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Descriptive epidemiology of injuries in Japanese collegiate men’s basketball: 2013/2014 to 2019/2020

Descriptive epidemiology of injuries in Japanese collegiate men’s basketball: 2013/2014 to 2019/2020 Background: Basketball is one of the most played sports in the world. However, only a few studies have examined the epidemiology of Japanese collegiate men’s basketball injuries. This study investigated the incidence of injury among Japanese collegiate men’s basketball from the 2013/2014 to the 2019/2020 seasons and identified unique pat - terns by comparing our data with the National Collegiate Athletic Association (NCAA) men’s basketball data. Methods: Data from Japanese collegiate basketball teams of the Kanto Collegiate Basketball Federation Division I League during the 2013/2014 to 2019/2020 academic years (23 team-seasons) were used in this study. Injury rates per 1000 athlete exposures (AEs), injury proportions, and the injury rate ratio (IRR) were calculated according to the events, injury types, body parts, and common injury mechanisms. Injury rates were then compared with that from the time-loss injury data of the NCAA’s previous reports. Results: In total, 480 injuries during 97,515 AEs were reported, leading to an injury rate of 4.92 per 1000 AEs (95% CI = 4.48–5.36). The overall injury rate was higher in Japan than in the NCAA ([2009/2010–2014/2015] IRR = 1.55, 95% CI = 1.39–1.73; [2014/2015–2018/2019] IRR = 1.64, 95% CI = 1.48–1.82). Lower extremity injuries occurred most frequently (73.5%). Ankle sprain was the most common injury in Japan, with higher injury rates than in the NCAA (IRR = 2.10; 95% CI = 1.72–2.57). The injury rate of concussion was lower in Japan than in the NCAA (IRR = 0.28; 95% CI = 0.14–0.55). Conclusions: The rates of overall injury and ankle sprain were higher and that of concussion was lower in Japan than in the NCAA. These results suggested the existence of international differences in the pattern or features of injuries in basketball players. Keywords: Basketball, Collegiate, Injury surveillance 2007; McInnes et al. 1995). The nature of basketball, such Background as changes in direction, player contact, repetitive jump- As a high-intensity sport, basketball is characterized by ing, and landing activities, might affect the incidence of high aerobic and anaerobic demands, continuous changes lower extremity injury (Zuckerman et  al. 2018), particu- in direction, accelerations and decelerations, jumps, larly ankle sprain (Tummala et al. 2018). sprints, contacts, and specific skills (Ben Abdelkrim et al. Various epidemiological studies on sports-related injuries have been reported from the injury surveil- *Correspondence: y.sekine@thu.ac.jp lance program of the National Collegiate Athletic Asso- Faculty of Modern Life, Teikyo Heisei University, 4-21-2 Nakano, Nakano-ku, Tokyo 164-8530, Japan ciation (NCAA-ISP) (Zuckerman et  al. 2018; Tummala Full list of author information is available at the end of the article © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:// creat iveco mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Sekine et al. Injury Epidemiology (2022) 9:4 Page 2 of 10 et  al. 2018; Clifton et  al. 2018; Dick et  al. 2007a; Morris 2019/2020 academic years in Japan (April 1st–March et  al. 2021). The studies from the NCAA-ISP emphasize 31st). A total of seven teams from the KCBF Divi- a high level of evidence-based practices related to injury sion I League, consisting of 10 (until 2017) to 12 teams prevention and are a vital resource for further research (2017-present), participated in the investigation. Since (Curtis et al. 2008; Silvers-Granelli et al. 2015). In Japan, some teams were unable to continue the survey due to the Japan Association for University Athletics and Sport factors such as dropping out of the survey (2 teams) and (UNIVAS) was established in 2019 by the Japan Sports replacing divisions (1 team), this study was conducted Agency, an external bureau of the Ministry of Education, using mixed data (23 team-seasons). This study was Culture, Sports, Science and Technology (MEXT) (Japan approved by the Human Ethics Review Committee of Association for University  Athletics and Sport 2021). Teikyo Heisei University (No. R01-080-1). The study was One of the chief projects of the UNIVAS is to improve conducted according to the tenets of the Declaration of the environment for collegiate athletic activities and to Helsinki. increase engagement in sports, safely and securely. To achieve these objectives, surveys and research on the Data collection aspects related to sports activity-related accidents are The injury and exposure data collected under the super - required. vision of an athletic trainer certified by the Japan Sports A total of 597,375 basketball players registered with Association in each team (all of them were employed the Japan Basketball Association in 2019 comprised part-time) were aggregated for each season. Data were over 8000 collegiate men (Japan Basketball Association recorded in a pre-designed and unified electronic spread - 2021). To prevent injury and illness and to improve the sheet, which were collected at the end of each season. athletic performance of the Japanese collegiate basket- Injuries that occurred during basketball games or basket- ball players, the Department of Medicine and Science ball-specific practices (e.g., shooting drills, offensive or attached to the Kanto Collegiate Basketball Federation defensive moves, and scrimmages) were included in the (KCBF) was established, comprising the area including study. Any injuries that occurred in weight training or the Tokyo, Kanagawa, Chiba, Saitama, Gunma, Ibaraki, conditioning sessions (e.g., sprint training, agility train- and Tochigi prefectures (Kanto Collegiate Basketball ing, and plyometrics) and illnesses were excluded. u Th s, Federation 2021). Currently, there have been no epi- we excluded a total of 4 injuries during weight training demiological studies on Japanese collegiate basketball and conditioning and 51 illnesses. players. Although one epidemiological study including elementary school mini-basketball players with a mean age of 10.9 ± 1.0 was reported, the rules and standards Definitions for mini-basketball vastly differ from those of general Based on previous studies Kuzuhara et  al. (2016), Dick basketball, including ball size, goal height, and game time et al. (2007b), an injury was defined as any event that (1) (Kuzuhara et  al. 2016). Moreover, the characteristics of occurred as a result of participation in regular practice or injuries in the childhood category alone was unidentifi - competition in sports, (2) caused the player to seek medi- able. For preventive intervention research in basketball cal care from a physician or alternative medical special- players, accurate epidemiological data are needed. In ist, or (3) resulted in the restriction of student-athlete addition, an international comparison with the results participation or performance for one or more calendar of previous studies might help to find and recognize the days since the day of injury. Time loss was one of the cri- current medical issues surrounding Japanese basketball teria used to describe the severity of health problems in players. Therefore, we aimed to describe the incidence of sports in the present study (Bahr et  al. 2020). To com- injuries in Japanese collegiate men’s basketball from the pare our data with the severe injuries reported in the 2013/2014 to the 2019/2020 seasons. We further aimed previous study (Zuckerman et  al. 2018), injuries that to investigate unique patterns by comparing our data required > 3 weeks to heal and allow the player to regain with the NCAA’s men’s basketball data, reported in pre- complete fitness for playing basketball or injuries that vious researches (Zuckerman et  al. 2018; Morris et  al. led to player retirement were defined as severe injuries. 2021). Athlete exposure (AE) was defined as one athlete partici - pating in the practice or official competition organized Methods by KCBF and the All Japan University Basketball Federa- Data source tion, wherein the player was exposed to the possibility of Data managed by the Department of Medicine and Sci- athletic injury, regardless of the time of participation. The ence of the KCBF were used in this study. The dura - player who warmed up before the match but did not play tion of the investigation was from the 2013/2014 to the was not considered an AE. S ekine et al. Injury Epidemiology (2022) 9:4 Page 3 of 10 Body parts, injury types, and mechanisms were clas- CIs were recalculated and applied from reported AEs and sified as follow (Table  1). To compare with previous number of time-loss injuries. research, isolated or a combination of anterior cruciate ligament (ACL), posterior cruciate ligament, collateral Results ligament (medial or lateral, not differentiated), or menis - Overall injury rates cus (medial or lateral, not differentiated) injury was also Over the period of 7  years, a total of 480 injuries across categorized as “knee internal derangement.” (Zuckerman 23 team-seasons were reported, of which 346 (72.1%) et al. 2018). occurred in practice, 130 (27.1%) occurred in com- petition, and 4 (0.8%) had missing event information (Table  2). These injuries occurred during 97,515 AEs Statistical analyses (practice: 89,559 AEs; competition: 7956 AEs), and The injury rate was calculated as the number of injuries a total of 87 (18.1% of overall injuries) were consid- per 1000 AEs. In the injury rate ratio, all 95% CIs, not ered severe injuries (> 21  days lost), one of which led to including 1.0, were considered statistically significant. forced medical retirement. A total of 57 (65.5% of severe The calculation of injury rates and rate ratios was ana - injuries) occurred in practice, 29 (33.3% of severe inju- lyzed with 95% confidence intervals (CIs) using Micro - ries) occurred in competition, and 1 (0.2%) was miss- soft Excel for Mac (version 16.45, Microsoft Corp, ing the event information. Injury rates in competition Redmond, WA) (Knowles et  al. 2006). The distribution were higher than those in practice among all injuries of the mechanisms of injury and proportion of severity (IRR = 4.23, 95% CI = 3.46–5.17) and severe injuries in each mechanism of injury were compared using the (IRR = 5.73, 95% CI = 3.66–8.96). 