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DIFFERENCES IN SPORTS PARTICIPATION AND SPORTS

INJURYBETWEEN TEAM SPORTS AND INJURIES OF INDIVIDUAL SPORTS INCOLLEGIAL SPORTS STUDENTS

p

25 April 2016

Ng Kei Wing 14686449

Dr. Gemma Gao

DIFFERENCES IN SPORTS PARTICIPATION AND SPORTS INJURY

BETWEEN TEAM SPORTS AND INJURIES OF INDIVIDUAL SPORTS IN

COLLEGIAL SPORTS STUDENTS

BY

NG KEI WING

14686449

AN HONOURS PROJECT SUBMITTED IN PARTICAL FULFILLMENT OF THE

REQUIREMENT FOR THE DEGREE OF

BACHELOR OF SOCIAL SCIENCE

IN

SPORT AND RECREATION LEADERSHIP

HONG KONG BAPTIST UNIVERSITY

APRIL 2016

HONG KONG BATIST UNVERSITY

Honours Project Release Form

Thesis Title: Differences in Sports Participation and Sports Injury Between

Team Sports and Injuries of Individual Sports in Collegial Sports

Students

Author:

Ng Kei Wing

Student No.:

14686449

Department:

Physical Edication

Programme:

Bachelor of Social Sciences in Sport and Recreation Leardership

Declaration:

I agree that the full text of my thesis may be consulted by the HKBU community

users in print version in the Hong Kong Baptist University Library according to the

circulation regulations currently in force. All rights are reserved governed by the

Hong Kong Copyright Ordinance.

Signature of Author: _________________________ Date: 25th April, 2016

HONG KONG BATIST UNIVERSITY

25th APRIL, 2016

We hereby recommend that the Independent Project by Ms. Ng Kei Wing entitled

“DIFFERENCES IN SPORTS PARTICIPATION AND SPORTS INJURY

BETWEEN TEAM SPORTS AND INJURIES OF INDIVIDUAL SPORTS IN

COLLEGIAL SPORTS STUDENTS” be accepted in partial fulfilment of the

requirement for the Bachelor of Social Sciences in Sport and Recreation Leadership.

________________________

Dr. Gemma Gao

Chief Advisor

DECLARATION

I hereby to declare this honours project “DIFFERENCES IN SPORTS

PARTICIPATION AND SPORTS INJURY BETWEEN TEAM SPORTS AND

INJURIES OF INDIVIDUAL SPORTS IN COLLEGIAL SPORTS STUDENTS”

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.

_______________________

Ng Kei Wing

25th April, 2016

ACKNOWLEDGEMENTS

I would like to express my deepest gratitude to my supervisor, Dr. Gemma Gao for

guiding and supporting me throughout the entire study. I would also like to thanks Dr.

Gemma Gao for providing me valuable suggestions in my thesis. Last but not least, I

would like to thank the participants and the school teachers. My project would have

not been conducted smoothly without their participations and supports.

_______________________

Ng Kei Wing

Department of Physical Education

Hong Kong Baptist University

Date: 25th April, 2016

ABSTRACT

AIMS: This cross-sectional study aimed to investigate sports injury patterns

among a sample of university sports students in Hong Kong and to compare the

sports-related injuries pattern in team sports and individual sports.

METHODS: 129 collegial sports majored sports students were invited to the

current study. Participants are asked to fill in a self-administrated questionnaire in

order to access the history of physical activity participation and injury episodes in the

past 12 months. Subjects were then regrouped into two sport groups: team sport and

individual sport according to the physical activity that the subject participanted most.

IBM SPSS statistic 21 was used for data analysis. Chi-square test was used to test the

differences of the injuries by studied variable. Two-sided tests and a=0.05 was used.

RESULTS: The distribution of subjects in terms of sport group was 50.4% in

team (n=65) and 49.6% in individuals (n=64). The injury rate among the subjects in

the past 12 months was 62.8% (n=81), where 54.3% were from the team sport group

(n=44) and 45.7% from the individuals (n=37). A significant difference among the

association of the physical activity participation frequency and the injury rate

(p=0.03). There was also a significant difference between the primary reason of injury

among the team sports and individual sports (p=0.04). There was no significance

between the injury rate and sport groups (p=0.25). There was no significant difference

among the injury pattern and the sport groups.

CONCLUSIONS: Injury within the subjects were popular. The association

between PA frenquency and injury rate had been found, which PA frequency can be

considered as a risk factor of causing sports-related injuries. The other hypothesis

need to be explored in the future studies. Moreover, future studies for the general

public should be conducted to indicate the situations as this reasrch is focused in

explaining the situation of the colleigal students instead of the gerenal public.

Keywords: sport injury; team sport; individual sport; collegial students; physical

Activities; Hong Kong

1

TABLE OF CONTENT

CHAPTER Page

1. INTRODUCTION………………………………………………………..............

Study Aims and Objectives…………………………………………..............

Significance of study…………………………………………………...........

Hypotheses……………………………………………………………...........

