Injury and illness definitions and data collection procedures for use in epidemiological studies in Athletics (track and field): Consensus statement

The role of prediagnostic data in injury epidemiology in preprofessional dancers

INTRODUCTION

preprofessional dance training starts at very early ages, on a highly demanding environment placing students at significant risk for injury. Injury management and prevention are a matter of concern. Given the constant interchangeability of risk factors, identifying injury patterns may prove to be equally as important. Data looking back from the time of injury through context-specific approaches are missing.

OBJECTIVES

To identify activity-related injury patterns based on prediagnostic data.

METHODS

Prospective, non-randomized, observational study, over a 3 years period on a full-time preprofessional dance school featuring both gender students aged 9-21 years old. Non-parametric statistics were used.

RESULTS

A total of 625 dance injury records from 209 students, n = 68 males and n = 141 females, were analyzed. Season injury risk probability was identified, proving different for each skill level (SkL). Multiple individual injuries revealed a trend toward prevalence rates in advanced level, while index injuries incidence becomes more noticeable in entry level students. Overall incidence rates had no significant differences within SkL. Anatomical location was in line with previous research, although differences were found between gender and SkL. Most injuries occurred in classes, with jumps standing out as the main motor action associated with injury symptoms of gradual onset mechanism.

CONCLUSION

Dance injuries happen because of dance practice. Knowing the context of injury history from the injured dancer perspective is determinant for management and prevention. prediagnostic data are an umbrella term encompassing several aspects of injury background and represents fertile ground for research. Context-specific methodological approaches are recommended.

Researching health behaviour in ‘real time’: Methodological insights from a prospective study on Olympic hopefuls

In this article, we share our experience of navigating qualitative longitudinal research with a ‘hard to recruit’ population. To detail design conception, methodological challenges and insights, we draw on the case of a 1-year-long study on health behaviour in Olympic hopefuls. In order to accompany 12 athletes who aimed to qualify for either an Olympic Games (n = 10) or a World Championship (n = 2), we developed and implemented a career background questionnaire; semi-structured interviews; weekly web surveys; a training observation and a compilation of competition results. Based on the longitudinal research experience, we present project management and project data of the Paths-to-Rio study to discuss the challenges we faced, including gaining access to an elite population, their retention and anonymity. We further outline insights the prospective study gave us on the value of missing data as data and on the benefits participants described in terms of learning through research involvement. We conclude with recommendations for future qualitative longitudinal research.

Specific interventions for prevention of muscle injury in lower limbs: systematic review and meta-analysis

Abstract Introduction: Muscle injuries show an incidence associated with extreme stretching, or even a high-intensity eccentric contraction. Such injuries cause severe damage to athletes, including lower performance, withdrawal, and psychological distress. In this scenario, the study of effective preventive methods is an indispensable factor in the routine of professional athletes, to reduce the incidence of injuries. Objective: To verify the effectiveness of three different interventions (warm-up, neuromuscular training, and eccentric exercise) to prevent muscle injuries in the lower limbs. Method: We searched the Cochrane Library, EMBASE, SPORTDiscus, PEDro, and PubMed databases from the earliest records until January 20, 2018. The search was performed from word combinations such as clinical trial, muscle strain, injury prevention. The data related to the outcome of prevention were grouped in meta-analysis and described in Risk Ratio (RR) with 95% confidence interval. Results: Sixteen studies were included: five assessed eccentric exercise, three investigated neuromuscular training, and eight observed warm-up. The eccentric exercise (RR = 3.49, 95% CI 2.36, 5.16, p < 0.00001) and the neuromuscular training (RR = 2.73, 95% CI 2.03, 2.68, p < 0.00001) showed significant effects on the prevention of muscle injuries in lower limbs. On the other hand, warm-up (RR = 1.57, 95% CI 0.92, 2.7, p = 0.10) was irrelevant in reducing the incidence of injuries in the body segment investigated. Conclusion: The outcomes presented provide clinical relevance inherent in the field practices, with intrinsic potential for practical application in the management of specific preventive techniques.

Injuries in Field Hockey Players: A Systematic Review

Background

To commence injury prevention efforts, it is necessary to understand the magnitude of the injury problem. No systematic reviews have yet investigated the extent of injuries in field hockey, despite the popularity of the sport worldwide.

Objective

Our objective was to describe the rate and severity of injuries in field hockey and investigate their characteristics.

Methods

We conducted electronic searches in PubMed, Embase, SPORTDiscus, and CINAHL. Prospective cohort studies were included if they were published in English in a peer-reviewed journal and observed all possible injuries sustained by field hockey players during the period of the study.

Results

The risk of bias score of the 22 studies included ranged from three to nine of a possible ten. In total, 12 studies (55%) reported injuries normalized by field hockey exposure. Injury rates ranged from 0.1 injuries (in school-aged players) to 90.9 injuries (in Africa Cup of Nations) per 1000 player-hours and from one injury (in high-school women) to 70 injuries (in under-21 age women) per 1000 player-sessions. Studies used different classifications for injury severity, but—within studies—injuries were included mostly in the less severe category. The lower limbs were most affected, and contusions/hematomas and abrasions were common types of injury. Contact injuries are common, but non-contact injuries are also a cause for concern.

Conclusions

Considerable heterogeneity meant it was not possible to draw conclusive findings on the extent of the rate and severity of injuries. Establishing the extent of sports injury is considered the first step towards prevention, so there is a need for a consensus on injury surveillance in field hockey.

Electronic supplementary material

The online version of this article (10.1007/s40279-017-0839-3) contains supplementary material, which is available to authorized users.

An Updated Subsequent Injury Categorisation Model (SIC-2.0): Data-Driven Categorisation of Subsequent Injuries in Sport

BACKGROUND

Accounting for subsequent injuries is critical for sports injury epidemiology. The subsequent injury categorisation (SIC-1.0) model was developed to create a framework for accurate categorisation of subsequent injuries but its operationalisation has been challenging.

OBJECTIVES

The objective of this study was to update the subsequent injury categorisation (SIC-1.0 to SIC-2.0) model to improve its utility and application to sports injury datasets, and to test its applicability to a sports injury dataset.

METHODS

The SIC-1.0 model was expanded to include two levels of categorisation describing how previous injuries relate to subsequent events. A data-driven classification level was established containing eight discrete injury categories identifiable without clinical input. A sequential classification level that sub-categorised the data-driven categories according to their level of clinical relatedness has 16 distinct subsequent injury types. Manual and automated SIC-2.0 model categorisation were applied to a prospective injury dataset collected for elite rugby sevens players over a 2-year period. Absolute agreement between the two coding methods was assessed.

RESULTS

An automated script for automatic data-driven categorisation and a flowchart for manual coding were developed for the SIC-2.0 model. The SIC-2.0 model was applied to 246 injuries sustained by 55 players (median four injuries, range 1-12), 46 (83.6%) of whom experienced more than one injury. The majority of subsequent injuries (78.7%) were sustained to a different site and were of a different nature. Absolute agreement between the manual coding and automated statistical script category allocation was 100%.

CONCLUSIONS

The updated SIC-2.0 model provides a simple flowchart and automated electronic script to allow both an accurate and efficient method of categorising subsequent injury data in sport.