2 ® χ test, using SPSS software (version 27.0; IBM Cor- poration, Armonk, NY, USA). The alpha level was set to Mechanisms of injury p < 0.05. Following analysis, we attempted to compare Figure  1 shows the distribution of the mechanisms of our data with the reported injury data on the NCAA injury for all injuries and the proportion of severe injuries men’s basketball injuries from 2009/2010–2014/2015 and in each mechanism of injury. The most common mecha - 2014/2015–2018/2019 (Zuckerman et  al. 2018; Morris nism of injury was contact with another player (n = 228, et  al. 2021). Common injuries and severe injuries were 47.5%), followed by no contact (n = 124, 25.8%), overuse also compared with those published in the previous study (n = 93, 19.4%), and contact with an object (n = 27, 5.6%) (Zuckerman et  al. 2018). Since non-time-loss injuries, (χ = 320.02, p < 0.001). A total of 53.1% of injuries were which were defined as injuries resulting in participation contact-related (n = 255). The proportion of severe inju - restriction for < 24  h, were not recorded in the present ries was as follows: overuse (n = 21, 22.6%), contact with study, only time-loss injuries reported in previous stud- an object (n = 6, 22.2%), no contact (n = 23, 18.5%), and ies were included for comparison. Injury rates and 95% contact with another player (n = 37, 16.2%). Injuries by body part Lower extremity (including hip/groin, upper leg, knee, Table 1 Classification of body parts, injury types, and lower leg, ankle, and foot) injuries accounted for the mechanisms majority of total injuries (73.5%) (Table  3). In particular, Body parts Injury types Mechanisms of injury ankle (35.8%), upper leg (12.1%), and trunk (11.0%) inju- ries were the most commonly reported. Injury rates in Head/face Sprain Contact (with another player) all body parts, except for the arm/elbow and hip/groin, Neck Strain Contact (with an object) were higher in competitions than during practice. Knees Shoulder Contusion No contact had the most severe injuries (40.8% of all knee injuries; Arm/elbow Concussion Overuse median, range of days lost = 77, 24–500). Hand/wrist Fracture Trunk Dislocation/subluxation Injury types Hip/groin Laceration All injury rates except for those of tendonitis were higher Upper leg Tendonitis in competitions than that during practice (Table  4). Knee Nerve injury Sprains (44.8%), contusions (13.5%), and strains (10.0%) Lower legCartilage injury accounted for the largest proportion of overall injuries. Ankle Other Cartilage injury was noted to be the most severe injury Foot (72.7% of all cartilage injuries; median, range of days a b Including the chest, abdomen, upper back, and lower back Including lost = 60.5, 45–109). meniscus injury Including the ball, surface, equipment, etc. Sekine et al. Injury Epidemiology (2022) 9:4 Page 4 of 10 Table 2 Injury rates and 95% CIs by the events in Japanese collegiate men’s basketball, 2013/2014–2019/2020 and comparison with NCAA men’s basketball Japan NCAA Japan versus NCAA 2009/2010– 2014/2015– 2009/2010–2014/2015 2014/2015–2018/2019 2014/2015 2018/2019 n IR and 95% CI (per 1000 n IR and 95% n IR and 95% IRR (95% CI) IRR (95% CI) AEs) CI (per 1000 CI (per 1000 AEs) AEs) Practice Injuries 346 3.86 (3.46–4.27) 635 2.80 (2.58–3.02) 950 2.59 (2.43–2.76) 1.38 (1.21–1.57)* 1.49 (1.32–1.68)* Severe injuries 57 0.64 (0.47–0.80) 65 0.29 (0.22–0.36) 2.19 (1.60–3.01)* Competition Injuries 130 16.34 (13.53–19.15) 286 4.56 (4.03–5.09) 482 4.31 (3.93–4.69) 3.58 (2.91–4.41)* 3.79 (3.12–4.60)* Severe injuries 29 3.65 (2.32–4.97) 52 0.83 (0.60–1.05) 4.39 (3.00–6.43)* Overall Injuries 480 4.92 (4.48–5.36) 921 3.18 (2.98–3.39) 1432 3.00 (2.84–3.15) 1.55 (1.39–1.73)* 1.64 (1.48–1.82)* Severe injuries 87 0.89 (0.71–1.08) 117 0.40 (0.33–0.48) 2.23 (1.69–2.94)* AEs; athlete exposure(s): Practice = 89,559, Competition = 7,956, CI; confidence interval, IR; injury rate, IRR; injury rate ratio Overall injuries do not equal sum of Practice and Competition injuries due to four injuries missing the event information Japan versus the NCAA data (Zuckerman et al. 2018; Morris et al. 2021) injury rate ratio > 1.00 and does not include 1.00 in the 95% CI Competition versus Practice injury rate ratio > 1.00 and does not include 1.00 in the 95% CI Comparison with the NCAA data (overall injury rates, common injuries) The overall injury rates in Japan were higher than those reported by the NCAA for the periods of 2009/2010– 2014/2015 and 2014/2015–2018/2019 ([2009/2010– 2014/2015]: practice IRR = 1.38, 95% CI = 1.21–1.57; competition IRR = 3.58, 95% CI = 2.91–4.41; over- all IRR = 1.55, 95% CI = 1.39–1.73) and [2014/2015– 2018/2019]: practice IRR = 1.49, 95% CI = 1.32–1.68; competition IRR = 3.79, 95% CI = 3.12–4.60; overall IRR = 1.64, 95% CI = 1.48–1.82). Severe injury rates were also higher in Japan than in the NCAA (practice IRR = 2.19, 95% CI = 1.60–3.01, competition IRR = 4.39, 95% CI = 3.00–6.43, and overall IRR = 2.23, 95% CI = 1.69–2.94) (Table  2). Ankle sprains constituted the Fig. 1 The distribution of the mechanisms of injury. Note: One injury highest proportion of injuries in Japan, as in the NCAA; in each of contact (player), contact (not player), no contact, and overuse had no time-loss recorded however, the rate was higher in Japan than that reported by the NCAA (IRR = 2.10, 95% CI = 1.72–2.57) (Table 6). The concussion rate in Japan was less than that reported by the NCAA (IRR = 0.28, 95% CI = 0.14–0.55). Common injuries Discussion Ankle sprains were the most common in the present This study primarily aimed to describe the incidence of study (Table  5). Other common injuries included the injuries in Japanese collegiate men’s basketball between following in order of increasing value: lower back inju- the 2013/2014 and 2019/2020 seasons. Injury rates were ries, thigh contusions, knee internal derangements, four times as high in competitions as in practices. This and hamstring strains. The rates of ankle sprains, thigh result corresponded to previous reports that concluded contusions, and knee internal derangements were that intensity demands are greater during competitions higher in competitions than during practice. S ekine et al. Injury Epidemiology (2022) 9:4 Page 5 of 10 Table 3 Injury counts, rates (per 1000 Athletes Exposures), and percentage of severity by body part and type of event in Japanese collegiate men’s basketball, 2013/2014–2019/2020 Practice Competition Overall n (%) IR and 95% CI (per n (%) IR and 95% CI (per n (%) IR and 95% CI (per % Severe (median 1000 AEs) 1000 AEs) 1000 AEs) of days lost, range) Head/face 13 (3.8) 0.15 (0.07–0.22) 12 (9.2) 1.51 (0.65–2.36)* 25 (5.2) 0.26 (0.16–0.36) 8 (29.5, 28–31) Neck 2 (0.6) 0.02 (0.0–0.05) 0 0 2 (0.4) 0.02 (0.0–0.05) 50 Shoulder 11 (3.2) 0.12 (0.05–0.20) 9 (6.9) 1.13 (0.39–1.87)* 20 (4.2) 0.21 (0.12–0.29) 30 (93.5, 42–180) Arm/elbow 7 (2.0) 0.08 (0.02–0.14) 2 (1.5) 0.25 (0.0–0.60) 9 (1.9) 0.09 (0.03–0.15) 33.3 (25, 25–60) Hand/wrist 10 (2.9) 0.11 (0.04–0.18) 8 (6.2) 1.01 (0.31–1.70)* 18 (3.8) 0.18 (0.10–0.27) 33.3 (49, 37–81) Trunk 40 (11.5) 0.45 (0.31–0.59) 11 (8.4) 1.38 (0.57–2.20)* 53 (11.0) 0.54 (0.40–0.69) 15.1 (25, 24–44) Hip/groin 13 (3.8) 0.15 (0.07–0.22) 1 (0.8) 0.13 (0.0–0.37) 14 (2.9) 0.14 (0.07–0.22) 0 Upper leg 44 (12.7) 0.49 (0.35–0.64) 14 (10.8) 1.76 (0.84–2.68)* 58 (12.1) 0.59 (0.44–0.75) 15.5 (36,22–120) Knee 34 (9.8) 0.38 (0.25–0.51) 15 (11.5) 1.89 (0.93–2.84)* 49 (10.2) 0.50 (0.36–0.64) 40.8 (77, 24–500) Lower leg 26 (7.5) 0.29 (0.18–0.40) 8 (6.2) 1.01 (0.31–1.70)* 34 (7.1) 0.35 (0.23–0.47) 17.6 (36.5, 30–65) Ankle 127 (36.7) 1.42 (1.17–1.66) 43 (33.1) 5.40 (3.79–7.02)* 172 (35.8) 1.76 (1.50–2.03) 13.4 (30, 22–104) Foot 19 (5.5) 0.21 (0.12–0.31) 7 (5.4) 0.88 (0.23–1.53)* 26 (5.4) 0.27 (0.16–0.37) 15.4 (95,30–139) AEs; athlete exposure(s): Practice = 89,559, Competition = 7,956, CI; confidence interval, IR; injury rate, IRR; injury rate ratio *Competition versus Practice injury rate ratio > 1.00 and does not include 1.00 in the 95% CI Overall injuries do not equal the sum of Practice and Competition injuries due to four injuries missing the event information (two are in the ankle and two are in the trunk) One player retired due to the injury Including the chest, abdomen, upper back, and lower back Table 4 Injury counts, percentages and rates (per 1000 Athletes Exposures) by type of injury and event in Japanese collegiate men’s basketball, 2013/2014–2019/2020 Practice Competition Overall n (%) IR and 95% CI n (%) IR and 95% CI n (%) IR and 95% CI % Severe (median (per 1000 AEs) (per 1000 AEs) (per 1000 AEs) of days lost, range) Sprain 155 (44.8) 1.73 (1.46–2.00) 60 (46.2) 7.54 (5.63–9.45)* 215 (44.8) 2.20 (1.91–2.50) 15.8 (30, 22–500) Strain 39 (11.3) 0.44 (0.30–0.57) 9 (6.9) 1.13 (0.39–1.87)* 48 (10.0) 0.49 (0.35–0.63) 16.7 (36, 22–82) Contusion 38 (11.0) 0.42 (0.29–0.56) 27 (20.8) 3.39 (2.11–4.67)* 65 (13.5) 0.67 (0.50–0.83) 9.2 (34, 24–120) Concussion 5 (1.4) 0.06 (0.01–0.10) 4 (3.1) 0.50 (0.01–1.00)* 9 (1.9) 0.09 (0.03–0.15) 11.1 (22) Fracture 19 (5.5) 0.21 (0.12–0.31) 8 (6.1) 1.01 (0.31–1.70)* 27 (5.6) 0.28 (0.17–0.38) 51.9 (49, 25–139) Dislocation/subluxation 7 (2.0) 0.08 (0.02–0.14) 6 (4.6) 0.75 (0.15–1.36)* 13 (2.7) 0.13 (0.06–0.21) 30.8 (96, 87–180) Laceration 6 (1.7) 0.07 (0.01–0.12) 6 (4.6) 0.75 (0.15–1.36)* 12 (2.5) 0.12 (0.05–0.19) 0 Tendonitis 31 (9.0) 0.35 (0.22–0.47) 4 (3.1) 0.50 (0.01–1.00) 35 (7.3) 0.36 (0.24–0.48) 17.1 (32, 25–83) Nerve injury 8 (2.3) 0.09 (0.03–0.15) 0 0 8 (1.7) 