Faculty of Health Sciences

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An epidemiological investigation into musculoskeletal pain in KwaZulu-Natal orchestral musicians
(2024) Muhondo, Linley; Thandar, Yasmeen; Kell, Colette
Background Non-communicable diseases pose a significant health threat worldwide. Of those diseases, musculoskeletal diseases are most responsible for a significant portion of occupational injuries in all job-sectors, including the musical sector. Musicians are prone to suffering from musculoskeletal injuries, more so than other populations. These injuries are termed playing-related musculoskeletal diseases (PRMDs). There are several risk factors associated with acquiring PRMDs including being of the female gender, age, and the type of instrument played. While most literature on musicians’ has been documented in countries abroad, there is a paucity of literature looking at the risk factors and attributes of African, and specifically South African, musicians. This is notable, as African musicians may have different characteristics to their international counterparts. The aim of this research was to examine orchestral musicians in Kwa Zulu-Natal from all sections of the orchestra to determine the prevalence of musculoskeletal injuries and the potential risk factors for these injuries, as well as their musculoskeletal injury profile. Methodology This study was a quantitative, cross-sectional descriptive study based on a self administered questionnaire. The questionnaire was piloted electronically and the necessary alterations were made. The final questionnaire was administered to members of 2 orchestras in Kwa Zulu-Natal, namely the Pietermaritzburg City Orchestra (25 members) and the Durban City Orchestra (30 members), making the targeted sample 55 musicians in total. All musicians who met the inclusion criteria were invited to participate in the study. The anonymously completed questionnaires were placed into marked boxes after completion to ensure musician anonymity. The data was analysed using IBM SPSS version 28. Association between specific risk factors and 12-month prevalence of MSK was assessed using Fisher’s exact 2-sided tests for categorical risk factors, and t-tests for continuous risk factors. A p-value of <0.05 was taken as statistical significance. Results Of the 55 musicians targeted, 30 of them participated, resulting in a response rate of 54.5%. Majority of the respondents were female (n=20). The data showed that the annual prevalence of PRMDs in the two orchestras was 46.7%. The point and one month prevalence were both 40%. The most injured section of the orchestra were the strings, followed by the woodwind section. The string section also reported the highest number of average affected areas in the orchestra (n=4). The most frequently injured anatomical sites of the body were the shoulders and wrists. There was no statistical significance found between the risk factors and injuries acquired. However, the results showed that females were injured more than the males (55%). Most of the respondents that reported musculoskeletal injury fell within the 18-24 age range and majority of the injured musicians fell in the overweight BMI body category. Most of the music teachers and the single career musicians in the study reported suffering from PRMDs and playing instruments for more than 16 hours a week on average. Conclusion The prevalence of playing-related musculoskeletal disorders among musicians was relatively high among the orchestral musicians in Kwa Zulu-Natal. Though not statistically significant, factors such as instrument played, age, and female gender were the factors that had the greatest influence on injury rates. The pain experienced was mild in nature and felt worse after playing their instruments. While the pain did not affect their activities of daily living, it did cause a few to change their way of playing or stop playing entirely for a period of time due to their pain. Majority of the players were aware of musician’s playing related health problems, and acknowledged that they are a problem, but none of them had received formal methods of education regarding them. The COVID-19 pandemic was a phenomenon that also affected the musicians in various ways.