4

6

7

7

2. LITERATURE REVIEW…………………………………………………...........

Injuries in Individual Sports………………………………………….............

Injuries in Team Sports………………………………………………............

8

9

10

3. METHODS……………………………………………………………….............

Subjects and Sampling……………………………………………….............

Measurements…………………………………………………………...........

Data Collection Procedures…………………………………………..............

Data Analysis…………………………………………………………...........

Timeline of the Project………………………………………………............

13

13

14

15

16

16

4. RESULTS…………………………………………………………………...........

Distribution of Subjects………………………………………………............

Injury rate and Physical Activity Participation Frequency……………...........

Injury Pattern among Team Sports and individual Sports……………............

17

17

19

21

5. DISCUSSION AND CONCLUSION……………………………………............

Summary of Main Results……………………………………………............

Sports Group and Injury Rate…… …………………………………..............

Physical Activity frequency and Injury Rate…………………………............

Injury Pattern Among Sports Group………………………………….............

Summary of Limitations………………………………………………...........

24

24

24

26

27

29

2

Conclusion…………………………………………………………............... 30

RERFERENCE……………………………………………………………...........

APPENDICES……………………………………………………………............

A. Informed Consent Form…………………………………………...........

B. Questionnaire…………………………………………………….....

31

36

37

3

LIST OF TABLES

TABLE Page

3.1 Timeline of the project

4.1 Distribution of subjects

4.2 Distribution of dominate sport in team sports participants

4.3 Distribution of dominate sport in individual sports participants

4.4 Distribution of subjects by sport group and history of injury

4.5 Distribution of injury in the past 12 months by sport group and PA

participation frequency

4.6 Distribution of primary injury reasons among injured subjects (n=81)

4.7 Regrouped data of primary injury reasons and result of chi square test

4.8 Distribution of types of injuries

4.9 Distribution and chi square result on major types of sport injuries among

different sports groups

16

17

18

19

20

20

21

22

22

23

4

Chapter 1

INTRODUCTION

According to Peterson, sports injuries are caused by trauma of different degree

which would be divided into traumatic injuries caused by large force and overuse

syndromes (2001) which are usually associated with the training load, training

frequencies and the level of body contact involved in a particular sport. As sports are

mainly divided into two big categories, team sports and individual sports, that include

different trainings methods, different kinds of motions that may cause different kinds of

sports injuries.

Individual sport refers to those sports that athletes competes as an individual

although most of them has training as a group, a typical example would be all kinds of

track and field events. It is more common to find overuse injuries in this kind of sports

comparing to that in team sports. In Hong Kong, examples of some of the most

commonly participated individual sports among university students are athletics,

badminton and swimming. According to Jacobsson’s research on the Injury patterns in

Swedish elite athletics, 96%(out of 199 injured athletes) of the reported injuries were

suffered in non-traumatic injuries that were associated with overuse symptoms (2013).

In badminton, injuries in associated with overuse was 74% (out of 229 injuries) and

12% (28/229) were reported with strains according to Jørgensen’s research (2008).

Bernard found that shoulder injuries, strain and overuse injuries were common in

swimmers (2011). On the other hand, team sports are believed to have a higher risk of

causing traumatic injuries as most of them are contract sports that two groups of

athletes are oppose towards each other on the field, basketball, soccer and rugby would

be commonly seen as typical team sports among Hong Kong university students.

5

Sprains were found to be the most common type of injuries associated with basketball

participation which was 62.5% out of 32 cases followed by strains which was 15.6%

out of 32 injuries cases according to Owoeye’s research (2012). Sprains and strains

were also found the most common type of injury in soccer and rugby according to Kerr

(2008) and Yard (2008). As more body contact between athletes may be caused in team

sports, the risk of being injured would be relatively higher comparing to individual

sports.

Results from previous studies are found to support the view. Langwith et al

indicated that injury rates are highest for athletes who participate in contact sports, but

the most serious injuries are associated with individual activities (2014). Also,

individual sports were found associated with lower injury risk compared to team sports,

which the risk was 66% lower according to Malisoux’ research (2013).

In Hong Kong, the 'Sports for All' scheme had been promoted since 2007 in Hong

Kong, which is still an indicator of the importance of sport development of all age

groups. In the promotion, the benefits gained from engaging in physical activities are

especially stressed. According to the Consultancy Study on Sport for All conducted in

2008 concerning the participation rate of Physical Activity (PA) found that the

participation rate was high in adolescents who aged 13-19 and young adult who aged

between 20-39, which were 84.5% and 67.2% (excluding Physical Education Lessons

in adolescence division) respectively. Also, the report points out that 57.4% of the

adolescence participants and 44.2 % of the young adult population in the survey were

regarded as ‘Active’ (Lo et al, 2009). Also, according to the Injury Survey 2008, there

were about 6.2% of the samples, around 415,200 people, reported to sustain at least one

injury episode, which is an unintentional injury that was serious enough to limit their

6

normal activities 12 months before the survey where 14.1% (about 58,550 cases) of

those were caused by sports (Surveillance and Epidemiology Branch Centre for Health

Protection Department of Health, 2010). As shown as above, there are studies on

participation in physical activities and injuries respectively, but detailed participation

rate of each sport had not been well classified in the previous research. Moreover, few

studies further examine what kinds of sports are with higher participations and which

sport is associated with the highest injury rate. Therefore, it is worth working on a study

exploring the participation rate of sports and the injuries causes in Hong Kong in order

to give a better reference in the sports field.