0.08 (0.03–0.14) 37.5 (24, 24–25) Cartilage injury 7 (2.0) 0.08 (0.02–0.14) 3 (2.3) 0.38 (0.0–0.80)* 11 (2.3) 0.11 (0.05–0.18) 72.7 (60.5, 45–109) Other 31 (9.0) 0.35 (0.22–0.47) 3 (2.3) 0.38 (0.0–0.80) 37 (7.7) 0.38 (0.26–0.50) 10.8 (65.5, 33–96) AEs; athlete exposure(s): Practice = 89,559, Competition = 7956, CI; confidence interval, IR; injury rate, IRR; injury rate ratio *Competition versus Practice injury rate ratio > 1.00 and does not include 1.00 in the 95% CI Overall injuries do not equal sum of Practice and Competition injuries due to missing event information One player retired due to the injury than during practice (Clifton et al. 2018; Hootman et al. was not classified in our investigation, although it 2007). In particular, the severe IRR might accentuate included a variety of intensity contents (e.g., shooting the high activity intensity in competitions rather than drill, offensive or defensive moves, and scrimmages). in practice (IRR = 5.73, 95% CI = 3.66–8.96). Practice The subdivision of events in practice would allow us to clarify the proportion of injuries. Sekine et al. Injury Epidemiology (2022) 9:4 Page 6 of 10 Table 5 Common injuries in Japanese collegiate men’s basketball, 2013/2014–2019/2020 Injury Practice Competition Overall n (%) IR and 95% CI n (%) IR and 95% CI n (%) IR and 95% CI % Severe (median (per 1000 AEs) (per 1000 AEs) (per 1000 AEs) of days lost, range) Ankle sprain 120 (34.7) 1.34 (1.10–1.58) 43 (33.1) 5.40 (3.79–7.02)* 163 (34.0) 1.67 (1.41–1.93) 11.7 (30, 22–104) Lower back injury 36 (10.4) 0.40 (0.27–0.53) 7 (5.4) 0.88 (0.23–1.53) 45 (9.3) 0.46 (0.33–0.60) 18.2 (25, 24–44) Thigh contusion 25 (7.2) 0.28 (0.17–0.39) 12 (9.2) 1.51 (0.65–2.36)* 37 (7.7) 0.38 (0.26–0.50) 8.1 (36, 32–120) Knee internal derangement 14 (4.0) 0.16 (0.07–0.24) 9 (7.0) 1.13 (0.39–1.87)* 23 (4.8) 0.24 (0.14–0.33) 65.2 (106, 30–500) Hamstring strain 13 (3.8) 0.15 (0.07–0.22) 2 (0.5) 0.25 (0.0–0.60) 15 (3.1) 0.15 (0.08–0.23) 33.3 (36, 22–82) AEs; athlete exposure(s): Practice = 89,559, Competition = 7956, CI; confidence interval, IR; injury rate, IRR; injury rate ratio *Competition versus Practice injury rate ratio > 1.00 and does not include 1.00 in the 95% CI Overall injuries do not equal sum of Practice and Competition injuries due to 2 lower back injuries missing the event information Table 6 Comparison of common injuries in Japanese collegiate and NCAA men’s basketball Injury Japan NCAA Japan versus NCAA n IR and 95% CI (per 1000 n IR and 95% CI (per 1000 IRR and 95% CI AEs) AEs) Ankle sprain 163 1.67 (1.41–1.93) 230 0.80 (0.69–0.90) 2.10 (1.72–2.57) * Hand/wrist sprain 7 0.07 (0.02–0.13) 30 0.10 (0.07–0.14) 0.69 (0.30–1.58) Concussion 9 0.09 (0.03–0.15) 97 0.34 (0.27–0.40) 0.28 (0.14–0.55) Hip/groin strain 5 0.05 (0.01–0.10) 30 0.10 (0.07–0.14) 0.49 (0.19–1.27) Knee internal derangement 23 0.24 (0.14–0.33) 59 0.20 (0.15–0.26) 1.16 (0.71–1.87) AEs; athlete exposure(s): Overall in Japan = 97,515, CI; confidence interval, IR; injury rate, IRR; injury rate ratio * Japan versus the NCAA data reported by Zuckerman et al. (2018) injury rate ratio > 1.00 and does not include 1.00 in the 95% CI The NCAA data reported by Zuckerman et al. (2018) versus Japan injury rate ratio > 1.00 and does not include 1.00 in the 95% CI Compared with previous reports (Zuckerman et  al. possibility of lesser implementation of injury prevention 2018; Morris et  al. 2021), the overall injury rates were strategies, such as coverage by full-time athletic train- 1.55 to 1.64 times as high in Japan as those reported in ers, in schools with relatively fewer resources might have the NCAA. Additionally, overall severe injury (time lost resulted in their higher injury rate (Clifton et  al. 2018). for more than 21  days) in Japan was 2.23 times higher Our results indicate the necessity to recognize the defi - than that reported in the NCAA (Zuckerman et al. 2018). ciency of the availability of medical support for colle- A previous study concluded that more skilled athletes giate athletes in Japan. To clarify these inferences, further might be at a greater risk of potential injury (Clifton et al. investigation should be conducted to confirm the details 2018). Furthermore, the height and strength of basketball of the medical support system in Japanese collegiate ath- players would be directly proportionate to the impact letes and preventive efforts for sports injuries, and to of the force generated during play, which would thereby evaluate the role of potential determinants that led to potentially increase the risk of injury (Clifton et al. 2018). time loss (Chandran et al. 2020). The present results were inconsistent with those of pre - vious studies, and the reasons were unclear. Some limi- Injury mechanisms tations in the interpretation of timeloss as severity were The leading cause of injury was contact with another stated, since this consisted of several factors (unique player (n = 228, 47.5%), and no contact was the sec- individual pattern, recovery process, etc.) (Chandran ond most common injury mechanism (n = 124, 25.8%). et  al. 2020). The fact that Japanese collegiate basketball The present results support previous findings in colle - players have little opportunity to undergo an appropri- giate men’s basketball players (Clifton et  al. 2018; Dick ate recovery process during the time-loss period might et  al. 2007a). Details of the mechanism of injury may have influenced the results of the present study. Insuffi - provide an important basis for injury prevention strate- cient medical support systems for recovery processes in gies (Silvers-Granelli et  al. 2015; Longo et  al. 2012; Omi Japanese collegiate athletes might also be one of the fac- et al. 2018). On the other hand, the classification of indi - tors of the present results. Clifton et al. discussed that the rect contact mechanism (defined as any injury sustained S ekine et al. Injury Epidemiology (2022) 9:4 Page 7 of 10 through external forces that did not directly cause the lower than that in the NCAA (Table  5). We believe that injury but influenced the natural process of movement) the concussion rate is not simply affected by the dif - (Luig et  al. 2020) should also be considered due to the ference in activity intensity. In the NCAA, increasing characteristics of basketball injuries. In particular, inju- sports-related concussions were observed after the new ries caused by indirect external forces might be char- concussion policy (Baugh et  al. 2015) was adopted, and acteristic of basketball due to its specific activities (e.g., it was concluded that the increased sensitivity to con- landing from aerial contact during a rebound or shot). cussion in players and medical personnel and reporting The definition of the injury mechanism needs to be fur - might reflect an increase in concussion incidence (Zuck - ther clarified in future studies. erman et al. 2015). Moreover, there is a possibility that in this study in Japan, such injuries should have been con- Body site sidered as a “concussion” as they may have been over- Lower extremity injuries occurred most frequently looked due to variability in clinical presentation. The rate (n = 353, 73.5% of overall injuries). Similar to previous of concussion in our study highlights the importance of studies (Zuckerman et al. 2018; Clifton et al. 2018; Mor- judging appropriately. In 2015, the Japanese Society of ris et al. 2021), the ankle was the most frequently injured Clinical Sports Medicine released the suggestion of first- part in this study on Japanese basketball players (35.8% of aid for head injuries, which included contents based on overall injuries). However, injury of the knee, which was recent findings in head injuries to help the decisions and the second most frequent injury in NCAA men’s basket- actions of people who stand by the athletes (i.e., coaches ball players (Zuckerman et  al. 2018; Clifton et  al. 2018; and parents) (Japanese Society of Clinical Sports Medi- Morris et  al. 2021), was not the second most common cine 2021). To continue the investigation, we could obtain injury after injury of the ankle in Japan. A previous study more accurate findings for further research, address - examined the predictors of the knee valgus angle, which ing the incidence, prevention, and evaluation of public is a risk factor for ACL injury during drop-jump landing awareness of the importance of head injury. and reported the possibility that body height was associ- ated with the knee valgus angle during landing (Nilstad Common injury et  al. 2015). The authors concluded that a greater body Consistent with previous epidemiologic studies from the height, which correlated with femur and tibia length, pro- NCAA of collegiate basketball players, ankle sprain was vided longer lever arms and greater demands of strength the most frequent injury in Japan, as well. Interestingly, to control the knee joint. This was inferred as one of sev - however, the incidence rate was 2.10 times as high in eral potential factors influencing the lesser proportion Japan as that reported in the NCAA. This apparent differ - of knee injuries in Japanese collegiate men’s basketball ence indicates the necessity to improve the recognition, players (189.0 ± 7.0 cm) (Koyama et al. 2020) on account prevention, and appropriate treatment of ankle sprains of body height, which was less than that of the NCAA in Japanese basketball players. This is especially true for men’s basketball players (197.6 ± 7.1 cm) (Heishman et al. those below the collegiate category, which urgently needs 2020). improvement. In addition to prophylactic injury pre- In the injury surveillance between the 2013/2014 and vention strategies such as neuromuscular propriocep- 2019/2020 seasons, only two cases of neck injuries that tive training and external ankle support (ankle bracing occurred in practice were reported. In one case, the and taping) (Tummala et  al. 2018; McGuine and Keene player