Sports injuries at the Rio de Janeiro 2016 Summer Paralympic Games: use of diagnostic imaging services

Sports-Related Health Problems in Para-Sports: A Systematic Review With Quality Assessment

CONTEXT

Participation in sports is associated with a risk of sports-related health problems. For athletes with an impairment, sports-related health problems further burden an already restricted lifestyle, underlining the importance of prevention strategies in para-sports.

OBJECTIVE

To provide a comprehensive overview with quality assessment of the literature on sports-related health problems, their etiology, and available preventive measures in para-sports following the steps of the Sequence of Prevention.

DATA SOURCES

A literature search (in PubMed, Embase, SPORTDiscus, CINAHL and the Cochrane Library) was performed up to December 8, 2021, in collaboration with a medical information specialist.

STUDY SELECTION

The search yielded 3006 articles, of which 64 met all inclusion criteria.

STUDY DESIGN

Systematic review with quality assessment.

LEVEL OF EVIDENCE

Level 3.

DATA EXTRACTION

Two independent researchers carried out the screening process and quality assessment. One researcher extracted data, and the Sequence of Prevention categorized evidence.

RESULTS

A total of 64 studies were included, of which 61 reported on the magnitude and risk factors of sports-related health problems, while only 3 reported on the effectiveness of preventive measures. Of these, 30 studies were of high quality. Most studies (84%) included elite-level athletes. The reported injury incidence varied widely between sports (0-91 per 1000 athlete days) and impairment categories (1-50 per 1000 athlete days). The same applies to illness incidence with regard to different sports (3-49 per 1000 athlete days) and impairment categories (6-14 per 1000 athlete days).

CONCLUSION

This review shows the current vast range of reported sport-related health problems in para-sports. There is limited evidence concerning the severity of these sports-related health problems and inconclusive evidence on the risk factors. Lastly, the evidence regarding the development and effectiveness of preventive measures for para-athletes is sparse.

Musculoskeletal Pain, Mood, and Sports Injury in Wheelchair Power Soccer Players

CONTEXT

Wheelchair Power Soccer (WPS) is the only team sport that allows the participation of people with severe physical disabilities who require the daily use of motorized wheelchairs. These individuals may live with chronic pain due to the characteristics of the disabilities and treatments, interfering with their health and limiting their participation in sports.

OBJECTIVES

To investigate the prevalence of musculoskeletal pain and its relationship with mood in WPS players and to analyze the incidence of traumatic injuries during a championship.

METHODS

A prospective, longitudinal study was carried out on 30 WPS athletes (93.33% male) with a mean (SD) (range) age of 22.37 (9.79) (47) years. Data collection was performed during a South American WPS Championship lasting 3 days, with: investigation of the presence of musculoskeletal pain and mood through a questionnaire; investigation of the occurrence of traumatic injuries through match observation; and confirmation of the occurrence of traumatic injuries through access to medical department records.

RESULTS

About 30% (n = 9/30) of the sample presented some pain on the day of evaluation, with an intensity of 5.67 (3.35) (10) points on the visual analog scale. The most common regions of pain were the lower back (13.3%, n = 4/30), thoracic (10%; n = 3/30), and cervical (10%; n = 3/30) areas of the spine. A total of 46.7% (n = 14/30) reported pain in the month before data collection but of less intensity (2.56 [4] [10] points), the most common regions being the lower limbs (20%; n = 6/30) and cervical spine (20%; n = 6/30). Among the between-group comparisons (ie, participants with pain vs without pain), no relationship was observed between mood state and pain. No traumatic injuries were identified during the competition.

CONCLUSION

The presence of musculoskeletal pain was common in WPS players, but it was not related to mood. As no traumatic injuries were observed during the championship, this modality seems to be safe for people with physical disabilities in general.

Incidence of injury and illness at the Beijing 2022 Paralympic Winter Games held in a closed-loop environment: a prospective cohort study of 7332 athlete days

OBJECTIVE

To describe the epidemiology of injuries and illnesses sustained during the Beijing 2022 Paralympic Winter Games, organised in a closed-loop environment to adhere with COVID-19 restrictions.

METHODS

Injuries and illnesses from all teams were recorded on a daily basis by team medical staff on a web-based form and by local organising committee medical (polyclinic) facilities and venue medical support. Duplicates recorded on both systems were removed. Incidence of injuries and illnesses are reported per 1000 athlete days (95% CI).

RESULTS

564 athletes (426 male and 138 female) representing 46 countries were monitored for the 13-day period of the Beijing 2022 Paralympic Winter Games (7332 athlete days). The overall incidences were 13.0 injuries (10.6-15.8) and 6.1 illnesses (4.5-8.4) per 1000 athlete days. The incidence of injury in alpine skiing (19.9; 15.2-26.1) was significantly higher compared with Nordic skiing, ice hockey and wheelchair curling (p<0.05), while the incidence of respiratory illness was significantly higher in Nordic skiing (1.6; 0.9-2.9) compared with alpine skiing, ice hockey and snowboarding (p<0.05).