In conclusion, Malisoux’s Research was the premier research in Luxembourg

associating the relationship in sport participation and injury risk; there is a need of

conducting similar kind of study in Hong Kong in order to give a clear look in the

relationships between the participation of different kinds of sports and the risks derive

from it would be explored.

Study Aims and Objectives

This study aimed to investigate the participation rate in sports and compare the

injuries pattern among university sports students. Specifically, the objectives of this

study would be:

1. To investigate sports injury patterns among a sample of university sports

students in Hong Kong;

2. To compare the sports-related injuries pattern in team sports and individual

sports

7

Significance of the Study

There were too little research stresses on sports participation and sports-related

injuries patterns in Hong Kong. The study would provide a close look of that through

questionnaires. This study would also provide the first handed information of sports

participation and the related injury pattern data for future researches.

Hypotheses

The hypotheses of this study were:

Hypotheses1: There would be no significant difference in the sports-related injury

pattern of individual sports comparing to team sports.

Hypotheses 2: There would be no significant different in the sports-related injury rate in

individual sports comparing to team sports.

Hypotheses 3: There would be no association between physical activities participation

frequency and injury rate.

8

Chapter 2

LITERATURE REVIEW

Sports participation in Hong Kong has been encouraged since the

implementation of the ‘Sports for all’ scheme (Lo et al, 2009). According to the

summary report on participation pattern in sport of Hong Kong People in physical

activities (PA) published in 2009, the age group having the highest participation in PA

is children aged 7-12 (95.6%), followed by adolescents and youths aged 13-19 (84.5%)

and young adults aged 20-39 (67.2%) respectively. The study also revealed that the top

three popular sports were jogging (13.8%), swimming (13.2%), and badminton

(10.1%), whilst basketball (7.3%) and football (4.5%) were the most popular “big ball”

games, which were also in the top ten sports. According to Maffulli (1996), specific

sports that caused injuries in Hong Kong were mostly ball games, such as basketball,

soccer, volleyball and rugby. Track and field and water sports are example in Maffulli’s

study which leads to sports injuries in individual sports.

Injury patterns vary across different sports. According to Theisen et al (2013),

team sports are those that two groups oppose each other on the playing field, with a

generally greater possibility of contact between players or athletes compared with

individual sports, such as basketball, football, and individual sports are those

participates competes as an individual although athletes may be trained in teams such

athletics, badminton and swimming. Thenisen also stated that the injury incidence was

higher in team sports compared with individual sports. In Theisen’s study, injury cases

of subjects were compared in the above categories. There is significant difference in

distribution in upper limbs, 21.7% in individual sports comparing to 13% in team

sports, and head/neck injuries, which is 3.8% in individual sports comparing to 0.7% in

9

team sports, in individual sports. Moreover, according to Malisoux et al (2013), young

athletes from team sports had one to two times higher risk of sustaining a traumatic or

overuse injury compared to individual sports when comparing 269 young elite athletes

aged between 12 to 19 years old. Also, Malisoux states that the risk of getting injured

was 66% lower for athletes engaged in individual sports compared to team sports.

In order to have a closer look in the difference in injuries of team sports and

individual sports, a series of previous literatures are reviewed. The following will sum

up the results of the reviewed literature according to the sports being studied. Injury

pattern data such as injury location, type and the injury category would be closed up

according studies of different kinds of team sports and individual sports. According to

the above description of sports participation in Hong Kong, basketball, soccer and

rugby are selected as examples of team sports, on the other hand, athletics (track and

field), swimming and badminton are selected as examples in reviewing the common

injury patterns.

Injuries in Individual Sports

According to Jacobsson et al (2013) study on elite athletics (track and field) ,

77% of injuries occurred in a lower extremity which the most common injured locations

were Achilles tendon, ankle, foot and toe (28%), followed by hip, groin and thigh

(24%), and the knee and lower leg (24%). Ninety-six per cent of the reported injuries

are classified as non-traumatic injuries caused be overuse. Jacobsson had also separates

the injury events according to the track and field and found common injury was

hamstring strain (23.5%) in sprinters, calf splits (22.5%) in middle and long distance

10

runners, lumbago (11.2%) in throwers and hamstring strains (10.2%) in jumpers. Also,

Kelly had sorted out some common runners’ injuries, which were knee, leg and ankle

injuries. She also indicates that only 20% of injuries of runners occurred above knee

(2010).

Kerr et al (2008) compared the injuries in male and female swimmers in

collegiate-level and found shoulder strains and overuses injuries were common in both

collegiate men’s and women’s swimming. In details, injuries occurred to shoulder in

men’s swimming and women’s swimming were 34.7% and 32% respectively. The

proportions on strains were 21.8% and 17% in men and women swimmers respectively.