Overuse injuries in Swedish elite athletics- a study protocol for a prospective multifactorial cohort study

BACKGROUND

Overuse injuries (OI) are common in elite athletics. Previous studies have had athletes self-report injuries rather than having a medical professional provide a clear diagnosis. This might be a major reason for the inconsistencies in reported incident proportions of OI in elite athletics, in addition to the varying definitions of OI in current literature. Risk factors or combinations of risk factors (biomechanical, clinical, and training-related) have been shown to be important in the developmental process of OI. However, no studies have examined these relationships using a multifactorial and prospective approach in elite athletics. The purpose of this study protocol is to describe OI incidence proportion, injury severity, location, and occurrence during a complete athletics season. Moreover, possible discipline specific and injury specific risk factors that might be associated with OI will be examined.

METHODS

This study will be an explorative prospective cohort study including approximately 120 elite athletes. All athletes will be screened twice during one complete athletics season. The screening will consist of a body composition scan to measure muscle mass, fat free mass, lean mass, bone density, and bone mineral content. In addition, clinical examination will measure range of motion for the lower back, hip, knee, shoulder, and elbow and ankle joints. A running analysis will measure the 3D motions of the hip, knee, and ankle joints. Finally, maximal isometric strength tests of the main core and lower extremity muscles will be carried out. To record injuries, each athlete will consult a physiotherapist or sports medicine doctor affiliated with the study to get a clear diagnosis. Injury data will be recorded according to the previously published athletics consensus statement.

DISCUSSION

Results from this study protocol will contribute more insight and detailed knowledge regarding the extent of OI occurrence among elite athletes during a complete athletics season. It will also provide further insights into which risk factors are associated with the development of OI in elite athletics.

Lifetime history of sexual and physical abuse among competitive athletics (track and field) athletes: cross sectional study of associations with sports and non-sports injury

OBJECTIVE

To examine associations between lifetime sexual and physical abuse, and the likelihood of injury within and outside sport in athletes involved in competitive athletics.

METHODS

A cross sectional study was performed among the top 10 Swedish athletics athletes using 1 year prevalence of sports and non-sports injuries as the primary outcome measure. Associations with sociodemographic characteristics, lifetime abuse history and training load were investigated. Data were analysed using simple and multiple logistic regression models.

RESULTS

11% of 197 participating athletes reported lifetime sexual abuse; there was a higher proportion of women (16.2%) than men (4.3%) (P=0.005). 18% reported lifetime physical abuse; there was a higher proportion of men (22.8%) than women (14.3%) (P=0.050). For women, lifetime sexual abuse was associated with an increased likelihood of a non-sports injury (OR 8.78, CI 2.76 to 27.93; P<0.001). Among men, increased likelihood of a non-sports injury was associated with more frequent use of alcoholic beverages (OR 6.47, CI 1.49 to 28.07; P=0.013), while commencing athletics training at >13 years of age was associated with a lower likelihood of non-sports injury (OR 0.09, CI 0.01 to 0.81; P=0.032). Lifetime physical abuse was associated with a higher likelihood of sports injury in women (OR 12.37, CI 1.52 to 100.37; P=0.019). Among men, athletes with each parents with ≤12 years formal education had a lower likelihood of sustaining an injury during their sports practice (OR 0.37, CI 0.14 to 0.96; P=0.040).

CONCLUSIONS

Lifetime sexual and physical abuse were associated with an increased likelihood of injury among female athletes. Emotional factors should be included in the comprehension of injuries sustained by athletes.

Risk models for lower extremity injuries among short- and long distance runners: A prospective cohort study

BACKGROUND

Running injuries are very common. Risk factors for running injuries are not consistently described across studies and do not differentiate between runners of long- and short distances within one cohort.

OBJECTIVES

The aim of this study is to determine risk factors for running injuries in recreational long- and short distance runners separately.

DESIGN

A prospective cohort study.

METHODS

Recreational runners from four different running events are invited to participate. They filled in a baseline questionnaire assessing possible risk factors about 4 weeks before the run and one a week after the run assessing running injuries. Using logistic regression we developed an overall risk model and separate risk models based on the running distance.

RESULTS

In total 3768 runners participated in this study. The overall risk model contained 4 risk factors: previous injuries (OR 3.7) and running distance during the event (OR 1.3) increased the risk of a running injury whereas older age (OR 0.99) and more training kilometers per week (OR 0.99) showed a decrease. Models between short- and long distance runners did not differ significantly. Previous injuries increased the risk of a running injury in all models, while more training kilometers per week decreased this risk.

CONCLUSIONS

We found that risk factors for running injuries were not related to running distances. Previous injury is a generic risk factor for running injuries, as is weekly training distance. Prevention of running injuries is important and a higher weekly training volume seems to prevent injuries to a certain extent.

Reporting Multiple Individual Injuries in Studies of Team Ball Sports: A Systematic Review of Current Practice

Background

To identify and prioritise targets for injury prevention efforts, injury incidence studies are widely reported. The accuracy and consistency in calculation and reporting of injury incidence is crucial. Many individuals experience more than one injury but multiple injuries are not consistently reported in sport injury incidence studies.

Objective

The aim of this systematic review was to evaluate current practice of how multiple injuries within individuals have been defined and reported in prospective, long-term, injury studies in team ball sports.

Data Sources

A systematic search of three online databases for articles published before 2016.

Study Selection

Publications were included if (1) they collected prospective data on musculoskeletal injuries in individual participants; (2) the study duration was >1 consecutive calendar year/season; and (3) individuals were the unit of analysis.

Data Extraction

Key study features were summarised, including definitions of injury, how multiple individual injuries were reported and results relating to multiple injuries.

Results

Of the 71 publications included, half did not specifically indicate multiple individual injuries; those that did were largely limited to reporting recurrent injuries. Eight studies reported the number/proportion of athletes with more than one injury, and 11 studies presented the mean/number of injuries per athlete.

Conclusions

Despite it being relatively common to collect data on individuals across more than one season, the reporting of multiple injuries within individuals is much more limited. Ultimately, better addressing of multiple injuries will improve the accuracy of injury incidence studies and enable more precise targeting and monitoring of the effectiveness of preventive interventions.

Electronic supplementary material

The online version of this article (doi:10.1007/s40279-016-0637-3) contains supplementary material, which is available to authorized users.

Does variability within natural turfgrass sports fields influence ground-derived injuries?

Natural turfgrass sports fields exhibit within-field variations due to climatic conditions, field construction, field management, and foot traffic patterns from field usage. Variations within a field could influence the playing surface predictability and require athletes to make abrupt or frequent adjustments that lead to increased ground-derived injury occurrence. This study introduces a new methodology aimed at evaluating the potential relationship between within-field variations of turfgrass sports field properties and ground-derived athlete injuries. Collegiate Club Sport athletes self-reported ground-derived injuries over two years. Soil moisture, turfgrass quality, surface hardness, and turfgrass shear strength were quantified from their two home fields. Hot spot analysis identified significantly high (hot spots) and low (cold spots) values within the fields. Injury locations were compared to hot spot maps each month. Binomial proportion tests determined if there were differences between observed injury proportions and expected proportions. Twenty-three ground-derived injuries were reported overall. The observed injury proportions occurring in turfgrass quality cold spots [0.52 (95% CI 0.29-0.76)] and soil moisture hot spots [0.43 (95% CI 0.22-0.66)] was significantly higher than expected [0.20 (p < .001) and 0.21 (p < .05), respectively]. Most injuries in significant areas of turfgrass quality, soil moisture, and surface hardness were along edges of hot and cold spots. These results suggest a potential relationship between within-field variations and ground-derived injuries, particularly in transition areas between non-significant and significant high and low values. Future larger-scale studies can incorporate the reported methodology to validate this relationship and implement strategies that reduce ground-derived injuries.