The injury profile of musculoskeletal injuries, and the impact thereof, in amateur pole sports athletes in eThekwini municipality
(2024) Worth, Kim; Pillay, Julian David
Background: Pole sport has gained popularity worldwide, especially in South Africa. Due to the nature of the sport, there is growing evidence of unique musculoskeletal injuries that accompany the sport. Despite this, there is little information regarding the specific musculoskeletal injuries that occur in pole sport athletes and, thus, the sport has been compared to gymnastics and circus arts which include certain similarities. Research in pole sports specifically is essential in order to assist healthcare professionals to manage the injuries specific to the sport appropriately. Aim: The aim of this study was to determine the prevalence, selected risk factors and types of injuries that amateur pole sport athletes experience, as well as the impact of the musculoskeletal injuries and the level of care used. Methodology: A quantitative, descriptive, cross-sectional method was utilised with the distribution of online questionnaires to five pole studios in the eThekwini municipality, KwaZulu-Natal, South Africa. The questionnaire consisted of the following sections: demographics; training history; risk factors; musculoskeletal injuries; consequence of injury on sport and performance, quality of life and the management approaches and impact thereof. The data was analysed using the IBM SPSS version 28. Results: A total of 59 female participants over the age of 18 years old were included in this study. A high prevalence of musculoskeletal injury was found, with a lifetime prevalence of 49.2% (n=29), and period prevalence over 12 months of 40.7% (n=24). The majority of injuries were found to affect the upper limb but injuries to the spine and lower limb were still common. The most commonly reported location of injuries was the shoulder (64.3%, n=18), followed by the hand and wrist (46.4%, n=13), and then the neck (35.7%, n=10) and thoracic back (35.6%, n=10). The most common type of injury was a strain type injury (48.1%, n=14), followed by contusions (11.1%, n=3). Significant risk factors included high skill level (p value of 0.005), increased strength (p value of 0.010), performing warm-ups for longer than 10 minutes (p value of 0.053) and performing static stretching cool-downs (p value of 0.005). The impact of pole sport injuries on the participants’ pole performance demonstrated that despite the athletes’ recovery from injury taking more than six weeks, the majority of the athletes either stopped pole sport and other activities for one week or less or did not stop the activities at all. The impact of pole sports injuries on the participants’ quality of life was significant, especially affecting their ability to perform daily activities, decreasing their ability to sleep and decreasing their mood as a result of injury. Various management approaches, including self-medication, home remedies and complementary healthcare were utilised by participants. Self-medication and home remedies were found to be utilised more commonly compared to seeking help from healthcare professionals. Conclusion: This study demonstrated that musculoskeletal injuries are largely present in pole sport athletes for which various management approaches were utilised. The injuries impacted multiple aspects of the participants’ lives. The uniqueness of this sport provides an interesting platform for new research, especially with regard to musculoskeletal injuries, as shown in this study.
Determining the normative value of the Functional Movement Screen™ in weightlifters in participating gyms within the eThekwini municipality, and its association to injury
(2021-12-01) Singh, Shaista; Sobuwa, Simpiwe; Bruijns, Stevan
Background: Weightlifting is an increasing popular form of fitness. Weightlifters train exceptionally hard in their daily training regimes, as well as for competitions. Despite the popularity of this high intensive and explosive training, there is no normative value determined for weightlifters in the eThekwini Municipality, South Africa, to compare themselves against and track their progress or regression or to use as a benchmark when beginners adopt a new training programme. The Functional Movement Screen (FMS™) is a pre-participation assessment which analyses the movements of its participants according to seven exercises, which form the basics of fundamental movement patterns. This assessment allows an analysis of dysfunctional movement patterns to be identified. Aims: The aim of this study has been to assess weightlifters according to the Functional Movement Screen™ (FMS™), to determine a normative value and examine their FMS™ score in relation to prior injury or musculoskeletal dysfunction. Methods: The methodology of this study included assessing 89 weightlifters from participating gym on the FMS™ in order to achieve a normative score of weightlifters within the eThekwini Municipality. Thereafter, participants were contacted telephonically and asked to provide information about their age, height, weight, number of years training, and an injury profile, including how long ago any injury occurred, how long the injury took to heal, the severity of the injury according to the pain rating numerical scale and what form of treatment they received for their injury. The mean FMS™ was then determined for the weightlifters within the eThekwini Municipality and an analysis was made between FMS™ score and injury sustained to determine whether the FMS™ is able to predict injury in this population. Results: The sample population of 89 revealed that the mean FMS™ score for weightlifters in participating gyms within the eThekwini Municipality is 13.88 out of 21. There is no correlation made between FMS™ score and injury and therefore there is no association to injury and FMS™ score in this sample population. There are significant findings in the scoring of the FMS™ exercises showing that weightlifters adapt their own lifting technique in order to lift their desired weight at the velocity expected. The most common recorded injuries are to the shoulder, followed by the knee. The most common injury sustained is musculature in nature and the most common treatment received for injury was physiotherapy. Conclusion: The normative value for weightlifters in participating gyms within the eThekwini Municipality is 13.88 out of 21 for the FMS™. It has been established that weightlifters deviate from the ideal movement pattern to develop stability and strength to lift their desired weights at explosive outputs. There was no link found between FMS™ score and injury and no correlation made between age, height, weight and number of years training and the FMS™ score.
A musculoskeletal injury profile of weight trainers at gyms within the eThekwini municipality
(2021-12-01) Dhlamini, Wabo; Maharaj, P.; Pastellides, A.