Overuse injuries was recorded 44.4% and 63.7% in men and women swimmer

respectively.

Krøner et al (1990) studied 217 patients of badminton injuries and found that

82.9% of the injuries were occurred to the lower extremities, 44.2% injured in the

ankle, 14.3% in the leg, 11.5% in the knee. The study found badminton injuries

occurred to joints and ligament strains and ligament ruptures were the most common

(58.5%) where 66.9% of that was occurred to the ankle joint. Leg muscle injuries were

also common in badminton according to Krøner’s research.

Injuries in Team Sports

Dick et al (2007) revealed that majority of injuries incurred by collegiate men’s

basketball players were to the lower extremity, which was 57.9% during game and

60.6% during practices, with ankle ligament sprains being the most common injury

11

overall (26.2%) and noncontact knee injuries being the most common serious injury.

Most game (52.3%) and practice (43.6%) injuries resulted from player contact. In

addition, another study (Borowski et al, 2008) showed that the most common body sites

injured in high-school basketball players were the ankle/foot (39.7%) and knee

(14.7%). The most frequent injury diagnoses were ligament sprains (44.0%) and

muscle/tendon strains (17.7%), which was similar to the findings of Dick’s study.

Yard et al (2008) found the most frequent injuries in high school soccer player

were incomplete ligament sprains (26.8%), incomplete muscle strains (17.9%).

Ankle (23.4%), and knee (18.7%) were the most commonly injured body sites. The

most common mechanisms leading to soccer related sports injury were player-to-player

contact (42.8%), noncontact (23.1%), and contact with the playing surface (17.7%).

Furthermore, according to the study of Stubbe et al (2015), Injuries of professional

soccer player were most likely to be located in the lower

extremities (82.9%) where 21.3% were located in knee. The most common diagnosis

was lower limb muscle or tendon injury (32.9%), especially hamstrings (13.3%) and

groin (8.3%). Most of these injuries occurred due to contact with players (32.9%).

Palmer-Green et al (2011) found the most common injury site of rugby match

injuries in English youth academy and school’s rugby union was the lower limb and the

most common injury type was a ligament sprain, with injuries to the knee and shoulder

region resulting in the greatest burden. Furthermore, according to Garraway and

Macleod (1995), main site of injury (42% of episodes) was the lower limb,

12

with a much greater frequency of dislocations, strains and sprains in rugby injuries

which most injuries were strongly associated with injury was the tackle, accounting for

49% of injury episodes.

After reviewing a list of literatures, previous studies indicated the

common injuries in individual sports are muscle strains associated with non-traumatic

and overuse issues, the common injury region would be at the lower extremities. On the

other hand, sprains in the lower extremities associated with contact between players

was found the most common injury in team sports. Previous studies from western

countries shows that the injury pattern differs between individual and team sports,

however there were limited studies about the differences in injury patterns in different

sports in Hong Kong, further studies would be needed to provide a clear view of the

situation in Hong Kong.

13

Chapter 3

METHODS

The study was a cross-sectional study. Convenience cluster sampling was used

to recruit subjects.

Subjects and Sampling

Students who are attending this sports major course were selected for this

research. They were 129 students from three Sports program of Hong Kong Baptist

University (HKBU), which were the Bachelor of Social Sciences (Honours) in Sport

and Recreation Leadership (SRL), Associate Degree in Sport and Recreation Studies

(SRS) and the Bachelor of Arts (Honours) in Physical Education and Recreation

Management (PERM). Students from the SRL were invited to join the study at school

during lesson breaks while I invited two volunteers from SRS and PERM separately to

help handing out the questionnaires to the subjects. The participants signed a written

informed consent when they conduct the questionnaire.

The reason of choosing the programs was that the subjects were more confirmed

to have regular physical activities participation comparing to that of other majors. The

more the subjects were engaged in physical activities, the more concise data of sport

related injuries could be accessed for the analysis. Therefore, the current study had

chosen the sport majored collegial students as subjects even though it would cause the

limitation of being too representative.

14

Measurements

A self-administrated questionnaire was developed in order to collect data from

the subjects.

The questionnaire focused on the types of sports mainly participated, the

training rate or participation rate and the injury history of the past 12 months. It was

completed by the student own experience. The sports were than analyzed and grouped

into two sports categories: 1) team sports (basketball, soccer, rugby, volleyball,

tchoukball); 2) individual sports (track and fields, badminton, swimming, table tennis).

Subjects were recruited from sports program in the HKBU, which were expected to be

more physically active comparing to students from their age group in order to analyzes

the trend of sports injuries associated with the physical activities more conveniently.

A modified questionnaire of a survey for secondary students was used in this

subject and it contains of two parts. The first part of the questionnaire includes the types

of sports that the subjects, the related training/participation. The subjects were asked to

fill in the three sports with the highest participation in the questionnaire, then, the

related training frequencies was being asked so that a full picture of the trend of training

was drawn. The sports participation frequencies were determined by the total physical

activities exposure time expressed in minutes. The times were added up to provide a

weekly training load. The mean and percentages of the training or physical activity

frequency were calculated from the data set.

