As of July 2013, Dr. Emery has overseen the completion of several research projects in four major areas aligned with injury prevention in youth sport and recreation:
Community and School-Delivered Neuromuscular Training Injury Prevention Programs
In several randomized controlled trials and cohort studies we demonstrated the consistent effectiveness of neuromuscular training injury prevention programs in reducing the risk of lower extremity injuries. Injury was reduced in youth community soccer by more than 30% and in junior high school students by more than 50%.
Maximizing Player Adherence to Neuromuscular Training in Youth Soccer
In partnership with FIFA we developed coach training workshops in community soccer to deliver FIFA’s11+ warm-up program with the goal of maximizing player adherence, reducing injury risk, increasing player/parent/coach knowledge and prevention behaviours, and improving player performance outcomes. Greater adherence to the neuromuscular training program was observed in teams that attended a coach-workshop as opposed to teams that were given the information but did not attend a coach-workshop. In addition, high player adherence to the 11+ program resulted in significant improvements in functional balance and greater reduction in injury risk. Further research examining a Health Action Process Approach (HAPPA) to coach training is ongoing over 3 seasons of play (2013-2016) to inform implementation and facilitate maintenance of such programs.
Combining Injury Prevention & Healthy Outcomes in Junior High
In a pilot randomized controlled trial (RCT) and a historical cohort study we evaluated a program combining a focus on injury prevention and healthy outcomes in junior high school students. We found that a curriculum-based neuromuscular training program of moderate intensity in junior high school physical education leads to significant reduction in sport and recreational injury risk, improved fitness, and decreased measures of adiposity. This work is ongoing with a three year RCT in which 12 junior high schools will be recruited for participation. Currently a teaching video is under development to inform teacher and student training. Evaluation of the implementation context and health behavior change is a major focus of this ongoing work.
Lower Extremity Joint Osteoarthritis & Prevention of Post-Traumatic Osteoarthritis
The implications for reducing joint injury risk through primary prevention strategies in youth sport and recreation are significant, including a reduced risk of post-traumatic osteoarthritis.
Through a systematic review and meta-analysis we examined the risk of lower extremity joint osteoarthritis (OA) related to previous joint injury, sport and occupational participation (lifetime and specificity), and obesity. We found that joint injury was a significant risk factor for knee OA (4-fold greater risk) and hip OA (5-fold greater risk). Knee meniscectomy (± anterior cruciate ligament injury) leads to a significantly greater risk of knee OA. There was also a greater risk of OA in individuals who are overweight or obese and among those who have physically demanding occupations, especially those involving squatting or kneeling activities.
A recent pilot historical cohort study (n=100) has been completed to examine the association between sport-related knee joint injury history in youth and clinical, functional, physiological, structural and health care utility outcomes related to future post-traumatic osteoarthritis (3-10 years following injury). This study provides preliminary evidence that young adults with a history of sport-related knee injury demonstrate greater clinical symptomology (KOOS), distinct physiology (inflammatory biomarker profile), knee muscle morphology and joint structure (MOAKS based on MRI) 3-10 years post-injury compared to uninjured controls. These findings will inform the early identification of individuals at risk of PTOA and development of secondary prevention strategies. This work will be expanded to a larger longitudinal cohort study (n=200) through CIHR open operating grant funding (2014-2017). Participants will be re-assessed annually in a longitudinal cohort study to facilitate a better understanding of PTOA progression and to inform the development and evaluation of secondary prevention strategies.
Alberta Program in Youth Sport and Recreational Injury Prevention
In 2013, Carolyn Emery and Brent Hagel were successful in being awarded an Alberta Innovates Health Solutions “Program in Youth Sport & Recreational Injury Prevention” (2013-2018). This five year research program highlights research projects in youth ice hockey, skiing and snowboarding and junior high school. The goal of this work and knowledge translation activities is to create a 20% reduction in injury risk in youth sport and recreation by 2020.