The associations between training load and baseline characteristics on musculoskeletal injury and pain in endurance sport populations: A systematic review

OBJECTIVES

To determine the associations between training load, baseline characteristics (e.g. age or previous injury) and rate of musculoskeletal injury and/or pain specifically within an Endurance Sporting Population (ESP).

DESIGN

Prospectively registered systematic review.

METHODS

Eight electronic databases were searched by two independent reviewers. Studies were required to prospectively monitor both (i) training loads and (ii) musculoskeletal injury and/or pain for >3 months. Methodological quality and risk of bias were determined utilising the Critical Skills Appraisal Program (CASP). Reported effect sizes were categorised as small, medium or large.

RESULTS

Twelve endurance sport studies were eligible (running, triathlon, rowing). Increased injury and/or pain risk was associated with: (i) high total training distances per week/month (medium effect size) (ii) training frequency <2 sessions/week (medium effect size) and (iii) both low weekly (<2hours/week) and high monthly (large effect size) training durations. None of the studies reported internal training load data or acute:chronic workload ratios. Baseline characteristics found to increase the rate of injury and/or pain included: (i) a history of previous injury (medium effect size), (ii) age >45 years (small effect size), (iii) non-musculoskeletal comorbidities (large effect size), (iv) using older running shoes (small effect size) and (v) non-competitive behaviour.

CONCLUSIONS

This review identifies a range of external training load factors and baseline characteristics associated with an increased rate of injury and/or pain within ESPs. There is an absence of research relating to internal training loads and acute:chronic workload ratios in relation to rate of injury and/or pain within ESPs.

Capture of Time-Loss Overuse Soccer Injuries in the National Collegiate Athletic Association's Injury Surveillance System, 2005-2006 Through 2007-2008

CONTEXT

  Overuse injuries are reported to account for nearly 50% of sports injuries and, due to their progressive nature and the uncertainty regarding date of onset, are difficult to define and categorize. Comparing the capture rates of overuse injuries between injury-surveillance systems and medical records can clarify completeness and determinants of how overuse injuries are represented in injury-surveillance data.

OBJECTIVE

  To estimate the capture rate of time-loss medical-attention overuse injuries in men's and women's soccer in the National Collegiate Athletic Association Injury Surveillance System (NCAA ISS) compared with medical records maintained by certified athletic trainers and assess the differences in completeness of capture and factors contributing to those differences.

DESIGN

  Capture-recapture study.

SETTING

  Fifteen NCAA institutions provided NCAA ISS and medical record data from men's and women's soccer programs from 2005-2006 through 2007-2008.

PATIENTS OR OTHER PARTICIPANTS

  National Collegiate Athletic Association men's and women's soccer players.

MAIN OUTCOME MEASURE(S)

  Time-loss medical-attention overuse injuries were defined as injuries with an overuse mechanism of injury in the NCAA ISS or medical records. Capture rates were calculated as the proportion of total overuse injuries classified as having overuse mechanisms in the NCAA ISS and the NCAA ISS and medical records combined.

RESULTS

  The NCAA ISS captured 63.7% of the total estimated overuse mechanisms of injury in men's and women's soccer players. The estimated proportion of overuse injury mechanisms captured by both the NCAA ISS and medical records was 37.1%. The NCAA ISS captured more overuse injury mechanisms in men's soccer than in women's soccer (79.2% versus 45.0%, χ² = 9.60; P = .002) athletes.

CONCLUSIONS

  From 2005-2006 through 2007-2008, the NCAA ISS captured only two thirds of time-loss medical-attention overuse mechanisms of injury in men's and women's soccer players. Future researchers should consider supplementing injury-surveillance data with a clinical record review to capture the burden of these injuries.

Associations between recreational runners' anti-inflammatory drug use, coping strategies, and time loss due to injury and illness during preparations for a marathon event

BACKGROUND

Due to the dominance of overuse injuries among runners, knowledge of how use of non-steroidal anti-inflammatory drugs (NSAIDs) and behavioral factors contribute to injury events is important. The aim of this study was to explore recreational marathon runners' strategies for coping with injury and illness, including use of drugs for control of pain and inflammation, and to investigate whether these strategies were associated with the 1-year prevalence of time-loss injury and illness.

METHODS

An online questionnaire was used for data collection in this cross-sectional study. The population consisted of runners who had registered for a marathon (N.=341). Strategies used to understand and manage perceptions of injury and illness were measured with the Brief COPE instrument and the use of NSAIDs was investigated.

RESULTS

Complete survey data were provided by 161 runners (47%). 42% reported NSAID use. A notable injury in the past year was reported by 43%, and 19% reported having had a time-loss illness episode. Runners who reported NSAID use in the past year reported significantly fewer time-loss injuries (P=0.003). Time loss due to illness only showed a negative correlation with using emotional support for coping (P=0.010) and a positive correlation with self-blame (P=0.039).

CONCLUSIONS

Runners stating NSAID use reported fewer time-loss running injuries than non-NSAID users. Time loss due to illness showed different correlates with NSAID use and coping strategies than time loss due to injury, i.e. no association with drug use, less use of emotional support for coping and more use of self-blame.

How do professional Australian Football League (AFL) players utilise social media during periods of injury? A mixed methods analysis

OBJECTIVES

The objective of this study was to explore how social media is used by a population of injured professional athletes, by comparing the content and frequency of posts on social media, pre and post-injury.

DESIGN

A retrospective mixed methods design was utilised.

METHODS

Professional Australian Football League (AFL) players, injured during the 2015 season, were included in the study. Publicly accessible social media profiles for these players were identified on Twitter and Instagram. All posts published on verified profiles, from four weeks prior to injury until return to play, were extracted. Thematic analysis was used to investigate the content of these posts, while univariate and multivariate linear regression was used to investigate the frequency of posts during this time period.

RESULTS

Two reoccurring themes were identified exclusively post-injury; 'supporting team from the sideline' and 'sharing information about injury and rehabilitation'. The frequency of total posts did not differ significantly pre and post-injury, but the frequency of injury related posts increased in the immediate post-injury phase, then decreased between 4-8 weeks and 8-12 weeks post-injury. The frequency of injury related posts was higher with more severe injuries.

CONCLUSIONS

The findings of this study suggest that injured players use social media to seek social support from their followers, especially in the immediate post-injury period and after sustaining a severe injury. The role of social media in injury rehabilitation may warrant further investigation, to determine if it could be used to facilitate return to play.

