Musculoskeletal injuries among professional players of the Nigeria female basketball league : A need for intervention

Abstract Introduction Despite the enormous growth in the game of basketball in Nigeria, there appears to be little attention on the player’s health even at the professional level. Studies to justify the need for injury prevention and management at the professional level are limited in Nigerian basketball. This study therefore sought to assess the pattern of musculoskeletal injuries in these players. Materials and methods A retrospective cross-sectional survey of all registered players of the Nigeria Female Basketball League was carried out at the end of the 2010–2011 league seasons. Information on any musculoskeletal injuries and time-loss injuries among others in the past 12 months was collected through a structured self-administered questionnaire. Data were analysed using descriptive and inferential statistics. Results A total of 108 injuries were sustained by 58 players (aged 18.2 ± 2.66 years) with a 12-month injury prevalence of 55.8%. The prevalence of time-loss injuries was 33.3%. The frequency of occurrence of injuries during matches and training did not differ significantly (P = 0.330). Sprains (34, 31.5%) and strains (21, 19.4%) were the most common types of injuries, while head injuries (4, 3.70%) were the least common type of injuries. Injuries predominantly occurred in the lower limbs, with the knee (29, 27.0%) and ankle (26, 24.1%) having the highest prevalence. Point guards sustained more injuries than players in other positions (14, 24.1%). The severity of time-loss injuries was mostly mild (20, 37.0%) and moderate (18, 33.3%). Conclusion The prevalence of injury was considerably high among professional female basketball players in Nigeria and one out of three players suffered a time-loss injury during a league season. The pattern of injury was mostly consistent with previous reports on basketball injuries. This study suggests the need for further studies and appropriate injury prevention and management strategies among the players of the Nigeria Female Basketball League.


Introduction
Despite the enormous growth in the game of basketball in Nigeria, there appears to be little attention on the player's health even at the professional level.Studies to justify the need for injury prevention and management at the professional level are limited in Nigerian basketball.This study therefore sought to assess the pattern of musculoskeletal injuries in these players.

Materials and methods
A retrospective cross-sectional survey of all registered players of the Nigeria Female Basketball League was carried out at the end of the 2010-2011 league seasons.Information on any musculoskeletal injuries and time-loss injuries among others in the past 12 months was collected through a structured self-administered questionnaire.Data were analysed using descriptive and inferential statistics.Results A total of 108 injuries were sustained by 58 players (aged 18.2 ± 2.66 years) with a 12-month injury prevalence of 55.8%.The prevalence of time-loss injuries was 33.3%.The frequency of occurrence of injuries during matches and training did not differ significantly (P = 0.330).Sprains (34, 31.5%) and strains (21, 19.4%) were the most common types of injuries, while head injuries (4, 3.70%) were the least common type of injuries.Injuries predominantly occurred in the lower limbs, with the knee (29, 27.0%) and ankle (26, 24.1%) having the highest prevalence.Point guards sustained more injuries than players in other positions (14, 24.1%).The severity of time-loss injuries was mostly mild (20, 37.0%) and moderate (18, 33.3%).

Conclusion
The prevalence of injury was considerably high among professional female basketball players in Nigeria and one out of three players suffered a time-loss injury during a league season.The pattern of injury

Introduction
Basketball is one of the world's most popular and widely viewed sports 1 .In Nigeria, it is the second most popular sport after football 2 .It is widely played from the grass-root to the professional level.Despite the enormous growth in the game of basketball in Nigeria, there appears to be little attention in terms of player's health even at the professional level.
The female basketball league in Nigeria is from March to November in three phases and in three different regions of the country.The 2010-2011 league season just like the previous ones lasted for 30 days.Each phase ran for 10 days, with intervals between each phase.Five matches were played each day, and all the teams were involved in all the matches each day of each phase.The three phases that spanned over a period of 8 months from March to November were played in Akure, Abuja and Lagos respectively.
As a sport grows in the number of participants and intensity, so does the number of injuries 3 .Women's sports, once dominated by a slow and defensive style, is now played with speed, precision and power; with these changes, increased injuries now occur 4 .Women's basketball is a faster-paced game than it was several years ago 5 .Unfortunately, less attention has been given to female players, especially when it comes to high-level participation, despite the increasingly engaging population in the sports 6 .
An important purpose of sports injury epidemiology is to supply knowledge on injuries that occur frequently and which have serious consequences, and to describe their aetiology in order to provide a basis for preventive measures 7 .However, such studies are globally limited on female basketball players.Thus, the conduction of epidemiological studies has become critical for characterizing injuries in this sport 8,9 .
A number of such epidemiological studies have been conducted in the United States and other parts of the world on both male and female players [4][5][6][8][9][10][11][12][13][14][15] . Howevr, in Nigeria, despite increased participation in the sport and the importance of research in this area, only very few published studies directly relate to basketball injuries 2,16,17 , and no published studies presently exist on professional female basketball players in Nigeria.Therefore, the purpose of this study common types, followed by bruise/ contusion (15, 13.9%) and cramp (9, 8.33%) during matches and trainings; dislocation (7, 6.50%), laceration (7, 6.50%) and head injury (4, 3.70%) were the least types of injuries sustained during matches and training (Table 1).There was no significant difference in the frequency of injury occurrence for the different types of injuries sustained during matches and training (P = 0.330).