reportedly was forced to retire due to injury. Our 2006; Taylor et  al. 2015; Riva et  al. 2016), screening the results suggest the necessity to be mindful not only of the history of ankle injury is the best way to identify risk fac- magnitude of the injury rate, but also of the possibility tors (Tummala et al. 2018) since a history of ankle sprains of serious incidence, even if it is lower than others. This is the most common risk factor for recurrence (with an awareness is also required while preparing for emergen- almost fivefold increased risk) (McKay et  al. 2001). The cies for all the staff, as well as spectators, on the basket - high incidence of ankle sprains in Japan might be due to ball court. the environment surrounding young athletes. Moreo- ver, some players, who had an ankle sprain, might have Injury type developed chronic ankle instability, which is character- Previous studies have reported that the most frequent ized by recurrent ankle sprain (Hertel and Corbett 2019). injury types were sprain, strain, and concussion in NCAA In Japan, the school administration, staff, and faculty are men’s basketball (Clifton et  al. 2018; Dick et  al. 2007a). unequipped with knowledge and skills regarding the pre- In Japan, sprain and strain were most frequent, as in the vention and management of sport-specific emergencies. NCAA, although the frequency of concussion was dif- This is because the current school safety guidelines set ferent. The rate of concussion in Japan was significantly forth by the MEXT focus on community safety, traffic Sekine et al. Injury Epidemiology (2022) 9:4 Page 8 of 10 safety, and natural disaster safety, without considerations appropriate environment for conducting it are necessary. for sport-specific safety. Due to concerns of catastrophic We did not record the details of the activity, mechanism, sports incidents associated with the current situation, or events during the injury. In particular, ankle injury, national and organizational actions to reconsider the cur- which had the highest incidence in this study, might be rent structure of school-organized sports and to improve attributed to the nature of basketball, which involves access to medical personnel during school-organized rapid changes in direction, contacts, repetitive jumping, sports are required (Hosokawa et  al. 2021). Our results and landing activities (Tummala et  al. 2018). Moreover, showed that the higher incidence of ankle sprain in Japan since non-time-loss injuries (participation restriction might be influenced by the history or process of treat - for < 24  h) were not included in the present study, data ment in younger generations. This study did not exam - on these injuries were not collected. The inclusion of ine the history of ankle sprains, which is a potential risk non-time-loss injuries to account for the full breadth of factor. For an appropriate prevention program for the injuries sustained by basketball athletes has also been extremely high incidence of ankle sprain in Japanese col- noted (Zuckerman et  al. 2018). The definition of each legiate basketball players, an investigation of the history item should be carefully reviewed to develop additional of ankle sprain and prospective studies on the injury in research. youth basketball players are required. Conclusion We aimed to describe the incidence of injuries in Japa- Limitations nese collegiate men’s basketball from the 2013/2014 to To the best of our knowledge, this study is the first the 2019/2020 season and to investigate the unique pat- descriptive epidemiological study of Japanese colle- terns emerging from comparing the data with the men’s giate men’s basketball players. However, the surveillance NCAA basketball data, from their current research. The size (7  years, 23 team-seasons, 97,515 AEs) of the pre- findings that the injury rate during competition is higher sent study was less than that in the NCAA reports dur- than that during practice, and that ankle sprain was the ing 2009/2010 to 2014/2015 (6  years, 176 team-seasons, most common injury, were consistent. However, the rate 289,406 AEs) (Zuckerman et  al. 2018) and 2014/2015 to of overall injury and the rate of ankle sprains were 1.55 to 2018/2019 (5  years, 276 participating programs, 478,150 1.64 times and 2.10 times as high in Japanese collegiate AEs) (Morris et  al. 2021). Due to the diversity in sports men’s basketball players as those in NCAA men’s basket- and the activities that comprise them, there is no sin- ball players, respectively. Moreover, the rate of concus- gle approach to appropriately express risk for all sports sion was 0.28 times as less in Japan as that reported in injury surveillance projects (Bahr et al. 2020). The adjust - the NCAA. We concluded that these results may have ment for injury rate ratios to explain the differences in been influenced by the environment surrounding bas - the population and the characteristics between collegiate ketball players and the level of medical support available basketball players in Japan and the NCAA would be nec- for various generations of Japanese athletes. Our results essary for further investigation. Furthermore, because provide a foundation for future research aimed at injury time-based measures better facilitate comparisons across prevention and suggest the urgent necessity to improve sports and can affect the calculation and interpretation the medical support systems to protect basketball players of estimated injury rates, it is important to consider chal- from injury. lenges associated with the detailed measurement of time spent at risk for injury (Morris et  al. 2021; Bahr et  al. 2020). According to the International Olympic Commit- Abbreviations tee consensus statement, the duration of the period for ACL: Anterior cruciate ligament; AE: Athlete exposure; IRR: Injury rate ratio; KCBF: Kanto Collegiate Basketball Federation; MEXT: Ministry of Education, which an athlete is unable to train/play is called time loss, Culture, Sports, Science and Technology; NCAA : National Collegiate Athletic which is included in assessing the severity of the health Association; NCAA-ISP: National Collegiate Athletic Association Injury Surveil- problem (Bahr et  al. 2020). Some limitations when con- lance Program; UNIVAS: Japan Association for University Athletics and Sport; 95% CI: 95% Confidence interval. sidering time loss as a measure of severity were suggested (no standards of severity, the unique individual of the Acknowledgements timing of return to play, etc.), persuading and advocating The authors thank all the members of the Department of Medicine and Sci- ence of KCBF who volunteered and made efforts to submit data. Their efforts the need to directly examine time loss (Chandran et  al. will help in the development of safety for future athletes. We would also like to 2020). For these reasons, consideration must be given thank Editage (www. edita ge. com) for the English language editing. when defining severity in further surveillance, other than Authors’ contributions time loss alone. Since the epidemiological data would be YS led to the study design, the statistical analysis, contributed to the inter- an important outcome for further intervention investiga- pretation of results, and oversaw the development of the manuscript. KK tion, expanding the scale of the survey and creating an contributed to the study design, interpreted the results, and contributed S ekine et al. Injury Epidemiology (2022) 9:4 Page 9 of 10 to the development of the manuscript. TK contributed to the study design, 2013–2014) and National Collegiate Athletic Association men’s basketball interpretation of results, and development of the manuscript. SH contrib- (2004–2005 Through 2013–2014). J Athl Train. 2018;53:1025–36. uted to the study design, interpretation of results, and development of the Curtis CK, Laudner KG, McLoda TA, McCaw ST. The role of shoe design in manuscript. SU contributed to the interpretation of results and oversaw the ankle sprain rates among collegiate basketball players. J Athl Train. development of the manuscript. TK co-led to the study design, supervised the 2008;43:230–3. statistical analysis, contributed to the interpretation of results, and oversaw Dick R, Hertel J, Agel J, Grossman J, Marshall SW. Descriptive epidemiology of the development of the manuscript. All authors read and approved the final collegiate men’s basketball injuries: National Collegiate Athletic Associa- manuscript. tion Injury Surveillance System, 1988–1989 through 2003–2004. J Athl Train. 2007a;42:194–201. Funding Dick R, Agel J, Marshall SW. National collegiate athletic association injury sur- This study was supported by a grant from the Japan Society for the Promotion veillance system commentaries: introduction and methods. J Athl Train. of Science, KAKENHI (JP20K19514). 2007b;42:173–82. Heishman AD, Daub BD, Miller RM, Freitas ED, Frantz BA, Bemben MG. Counter- Availability of data and materials movement jump reliability performed with and without an arm swing in The datasets used and analyzed during the current study are available from NCAA Division 1 intercollegiate basketball players. J Strength Cond Res. the corresponding author on reasonable request. 2020;34:546–58. Hertel J, Corbett RO. An updated model of chronic ankle instability. J Athl Train. 2019;54:572–88. Declarations Hootman JM, Dick R, Agel J. Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Athl Ethics approval and consent to participate Train. 2007;42:311–9. Ethical approval for this study was obtained from the Human Ethics Review Hosokawa Y, Murata Y, Stearns RL, Suzuki-Yamanaka M, Kucera KL, Casa DJ. Committee of Teikyo Heisei University (No. R01-080-1). Epidemiology of sudden death in organized school sports in Japan. Inj Epidemiol. 2021;8(1):27. Consent for publication Japan Association for University Athletics and Sport. Guideline and investiga- Not applicable. tion for the safety (in Japanese). https:// www. univas. jp/ proje ct/ safety/. Accessed 23 Mar 2021. Competing interests Japan Basketball Association. Number of registrants (in Japanese). http:// www. No potential conflicts of interest were reported by the authors. japan baske tball. jp/ jba/ data/ enrol lment/. Accessed 23 Mar 2021. Japanese Society of Clinical Sports Medicine (in Japanese). https:// concu ssion Author details japan. jimdo free. com. Accessed 23 Mar 2021. Faculty of Modern Life, Teikyo Heisei University, 4-21-2 Nakano, Nakano-ku, Kanto Collegiate Basketball Federation. Department of Medicine and Sci- Tokyo 164-8530, Japan. Faculty of Sports and Health Science, Daito ence (in Japanese). https:// www. kcbbf. jp/ train er/ index/ type/ medic al. Bunka University, 560 Iwadono, Higashimatsuyama-shi, Saitama 355-8501, Accessed 20 Nov 2021. Japan. 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Descriptive epidemiology of injuries in Japanese collegiate men’s basketball: 2013/2014 to 2019/2020