Design of ProjectRun21: a 14-week prospective cohort study of the influence of running experience and running pace on running-related injury in half-marathoners

BACKGROUND

Participation in half-marathon has been steeply increasing during the past decade. In line, a vast number of half-marathon running schedules has surfaced. Unfortunately, the injury incidence proportion for half-marathoners has been found to exceed 30% during 1-year follow-up. The majority of running-related injuries are suggested to develop as overuse injuries, which leads to injury if the cumulative training load over one or more training sessions exceeds the runners' load capacity for adaptive tissue repair. Owing to an increase of load capacity along with adaptive running training, the runners' running experience and pace abilities can be used as estimates for load capacity. Since no evidence-based knowledge exist of how to plan appropriate half-marathon running schedules considering the level of running experience and running pace, the aim of ProjectRun21 is to investigate the association between running experience or running pace and the risk of running-related injury.

METHODS

Healthy runners using Global Positioning System (GPS) watch between 18 and 65 years will be invited to participate in this 14-week prospective cohort study. Runners will be allowed to self-select one of three half-marathon running schedules developed for the study. Running data will be collected objectively by GPS. Injury will be based on the consensus-based time loss definition by Yamato et al.: "Running-related (training or competition) musculoskeletal pain in the lower limbs that causes a restriction on or stoppage of running (distance, speed, duration, or training) for at least 7 days or 3 consecutive scheduled training sessions, or that requires the runner to consult a physician or other health professional". Running experience and running pace will be included as primary exposures, while the exposure to running is pre-fixed in the running schedules and thereby conditioned by design. Time-to-event models will be used for analytical purposes.

DISCUSSION

ProjectRun21 will examine if particular subgroups of runners with certain running experiences and running paces seem to sustain more running-related injuries compared with other subgroups of runners. This will enable sport coaches, physiotherapists as well as the runners to evaluate their injury risk of taking up a 14-week running schedule for half-marathon.

A systematic review of prospective epidemiological research into injury and illness in Olympic combat sport

BACKGROUND

Combat sports involve body contact through striking, kicking and/or throwing. They are anecdotally referred to as 'dangerous', yet long-term investigation into specific injury rates is yet to be explored.

OBJECTIVE

To describe incidence and prevalence of injury and illness within Olympic combat sports and to investigate risk of bias of prospective injury and illness research within these sports.

METHODS

We systematically searched literature published up until May 2016. We included prospective studies of injury/illness in elite combat athletes lasting more than 12 weeks. Risk of bias was assessed using a modified version of the Downs and Black checklist for methodological quality. Included studies were mapped to the Oxford Centre for Evidence-Based Medicine levels of evidence.

RESULTS

Nine studies were included, and most (n=6) had moderate risk of bias. Studies provided level 1/2b evidence that the most frequently injured areas were the head/face (45.8%), wrist (12.0%) and lower back (7.8%) in boxing; the lower back (10.9%), shoulder (10.2%) and knee (9.7%) in judo; the fingers (22.8%) and thigh (9.1%) in taekwondo; and the knee (24.8%), shoulder (17.8%) and head/face (16.6%) in wrestling. Heterogeneity of injury severity classifications and inconsistencies inexposure measures prevented any direct comparisons of injury severity/incidence across combat sports.

CONCLUSIONS

There is currently a lack of consensus in the collection of injury/illness data, limiting the development of prevention programmes for combat sport as a whole. However, sport-specific data that identify body areas with high injury frequency can provide direction to clinicians, enabling them to focus their attention on developing pathologies in these areas. In doing so, clinicians can enhance the practical elements of their role within the integrated combat sport performance team and assist in the regular update of surveillance records.

Descriptive Epidemiology of Non-Time-Loss Injuries in Collegiate and High School Student-Athletes

CONTEXT

  Research on non-time-loss (NTL) injuries, which result in less than 24 hours of restriction from participation, is limited.

OBJECTIVE

  To describe the epidemiology of NTL injuries among collegiate and high school student-athletes.

DESIGN

  Descriptive epidemiology study.

SETTING

  Aggregate injury and exposure data collected from a convenience sample of National College Athletic Association varsity teams and 147 high schools in 26 states.

PATIENTS OR OTHER PARTICIPANTS

  Collegiate and high school student-athletes participating in men's and boys' baseball, basketball, football, lacrosse, soccer, and wrestling and women's and girls' basketball, field hockey, lacrosse, soccer, softball, and volleyball during the 2009-2010 through 2013-2014 and the 2011-2012 through 2013-2014 academic years, respectively, participated. Collegiate student-athletes participating in men's and women's ice hockey were also included.

MAIN OUTCOME MEASURE(S)

  Injury data from the National Collegiate Athletic Association Injury Surveillance Program and the National Athletic Treatment, Injury and Outcomes Network were analyzed. Injury counts, rates per 1000 athlete-exposures (AEs), and rate ratios were reported with 95% confidence intervals (CIs).

RESULTS

  A total of 11 899 and 30 122 NTL injuries were reported in collegiate and high school student-athletes, respectively. The proportion of NTL injuries in high school student-athletes (80.3%) was 1.61 times greater than that of collegiate student-athletes (49.9%; 95% CI = 1.59, 1.63). The NTL injury rate in high school student-athletes (8.75/1000 athlete-exposures [AEs]) was 2.18 times greater than that of collegiate student-athletes (4.02/1000 AEs; 95% CI = 2.13, 2.22). Men's ice hockey (5.27/1000 AEs) and boys' football (11.94/1000 AEs) had the highest NTL injury rates among collegiate and high school athletes, respectively. Commonly injured body parts in collegiate and high school student-athletes were the hip/thigh/upper leg (17.5%) and hand/wrist (18.2%), respectively. At both levels, contusions, sprains, and strains were the most frequent diagnoses. Contact with another player was the most cited injury mechanism (college = 38.0%, high school = 46.3%).

CONCLUSIONS

  Non-time-loss injuries compose large proportions of collegiate and high school sports injuries. However, the NTL injury rate was higher in high school than in collegiate student-athletes. Tracking NTL injuries will help to better describe the breadth of injuries sustained by athletes and managed by athletic trainers.

How much is too much? (Part 2) International Olympic Committee consensus statement on load in sport and risk of illness

The modern-day athlete participating in elite sports is exposed to high training loads and increasingly saturated competition calendar. Emerging evidence indicates that inappropriate load management is a significant risk factor for acute illness and the overtraining syndrome. The IOC convened an expert group to review the scientific evidence for the relationship of load—including rapid changes in training and competition load, competition calendar congestion, psychological load and travel—and health outcomes in sport. This paper summarises the results linking load to risk of illness and overtraining in athletes, and provides athletes, coaches and support staff with practical guidelines for appropriate load management to reduce the risk of illness and overtraining in sport. These include guidelines for prescription of training and competition load, as well as for monitoring of training, competition and psychological load, athlete well-being and illness. In the process, urgent research priorities were identified.

How should we categorise self-reported data on subsequent injuries?