Body parts injured
Regarding the anatomical region, injuries predominantly occurred in the lower limbs, with the knee (29, 27.0%) and ankle (26, 24.1%) having the highest prevalence.The third most common body part injured was the wrist/hand (12, 11.1%).The least injured body part was the abdomen (2, 1.9%) (Table 2).
For the purpose of analysis, players who sustained injury and could not continue with play during either training or matches between 1 and 3 days were classified as minimal, 4-7 days as mild, 8-28 days as moderate and above 28 days as severe 18 .

Data analysis
Data are summarized using descriptive statistics of frequency, percentage, mean, standard deviation and inferential statistics of chi-square.Level of significance was accepted at P < 0.05.

Results
Out of the 120 copies of the questionnaires distributed, 104 copies were returned by the players (aged 18.2 ± 2.66 years; range 14-28 years), giving a response rate of 86.7%.A total of 108 injuries were sustained by 58 players (each player sustained at least one or more injuries) in the past 12 months, giving an overall injury prevalence of 55.8%.Also, a total of 54 time-loss injuries were reported by 36 players; giving a time-loss prevalence of 33.3%.

Types of injuries sustained
Sprains (34, 31.5%) and strains (21, 19.4%) were found to be the most was to investigate the pattern of injuries in female players of the Nigeria Basketball League.

Materials and methods
This work conforms to the values laid down in the Declaration of Helsinki (1964).The protocol of this study has been approved by the relevant ethical committee related to our institution in which it was performed.All subjects gave full informed consent to participate in this study.
This study was a retrospective cross-sectional survey that involved all the professional female basketball players who participated in the 2010-2011 league season.Data were collected at the end of the league season after the third phase of the national league held at the National Stadium indoor games, Surulere, Lagos State, in November 2011.The female basketball league for the 2010-2011 season had 10 teams, and each team registered 12 players for the league season.A total of 104 out of the 120 basketball players consented to participate in this study.
The questionnaires were distributed to all participating players registered for the 2010-2011 Nigeria Female Basketball League either directly at the hotels where they were lodged or through their coaches who also helped in retrieving questionnaires.All players and coaches were informed about the aim of the study and anonymity of the data before questionnaires were distributed.
The research instrument used for the study was an injury questionnaire adapted from previous local studies on basketball injury 2,16 .The questionnaire had two sections: section A included demographic data of the players which include their age, height, weight, team, and playing position; section B recorded the total number of injuries sustained during the 2010-2011 league season, timeloss injuries and period of absence from matches and training, type of injury/injuries and body parts injured.the lower limb.This study found injuries involving the knee joint to be the most prevalent.The complexity of the knee joint structure and the multidirectional forces imposed on the knee joint during sporting activities may explain why knee injuries are often more severe than injuries to other body regions.Factors that could predispose players to injuries include anatomical differences in structure, lower limb biomechanical differences and hormonal factors 10,19 .
Although injury aetiology relates primarily to sport-specific activity, female athletes are at higher risk of knee injury than their male counterparts in jumping and cutting sports 20 .Sprain and strain were the most documented types of injury in congruence with most other studies [8][9][10][11][12][13][14][15][16] , which showed that ligament sprain and muscle/tendon strain were the most frequent injury diagnosis.Regarding injury prevalence and players' positions in the court, point guards had the highest prevalence.This could be because the point guard position is a very crucial one and usually the most active player on the basketball court.The point guard is the playmaker and one in charge of controlling and distributing the ball and making sure that the right players get the ball at the right time 1 .
Epidemiological studies in all categories and levels of basketball are required to assess the pattern of injury and identify risk factors associated with playing basketball.This study is the first cohort study on female basketball players in Nigeria, and thus its findings may provide a platform for preparing preventive measures in the population studied.However, a limitation of the present study is that players themselves retrospectively documented injuries.We recommend more studies, especially prospective studies, for an accumulation of data that will help proffer objective measures of injury prevention in basketball.
studied reported time-loss injuries of which most were mild.One out of three players losing play time for training and matches raises an alarm for concern and a need for appropriate intervention.Since most previous studies available currently did not assess injury severity, it becomes difficult comparing our results with others in order to determine the peculiarity of the problem.
Our study found the lower limbs to be the most commonly injured body region (73.4%); this finding is consistent with previous studies on basketball injuries 2,[4][5][6][8][9][10][11][12][13][14][15][16] . Howevr, in terms of the most commonly injured anatomical region in basketball, there are some controversies in literature on whether the knee or the ankle is the most frequently injured part of Severity of injuries Time-loss injuries were mostly mild (20, 37.0%) and moderate (18, 33.3%), accounting for 4-7 days and 8-28 days off play respectively.There was no significant difference between the severity of injuries during training and matches (P = 0.781) (Table 4).

Discussion
The growth and popularity in basketball participation in Nigeria creates an urgent need for injury surveillance to identify potential avenues for injury prevention.This study showed an injury prevalence of 55.8% among female players of the Nigeria Basketball League, which indicates a substantially high prevalence of injury.A third of the players

Conclusion
The prevalence of injury was considerably high among professional female basketball players in Nigeria, and one out of three players suffered a time-loss injury during a league season.The pattern of injury was mostly consistent with previous reports on basketball injuries in the literature.This study suggests the need for appropriate injury prevention and management strategies among the players of the Nigeria Female Basketball League.Furthermore, there is a pertinent need for more studies relating to injury surveillance in basketball.

Table 1 Injuries sustained and player's exposure Types of Injury Training Matches Total
X 2 = 9.14, P = 0.330.