CONCLUSION

The incidence of both injury and illness at the Beijing 2022 Games were the lowest yet reported in the Paralympic Winter Games. The incidence of injury was highest in alpine skiing. These findings underscore the importance of ongoing vigilance and continued injury risk mitigation strategies to safeguard the well-being of athletes in these high-risk competitions. Respiratory illnesses were most commonly reported in Nordic skiing, which included the three cases of COVID-19 recorded at the games.

Evaluating the Asymmetry of Muscle Activation and Strength in Paralympic Powerlifting Athletes

BACKGROUND

Strength training is a complex task, as it requires a combination of many variables. In paralympic powerlifting (PP) asymmetries for the evaluation of activation, and static force indicators have been increasingly studied.

OBJECTIVE

To investigate the asymmetries in the strength and muscle activation indicators, before and after a training session of PP athletes.

METHODOLOGY

Twelve elite athletes from the PP participated in the study, and asymmetry was evaluated through surface electromyography (sEMG) and static strength indicators. Evaluations were made before and after a protocol of five series of five repetitions (5 × 5), with 80% of 1-Maximum Repetition (1RM).

RESULTS

In the pectoral muscles, there were differences in the non-dominant limbs between the before and after in the sEMG. There were differences in the pectoralis muscle in the non-dominant limb between moments before (110.75 ± 59.52%) and after (130.53 ± 98.48%, p < 0.001), and there was no difference in triceps activation. In the Maximum Isometric Strength (MIF), there was a difference in the non-dominant limb between before (710.36 ± 129.36) and after (620.27 ± 69.73; p < 0.030). There was a difference before in the dominant (626.89 ± 120.16; 95% CI 550.55-703.24) and non-dominant (710.36 ± 129.36; p = 0.011) limbs. There was no difference in time to MIF.

CONCLUSION

PP athletes showed small levels of asymmetry before and after training, and adaptation to training tends to promote fewer asymmetries.

Incidence and burden of injury at the Tokyo 2020 Paralympic Games held during the COVID-19 pandemic: a prospective cohort study of 66 045 athlete days

OBJECTIVE

To describe the epidemiology of injuries at the Tokyo 2020 Paralympic Games, including injuries sustained in the new sports of badminton and taekwondo.

METHODS

Injury data were obtained daily via the established web-based injury and illness surveillance system (WEB-IISS; 81 countries, 3836 athletes) and local organising committee medical facilities (81 countries, 567 athletes). Univariate unadjusted incidences (injuries per 1000 athlete days with 95% CIs), injury proportion (IP, %) and injury burden (days lost per 1000 athlete days) are reported.

RESULTS

A total of 4403 athletes (1853 women, 2550 men) from 162 countries were monitored prospectively during the 3-day pre-competition and 12-day competition periods (66 045 athlete days). 386 injuries were reported in 352 athletes (IP=8.0%) with an incidence of 5.8 per 1000 athlete days (95% CI 5.3 to 6.5). Football 5-a-side (17.2), taekwondo (16.0), judo (11.6) and badminton (9.6) had the highest incidence. There was a higher incidence of injuries in the pre-competition period than in the competition period (7.5 vs 5.4; p=0.0053). Acute (sudden onset) injuries and injuries to the shoulder (0.7) and hand/fingers (0.6) were most common. Injury burden was 10.9 (8.6-13.8), with 35% of injuries resulting in time loss from training and competition.

CONCLUSION

Compared with previous Paralympic Games, there was a reduction in injury incidence but higher injury burden at the Tokyo 2020 Paralympic Games. The new sports of taekwondo and badminton had a high injury incidence, with the highest injury burden in taekwondo, compared with other sports. These findings provide epidemiological data to inform injury prevention measures for high-risk sports.

A Bibliometrics-Enhanced, PAGER-Compliant Scoping Review of the Literature on Paralympic Powerlifting: Insights for Practices and Future Research