15

In the second part of the questionnaire, information of the sport related injury

occurred in the past 12 months will be accessed. In this part, injuries mean any injuries

(including heat stroke and sun burn) that causes immediate stop on the PA, a ban on

attending the next planned PA, an absent on the schedule of the following day and any

medical care (exclude if only bandage is needed). Also, in this part, subjects were asked

to select the features describing the previous injuries and the related information will be

accessed in order to get a clear look in the type of injury the subject suffered, the

answers were listed as an multiple choice question including joint/ligament sprain,

muscle strain,bone fracture etc. Subjects could choose more than one answer in this

question. Moreover, the primary reason of the injury episode was accessed by a

multiple choice question with a list of answer for the subject to choose, the answers

includes contact with people, contact with objects or animal etc. Subjects could only

choose one answer for this question.

.

Data Collection Procedures

All subjects were invited in person during lesson breaks and questionnaires were

distributed at the time. The data collection was conducted at the time of questionnaire

distribution. Subjects were asked to fill in the questionnaire at the college with my

support or volunteers’ support. All questionnaires were collected immediately. I have

provided onsite supervision unless subjects have questions when they fill in the

questionnaire. Also, the questions were explained to the volunteers in order to clarify

the question requirement while I gave them the questionnaire.

16

Data Analysis

SPSS for windows version 21 were used for data analysis. Firstly, subjects were

divided into individual sports (IS) and team sport (TS) players. Then, the reported

injuries were grouped to analyze the injury pattern.

In this study, the significant level was α= 0.05. The categorical variables (e.g.

get injured or not) were presented in percentage and tested for between-group

difference by using chi-square test. Contiguous variables (e.g. times of training per

week) will be presented with mean (standard deviation, SD) and test for difference

between-group using Pearson Chi square test were used.

Then, all data were compared in order to research a conclusion of the difference

between the individual sports group and the team sports group.

Time Line of the project

The project was conducted according to the following timeline:

Table 3.1 Timeline of the project Before the time Task to be completed 1 Mar 2016 Data Collection 14 Mar 2016 Data Analysis 21 Mar 2016 Writing up results 11 Apr 2016 Writing up discussion and conclusion

17

Chapter 4

RESULTS

Distribution of Subjects

The 129 subjects were recruited from the Hong Kong Baptist University Sports

Department. There were 65 males (50.4%) and 64 females (49.6%), aged between 18 to

26 years old. Subjects were divided into three age groups, which were 18 to 20 years

old, 21 to 23 years old and above 24 years old, and there were 45 (34.9%), 72 (55.8%)

and 12 (9.3%) in each of the age group respectively. All subjects were from three

different sport programs of the HKBU, SRL, SRS and PERM, which contains 51

(39.5%), 41 (31.8%) and 37 (28.7%) subjects respectively. 61 (47.3%) subjects were

year 4 students, which took up most the population, year 2 and year 3 students shared

the same amount of subjects, which were both 25 (19.4%). 18 (14.0%) year 1 students

joined the research. The details of subjects were listed in Table 4.1.

Table 4.1 Distribution of subjects n % Gender

Male Female

65 64

50.4 49.6

Age 18-20 21-23 24 or above

45 72 12

34.9 55.8 9.3

Studying Program SRL SRS PERM

51 41 37

39.5 31.8 28.7

Year of Study Year 1 Year 2 Year 3 Year 4

18 25 25 61

14.0 19.4 19.4 47.3

18

After classification by the reported PA, all subjects were divided into Team Sports

Group and individual Sports Group which were 65 (52.7%) and 64 (47.3%) subjects

respectively.

In team sport section, the most popular dominate sport is basketball, which has 27

out of 65 subjects participated in. the second popular team sports are volleyball, where

12 out of 65 subjects participated in. Rugby is also popular within the team sports

participants, where were 9 out of 65 people participated in. Details were shown in Table

4.2.

Table 4.2 Distribution of dominate sport in team sports participants

In the individual section, data is more scattered for dominate sports, the most

popular sports were badminton (11 out of 64 people), jogging (9 out of 64) and cross

country run (8 out of 64). The kinds of dominate sport varies very rapidly with in the

individual participants and the details were shown in Table 4.3.

n %

Basketball 27 41.5 Handball 4 6.2 Korfball 2 3.0 Rugby 9 13.8 Soccer 7 10.8 Tchoukball 4 6.2 Volleyball 12 18.4

19

Table 4.3 Distribution of dominate sport in individual sports participants n % Badminton 11 8.5 Bowling 1 0.8 Cross country run 8 6.2 Cycling 1 0.8 Fencing 2 1.6 Gym 5 3.9 Gymnastic 3 2.3 High jump 2 1.6 Hiking 1 0.8 Hurdle 1 0.8 Javalin 1 0.8 Jogging 9 7.0 Karate 2 1.6 Lifesaving 1 0.8 Rope skipping 1 0.8 Rowing 2 1.6 Shuttlecock 1 0.8 Sprint 3 2.3 Squash 1 0.8 Swimming 4 3.1 Table tennis 3 2.3 Taekwando 1 0.8

Injury rate and Physical Activity Participation Frequency

There were 81 of them (62.8%) had reported injured when they participate in

physical activities. As shown as Table 4.1, there were 44 out of 65 (67.7%) subjects

who were team sports participants reported injured which is 36.4% of all injured

subjects. As shown as Table 4.5, there were 37 out of 64 (57.8%) individual sports

participants, which is 28.7% of all injured subjects, had injured in the past 12 months.