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Abstract

Background: Basketball is one of the most played sports in the world. However, only a few studies have examined the epidemiology of Japanese collegiate men’s basketball injuries. This study investigated the incidence of injury among Japanese collegiate men’s basketball from the 2013/2014 to the 2019/2020 seasons and identified unique pat - terns by comparing our data with the National Collegiate Athletic Association (NCAA) men’s basketball data. Methods: Data from Japanese collegiate basketball teams of the Kanto Collegiate Basketball Federation Division I League during the 2013/2014 to 2019/2020 academic years (23 team-seasons) were used in this study. Injury rates per 1000 athlete exposures (AEs), injury proportions, and the injury rate ratio (IRR) were calculated according to the events, injury types, body parts, and common injury mechanisms. Injury rates were then compared with that from the time-loss injury data of the NCAA’s previous reports. Results: In total, 480 injuries during 97,515 AEs were reported, leading to an injury rate of 4.92 per 1000 AEs (95% CI = 4.48–5.36). The overall injury rate was higher in Japan than in the NCAA ([2009/2010–2014/2015] IRR = 1.55, 95% CI = 1.39–1.73; [2014/2015–2018/2019] IRR = 1.64, 95% CI = 1.48–1.82). Lower extremity injuries occurred most frequently (73.5%). Ankle sprain was the most common injury in Japan, with higher injury rates than in the NCAA (IRR = 2.10; 95% CI = 1.72–2.57). The injury rate of concussion was lower in Japan than in the NCAA (IRR = 0.28; 95% CI = 0.14–0.55). Conclusions: The rates of overall injury and ankle sprain were higher and that of concussion was lower in Japan than in the NCAA. These results suggested the existence of international differences in the pattern or features of injuries in basketball players. Keywords: Basketball, Collegiate, Injury surveillance 2007; McInnes et al. 1995). The nature of basketball, such Background as changes in direction, player contact, repetitive jump- As a high-intensity sport, basketball is characterized by ing, and landing activities, might affect the incidence of high aerobic and anaerobic demands, continuous changes lower extremity injury (Zuckerman et  al. 2018), particu- in direction, accelerations and decelerations, jumps, larly ankle sprain (Tummala et al. 2018). sprints, contacts, and specific skills (Ben Abdelkrim et al. Various epidemiological studies on sports-related injuries have been reported from the injury surveil- *Correspondence: y.sekine@thu.ac.jp lance program of the National Collegiate Athletic Asso- Faculty of Modern Life, Teikyo Heisei University, 4-21-2 Nakano, Nakano-ku, Tokyo 164-8530, Japan ciation (NCAA-ISP) (Zuckerman et  al. 2018; Tummala Full list of author information is available at the end of the article © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:// creat iveco mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Sekine et al. Injury Epidemiology (2022) 9:4 Page 2 of 10 et  al. 2018; Clifton et  al. 2018; Dick et  al. 2007a; Morris 2019/2020 academic years in Japan (April 1st–March et  al. 2021). The studies from the NCAA-ISP emphasize 31st). A total of seven teams from the KCBF Divi- a high level of evidence-based practices related to injury sion I League, consisting of 10 (until 2017) to 12 teams prevention and are a vital resource for further research (2017-present), participated in the investigation. Since (Curtis et al. 2008; Silvers-Granelli et al. 2015). In Japan, some teams were unable to continue the survey due to the Japan Association for University Athletics and Sport factors such as dropping out of the survey (2 teams) and (UNIVAS) was established in 2019 by the Japan Sports replacing divisions (1 team), this study was conducted Agency, an external bureau of the Ministry of Education, using mixed data (23 team-seasons). This study was Culture, Sports, Science and Technology (MEXT) (Japan approved by the Human Ethics Review Committee of Association for University  Athletics and Sport 2021). Teikyo Heisei University (No. R01-080-1). The study was One of the chief projects of the UNIVAS is to improve conducted according to the tenets of the Declaration of the environment for collegiate athletic activities and to Helsinki. increase engagement in sports, safely and securely. To achieve these objectives, surveys and research on the Data collection aspects related to sports activity-related accidents are The injury and exposure data collected under the super - required. vision of an athletic trainer certified by the Japan Sports A total of 597,375 basketball players registered with Association in each team (all of them were employed the Japan Basketball Association in 2019 comprised part-time) were aggregated for each season. Data were over 8000 collegiate men (Japan Basketball Association recorded in a pre-designed and unified electronic spread - 2021). To prevent injury and illness and to improve the sheet, which were collected at the end of each season. athletic performance of the Japanese collegiate basket- Injuries that occurred during basketball games or basket- ball players, the Department of Medicine and Science ball-specific practices (e.g., shooting drills, offensive or attached to the Kanto Collegiate Basketball Federation defensive moves, and scrimmages) were included in the (KCBF) was established, comprising the area including study. Any injuries that occurred in weight training or the Tokyo, Kanagawa, Chiba, Saitama, Gunma, Ibaraki, conditioning sessions (e.g., sprint training, agility train- and Tochigi prefectures (Kanto Collegiate Basketball ing, and plyometrics) and illnesses were excluded. u Th s, Federation 2021). Currently, there have been no epi- we excluded a total of 4 injuries during weight training demiological studies on Japanese collegiate basketball and conditioning and 51 illnesses. players. Although one epidemiological study including elementary school mini-basketball players with a mean age of 10.9 ± 1.0 was reported, the rules and standards Definitions for mini-basketball vastly differ from those of general Based on previous studies Kuzuhara et  al. (2016), Dick basketball, including ball size, goal height, and game time et al. (2007b), an injury was defined as any event that (1) (Kuzuhara et  al. 2016). Moreover, the characteristics of occurred as a result of participation in regular practice or injuries in the childhood category alone was unidentifi - competition in sports, (2) caused the player to seek medi- able. For preventive intervention research in basketball cal care from a physician or alternative medical special- players, accurate epidemiological data are needed. In ist, or (3) resulted in the restriction of student-athlete addition, an international comparison with the results participation or performance for one or more calendar of previous studies might help to find and recognize the days since the day of injury. Time loss was one of the cri- current medical issues surrounding Japanese basketball teria used to describe the severity of health problems in players. Therefore, we aimed to describe the incidence of sports in the present study (Bahr et  al. 2020). To com- injuries in Japanese collegiate men’s basketball from the pare our data with the severe injuries reported in the 2013/2014 to the 2019/2020 seasons. We further aimed previous study (Zuckerman et  al. 2018), injuries that to investigate unique patterns by comparing our data required > 3 weeks to heal and allow the player to regain with the NCAA’s men’s basketball data, reported in pre- complete fitness for playing basketball or injuries that vious researches (Zuckerman et  al. 2018; Morris et  al. led to player retirement were defined as severe injuries. 