Background Weight training is an ancient practice that has been growing and evolving over time. It has gained more popularity in modern times due to its benefits for the musculoskeletal and cardiovascular systems. Although weight training has been associated with numerous benefits, there are also documented risks of injury associated with it. There are several gyms within the eThekwini municipality where people perform weight training exercises and possibly sustain injuries related to weight training. However, there is a paucity of literature relating to this group of individuals, some of whom are not professional athletes and could possibly be at higher risk of sustaining injuries. The aim of this research was to ascertain the musculoskeletal injury profile of weight trainers at gyms within the eThekwini municipality. Methodology This research was a quantitative cross-sectional survey; a questionnaire was used as the research tool. The questionnaire was administered to 322 participants who met the inclusion criteria. Individuals who read the letter of information and signed the consent form were allowed to participate in the research. Once completed, the consent forms and questionnaires were placed in different boxes by the researcher in order to maintain confidentiality. The results of the research were analysed using the Statistical Package for the Social Sciences (SPSS version 25) to determine statistical significance, wherein a p value of less than 0.05 was considered statistically significant. The logistics regression model was used to analyse the relationship between one dependent binary variable and independent nominal variables. Results and discussion There was a 100% response rate and of the 322 participants in the research, only 31.4% had sustained at least one injury related to weight training. The majority of the participants were males (90.4%). Furthermore, there was a higher number of injuries sustained when using free weights (88.1%) as compared to weight training machines (11.8%). Most injuries were sustained while performing the barbell shoulder press (18.8%). The shoulder was the anatomical location with the highest injury frequency (31.7%). Muscle strains (40.5%) were the most common types of injuries. Risk factors that were found to have a significant effect on injury were individuals within the age group 32-38 years who sustained 48.9% of the reported injuries. Individuals who had sustained injuries in the past (p=0.017) were also at higher risk of sustaining other injuries. The number of hours spent weight training (p=0.017) were also found to increase the risk of sustaining injuries. Conclusion The findings of this study show that there are certain anatomical locations that are more prone to injury than others. Weight training, just like any other type of exercise, can predispose one to injury, but the rate of injury due to weight training is generally low. The most prevalent types of injuries were muscle strains and joint sprains, with a few rare exceptions of serious injuries such as muscle tears and bone fractures.
An epidemiological study of musculoskeletal injuries in league squash players in the eThekwini Municipality
(2019) Hawkesworth, Stephen; Haswell, Garrick David
Background: Internationally squash is a very popular sport with over 15 million players worldwide from 135 nations. With the rapid growth of squash comes a rise in the number of injuries occurring during play. Despite squash being such a popular sport, several reports have stated that there is a paucity of literature and limited research that has been conducted on the injuries occurring from playing the sport. A study of this nature would create an awareness and understanding of the prevalence of injuries in squash which will allow for event organisers, medical personnel, managers and coaches to adapt training approaches that will minimise the development of injuries. Objectives: This study aimed to investigate the prevalence of musculoskeletal injuries in squash players within the eThekwini Municipality, and to identify selected factors associated with an increased risk of injury in order to improve the management of squash players. Methods: A quantitative, descriptive questionnaire-based survey was conducted on 126 league squash players in the eThekwini Municipality. Statistical analysis was performed on the results obtained from the questionnaire using IBM SPSS version 24. A p value < 0.05 was used to indicate statistical significance. Associations between demographic variables and the prevalence of injury were first tested using chi-square tests in the case of categorical variables, and t-tests in the case of continuous variables. The variables that were associated at the p = < 0.01 level of significance were entered into a binary logistical regression to analyse the risk factors of injury. A backward selection method was used, using likelihood ratios. Odds ratios and 95% confidence intervals of the variables remaining in the model at the end were reported. Graphical representation of scores by groups was done using graphs and tables. Results: One hundred and twenty-nine squash players responded giving a response rate of 69%. The period prevalence and point prevalence of squash related musculoskeletal injury was 62% and 25.6% respectively. A predominance of injuries to the lower limb were recorded (67.65%) compared to the upper limb (21.4%) and the back and trunk (11.3%). The foot and ankle were the most common anatomical site of injury (22.5%) followed by the knee (15%), the thigh (13.8%) and the elbow (13.8%). Alcohol consumption was considered to be a risk factor for injury (p = 0.03); for every increase in five units of alcohol consumption the odds of incurring an injury increased by 29%. The likelihood of injury decreased in those that did weight training; the odds of an injury for a player not doing weight training was 3.3 (1/0.305) times more compared to a player who did weight training. Thus, it was more likely for a player not doing weight training to sustain an injury. Conclusion: The lack of evidence that players train off the court, and the large amount of alcohol consumed on a weekly basis shows that for the majority of players in the eThekwini Municipality squash is more a recreational activity than a professional activity. Despite the study sample being ranked in the top three divisions, this study found that within the eThekwini Municipality squash has not developed on a professional level. Results found that players were more likely to get injured if they did not do weight training and/or consumed alcohol. The population seems to be living a sedentary lifestyle in which squash is their only weight training activity, and after their squash session they consumed alcohol. This lack of training and alcohol consumption predisposes them to lower limb injuries, especially the ankle. Given these results coaches, team captains and medical practitioners should put together cross training programs, which would be a helpful injury prevention. Future studies could look at the effect that cross training programs have on lowering injury prevalence.