There was no significant difference (p=0.25) between the injury rate and the sport

group of the subjects. Thus, we cannot reject the second hypothesis (i.e. There would be

20

no significant difference in the sport-related injury rate in individual sports comparing

to team sports).

Also, 35 (43.2%) subjects reported injured while their PA participation rate were

about 3 to 5 times a week. 33 (40.7%) reported injured while they participated in PA

more than 5 times a week. Also, 13 (16.0%) were injured when they participated in PA

for less than 3 times a week. After running a chi square test on the data, it showed there

were significant difference (p=0.03) between the participation rate of physical activities

and the injury rate. Thus, the third null hypothesis (i.e. There would be no association

between physical activities participation rate and injury rate) of this research is rejected.

Table 4.4 Distribution of subjects by sport group and history of injury n % Sports Group

Team Individual

65 64

50.4 49.6

Injured in the past 12 months No Yes

48 81

37.2 62.8

Table 4.5 Distribution of injury in the past 12 months by sport group and PA participation frequency No YES X2 P

n % n % Sports Group

Team Sports Individual Sports

21 27

32.3 42.2

44 37

67.7 57.8

1.347 0.25

PA Participation Frequency Less than 3 times a week 3 to 5 times a week More than 5 times a week

15 23 10

31.3 47.9 20.8

13 35 33

16.0 43.2 40.7

6.94 0.03

21

Injury Pattern among Team Sports and individual Sports

There were 81 subjects reported injured in the past 12 months and the primary

reasons for each reported injury episode is listed in Table 6. The primary reason of

injury with the highest frequency was overuse, which counts 21 out of 81 (25.9% of the

injured population). There were 17 and 15 out of 81 subjects injured because of

compacting with people or compacting with objects, which were 20.9% and 18.5%

respectively.

Table 4.6 Distribution of primary injury reasons among injured subjects (n=81) n % Primary Reason of injury

Overuse Contact with people Contact with object or animal Falling Others Scratches Roll over

21 17 15 9 9 8 2

25.9 20.9 18.5 11.1 11.1 9.9 2.5

As scratches, falling and roll over might not be considered as serious sport injuries,

the subjects belong to these categories were then regrouped into the ‘other reason’

group for better analysis. The regrouped data was shown in Table 4.7.

After running a chi square test among the primary reason of injury to the injured

population in terms of sports group, a significate difference (p=0.04) was found. The

results showed that the percentage of team sports players to get injured due to contact

with people or objects is higher comparing to that in individual sport players, which

22

team sports had caused 26 contact injuries while individual sports had 9 only. on the

other hand, individual sports players had a double amount of injuries caused by overuse

comparing to that in team sports.

Table 4.7 Regrouped data of primary injury reasons and result of chi square test Team Individual X2 P

n % n % Primary Reason of injury

Contact with people Contact with object or animal Overuse Others

13 10 7 14

29.5 22.7 15.9 31.8

4 5 14 14

10.8 13.5 37.8 37.8

8.22

0.04

All types of reported injuries were listed in Table 4.8. The type of injury with

the highest frequency was joint/ligament sprain, which had 43 reported cases. Muscle

strain had the second highest frequency, which was 26 reported cases.

Table 4.8 Distribution of types of injuries n %

Types of injuries Joint/Ligament Sprain Muscle Strain Bone Fracture Scratches Slash Muscle/Ligament inflammation Cerebral Concussion

43 26 3 11 7 12 1

33.3 20.2 2.3 8.5 5.4 9.3 0.8

As mentioned above, scratches and slash might not be considered as serious

sport injuries, these data were not used on detailed analysis. Also, due to the small

number of subjects were suffered from bone fracture and cerebral concussion

therefore they were eliminated as well. A Chi Square test was run for joint/ligament

sprain, muscle strain and muscle/ligament inflammation. However, none of the

23

above had significant different when comparing among the sport groups. For

injured region of body, there were no significant differences among each body

region to the subjects’ sport group, there were still very obvious different in

numbers of reported injuries associate with injured the body part. There were 32

and 23 subjects from each sport groups respectively reported injuries associated

with lower extremity which is significantly higher than other body regions.