2021). Athlete exposure (AE) was defined as one athlete partici - pating in the practice or official competition organized Methods by KCBF and the All Japan University Basketball Federa- Data source tion, wherein the player was exposed to the possibility of Data managed by the Department of Medicine and Sci- athletic injury, regardless of the time of participation. The ence of the KCBF were used in this study. The dura - player who warmed up before the match but did not play tion of the investigation was from the 2013/2014 to the was not considered an AE. S ekine et al. Injury Epidemiology (2022) 9:4 Page 3 of 10 Body parts, injury types, and mechanisms were clas- CIs were recalculated and applied from reported AEs and sified as follow (Table  1). To compare with previous number of time-loss injuries. research, isolated or a combination of anterior cruciate ligament (ACL), posterior cruciate ligament, collateral Results ligament (medial or lateral, not differentiated), or menis - Overall injury rates cus (medial or lateral, not differentiated) injury was also Over the period of 7  years, a total of 480 injuries across categorized as “knee internal derangement.” (Zuckerman 23 team-seasons were reported, of which 346 (72.1%) et al. 2018). occurred in practice, 130 (27.1%) occurred in com- petition, and 4 (0.8%) had missing event information (Table  2). These injuries occurred during 97,515 AEs Statistical analyses (practice: 89,559 AEs; competition: 7956 AEs), and The injury rate was calculated as the number of injuries a total of 87 (18.1% of overall injuries) were consid- per 1000 AEs. In the injury rate ratio, all 95% CIs, not ered severe injuries (> 21  days lost), one of which led to including 1.0, were considered statistically significant. forced medical retirement. A total of 57 (65.5% of severe The calculation of injury rates and rate ratios was ana - injuries) occurred in practice, 29 (33.3% of severe inju- lyzed with 95% confidence intervals (CIs) using Micro - ries) occurred in competition, and 1 (0.2%) was miss- soft Excel for Mac (version 16.45, Microsoft Corp, ing the event information. Injury rates in competition Redmond, WA) (Knowles et  al. 2006). The distribution were higher than those in practice among all injuries of the mechanisms of injury and proportion of severity (IRR = 4.23, 95% CI = 3.46–5.17) and severe injuries in each mechanism of injury were compared using the (IRR = 5.73, 95% CI = 3.66–8.96). 2 ® χ test, using SPSS software (version 27.0; IBM Cor- poration, Armonk, NY, USA). The alpha level was set to Mechanisms of injury p < 0.05. Following analysis, we attempted to compare Figure  1 shows the distribution of the mechanisms of our data with the reported injury data on the NCAA injury for all injuries and the proportion of severe injuries men’s basketball injuries from 2009/2010–2014/2015 and in each mechanism of injury. The most common mecha - 2014/2015–2018/2019 (Zuckerman et  al. 2018; Morris nism of injury was contact with another player (n = 228, et  al. 2021). Common injuries and severe injuries were 47.5%), followed by no contact (n = 124, 25.8%), overuse also compared with those published in the previous study (n = 93, 19.4%), and contact with an object (n = 27, 5.6%) (Zuckerman et  al. 2018). Since non-time-loss injuries, (χ = 320.02, p < 0.001). A total of 53.1% of injuries were which were defined as injuries resulting in participation contact-related (n = 255). The proportion of severe inju - restriction for < 24  h, were not recorded in the present ries was as follows: overuse (n = 21, 22.6%), contact with study, only time-loss injuries reported in previous stud- an object (n = 6, 22.2%), no contact (n = 23, 18.5%), and ies were included for comparison. Injury rates and 95% contact with another player (n = 37, 16.2%). Injuries by body part Lower extremity (including hip/groin, upper leg, knee, Table 1 Classification of body parts, injury types, and lower leg, ankle, and foot) injuries accounted for the mechanisms majority of total injuries (73.5%) (Table  3). In particular, Body parts Injury types Mechanisms of injury ankle (35.8%), upper leg (12.1%), and trunk (11.0%) inju- ries were the most commonly reported. Injury rates in Head/face Sprain Contact (with another player) all body parts, except for the arm/elbow and hip/groin, Neck Strain Contact (with an object) were higher in competitions than during practice. Knees Shoulder Contusion No contact had the most severe injuries (40.8% of all knee injuries; Arm/elbow Concussion Overuse median, range of days lost = 77, 24–500). Hand/wrist Fracture Trunk Dislocation/subluxation Injury types Hip/groin Laceration All injury rates except for those of tendonitis were higher Upper leg Tendonitis in competitions than that during practice (Table  4). Knee Nerve injury Sprains (44.8%), contusions (13.5%), and strains (10.0%) Lower legCartilage injury accounted for the largest proportion of overall injuries. Ankle Other Cartilage injury was noted to be the most severe injury Foot (72.7% of all cartilage injuries; median, range of days a b Including the chest, abdomen, upper back, and lower back Including lost = 60.5, 45–109). meniscus injury Including the ball, surface, equipment, etc. Sekine et al. Injury Epidemiology (2022) 9:4 Page 4 of 10 Table 2 Injury rates and 95% CIs by the events in Japanese collegiate men’s basketball, 2013/2014–2019/2020 and comparison with NCAA men’s basketball Japan NCAA Japan versus NCAA 2009/2010– 2014/2015– 2009/2010–2014/2015 2014/2015–2018/2019 2014/2015 2018/2019 n IR and 95% CI (per 1000 n IR and 95% n IR and 95% IRR (95% CI) IRR (95% CI) AEs) CI (per 1000 CI (per 1000 AEs) AEs) Practice Injuries 346 3.86 (3.46–4.27) 635 2.80 (2.58–3.02) 950 2.59 (2.43–2.76) 1.38 (1.21–1.57)* 1.49 (1.32–1.68)* Severe injuries 57 0.64 (0.47–0.80) 65 0.29 (0.22–0.36) 2.19 (1.60–3.01)* Competition Injuries 130 16.34 (13.53–19.15) 286 4.56 (4.03–5.09) 482 4.31 (3.93–4.69) 3.58 (2.91–4.41)* 3.79 (3.12–4.60)* Severe injuries 29 3.65 (2.32–4.97) 52 0.83 (0.60–1.05) 4.39 (3.00–6.43)* Overall Injuries 480 4.92 (4.48–5.36) 921 3.18 (2.98–3.39) 1432 3.00 (2.84–3.15) 1.55 (1.39–1.73)* 1.64 (1.48–1.82)* Severe injuries 87 0.89 (0.71–1.08) 117 0.40 (0.33–0.48) 2.23 (1.69–2.94)* AEs; athlete exposure(s): Practice = 89,559, Competition = 7,956, CI; confidence interval, IR; injury rate, IRR; injury rate ratio Overall injuries do not equal sum of Practice and Competition injuries due to four injuries missing the event information Japan versus the NCAA data (Zuckerman et al. 2018; Morris et al. 2021) injury rate ratio > 1.00 and does not include 1.00 in the 95% CI Competition versus Practice injury rate ratio > 1.00 and does not include 1.00 in the 95% CI Comparison with the NCAA data (overall injury rates, common injuries) The overall injury rates in Japan were higher than those reported by the NCAA for the periods of 2009/2010– 2014/2015 and 2014/2015–2018/2019 ([2009/2010– 2014/2015]: practice IRR = 1.38, 95% CI = 1.21–1.57; competition IRR = 3.58, 95% CI = 2.91–4.41; over- all IRR = 1.55, 95% CI = 1.39–1.73) and [2014/2015– 2018/2019]: practice IRR = 1.49, 95% CI = 1.32–1.68; competition IRR = 3.79, 95% CI = 3.12–4.60; overall IRR = 1.64, 95% CI = 1.48–1.82). Severe injury rates were also higher in Japan than in the NCAA (practice IRR = 2.19, 95% CI = 1.60–3.01, competition IRR = 4.39, 95% CI = 3.00–6.43, and overall IRR = 2.23, 95% CI = 1.69–2.94) (Table  2). Ankle sprains constituted the Fig. 1 The distribution of the mechanisms of injury. Note: One injury highest proportion of injuries in Japan, as in the NCAA; in each of contact (player), contact (not player), no contact, and overuse had no time-loss recorded however, the rate was higher in Japan than that reported by the NCAA (IRR = 2.10, 95% CI = 1.72–2.57) (Table 6). The concussion rate in Japan was less than that reported by the NCAA (IRR = 0.28, 95% CI = 0.14–0.55). Common injuries Discussion Ankle sprains were the most common in the present This study primarily aimed to describe the incidence of study (Table  5). Other common injuries included the injuries in Japanese collegiate men’s basketball between following in order of increasing value: lower back inju- the 2013/2014 and 2019/2020 seasons. Injury rates were ries, thigh contusions, knee internal derangements, four times as high in competitions as in practices. This and hamstring strains. The rates of ankle sprains, thigh result corresponded to previous reports that concluded contusions, and knee internal derangements were that intensity demands are greater during competitions higher in competitions than during practice. S ekine et al. Injury Epidemiology (2022) 9:4 Page 5 of 10 Table 3 Injury counts, rates (per 1000 Athletes Exposures), and percentage of severity by body part and type of event in Japanese collegiate men’s basketball, 2013/2014–2019/2020 Practice Competition Overall n (%) IR and 95% CI (per n (%) IR and 95% CI (per n (%) IR and 95% CI (per % Severe (median 1000 AEs) 1000 AEs) 1000 AEs) of days lost, range) Head/face 13 (3.8) 0.15 (0.07–0.22) 12 (9.2) 1.51 (0.65–2.36)* 25 (5.2) 0.26 (0.16–0.36) 8 (29.5, 28–31) Neck 2 (0.6) 0.02 (0.0–0.05) 0 0 2 (0.4) 0.02 (0.0–0.05) 50 Shoulder 11 (3.2) 0.12 (0.05–0.20) 9 (6.9) 1.13 (0.39–1.87)* 20 (4.2) 0.21 (0.12–0.29) 30 (93.5, 42–180) Arm/elbow 7 (2.0) 0.08 (0.02–0.14) 2 (1.5) 0.25 (0.0–0.60) 9 (1.9) 0.09 (0.03–0.15) 33.3 (25, 25–60) Hand/wrist 10 (2.9) 0.11 (0.04–0.18) 8 (6.2) 1.01 (0.31–1.70)* 18 (3.8) 0.18 (0.10–0.27) 33.3 (49, 37–81) Trunk 40 (11.5) 0.45 (0.31–0.59) 11 (8.4) 1.38 (0.57–2.20)* 53 (11.0) 0.54 (0.40–0.69) 15.1 (25, 24–44) Hip/groin 13 (3.8) 0.15 (0.07–0.22) 1 (0.8) 0.13 (0.0–0.37) 14 (2.9) 0.14 (0.07–0.22) 0 Upper leg 44 (12.7) 0.49 (0.35–0.64) 14 (10.8) 1.76 (0.84–2.68)* 58 (12.1) 0.59 (0.44–0.75) 15.5 (36,22–120) Knee 34 (9.8) 0.38 (0.25–0.51) 15 (11.5) 1.89 (0.93–2.84)* 49 (10.2) 0.50 (0.36–0.64) 40.8 (77, 24–500) Lower leg 26 (7.5) 0.29 (0.18–0.40) 8 (6.2) 1.01 (0.31–1.70)* 34 (7.1) 0.35 (0.23–0.47) 17.6 (36.5, 30–65) Ankle 127 (36.7) 1.42 (1.17–1.66) 43 (33.1) 5.40 (3.79–7.02)* 172 (35.8) 1.76 (1.50–2.03) 13.4 (30, 22–104) Foot 19 (5.5) 0.21 (0.12–0.31) 7 (5.4) 0.88 (0.23–1.53)* 26 (5.4) 0.27 (0.16–0.37) 15.4 (95,30–139) AEs; athlete exposure(s): Practice = 89,559, Competition = 7,956, CI; confidence interval, IR; injury rate, IRR; injury rate ratio *Competition versus Practice injury rate ratio > 1.00 and does not include 1.00 in the 95% CI Overall injuries do not equal the sum of Practice and Competition injuries due to four injuries missing the event information (two are in the ankle and two are in the trunk) One player retired due to the injury Including the chest, abdomen, upper back, and lower back Table 4 Injury counts, percentages and rates (per 1000 Athletes Exposures) by type of injury and event in Japanese collegiate men’s basketball, 2013/2014–2019/2020 Practice Competition Overall n (%) IR and 95% CI n (%) IR and 95% CI n (%) IR and 95% CI % Severe (median (per 1000 AEs) (per 1000 AEs) (per 1000 AEs) of days lost, range) Sprain 155 (44.8) 1.73 (1.46–2.00) 60 (46.2) 7.54 (5.63–9.45)* 215 (44.8) 2.20 (1.91–2.50) 