Classifying subsequent injuries is of high importance in injury epidemiology since a previous injury has been reported to increase the risk of a new injury or increase the risk of a more severe injury. Multiple reports have shown that self-reported data provide an extensive view of an injury problem and add valuable information to the understanding of the athlete's health. The purpose of this study was to display a method that can be used to facilitate classification of subsequent injuries and to discuss challenges faced when categorising subsequent injuries based on self-reported data. The suitability of a new model for Subsequent Injuries Adjusted for Self-reported data (SIAS model) was demonstrated with sport injury data from a cohort of 101 adolescent elite track & field athletes, followed over 52 weeks. A total number of 71 subsequent injuries were identified. Of all subsequent injuries, recurrent injuries represented 69.0% (n = 49) and 31.0% (n = 22) were classified as new injuries. The majority of subsequent injuries (n = 60, 84.5%) occurred after athletes had recovered from a previous injury. Of all subsequent injuries, 15.5% (n = 11) represented injuries where athletes had not fully recovered from a previous injury. Application of the SIAS model allows for classification of subsequent injuries based on self-reported data on the recovery level of the athletes, the injury onset and injury type. The developed SIAS model follows the consensus recommendations of injury definition, injury classification and is an attempt to increase the understanding of the complex relationship of subsequent injuries in self-reported data sets.

Application of the subsequent injury categorisation model for longitudinal injury surveillance in elite rugby and cricket: intersport comparisons and inter-rater reliability of coding

BACKGROUND

When an athlete has more than one injury over a time period, it is important to determine if these are related to each other or not. The subsequent injury categorisation (SIC) model is a method designed to consider the relationship between an index injury and subsequent injury(ies).

OBJECTIVE

The primary aim was to apply SIC to longitudinal injury data from two team sports: rugby union and cricket. The secondary aim was to determine SIC inter-rater reliability.

METHODS

Rugby union (time-loss; TL) and cricket (TL and non-time-loss; NTL) injuries sustained between 2011 and 2014 within one international team, respectively, were recorded using international consensus methods. SIC was applied by multiple raters, team clinicians, non-team clinicians, and a sports scientist. Weighted kappa and Cohen's kappa scores were calculated for inter-rater reliability of the rugby union TL injuries and cricket NTL and TL injuries.

RESULTS

67% and 51% of the subsequent injuries in rugby union and cricket respectively were categorised as injuries to a different body part not related to an index injury (SIC code 10). At least moderate agreement (weighted and Cohen kappa ≥0.60) was observed for team clinicians and the non-team clinician for both sports. Including NTL and TL injuries increased agreement between team clinician and non-team clinician, but not between clinician and sports scientist.

CONCLUSION

The most common subsequent injury in both sports was an injury to a different body part that was not related to an index injury. The SIC model was generally reliable, with the highest agreement between clinicians working within the same team. Recommendations for future use of SIC are provided based on the proximity of the rater to the team and the raters' level of clinical knowledge.

Preparticipation predictors for championship injury and illness: cohort study at the Beijing 2015 International Association of Athletics Federations World Championships

OBJECTIVES

To determine preparticipation predictors of injury and illness at a major Athletics championship.

METHODS

A cohort study design was used. Before the 2015 International Association of Athletics Federations World Championships in Athletics, all 207 registered national teams were approached about partaking in a study of preparticipation health; 50 teams accepted. The athletes (n=957) in the participating teams were invited to complete a preparticipation health questionnaire (PHQ). New injuries and illnesses that occurred at the championships were prospectively recorded. Logistic regression analyses were performed with simple and multiple models using any in-championship injury and in-championship illness as outcomes.

RESULTS

The PHQ was completed by 307 (32.1%) of the invited athletes; 116 athletes (38.3%) reported an injury symptom during the month before the championships, while 40 athletes (13%) reported an illness symptom. 20 (6.5%) of the participating athletes sustained a health problem during the championships. Endurance athletes were almost 10-fold more likely to sustain an in-championship illness than speed/power athletes (OR, 9.88; 95% CI 1.20 to 81.31; p=0.033). Participants reporting a preparticipation gradual-onset injury symptom were three times more likely (OR, 3.09; 95% CI 1.08 to 8.79; p=0.035) and those reporting an illness symptom causing anxiety were fivefold more likely (OR, 5.56; 95% CI 1.34 to 23.15; p=0.018) to sustain an in-championship injury.

SUMMARY AND CONCLUSIONS

Analyses of preparticipation predictors of injury and illness at a major Athletics championship suggest that endurance athletes require particular clinical attention. Preparticipation symptoms causing anxiety are interesting predictors for in-championship health problems.

Strategies and factors associated with preparing for competing in the heat: a cohort study at the 2015 IAAF World Athletics Championships

PURPOSE

Assess exertional heat illness (EHI) history and preparedness in athletes competing in a World Athletics Championships under hot/humid conditions and identify the factors associated with preparedness strategies.

METHODS

Of the 207 registered national teams invited to participate in the study, 50 (24%) accepted. The 957 athletes (49% of all 1965 registered) in these teams were invited to complete a precompetition questionnaire evaluating EHI history, heat stress prevention (heat acclimatisation, precooling and hydration) and recovery. Responses from 307 (32%) athletes were separated in field events, sprints, middle-distance and long-distance running, and decathlon/heptathlon for analysis.

RESULTS

48% of athletes had previously experienced EHI symptoms and 8.5% had been diagnosed with EHI. 15% heat acclimatised (∼20 days) before the championships. 52% had a precooling strategy, ice slurry ingestion (24%) being the most prevalent and women using it more frequently than men (p=0.005). 96% of athletes had a fluid consumption strategy, which differed between event categories (p<0.001). The most common volumes planned on being consumed were 0.5-1 L (27.2%) and ≥2 L (21.8%), water being the most frequent. 89% of athletes planned on using at least one recovery strategy. Female sex (p=0.024) and a previous EHI diagnosis increased the likelihood of using all 3 prevention strategies (p<0.001).

CONCLUSIONS

At a World Championships with expected hot/humid conditions, less than one-fifth of athletes heat acclimatised, half had a precooling strategy and almost all a hydration plan. Women, and especially athletes with an EHI history, were more predisposed to use a complete heat stress prevention strategy. More information regarding heat acclimatisation should be provided to protect athlete health and optimise performance at major athletics competitions in the heat.

Influence of the Heel-to-Toe Drop of Standard Cushioned Running Shoes on Injury Risk in Leisure-Time Runners: A Randomized Controlled Trial With 6-Month Follow-up

BACKGROUND

Modern running shoes are available in a wide range of heel-to-toe drops (ie, the height difference between the forward and rear parts of the inside of the shoe). While shoe drop has been shown to influence strike pattern, its effect on injury risk has never been investigated. Therefore, the reasons for such variety in this parameter are unclear.

PURPOSE

The first aim of this study was to determine whether the drop of standard cushioned running shoes influences running injury risk. The secondary aim was to investigate whether recent running regularity modifies the relationship between shoe drop and injury risk.

STUDY DESIGN

Randomized controlled trial; Level of evidence, 1.

METHODS

Leisure-time runners (N = 553) were observed for 6 months after having received a pair of shoes with a heel-to-toe drop of 10 mm (D10), 6 mm (D6), or 0 mm (D0). All participants reported their running activities and injuries (time-loss definition, at least 1 day) in an electronic system. Cox regression analyses were used to compare injury risk between the 3 groups based on hazard rate ratios (HRs) and their 95% CIs. A stratified analysis was conducted to evaluate the effect of shoe drop in occasional runners (<6 months of weekly practice over the previous 12 months) versus regular runners (≥6 months).