Table 4.9 Distribution and chi square result on major types of sport injuries among different sports groups Team

(n=65) Individual

(n=64) X2 P

n % n % Region of injury

Head Yes No

Upper extremity Yes No

Lower extremity Yes No

Trunk Yes No

4 61

12 53

32 33

10 55

6.2 93.8

18.5 81.5

49.2 64.1

15.4 84.6

3 61 9 55

23 41 4 60

4.7 95.3

14.1 85.9

35.9 64.1

6.3 93.8

0.15

0.46

2.33

2.78

0.70

0.50

0.13

0.10

Type of injury Muscle Strain

Yes No

Joint/Ligament Sprain Yes No

Muscle/Ligament Inflammation Yes No

12 53

25 40 6 59

18.5 81.5

38.5 61.5

9.2 90.8

14 50

18 46 6 58

21.9 78.1

28.1 71.9

9.4 90.6

0.23

1.55

0.01

0.63

0.21

0.98

24

Chapter 5

DISCUSSION AND CONCLUSION

Summary of Main Results

The result of the current study confirms there were association between injury rate

and PA participation frequency, which was one of the main research hypothesis.

However, two other hypotheses, association between injury rate and sport group and

differences in injury pattern among the sport groups were not confirmed related. Detail

of all hypotheses would be discussed in the following.

The summary of the subjects would be as listed as the followings, 129 HKBU sport

majored students, 65 males and 64 females, were approached according to a

convenience sampling, where 81 of them reported injured in the past 12 months. The

subjects were than regrouped into two sport groups, team sport and individual sport

according to their dominate sport, which is determined by the highest participation time.

There were 65 in the team sport group and 64 in the individual one. Subjects were

separated in all years of studies, about half of them were year 4 students, aged from 18

to 26 years old.

Sports Group and Injury Rate

There was not association found between sports group and injury rate. Despite

previous studies showed that individual sports were associated with lower injury risk

compared to team sports (Malisoux et al, 2013), no significant association (p=0.25) was

found in the current study. As the distribution of subjects was surprising equal, 65 in the

team sports group and 64 in the individual sports group. Although there were not

significate associations between the sport groups. Despite the result of the current

research did not match with the previous, which Thenisen et al indicates that individual

25

sports being associated with a lower risk compared to team sports (2013), there were

still a slightly higher number of reported injury episodes in the team sports comparing

to that of individual sport participants, which was 44 team sports player comparing to

37 individual sports player. The result may be more significant if the sample is larger.

The reason of causing thisconsequence was investigated. We found that there were

several team sports that were expected to have low risk in causing injuries such as

Tchouckball as this sport requires very low body contact. For more information,

Tchouckball is designed to encourage the positive aspects of sport such as teamwork,

inclusion, and celebration of excellent play while discouraging the negative aspects of

sport which are aggressive behavior and elitism (Eberly et al, 2005). Besides having

‘low injury risk’ team sports, there were several ‘high injury risk’ individual sports

were included in the subject population. The examples would be gymnastic, lifesaving

and martial arts such as karate and taekwando, as these sport involves a relatively

higher chances to have contact with people and objects that may lead to enlarge of risk

of injury exposure. The effects of the ‘low injury rate’ team sport and the ‘high injury

rate’ individual sport may explain the absent of significant differences in the chi square

test for association for the sport group and the injury rate. The relatively low population

size may also have regarded as the reason for not gaining significant differences.

Previous studies (Thenisen et al, 2010; Malisoux et al, 2013) had a larger number of

subject involved in analysis, which were 279 subjects in the research of Thenisen et al

and 154 for the research of Malisoux et al in details. Moreover, the current study is

based on a self- reported questionnaire while data collection, the data may be varied

since there may be one year away from the happening of injury episodes to the time of

data collection. Previous studies (Thenisen et al, 2010; Malisoux et al, 2013) made used

26

of observations during subjects PA engagement which were more reliable in terms of

data accuracy.

Physical Activity frequency and Injury Rate

There were association among PA participation frequency and injury rate. The

current research found a significant different among physical activities participation

frequencies and injury rate, which is p=0.03 (95% confidence interval). According to

the research of Backx et al published in 1991,injured youths spent more time in

practice than the non-injured ones, both in organized and non-organized sports which

proves that the association of high frequency of physical activity engagement and

relatively high injury rate had been proved for a long period of time. Results from the

current research also proves the correctness of this phenomenon. There were triple of

injured players than never injured in the past 12 months when the PA participation

frequency came to more than 5 times a week. There were also 35 cases of injuries when

the participation frequency was about 3 to 5 times a week. Although there were 23

subjects reported never injured off the same category, there were still quite a different

between the injured and never injured population. According to Dupont, 72 to 96 hours’

recovery time between 2 matches is sufficient to maintain physical performance.

