occur in a match situation. This area is worthy of further investigation, and the results might allow coaches to manage the risks associated with certain drills in a more informed way.

Some questionnaires filled out by participants were incomplete. It would have been better if the researchers had been present when the players completed them, so that any confusion surrounding questions might have been avoided.

Areas for future research recommended by the authors include an investigation of injuries sustained in training versus competition, and of injuries sustained during set plays (such as penalty corners and diving in the goalmouth area) with concurrent exposure data recorded. Return to play should be examined with particular reference to the time to return from injury in hypermobile versus non- hypermobile players. It would be interesting to interview coaches to explore the rationale for employing the different types of training programmes that our questionnaire revealed.

CONCLUSIONS This study revealed a high prevalence of hypermobility amongst female junior elite hockey players in England, as well as statistically significant increased injury reporting by hypermobile females. Boys did not present with hypermobility in great numbers and were more likely to sustain contact injuries than girls, who more often sustained overuse (chronic) injuries. The hypothesis that hypermobility is more prevalent in girls than boys may be accepted. That hypermobility is linked with an increased risk of injury may not be true for the group as whole, but there may be an association in girls that is worthy of future investigation. Unlike previous research on the game of hockey, goalkeepers were no more vulnerable to injury than any other playing position; in fact, hypermobility might offer a performance advantage for goalkeepers (14). Further research is prompted

by the results of this study, but as an interim measure the authors are recommending England Hockey to screen its junior female players for hypermobility, to facilitate their education and instigate joint protection strategies such as movement control training.

22

ACKNOWLEDGEMENTS The principle author would like to thank the staff and players from England Hockey for their participation in, and support of, this study. Sincere thanks are also due to Dr Zoe Hudson for her guidance and encouragement to the principal author in this research project.

USEFUL WEBSITES England Hockey http://bit.ly/ahiS8d

References 1. Munday S Chief Executive England Hockey. Personal email 20 March 2009 2. Al-Rawi A, Nessan AH. Joint hypermobility in patients with chondromalacia patellae. British Journal of Rheumatology 1997;36:1324–1327 3. Adib N, Davies K, Grahame R, Woo P, Murray KJ. Joint hypermobility syndrome in childhood. A not so benign multisystem disorder? Rheumatology 2005;44:744– 750

4. Mallik AK, Ferrell WR, McDonald AG, Sturrock RD. Impaired proprioceptive acuity at the proximal interphalangeal joint in patients with the hypermobility syndrome. British Journal of Rheumatology 1994;33:631–637 5. Hall MG, Ferrell WR, Sturrock RD, Hamblen DL, Baxendale RH. The effect of the hypermobility syndrome on knee joint proprioception. British Journal of Rheumatology 1995;34:121–125 6. Beighton P, Solomon L, Soskolne CL. Articular mobility in an African population. Annals of Rheumatic Diseases 1973;32:413–418 7. Hakim AJ, Grahame R. A simple questionnaire to detect hypermobility: An adjunct to the assessment of patients with diffuse musculoskeletal pain. International Journal of Clinical Practice 2003;57(3):163–166

THE AUTHORS

Lisa Kerry is a sports physiotherapist who works in private practice as well as undertaking contract work for England Hockey and the English Institute of Sport based at Bisham Abbey. Her involvement in hockey began as a player and then as a squad physiotherapist for England Hockey under-age squads. She continues to work with the sports governing body as a contractor physiotherapist and is also involved with cricket, wheelchair basketball and women’s rugby and is the lead physiotherapist for British Universities and Colleges Sport.

Dr Zoe Hudson is the Editor of Physical Therapy in Sport and an Honorary Senior Clinical Lecturer at the Centre for Sports and Exercise Medicine at Barts and the London School of Medicine and Dentistry. Her principal research interests include lower limb biomechanics and rehabilitation and return to high performance sport, and physical activity and health in the general population, especially children. Zoe worked in sport for 10 years at international level and has worked with national squads in rugby, swimming (able-bodied and disabled), basketball and volleyball. Major competitions include Team England, Manchester 2002, GB Paralympic team, Sydney 2000, and GB team World University Games, Beijing 2001, Palma 1999. Zoe took part in successful expeditions to both the North Pole and the South Pole.

sportEX medicine 2010;45(Jul):17-22 8. Boyle KL, Will P, Riegger-Krugh C.

Intra-rater and inter-rater reliability of the Beighton and Horan Joint Mobility Index. Journal of Athletic Training 2003;38(4):281–285 9. Simmonds JV, Keer RJ. Hypermobility and the hypermobility syndrome. Masterclass. Manual Therapy 2007;12:298–309 10. Stewart Burden DR, Burden SB. Does generalised ligamentous laxity increase seasonal incidence of injury in male first division club rugby players? British Journal of Sports Medicine 2004;38:457–460 11. Smith R, Damodaran AK, Swaminathan S, Campbell R, Barnsley L. Hypermobility and sports injuries in junior netball players. British Journal of Sports Medicine 2005;39:628–631 12. Collinge R, Simmonds JV. Hypermobility, injury rate and rehabilitation in a professional football squad – A preliminary study. Physical Therapy in Sport 2009 doi:10.1016/j.ptsp.2009.03.001 13. Decoster LC, Bernier JN, Lindsay RH, Vailas JC. Generalized joint hypermobility and its relationship to injury patterns among NCAA lacrosse players. Journal of Athletic Training 1999;34(2):99–105 14. Murtagh J. Injury patterns amongst female field hockey players. Medicine and Science in Sport and Exercise 2001;33(2):201–207

TEST YOUR LEARNING

n Could hypermobility enhance performance in some sporting activities? n Could screening for hypermobility reduce the injury rate in junior hockey players?