15.8 (30, 22–500) Strain 39 (11.3) 0.44 (0.30–0.57) 9 (6.9) 1.13 (0.39–1.87)* 48 (10.0) 0.49 (0.35–0.63) 16.7 (36, 22–82) Contusion 38 (11.0) 0.42 (0.29–0.56) 27 (20.8) 3.39 (2.11–4.67)* 65 (13.5) 0.67 (0.50–0.83) 9.2 (34, 24–120) Concussion 5 (1.4) 0.06 (0.01–0.10) 4 (3.1) 0.50 (0.01–1.00)* 9 (1.9) 0.09 (0.03–0.15) 11.1 (22) Fracture 19 (5.5) 0.21 (0.12–0.31) 8 (6.1) 1.01 (0.31–1.70)* 27 (5.6) 0.28 (0.17–0.38) 51.9 (49, 25–139) Dislocation/subluxation 7 (2.0) 0.08 (0.02–0.14) 6 (4.6) 0.75 (0.15–1.36)* 13 (2.7) 0.13 (0.06–0.21) 30.8 (96, 87–180) Laceration 6 (1.7) 0.07 (0.01–0.12) 6 (4.6) 0.75 (0.15–1.36)* 12 (2.5) 0.12 (0.05–0.19) 0 Tendonitis 31 (9.0) 0.35 (0.22–0.47) 4 (3.1) 0.50 (0.01–1.00) 35 (7.3) 0.36 (0.24–0.48) 17.1 (32, 25–83) Nerve injury 8 (2.3) 0.09 (0.03–0.15) 0 0 8 (1.7) 0.08 (0.03–0.14) 37.5 (24, 24–25) Cartilage injury 7 (2.0) 0.08 (0.02–0.14) 3 (2.3) 0.38 (0.0–0.80)* 11 (2.3) 0.11 (0.05–0.18) 72.7 (60.5, 45–109) Other 31 (9.0) 0.35 (0.22–0.47) 3 (2.3) 0.38 (0.0–0.80) 37 (7.7) 0.38 (0.26–0.50) 10.8 (65.5, 33–96) AEs; athlete exposure(s): Practice = 89,559, Competition = 7956, CI; confidence interval, IR; injury rate, IRR; injury rate ratio *Competition versus Practice injury rate ratio > 1.00 and does not include 1.00 in the 95% CI Overall injuries do not equal sum of Practice and Competition injuries due to missing event information One player retired due to the injury than during practice (Clifton et al. 2018; Hootman et al. was not classified in our investigation, although it 2007). In particular, the severe IRR might accentuate included a variety of intensity contents (e.g., shooting the high activity intensity in competitions rather than drill, offensive or defensive moves, and scrimmages). in practice (IRR = 5.73, 95% CI = 3.66–8.96). Practice The subdivision of events in practice would allow us to clarify the proportion of injuries. Sekine et al. Injury Epidemiology (2022) 9:4 Page 6 of 10 Table 5 Common injuries in Japanese collegiate men’s basketball, 2013/2014–2019/2020 Injury Practice Competition Overall n (%) IR and 95% CI n (%) IR and 95% CI n (%) IR and 95% CI % Severe (median (per 1000 AEs) (per 1000 AEs) (per 1000 AEs) of days lost, range) Ankle sprain 120 (34.7) 1.34 (1.10–1.58) 43 (33.1) 5.40 (3.79–7.02)* 163 (34.0) 1.67 (1.41–1.93) 11.7 (30, 22–104) Lower back injury 36 (10.4) 0.40 (0.27–0.53) 7 (5.4) 0.88 (0.23–1.53) 45 (9.3) 0.46 (0.33–0.60) 18.2 (25, 24–44) Thigh contusion 25 (7.2) 0.28 (0.17–0.39) 12 (9.2) 1.51 (0.65–2.36)* 37 (7.7) 0.38 (0.26–0.50) 8.1 (36, 32–120) Knee internal derangement 14 (4.0) 0.16 (0.07–0.24) 9 (7.0) 1.13 (0.39–1.87)* 23 (4.8) 0.24 (0.14–0.33) 65.2 (106, 30–500) Hamstring strain 13 (3.8) 0.15 (0.07–0.22) 2 (0.5) 0.25 (0.0–0.60) 15 (3.1) 0.15 (0.08–0.23) 33.3 (36, 22–82) AEs; athlete exposure(s): Practice = 89,559, Competition = 7956, CI; confidence interval, IR; injury rate, IRR; injury rate ratio *Competition versus Practice injury rate ratio > 1.00 and does not include 1.00 in the 95% CI Overall injuries do not equal sum of Practice and Competition injuries due to 2 lower back injuries missing the event information Table 6 Comparison of common injuries in Japanese collegiate and NCAA men’s basketball Injury Japan NCAA Japan versus NCAA n IR and 95% CI (per 1000 n IR and 95% CI (per 1000 IRR and 95% CI AEs) AEs) Ankle sprain 163 1.67 (1.41–1.93) 230 0.80 (0.69–0.90) 2.10 (1.72–2.57) * Hand/wrist sprain 7 0.07 (0.02–0.13) 30 0.10 (0.07–0.14) 0.69 (0.30–1.58) Concussion 9 0.09 (0.03–0.15) 97 0.34 (0.27–0.40) 0.28 (0.14–0.55) Hip/groin strain 5 0.05 (0.01–0.10) 30 0.10 (0.07–0.14) 0.49 (0.19–1.27) Knee internal derangement 23 0.24 (0.14–0.33) 59 0.20 (0.15–0.26) 1.16 (0.71–1.87) AEs; athlete exposure(s): Overall in Japan = 97,515, CI; confidence interval, IR; injury rate, IRR; injury rate ratio * Japan versus the NCAA data reported by Zuckerman et al. (2018) injury rate ratio > 1.00 and does not include 1.00 in the 95% CI The NCAA data reported by Zuckerman et al. (2018) versus Japan injury rate ratio > 1.00 and does not include 1.00 in the 95% CI Compared with previous reports (Zuckerman et  al. possibility of lesser implementation of injury prevention 2018; Morris et  al. 2021), the overall injury rates were strategies, such as coverage by full-time athletic train- 1.55 to 1.64 times as high in Japan as those reported in ers, in schools with relatively fewer resources might have the NCAA. Additionally, overall severe injury (time lost resulted in their higher injury rate (Clifton et  al. 2018). for more than 21  days) in Japan was 2.23 times higher Our results indicate the necessity to recognize the defi - than that reported in the NCAA (Zuckerman et al. 2018). ciency of the availability of medical support for colle- A previous study concluded that more skilled athletes giate athletes in Japan. To clarify these inferences, further might be at a greater risk of potential injury (Clifton et al. investigation should be conducted to confirm the details 2018). Furthermore, the height and strength of basketball of the medical support system in Japanese collegiate ath- players would be directly proportionate to the impact letes and preventive efforts for sports injuries, and to of the force generated during play, which would thereby evaluate the role of potential determinants that led to potentially increase the risk of injury (Clifton et al. 2018). time loss (Chandran et al. 2020). The present results were inconsistent with those of pre - vious studies, and the reasons were unclear. Some limi- Injury mechanisms tations in the interpretation of timeloss as severity were The leading cause of injury was contact with another stated, since this consisted of several factors (unique player (n = 228, 47.5%), and no contact was the sec- individual pattern, recovery process, etc.) (Chandran ond most common injury mechanism (n = 124, 25.8%). et  al. 2020). The fact that Japanese collegiate basketball The present results support previous findings in colle - players have little opportunity to undergo an appropri- giate men’s basketball players (Clifton et  al. 2018; Dick ate recovery process during the time-loss period might et  al. 2007a). Details of the mechanism of injury may have influenced the results of the present study. Insuffi - provide an important basis for injury prevention strate- cient medical support systems for recovery processes in gies (Silvers-Granelli et  al. 2015; Longo et  al. 2012; Omi Japanese collegiate athletes might also be one of the fac- et al. 2018). On the other hand, the classification of indi - tors of the present results. Clifton et al. discussed that the rect contact mechanism (defined as any injury sustained S ekine et al. Injury Epidemiology (2022) 9:4 Page 7 of 10 through external forces that did not directly cause the lower than that in the NCAA (Table  5). We believe that injury but influenced the natural process of movement) the concussion rate is not simply affected by the dif - (Luig et  al. 2020) should also be considered due to the ference in activity intensity. In the NCAA, increasing characteristics of basketball injuries. In particular, inju- sports-related concussions were observed after the new ries caused by indirect external forces might be char- concussion policy (Baugh et  al. 2015) was adopted, and acteristic of basketball due to its specific activities (e.g., it was concluded that the increased sensitivity to con- landing from aerial contact during a rebound or shot). cussion in players and medical personnel and reporting The definition of the injury mechanism needs to be fur - might reflect an increase in concussion incidence (Zuck - ther clarified in future studies. erman et al. 2015). Moreover, there is a possibility that in this study in Japan, such injuries should have been con- Body site sidered as a “concussion” as they may have been over- Lower extremity injuries occurred most frequently looked due to variability in clinical presentation. The rate (n = 353, 73.5% of overall injuries). Similar to previous of concussion in our study highlights the importance of studies (Zuckerman et al. 2018; Clifton et al. 2018; Mor- judging appropriately. In 2015, the Japanese Society of ris et al. 2021), the ankle was the most frequently injured Clinical Sports Medicine released the suggestion of first- part in this study on Japanese basketball players (35.8% of aid for head injuries, which included contents based on overall injuries). However, injury of the knee, which was recent findings in head injuries to help the decisions and the second most frequent injury in NCAA men’s basket- actions of people who stand by the athletes (i.e., coaches ball players (Zuckerman et  al. 2018; Clifton et  al. 2018; and parents) (Japanese Society of Clinical Sports Medi- Morris et  al. 2021), was not the second most common cine 2021). To continue the investigation, we could obtain injury after injury of the ankle in Japan. A previous study more accurate findings for further research, address - examined the predictors of the knee valgus angle, which ing the incidence, prevention, and evaluation of public is a risk factor for ACL injury during drop-jump landing awareness of the importance of head injury. and reported the possibility that body height was associ- ated with the knee valgus angle during landing (Nilstad Common injury et  al. 2015). The authors concluded that a greater body Consistent with previous epidemiologic studies from the height, which correlated with femur and tibia length, pro- NCAA of collegiate basketball players, ankle sprain was vided longer lever arms and greater demands of strength the most frequent injury in Japan, as well. Interestingly, to control the knee joint. This was inferred as one of sev - however, the incidence rate was 2.10 times as high in eral potential factors influencing the lesser proportion Japan as that reported in the NCAA. This apparent differ - of knee injuries in Japanese collegiate men’s basketball