However, it is not long enough to maintain a low injury rate (2010). The subjects with

high participation frequency are suggested to reduce their frequency of PA in order to

lower their risk to expose to sports injury. According to Luke et al, potential activity

volume and intensity over any 48-hour period, recovery time between all training and

competition bouts is needed (2011). In other words, subjects with a very high PA

participation frequency was exposed from a relatively higher risk of getting injured

27

Injury Pattern Among Sports Group

There were no associations in injury pattern among the sports group except for the

primary reason of injury. For the primary reason of injuries, there was a significant

difference (p=0.04). There was a double in number for overuse injury of team sport to

that of individual sport, which was 7 in team sport and 14 in individual sport

numerically presented. The result matches with the findings from the previous studies,

which Thenisen et al (2013) states that athletes from team sports had about two times

higher risk of sustaining a traumatic injury compared to individual sports. Also,

Malisoux et al also stated that there was a higher incident of traumatic injuries in team

sports as contacts between player and teammates are generally more frequent in team

sports (2010). Besides the difference in contact injuries, there were difference in

overuse injuries among the sport groups. There was a double on number of injury

episodes associated with overuse of individual sports comparing to that of team sports,

which is 14 in individual sport and 7 in team sports. Although the population is small,

we could still see the differences between the two sport groups which is a great

breakthrough for a research that was not able to access a huge group of subjects for

detailed analysis. As injury primary reasons such as scratches, roll over and falling

cannot be considered as serious sports injuries, they were regrouped into the category of

‘other reason of injuries’ during data analysis. There were the dame number of injury

episodes, which were 14 episodes from each of the sport groups. As there were the

same number from teach of the sport group, this category is considered not to have

influence to the result of chi square test that indicates the associations among primary

reason of injury and the sport group.

28

Both injured region and type of injury showed no significant different after the chi

square test. Chi square testes were run between sports group and each injured body part,

none of them returned with significate differences. However, findings could be noticed

from cross matching with different injured regions. Lower extremity has the highest

report rate among the injured population of the two sport groups, which were 32 from

team sport group and 23 from the individuals. According to the study of Hootman et al

in summarizing 16 years of National Collegiate Athletic Association (NCAA) injury

surveillance data for 15 sports, more than 50 % of all reported injuies were to the lower

extremity (2007). This explains the results from the current study which most injuries

were associated with the lower extremities. Similar findings were found from the

research of Dane et al (2004), each sports included in the research, which were soccer,

basketball, volleyball, running and wrestling, found that an average of over 30 % of

each sports had reported injured in lower extremity. Although the current study did not

find association between lower extremity injuries and the sport group subjects were in,

the high report rate of lower extremity explains the phenomena of a higher risk in

suffering from lower extremity sport injuries comparing to other body regions. For

types of injuries, there were no significant different among types of injuries and the

sports group. However, there were a double in number of subjects reported in suffering

from joint or ligament sprain in the team sport group comparing to the number of

muscle strain, which was 25 and 12 respectively. There were a slightly higher number

in the same situation within the individual sport group, which is 18 cases for joint or

ligament sprain to 14 muscle strains. Moreover, there were 6 subjects from each of the

sport groups had reported in suffering from muscle or ligament inflammation. There

were little researches that had addressed the suitation, there were researches suggested

that sprains, especially ankle as the most common sport injury among varies of sports.

29

According to the review of Fong et al, Ankle sprain was the major ankle injury in 33 of

43 sports and the results show that the ankle was the most common injured body site in

24 of 70 included sports (2007). The results from the review could help explaining the

difference in the higher number of joint or ligament sprain in terms of reported number

from the current research. Futher studies are need to explain the association among

sport type and the types of injuries that were easier to suffer from.

Summary of Limitations

Study design. The research is a cross sectional study included a self-reported

questionnaire. As all the data is relied on subjects’ memory on their injury episodes in

the past 12 months, there might be sight error on the responds due to the length from

injury till data collection. Thus, the data of this research may not be as concise as the

data of a longitudinal study. Moreover, self-reported based questionnaire has a

relatively lower data accuracy comparing to that of other study designs such as

prospective cohort study which used observation sections for data collection. There

may be error for data collected in the current research.

Size of research population. As the time and resource allowed for this research is

limited, not a large amount of subjects could be contacted. Thus, a population of 129

subjects were used in the current research. However, the lack of sample size leads to

many inconvenience for the research such as lacking data to support some of the

hypotheses to reach significant different.

30

Representative. As the recent study had only analyzed the participation frequency

and injury pattern of sports major students from the Hong Kong Baptist University. The

findings can only explain the phenomena of this focused population or similar

population such as sport majored students where the situation of sport injury pattern and

PA participation mode of the general public could not be explained based on the

findings of this research. For situations of that in the general public may be needed to

be explain and explored in the future researches.

Conclusion

The current research investigated the relationship between injury rate, physical

activities participation frequencies and injury pattern among team sports and individual

sports in the sports majored university students in Hong Kong. The association between

PA participations and injury rate and relations of types of injury and sport group were

being proved positive. However, the research did not indicate the differences between

the injury pattern in the sport groups. Further studies is needed to investigate the

difference in injury patterns among sport groups. Also, the relationships of the above

findings among general public should also be investigated in future studies as this

research only indicates the relationship the variables to the situation of collegial sports

students.

31

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36

APPENDIX A

Informed Consent Form

研究知情同意書

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APPENDIX B

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DIFFERENCES IN SPORTS PARTICIPATION AND SPORTS ...libproject.hkbu.edu.hk/trsimage/hp/Ng Kei Wing...

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