RESULTS

The overall injury risk was not different among the participants who had received the D6 (HR, 1.30; 95% CI, 0.86-1.98) or D0 (HR, 1.17; 95% CI, 0.76-1.80) versions compared with the D10 shoes. After stratification according to running regularity, low-drop shoes (D6 and D0) were found to be associated with a lower injury risk in occasional runners (HR, 0.48; 95% CI, 0.23-0.98), whereas these shoes were associated with a higher injury risk in regular runners (HR, 1.67; 95% CI, 1.07-2.62).

CONCLUSION

Overall, injury risk was not modified by the drop of standard cushioned running shoes. However, low-drop shoes could be more hazardous for regular runners, while these shoes seem to be preferable for occasional runners to limit injury risk.

Sports Injury Surveillance Systems: A Review of Methods and Data Quality

BACKGROUND AND AIMS

Data from sports injury surveillance systems are a prerequisite to the development and evaluation of injury prevention strategies. This review aimed to identify ongoing sports injury surveillance systems and determine whether there are gaps in our understanding of injuries in certain sport settings. A secondary aim was to determine which of the included surveillance systems have evaluated the quality of their data, a key factor in determining their usefulness.

METHODS

A systematic search was carried out to identify (1) publications presenting methodological details of sports injury surveillance systems within clubs and organisations; and (2) publications describing quality evaluations and the quality of data from these systems. Data extracted included methodological details of the surveillance systems, methods used to evaluate data quality, and results of these evaluations.

RESULTS

Following literature search and review, a total of 15 sports injury surveillance systems were identified. Data relevant to each aim were summarised descriptively. Most systems were found to exist within professional and elite sports. Publications concerning data quality were identified for seven (47%) systems. Validation of system data through comparison with alternate sources has been undertaken for only four systems (27%).

CONCLUSIONS

This review identified a shortage of ongoing injury surveillance data from amateur and community sport settings and limited information about the quality of data in professional and elite settings. More surveillance systems are needed across a range of sport settings, as are standards for data quality reporting. These efforts will enable better monitoring of sports injury trends and the development of sports safety strategies.

The Sports-Related Injuries and Illnesses in Paralympic Sport Study (SRIIPSS): a study protocol for a prospective longitudinal study

BACKGROUND

Paralympic sport provides sporting opportunities for athletes with a disability, with the Paralympic Games as the main event. Participation in sport is, however, associated with a significant risk for sustaining injuries and illnesses. Our knowledge of sports-related injuries and illnesses in Paralympic sport is very limited and there are no large-scale epidemiological cohort studies. The purpose here is to present a protocol for a prospective longitudinal study: The Sports-Related Injuries and Illnesses in Paralympic Sport Study (SRIIPSS).

METHODS/DESIGN

An argument-based method for investigation of design problems was used to structure the study protocol. The primary requirement of the protocol is to allow prospective studies over time and include exposure to both training and competition. To reflect the complexity of Paralympic sport with athletes' pre-existing impairments, use of assistive equipment, pain and other and medical issues, it is required that the data collection system is specifically adapted to Paralympic sport. To allow the collection of data, at the same time as there is limited access to coaches and medical personnel, it is advantageous that data can be collected online directly from the athletes. Based on this a self-report athlete monitoring system will be developed, where the athletes can enter data weekly via their mobile phones or lap-tops. Data will be collected from around 100 Swedish Paralympic athletes for approximately 1 year, which will allow us to i) prospectively estimate the annual incidence of sports-related injuries and illnesses and ii) explore risk factors and mechanisms for sustaining sports-related injuries and illnesses based on athlete exposure and training loads.

DISCUSSION

For effective implementation of injury and illness prevention measures, comprehensive epidemiological knowledge is required. This study will be the first prospective longitudinal self-report study of sports-related injuries and illnesses in Paralympic sport over a longer period of time. The results will eventually contribute to the development of evidence-based preventive measures specifically adapted to Paralympic sport in order to provide safe and healthy sport participation. Thereby, the project will be of relevance for Paralympic athletes at all levels and to the Paralympic Movement.

TRIAL REGISTRATION

The study is registered at ClinicalTrials.gov (Identifier: NCT02788500; Registration date: 22 May 2016).

Electronic data capture on athletes’ pre-participation health and in-competition injury and illness at major sports championships: An extended usability study in Athletics

This study set out to identify factors critical for the usability of electronic data collection in association with championships in individual sports. A qualitative analysis of electronic data collection system usability for collection of data on pre-participation health from athletes and in-competition injury and illness from team physicians was performed during the 2013 European Athletics Indoor Championships. A total of 15 athletes and team physicians participated. Athletes were found to experience few problems interacting with the electronic data collection system, but reported concerns about having to reflect on injury and illness before competitions and the medical terminology used. Team physicians encountered problems when first navigating through the module for clinical reporting, but they were not subjected to motivational problems. We conclude that athletes’ motivation to self-report health data and the design of the human–computer interface for team physicians are key issues for the usability of electronic data collection systems in association with championships in individual sports.

Epidemiology of Injuries in United States High School Track and Field: 2008-2009 Through 2013-2014

BACKGROUND

Track and field is one of the most popular high school sports among boys and girls, but epidemiological research on the sport and its individual events has been limited.

PURPOSE

To describe injury rates and patterns in boys' and girls' high school track and field.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

A retrospective epidemiological analysis of injury and exposure data from a longitudinal national high school sports injury surveillance system was conducted.

RESULTS

From 2008-2009 through 2013-2014, 2485 track and field injuries occurred during 2,962,308 athlete exposures (0.84 injuries per 1000 athlete exposures). Injury rates were higher in competition versus practice for both sexes. Girls had higher injury rates than boys overall (rate ratio, 1.37; 95% CI, 1.27-1.48) and in practice (rate ratio, 1.60; 95% CI, 1.46-1.76), but competition injury rates did not differ. Overuse/chronic injuries accounted for 27.5% and 36.2% of boys' and girls' track and field injuries, respectively. The majority of injuries were to the lower extremity. Sprints, distance running, and jumps accounted for over 65% of all track injuries. Boys sustained a greater proportion of injuries in relay events (injury proportion ratio, 2.02; 95% CI, 1.69-2.36) but fewer in hurdle events (injury proportion ratio, 0.51; 95% CI, 0.23-0.78).

CONCLUSION

Injury rates varied by event, sex, and competition versus practice exposure. To increase effectiveness, targeted strategies for injury prevention should be driven by an understanding of such differences. Because many track and field injuries are overuse/chronic across sexes and for both competitions and practices, coaches and athletic trainers should be adept at recognizing early injury symptoms, intervene to treat minor injuries in order to prevent severe injuries, and ensure the prompt diagnosis and management of all injuries.

Risk of Injuries in Paralympic Track and Field Differs by Impairment and Event Discipline: A Prospective Cohort Study at the London 2012 Paralympic Games

BACKGROUND

The incidence rates (IRs) and factors associated with injuries in the sport of Paralympic athletics (track and field) have not been comprehensively and prospectively studied.

