GENERALIZED JOINT HYPERMOBILITY AND ITS RELATIONSHIP TO INJURY PATTERNS AMONG NCAA LACROSSE PLAYERS

The purpose of this study was to prospectively observe injury patterns among hypermobile (H) and normally-mobile (NM) NCAA lacrosse players. Methods: Three hundred forty eight (161 males, age 20.37 +1.66; 187 females, age 20.24 +4.35) volunteers from 17 teams were screened for hypermobility using the Carter- Wilkinson-Beighton technique.

This method examines range of motion at the fingers, thumbs, elbows, trunk and knees bilaterally, and employs a 0-9 scoring scheme. Athletes who scored 5 or higher were considered hypermobile. Certified athletic trainers prospectively recorded injuries on a standard form during the 1995 season, including pre- and postseason play. For this study, only injuries which required the athlete to miss at least one practice or game were considered. To account for exposure differences, athletic trainers also recorded hours of practice and game participation for their team/s.

Results: The prevalence of generalized joint hypermobility was 23% (80/348; 32% [60/187] of females; 12.4% [20/161] of males). Fourteen athletes failed to complete the season, 12 NM, and 2 H (p=<.05). One hundred thirty four injuries were sustained by 100 athletes. Males suffered injuries at a rate of .6 per 1000 player-hours of exposure, and females at a rate of .2/1000 hours (p=<.001). Analysis of the injury data by hypermobility status showed no significant difference (p=>.05) in injury rate among H (.2/1000 hours) compared to NM (.4/1000 hours), or in any of the following sub-categories: activity at the time of injury (89% occurred during sport), referral to physician (27% of injuries referred), mechanism of injury (35% direct contact). There was also no significant difference in the occurrence of sprains, fractures, bursitis or cartilage injuries. Hypermobiles showed an increased rate of ankle injuries (26% or 6/23 of injuries to H versus 9% or 10/111 to NM; p=<.05). NM athletes showed a trend toward an increased rate of strains (41% or 45/111 of injuries to NM versus 30% or 7/23 to H; p=.051).

Discussion: It appears that generalized joint hypermobility had no effect on overall injury rates between H and NM in this group of lacrosse players. However, other research, based mainly on data collected in non-athletic patients with arthralgia and other joint complaints, strongly suggests that compared to NM, hypermobiles run an increased risk of musculoskeletal injury. In fact, many hypermobility researchers recommend that H avoid or curtail participation in strenuous physical activity. Studies of athletes, which might directly support this recommendation, however, are evenly divided in their findings of relative injury incidence among H and NM populations.

While our study suggests some differences in injury patterns, a more conclusive and persuasive answer to this question must be found before we could justify depriving hypermobiles of the many known benefits of regular/strenuous exercise.

1996 Decoster LC, Lindsay RH, Bernier JN, Vailas JC: Generalized joint hypermobility and its relationship to injury patterns among NCAA lacrosse players (Abstract). J Athletic Training, Volume 31, Supplement.