An epidemiological investigation of musculoskeletal injuries among rhythmic gymnasts in the eThekwini Municipality
(2018) Strauss, Tylah; Van der Meulen, Anthony G.
Background: Rhythmic Gymnastics is a sporting discipline involving the use of an apparatus (hoop, ball, clubs, ribbon or rope) to a choreographed routine with music. It requires agility, grace, co-ordination and most of all flexibility. Safety in Rhythmic Gymnastics is questionable when one takes training hours and the extreme flexibility required into consideration. An awareness and understanding of the prevalence and risk factors in Rhythmic Gymnastics will allow event organisers, medical personnel, managers, and coaches to adapt training approaches that will minimize the development of injuries. This information will also aid in developing monitoring systems to prevent adaptation injuries, which will lead to safer training and better management of gymnasts Objectives: This study aimed to investigate the prevalence of musculoskeletal injuries in rhythmic gymnasts within the eThekwini municipality and to identify selected factors associated with an increased risk of injury, in order to improve the management of gymnasts. Methods: A quantitative, descriptive questionnaire-based survey with a Beighton Score assessment was conducted on 67 Rhythmic gymnasts in the eThekwini municipality. Statistical analysis was performed on the results obtained from the questionnaire and the Beighton Score using IBM SSS version 23.0. The Chi-squared test was used (Fisher’s Exact Test was used when the Chi-squared test was violated); A p value of less than 0.05 was considered as statistically significant. Graphical representation of scores by groups was done using various types of tables and graphs. Risk factors for injuries were assessed using logistic regression. Factors were entered individually into the model to determine the co- efficients and odds ratios. Trend tests were computed in order to better assess associations between specific factors and injury. Results: A 100% response rate was achieved in this study. The average age of the participants was 12.3 years (95% CI= 11.7-12.8), average height was 148.5 centimetres (95% CI= 145.1-151.9), average weight was 41.0 kilograms (95% CI= 38.3-43.7), the average level of performance was 4.9 (95% CI= 4.1-5.8) and the average Beighton Score was 5.8 (95% CI= 5.3-6.3). The most commonly previously injured areas were the ankle (n=25) (14.0%), hip and knee (each n=19) (each 10.6%) and the low back (n=18) (10.1%). When considering the two most severe previous injuries the results stay similar, with the ankle being most commonly injured (n=15) (28.0%), followed by the hip (n=9) (17.0%) and the knee (n=6) (11.0%). When considering current injuries, the most commonly injured area is the knee and low back (each n=11) (each 14.5%), and the hip and ankle (each n=9) (each 11.8%). From the above it can be deduced that RG results in more injuries to the lower limb than the upper limb, or core/abdomen or the spine. The most common types of RG injury were muscle strains (n=16) (23.9%), followed by unsure (n=9) (13.4%) and joint sprains (n=8) (11.9%). The most common cause of injury for both previous and current RG injuries were overstretching and overuse ((n=23) (34.3%) for previous injuries; (n=15) (22.4%) for current injuries). Risk factors for injury were significant for the following: training hours per week (36.5 times for 5-8 hours of training per week; 15.7 times for under five hours of training per week; both when compared to more than 8 hours) and lack of balance skills included in RG training (4.5 times more likely than not). When considering treatment option used to keep the body in a good condition, a participant was 4.3 times more likely to utilize home remedies than any other treatment option. Trend tests noted that there is an increase in the mean of injuries as one goes up in age, up until a certain age (13-14 years of age for current injuries; 15-16 years of age for previous injuries), thereafter, there is a decease. Trend tests were also constructed for training hours per week; there was a directly proportional relationship between training hours per week and injury. Conclusion: When considering risk of injury in RG, many of the risk factors cannot be modified (such as age). Those risk factors that can be modified (such as training amount and components of training) should be considered by gymnasts and their coaches in order to implement strategies that could prevent injury.