PURPOSE

To determine injury IRs, characteristics of injuries, and associated factors in the sport of athletics at the London 2012 Paralympic Games.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

A total of 977 athletes competing in the sport of athletics were followed over a total 10-day competition period of the Paralympic Games. Daily injury data were obtained via 2 databases: (1) a custom-built, web-based injury and illness surveillance system (WEB-IISS), maintained by team medical personnel; and (2) the organizing committee database, maintained by medical providers in the medical stations operated by the London Organising Committee of the Olympic and Paralympic Games. Athlete impairment and event discipline were obtained via the International Paralympic Committee athlete database. IRs (injuries per 1000 athlete-days) by impairment, event discipline, sex, and age were examined.

RESULTS

The overall IR was 22.1 injuries per 1000 athlete-days (95% CI, 19.5-24.7). In track disciplines, ambulant athletes with cerebral palsy experienced a lower incidence of injuries (IR, 10.2; 95% CI, 4.2-16.2) when compared with ambulant athletes from other impairment categories. Athletes in seated throwing experienced a higher incidence of injuries (IR, 23.7; 95% CI, 17.5-30.0) when compared with athletes in wheelchair racing (IR, 10.6; 95% CI, 5.5-15.6). In both track and field disciplines, the majority of injuries did not result in time loss from competition or training. Ambulant athletes experienced the greatest proportion of injuries to the thigh (16.4% of all injuries; IR, 4.0), observed predominantly in track athletes. Wheelchair or seated athletes experienced the greatest proportion of injuries to the shoulder/clavicle (19.3% of all injuries; IR, 3.4), observed predominantly in field athletes.

CONCLUSION

This is the first prospective cohort study examining injury IRs and associated factors in the sport of athletics at the Paralympic Games. Injury patterns were specific to the event discipline and athlete impairment. The majority of injuries occurred to the thigh (ambulant athletes) or shoulder/clavicle (wheelchair or seated athletes) and did not result in time loss.

Methodological quality of the injury surveillance system used in international athletics championships

OBJECTIVES

Incidence and prevalence data obtained from injury surveillance studies could be biased by the response rate as well as by the completeness and quality of the reports. It therefore appears crucial to analyse the quality of the injury surveillance system itself and thereby validate the quality of the data. This study aimed to analyse the quality of and compliance with the injury surveillance system implemented during international athletics championships.

DESIGN

Prospective, epidemiological study.

METHODS

The national medical teams and the local organising committee physicians daily reported all injuries on a standardised injury report form during 14 international athletics championships from 2007 to 2015. The quality of the injury surveillance system was analysed following the guidelines laid down by the Centre for Disease Control and Prevention.

RESULTS

On average 41.7±17.4% (mean±standard deviation) of all registered countries participated in the injury surveillance project, accounting for a coverage of athletes of 79.5±10.2% of all registered athletes. Their medical staff returned 89.2±8.4% of the expected injury report forms (information is missing for one championship). The completeness of injury data provided by medical teams and local organising committee physicians averaged 95.8±6.5%. National medical teams reported 60.6±16.6% of all injuries, and local organising committee physicians 28.7±15.0% whereas 10.6±6.5% of injuries were reported by both.

CONCLUSIONS

The injury surveillance system used during international athletics championships provided good national medical team participation, coverage of athletes, response rate, and completeness of reports. These parameters should be systematically reported for injury surveillance studies to show the quality of the study.

Role of illness in male professional football: not a major contributor to time loss

BACKGROUND

There are limited data on the nature, type and incidence of illness in football. Previous studies indicate that gastrointestinal and respiratory tract illnesses are most common.

AIM

To describe the incidence and burden of illness in male professional football.

METHODS

Over the 4-year study period, 2011-2014, 73 professional football teams in Europe participated, with a total of 1 261 367 player-days recorded. All time-loss illnesses were recorded by the medical staff of each club. A recordable illness episode was any physical or psychological symptom (not related to injury) that resulted in the player being unable to participate fully in training or match play.

RESULTS

A total of 1914 illness episodes were recorded. The illness incidence was 1.5 per 1000 player-days, meaning that, on average, a player experienced an illness episode every second season, with a median of 3 days absence per illness episode. Severe illness (absence >4 weeks) constituted 2% of all illnesses. Respiratory tract illness was the most common (58%), followed by gastrointestinal illness (38%). Respiratory tract illness, gastrointestinal illness and cardiovascular illness caused the highest illness burden.

CONCLUSIONS

The illness incidence among male professional football players is low compared with the injury incidence. We found that the highest illness burden was caused by illness to the respiratory tract, gastrointestinal tract and cardiovascular system.

Injury risk in runners using standard or motion control shoes: a randomised controlled trial with participant and assessor blinding

Background/aim

This randomised controlled trial investigated if the usage of running shoes with a motion control system modifies injury risk in regular leisure-time runners compared to standard shoes, and if this influence depends on foot morphology.

Methods

Recreational runners (n=372) were given either the motion control or the standard version of a regular running shoe model and were followed up for 6 months regarding running activity and injury. Foot morphology was analysed using the Foot Posture Index method. Cox regression analyses were used to compare injury risk between the two groups, based on HRs and their 95% CIs, controlling for potential confounders. Stratified analyses were conducted to evaluate the effect of motion control system in runners with supinated, neutral and pronated feet.

Results

The overall injury risk was lower among the participants who had received motion control shoes (HR=0.55; 95% CI 0.36 to 0.85) compared to those receiving standard shoes. This positive effect was only observed in the stratum of runners with pronated feet (n=94; HR=0.34; 95% CI 0.13 to 0.84); there was no difference in runners with neutral (n=218; HR=0.78; 95% CI 0.44 to 1.37) or supinated feet (n=60; HR=0.59; 95% CI 0.20 to 1.73). Runners with pronated feet using standard shoes had a higher injury risk compared to those with neutral feet (HR=1.80; 95% CI 1.01 to 3.22).

Conclusions

The overall injury risk was lower in participants who had received motion control shoes. Based on secondary analysis, those with pronated feet may benefit most from this shoe type.

Performance success or failure is influenced by weeks lost to injury and illness in elite Australian track and field athletes: A 5-year prospective study

OBJECTIVES

To investigate the impact of training modification on achieving performance goals. Previous research demonstrates an inverse relationship between injury burden and success in team sports. It is unknown whether this relationship exists within individual sport such as athletics.

DESIGN

A prospective, cohort study (n=33 International Track and Field Athletes; 76 athlete seasons) across five international competition seasons.

METHODS

Athlete training status was recorded weekly over a 5-year period. Over the 6-month preparation season, relationships between training weeks completed, the number of injury/illness events and the success or failure of a performance goal at major championships was investigated. Two-by-two table were constructed and attributable risks in the exposed (AFE) calculated. A mixed-model, logistic regression was used to determine the relationship between failure and burden per injury/illness. Receiver Operator Curve (ROC) analysis was performed to ascertain the optimal threshold of training week completion to maximise the chance of success.