ence indicates the necessity to improve the recognition, players (189.0 ± 7.0 cm) (Koyama et al. 2020) on account prevention, and appropriate treatment of ankle sprains of body height, which was less than that of the NCAA in Japanese basketball players. This is especially true for men’s basketball players (197.6 ± 7.1 cm) (Heishman et al. those below the collegiate category, which urgently needs 2020). improvement. In addition to prophylactic injury pre- In the injury surveillance between the 2013/2014 and vention strategies such as neuromuscular propriocep- 2019/2020 seasons, only two cases of neck injuries that tive training and external ankle support (ankle bracing occurred in practice were reported. In one case, the and taping) (Tummala et  al. 2018; McGuine and Keene player reportedly was forced to retire due to injury. Our 2006; Taylor et  al. 2015; Riva et  al. 2016), screening the results suggest the necessity to be mindful not only of the history of ankle injury is the best way to identify risk fac- magnitude of the injury rate, but also of the possibility tors (Tummala et al. 2018) since a history of ankle sprains of serious incidence, even if it is lower than others. This is the most common risk factor for recurrence (with an awareness is also required while preparing for emergen- almost fivefold increased risk) (McKay et  al. 2001). The cies for all the staff, as well as spectators, on the basket - high incidence of ankle sprains in Japan might be due to ball court. the environment surrounding young athletes. Moreo- ver, some players, who had an ankle sprain, might have Injury type developed chronic ankle instability, which is character- Previous studies have reported that the most frequent ized by recurrent ankle sprain (Hertel and Corbett 2019). injury types were sprain, strain, and concussion in NCAA In Japan, the school administration, staff, and faculty are men’s basketball (Clifton et  al. 2018; Dick et  al. 2007a). unequipped with knowledge and skills regarding the pre- In Japan, sprain and strain were most frequent, as in the vention and management of sport-specific emergencies. NCAA, although the frequency of concussion was dif- This is because the current school safety guidelines set ferent. The rate of concussion in Japan was significantly forth by the MEXT focus on community safety, traffic Sekine et al. Injury Epidemiology (2022) 9:4 Page 8 of 10 safety, and natural disaster safety, without considerations appropriate environment for conducting it are necessary. for sport-specific safety. Due to concerns of catastrophic We did not record the details of the activity, mechanism, sports incidents associated with the current situation, or events during the injury. In particular, ankle injury, national and organizational actions to reconsider the cur- which had the highest incidence in this study, might be rent structure of school-organized sports and to improve attributed to the nature of basketball, which involves access to medical personnel during school-organized rapid changes in direction, contacts, repetitive jumping, sports are required (Hosokawa et  al. 2021). Our results and landing activities (Tummala et  al. 2018). Moreover, showed that the higher incidence of ankle sprain in Japan since non-time-loss injuries (participation restriction might be influenced by the history or process of treat - for < 24  h) were not included in the present study, data ment in younger generations. This study did not exam - on these injuries were not collected. The inclusion of ine the history of ankle sprains, which is a potential risk non-time-loss injuries to account for the full breadth of factor. For an appropriate prevention program for the injuries sustained by basketball athletes has also been extremely high incidence of ankle sprain in Japanese col- noted (Zuckerman et  al. 2018). The definition of each legiate basketball players, an investigation of the history item should be carefully reviewed to develop additional of ankle sprain and prospective studies on the injury in research. youth basketball players are required. Conclusion We aimed to describe the incidence of injuries in Japa- Limitations nese collegiate men’s basketball from the 2013/2014 to To the best of our knowledge, this study is the first the 2019/2020 season and to investigate the unique pat- descriptive epidemiological study of Japanese colle- terns emerging from comparing the data with the men’s giate men’s basketball players. However, the surveillance NCAA basketball data, from their current research. The size (7  years, 23 team-seasons, 97,515 AEs) of the pre- findings that the injury rate during competition is higher sent study was less than that in the NCAA reports dur- than that during practice, and that ankle sprain was the ing 2009/2010 to 2014/2015 (6  years, 176 team-seasons, most common injury, were consistent. However, the rate 289,406 AEs) (Zuckerman et  al. 2018) and 2014/2015 to of overall injury and the rate of ankle sprains were 1.55 to 2018/2019 (5  years, 276 participating programs, 478,150 1.64 times and 2.10 times as high in Japanese collegiate AEs) (Morris et  al. 2021). Due to the diversity in sports men’s basketball players as those in NCAA men’s basket- and the activities that comprise them, there is no sin- ball players, respectively. Moreover, the rate of concus- gle approach to appropriately express risk for all sports sion was 0.28 times as less in Japan as that reported in injury surveillance projects (Bahr et al. 2020). The adjust - the NCAA. We concluded that these results may have ment for injury rate ratios to explain the differences in been influenced by the environment surrounding bas - the population and the characteristics between collegiate ketball players and the level of medical support available basketball players in Japan and the NCAA would be nec- for various generations of Japanese athletes. Our results essary for further investigation. Furthermore, because provide a foundation for future research aimed at injury time-based measures better facilitate comparisons across prevention and suggest the urgent necessity to improve sports and can affect the calculation and interpretation the medical support systems to protect basketball players of estimated injury rates, it is important to consider chal- from injury. lenges associated with the detailed measurement of time spent at risk for injury (Morris et  al. 2021; Bahr et  al. 2020). According to the International Olympic Commit- Abbreviations tee consensus statement, the duration of the period for ACL: Anterior cruciate ligament; AE: Athlete exposure; IRR: Injury rate ratio; KCBF: Kanto Collegiate Basketball Federation; MEXT: Ministry of Education, which an athlete is unable to train/play is called time loss, Culture, Sports, Science and Technology; NCAA : National Collegiate Athletic which is included in assessing the severity of the health Association; NCAA-ISP: National Collegiate Athletic Association Injury Surveil- problem (Bahr et  al. 2020). Some limitations when con- lance Program; UNIVAS: Japan Association for University Athletics and Sport; 95% CI: 95% Confidence interval. sidering time loss as a measure of severity were suggested (no standards of severity, the unique individual of the Acknowledgements timing of return to play, etc.), persuading and advocating The authors thank all the members of the Department of Medicine and Sci- ence of KCBF who volunteered and made efforts to submit data. Their efforts the need to directly examine time loss (Chandran et  al. will help in the development of safety for future athletes. We would also like to 2020). For these reasons, consideration must be given thank Editage (www. edita ge. com) for the English language editing. when defining severity in further surveillance, other than Authors’ contributions time loss alone. Since the epidemiological data would be YS led to the study design, the statistical analysis, contributed to the inter- an important outcome for further intervention investiga- pretation of results, and oversaw the development of the manuscript. KK tion, expanding the scale of the survey and creating an contributed to the study design, interpreted the results, and contributed S ekine et al. Injury Epidemiology (2022) 9:4 Page 9 of 10 to the development of the manuscript. TK contributed to the study design, 2013–2014) and National Collegiate Athletic Association men’s basketball interpretation of results, and development of the manuscript. SH contrib- (2004–2005 Through 2013–2014). J Athl Train. 2018;53:1025–36. uted to the study design, interpretation of results, and development of the Curtis CK, Laudner KG, McLoda TA, McCaw ST. The role of shoe design in manuscript. SU contributed to the interpretation of results and oversaw the ankle sprain rates among collegiate basketball players. J Athl Train. development of the manuscript. TK co-led to the study design, supervised the 2008;43:230–3. statistical analysis, contributed to the interpretation of results, and oversaw Dick R, Hertel J, Agel J, Grossman J, Marshall SW. Descriptive epidemiology of the development of the manuscript. All authors read and approved the final collegiate men’s basketball injuries: National Collegiate Athletic Associa- manuscript. tion Injury Surveillance System, 1988–1989 through 2003–2004. J Athl Train. 2007a;42:194–201. Funding Dick R, Agel J, Marshall SW. National collegiate athletic association injury sur- This study was supported by a grant from the Japan Society for the Promotion veillance system commentaries: introduction and methods. J Athl Train. of Science, KAKENHI (JP20K19514). 2007b;42:173–82. Heishman AD, Daub BD, Miller RM, Freitas ED, Frantz BA, Bemben MG. 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Journal

Injury Epidemiology – Springer Journals

Published: Jan 17, 2022

Keywords: Basketball; Collegiate; Injury surveillance

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