The prevalence and selected risk factors of musculoskeletal injuries affecting working canines in KwaZulu-Natal
(2016) Radtke, Storm; Matkovich, Grant; Singh, Sanil D.
Background Dog agility has become one of the most popular canine sport disciplines, growing annually with many owners enrolling their canines without an educated understanding of what the sport of agility entails. Various factors have been identified that can contribute to the injury of the agility dog, these include coming into contact with the agility equipment, the experience of the dog, nutrition, supplementation, handler training in warm up technique and participation in additional sporting activities such as flyball, and risk factors such as breed, sex and age of the dog have been shown to have an impact on the prevalence and type of injury that sporting dogs are at risk for, most commonly, injuries to the shoulder, wrists, hip and an extensive range of soft tissue injuries. There is a significant knowledge gap in the literature that describes injury prevalence, profiles and the potential risks facing the sporting canine participants in a South African context and that, as more and more owners are seeking out CAM therapies such as chiropractic, literature is needed in order to enable these owners and veterinary chiropractors to better understand the risk that the sport of agility entails. Chiropractic treatment can offer both treatment and prevention, from enhancing the performance of the canine athlete, allowing them to compete more effectively and for a longer period at national and international level, to improving the quality of life of the geriatric canine patient. Aim The aim of this study is to determine the prevalence and selected risk factors of musculoskeletal conditions affecting working canines registered in the herding breed category in Kwa-Zulu Natal. Study Design This study was a cross sectional, prospective survey of sporting canine owners registered with the KZNDAA. The study employed a quantitative descriptive design. Participants The study comprised of 70 dogs registered to 38 owners who are affiliated with the KZNDAA. Methodology Potential participants were identified on the KZNDAA membership list. These members were approached by the researcher at registered agility shows and invited to participate in the study. Once it has been established that the owners and the canines met the inclusion and exclusion criteria of the study, participants were required to sign a letter of information and confidentiality and a consent form and were included as participants in the study. The research questionnaire was then given to participants, who then completed the questionnaire on site and returned it by hand to the researcher. Data was captured on excel and transferred to IBM SPSS version 23. A p value of <0.05 was considered statistically significant. Descriptive statistics such as mean, standard deviation and range were used to describe continuous variables which were normally distributed, while median and inter-quartile range were used for skew variables. Categorical variables were summarized using frequency tables. Associations between lifetime prevalence and risk factors were tested using Pearson’s chi square tests for categorical risk factors, or Fischer’s Exact tests for continuous variables. Results The period prevalence of MS conditions was found to be 8.5% and the lifetime prevalence 45.8%. Injuries were found to occur most often during play, followed by injury during agility competition, a very small percentage of the injuries incurred were due to direct contact with agility equipment. Shoulders and hips were the areas most commonly affected, with arthritis and DJD being the most prevalent type of conditions and muscular strains being the most prevalent type of injury. The breed with the highest prevalence of injury was the Border Collie(63%). Neutered males had the highest prevalence of injury (52%), followed by spayed females (30%). The 8-10 year old category had the highest prevalence of injury (30%), followed by the 2-4 year old category (22%). Large breed dogs in the 15-20kg weight category had the highest prevalence of MS injury (40%). Dogs participating in dog jumping showed a decreased risk of MS injury, while dogs participating in flyball showed an increased risk of developing MS injuries. Handlers with training in specific warm up techniques showed a decreased risk of having dogs developing MS injury. Reverse casualty associations were found between the increased risk of MS injury and dogs fed on Hills specific diets, dogs supplemented with glucosamine and chondroitin, and dogs currently receiving anti-inflammatories. Conclusion The prevalence of musculoskeletal (MS) injuries in agility dogs in KZN is low when compared to studies done outside of South Africa. Factors such as breed, age, sex, and weight of the dog influence the prevalence of MS conditions. Risk factors influencing the development of MS conditions include contact with the equipment, nutrition, participation in other sporting activities and whether warm up periods are allowed. A larger population is needed in order to further analyse the risk of injury in sporting dogs in a South African context.

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