RESULTS

Likelihood of achieving a performance goal increased by 7-times in those that completed >80% of planned training weeks (AUC, 0.72; 95%CI 0.64-0.81). Training availability accounted for 86% of successful seasons (AFE=0.86, 95%CI, 0.46 to 0.96). The majority of new injuries occurred within the first month of the preparation season (30%) and most illnesses occurred within 2-months of the event (50%). For every modified training week the chance of success significantly reduced (OR=0.74, 95%CI 0.58 to 0.94).

CONCLUSIONS

Injuries and illnesses, and their influence on training availability, during preparation are major determinants of an athlete's chance of performance goal success or failure at the international level.

Football injuries during the 2014 FIFA World Cup

Background

FIFA has surveyed match injuries in its tournaments since 1998.

Aim

To analyse the incidence and characteristics of match injuries incurred during the 2014 FIFA World Cup in comparison to previous FIFA World Cups.

Methods

The chief physicians of the participating teams reported all newly incurred injuries of their players after the match on a standardised report form. 124 (97%) forms were returned.

Results

A total of 104 injuries were reported, equivalent to an incidence of 1.68 injuries per match (95% CI 1.36 to 2.00). 64 (63.4%) injuries were caused by contact with another player. Thigh (26; 25%) and head (19; 18%) were the most frequently injured body parts. The most frequent diagnosis was thigh strain (n=18). Five concussions and three fractures to the head were reported. While most thigh strains (15/17; 88.2%) occurred without contact, almost all head injuries (18/19; 94.7%) were caused by contact. 0.97 injuries per match (95% CI 0.72 to 1.22) were expected to result in absence from training or match. Eight injuries were classified as severe. The incidence of match injuries in the 2014 FIFA World Cup was significantly lower than the average of the four preceding FIFA World Cups, both for all injuries (2.34; 95% CI 2.15 to 2.53) and time-loss injuries (1.51; 95% CI 1.37 to 1.65).

Conclusions

The overall incidence of injury during the FIFA World Cups decreased from 2002 to 2014 by 37%. A detailed analysis of the injury mechanism is recommended to further improve prevention strategies.

Epidemiology of National Collegiate Athletic Association Men's and Women's Cross-Country Injuries, 2009-2010 Through 2013-2014

CONTEXT

Recent injury-surveillance data for collegiate-level cross-country athletes are limited.

OBJECTIVE

To describe the epidemiology of National Collegiate Athletic Association (NCAA) men's and women's cross-country injuries during the 2009-2010 through 2013-2014 academic years.

DESIGN

Descriptive epidemiology study.

SETTING

Aggregate injury and exposure data collected from 25 men's and 22 women's cross-country programs, providing 47 and 43 seasons of data, respectively.

PATIENTS OR OTHER PARTICIPANTS

Collegiate student-athletes participating in men's and women's cross-country during the 2009-2010 through 2013-2014 academic years.

MAIN OUTCOME MEASURE(S)

Injury rates; injury rate ratios (RRs); injury proportions by body site, diagnosis, and apparatus; and injury proportion ratios were reported with 95% confidence intervals (CIs).

RESULTS

The Injury Surveillance Program captured 216 injuries from men's cross-country and 260 injuries from women's cross-country, leading to injury rates of 4.66/1000 athlete-exposures (AEs) for men (95% CI = 4.04, 5.28) and 5.85/1000 AEs for women (95% CI = 5.14, 6.56). The injury rate in women's cross-country was 1.25 times that of men's cross-country (95% CI = 1.05, 1.50). Most injuries affected the lower extremity (men = 90.3%, women = 81.9%). The hip/groin-injury rate in women (0.65/1000 AEs) was higher than that in men (0.15/1000 AEs; RR = 4.32; 95% CI = 1.89, 9.85). The ankle-injury rate in men (0.60/1000 AEs) was higher than that in women (0.29/1000 AEs; RR = 2.07; 95% CI = 1.07, 3.99). Common diagnoses were strains (men = 19.9%, women = 20.4%) and inflammation (men = 18.1%, women = 23.8%). The majority of injuries were classified as overuse (men = 57.6%, women = 53.3%).

CONCLUSIONS

Consistent with prior research, injury distributions varied between male and female athletes, and the injury rate among females was higher. Understanding the epidemiology of these cross-country injuries may be important for developing appropriate preventive interventions.

Injury and illness among athletes during a multi-day elite cycling road race

OBJECTIVES

Although road bicycle races have been held for more than a century, injury and illness patterns during multi-day bicycle events have not been widely studied. The aim of this study was to determine the incidence of injury and illness among riders and describe the medical care interventions provided to participants of cycling road races.

METHODS

A prospective observational study was conducted on the Presidential Cycling Tour of Turkey, which was held between April 26 and May 3, 2015. The race lasted 8 days and covered 1258 km of road. There were 166 elite cycling athletes representing 21 teams from various countries. Data collected pertaining to incidents involving injury or illness included the following: type of injury; anatomical location of injury; details of the medical encounter; location of the intervention; treatment provided; medication administered and disposition of the rider. An injury was defined as a physical complaint or observable damage to the body produced by the transfer of energy of the rider. An illness was defined as a physical complaint or presentation not related to injury.

RESULTS

The overall incidence (injury and illness) was 5.83 per 1000 cycling hours. (Injury incidence was 2.82 vs illness incidence of 3.01 per 1000 hours cycling). A total of 31 incidents occurred. Of these, 15 were injuries, while 16 were complaints of a non-traumatic nature. A total of 43 interventions were made in the 15 cases of injury. The most commonly injured body regions were limbs; the majority of injuries involved the skin and soft tissue. The most common medical intervention was wound care (64% of all interventions). Two riders had to withdraw from the race, and one was hospitalized due to a traumatic pneumothorax. None of the non-traumatic cases resulted in withdrawal from the race.

CONCLUSIONS

A broad spectrum of illness and injury occurs during elite multi-day road races, ranging from simple skin injuries to serious injuries requiring hospital admission. Most injuries and illnesses are minor; however, medical teams must be prepared to treat life-threatening trauma.

Do Basketball Players Have a High Risk of Pulmonary Embolism? A Scoping Review

PURPOSE

Pulmonary embolism (PE) is a serious preventable disease that requires urgent care. In recent years, there have been several reports in the media about basketball players experiencing PE. The aim of the present study was to assess whether there is a need for in-depth studies to determine whether basketball players constitute a group particularly at risk of PE and to describe some hypotheses to be investigated.

METHODS

We reviewed original articles about PE among professional and amateur basketball players in the scientific literature (PubMed) and the Internet (Google search) for the seasons 2010-2011 to 2014-2015, both of which were included. We used search strategies that included some combination of PE-related terms. Rates of PE were calculated and were compared with those obtained from other studies.

RESULTS

Of the 15 cases detected, the majority were men (66.7%), mean ages being 28.8 yr among males and 20.4 yr among females. We focused on six cases which, were detected among National Basketball Association and Asociación de Clubes de Baloncesto basketball players, resulting in an average incidence of 1.27 and 2.06 cases per 1000 players per year in the National Basketball Association and Asociación de Clubes de Baloncesto, respectively. This incidence is much higher than that observed in general population studies for the same age group.

CONCLUSIONS

Basketball players seem to have a higher risk of PE than their peers from the general population. More studies are needed to confirm these findings and identify factors predisposing them to PE to contribute to its prevention.