (1993) Overuse injuries of the

musculoskeletal system Boca Raton FL CRC Press LLC

Prentice W E (2008) Essentials of athletic injury

management (7th ed) New York NY McGraw-Hill

Reilly T (1992) Strength training for injury prevention

In T Reilly (Ed) Sports fitness and sports injuries

(pp 71) London Wolfe Publishing Limited

Richards D W Sekyi-Out A amp Marks P H (1999)

Basketball injuries In R C Bull (Ed) Handbook of

sports injuries (pp 307 325-326) New York NY

McGraw-Hill

Ritter M A amp Albohm M J (2000) Your injury A common

sense guide to sports injuries Carmel IN Cooper

Publishing Group

The Scottish Sports Council St Andrewrsquos Ambulance

Association The National Coaching Foundation (1991)

Sports injury Prevention and first aid management

Edinburgh The Scottish Sports Council

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

Page 87: Hong Kong Baptist University - A COMPARISON OF …libproject.hkbu.edu.hk/trsimage/hp/09005161.pdfUniversity soccer team member refers to the local member of any university soccer team

87

Yard E E Shcroeder M J Fields S K Collins C L

amp Comstock R D (2008) The epidemiology of united states

high school soccer injuries 2005mdash2007 American Journal

of Sports Medicine 36(10) 1930-1937

doi1011770363546508318047

88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

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88

APPENDIX A

Knee Injury Questionnaire

香港大專籃球足球球員膝蓋創傷問卷調查

您好本人是香港浸會大學體育及康樂管理文學士(榮譽)學位課程的三年級生

現在進行有關香港大專籃球足球球員膝蓋創傷的研究 希望收集不同大專院校

的校隊成員的受傷紀錄這項調查是以不記名的方式進行閣下提供的資料只作

研究之用且絕對保密

請在適當的內加上ldquo

甲部 (請勿填上姓名)

1 性別 男 女

2 年齡 __________

3 身高 __________米 體重 __________公斤

4 您是哪項運動項目的校隊成員 (只選一項)

籃球 足球

5 過去一年內 您平均每星期進行多少小時訓練比賽

1-5小時 6-10小時 11-15小時 16小時或以上

6 在每次訓練中 您會否進行體能訓練

會(請往第7條作答) 不會(請往第8條作答)

7 您每次平均進行多久體能訓練

15分鐘或以下 16-30分鐘 31 -45分鐘 46分鐘或以上

8 運動前 您有否進行熱身運動

有(請往第9條作答) 沒有(請往第11條作答)

9 您平均用多少時間作熱身運動

10分鐘或以下 11-20分鐘 21-30分鐘 31分鐘或以上

89

10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-

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10 您進行的熱身運動包括 (可選多項)

緩步跑 肌肉伸展(拉筋) 針對性熱身運動

11 運動後 您有沒有進行舒緩運動

有 沒有

乙部

1 過去一年內 您有沒有在運動訓練比賽時出現膝蓋受傷

有(請繼續回答以下問題) 沒有

2 該受傷是哪類型的受傷 (可選多項)

急性 慢性

3 膝蓋出現的受傷是 (可選多項)

擦傷 撞傷 扭傷 勞損 半月板碎裂

前十字韌帶(ACL)撕裂 後十字韌帶(PCL)撕裂

內側韌帶(MCL)撕裂 外側韌帶(LCL)撕裂

4 您認為受傷的原因是 (可選多項)

熱身不足 體能欠佳 訓練過度 精神不集中

與人碰撞 場地問題 裝備不合適

其他(請註明) _________

5 受傷後 您到哪裡處理 (可選多項)

自行休息 急症室 普通科門診 家庭醫生

骨科醫生 物理治療 跌打 針灸 其他(請註明) __________

6 受傷後 您有沒有進行手術

有 沒有

7 您的康復時間大概是多久

1星期或以下 2-3星期 4-5星期 6星期或以上

8 康復後 您有沒有再次進行訓練

有 沒有

-完-