Paralympic powerlifting (PP), formerly known as "International Paralympic Committee" (IPC) powerlifting, is the format of powerlifting adapted for athletes with disabilities, and it differs from the version for able-bodied athletes in that it consists of bench press only. According to the mandate of the IPC, PP athletes should be enabled to achieve sporting excellence. As such, rigorous evidence is needed. However, to the best of our knowledge, there exists no systematic assessment of the body of scholarly evidence in the field of PP. Therefore, the present study was conducted to fill in this gap of knowledge, by conducting a scoping review of the literature enhanced by a bibliometrics analysis and by mining two major scholarly databases (MEDLINE via PubMed and Scopus). The aim was to provide a review/summary of the findings to date to help practitioners and athletes. Thirty-seven studies were retained in the present study. These covered the following thematic areas: (i) warm-up strategies (n = 2); (ii) aspects of training (n = 2); (iii) physiological aspects and responses (n = 2); (iv) psychological aspects and responses (n = 2); (v) biomechanics of bench press (n = 8); (vi) recovery strategy (n = 5); (vii) impact of the disability and type of disability (n = 4); (viii) epidemiology of PP (n = 6); and (ix) new analytical/statistical approaches for kinematics assessments, internal load monitoring, and predictions of mechanical outputs in strength exercises and in PP (n = 6). Bibliometrics analysis of the PP-related scientific output revealed that, despite having already become a paralympic sports discipline in 1984, only in the last few years, PP has been attracting a lot of interest from the community of researchers, with the first scholarly contribution dating back to 2012, and with more than one-third of the scientific output being published this year (2022). As such, this scholarly discipline is quite recent and young. Moreover, the community dealing with this topic is poorly interconnected, with most authors contributing to just one article, and with one single author being a hub node of the author network. Distributions of the number of articles and the authors/co-authors were found to be highly asymmetrical, indicating that this research is still in its infancy and has great room as well as great potential to grow. Reflecting this, many research topics are also overlooked and underdeveloped, with the currently available evidence being based on a few studies.

Physique and performance in male sitting volleyball players: implications for classification and training

Background

This study assessed whether anthropometry, physical fitness and sport-specific sprint performance vary across the three groups of sitting volleyball (SV) athletes (athletes with a disability (VS1), athletes with a minimal disability (VS2) and able-bodied SV athletes (AB)) in order to explore the validity of the current system of classification. This study also investigated how the anthropometric and physical fitness characteristics of athletes relate to their sprint performance.

Methods

Thirty-five SV male athletes aged 37.4 ± 10.8 years and practicing SV at a national/international level volunteered for this study. Testing consisted in the evaluation of linear anthropometry, physical fitness (body composition by-means of dual-energy X-ray absorptiometry and upper-body strength) and sprint performance (5-meter sprint tests, agility test and speed and endurance test).

Results

Athletes in the three groups differed in fat mass percentage (%FM) which was higher in VS1 versus AB at the sub-total level (+9%), in the arms (+15%) and in the non-impaired leg (+8%) regions. Greater hand span, greater length of the impaired lower leg, lower %FM at both the sub-total and regional level and a higher level of strength in the upper body are all associated with better performances in the considered sprint tests (P < 0.05 for all). These results do not confirm the validity of the current system of classification of athletes adopted in SV. Professionals dealing with SV athletes should include specific exercises aimed at improving whole-body and regional body composition and the strength of the trunk and upper limbs in their training programs.

Machine Leaning-Based Optimization Algorithm for Myocardial Injury under High-Intensity Exercise in Track and Field Athletes

In order to train at high-intensity, athletics can again cause varying degrees of myocardial damage. Evaluating the balance between exercise myocardial injury and exercise intensity should actively prevent myocardial injury caused by high-intensity athletic training. In this paper, an intelligent optimization algorithm is used to investigate the degree of myocardial injury. The basic idea is to define the measured data and the output of the numerical model as an objective function of the structural parameters, to obtain the structural parameters by finding ways to continuously optimize the objective function to be close to the observed values, and to identify the injury based on the changes in these parameters before and after myocardial injury. The objective function can be defined in various ways, and the myocardial injury optimization algorithm can be chosen. In order to obtain the best computational results, numerical simulations of damage identification are performed using the objective function and three machine learning-based optimization algorithms. The computational results show that the combination of the objective function and the machine learning algorithms provides good accuracy and computational speed in identifying myocardial injury.

Does the Level of Training Interfere with the Sustainability of Static and Dynamic Strength in Paralympic Powerlifting Athletes?

Background: Paralympic powerlifting (PP) presents adaptations that the training tends to provide, mainly concerning the mechanical variables. Objective: Our aim was to analyze mechanical, dynamic and static indicators, at different intensities, on the performance of paralympic powerlifting athletes. Methods: 23 athletes of PP, 11 national level (NL) and 12 regional level (RL) performed dynamic and static tests over a comprehensive range of loads. The study evaluated regional and national level athletes and the influence on the training level on the performance of strength. The study was carried out in four weeks, with the first week to familiarize with the one repetition maximum (1RM), day 1, and there was a 72-h rest and familiarization with dynamic and static tests carried out day 2. In week 2, the 1RM tests were performed (day 1 and 72 h later), and the static tests were performed with a distance of 15 cm from the bar to the chest, with the tests of maximum isometric strength, time to maximum isometric strength, rate of force development (RFD), impulse, variability and fatigue index (IF) taking place on day 2. In weeks three and four dynamic tests were performed, including means propulsive velocity, maximum velocity, power and prediction of one maximum repeat. Results: Differences were found, with better results than for RL in relation to NL in MVP (45%, 55%, and 75% 1RM), in VMax (50%, 55%, 75% and 95% 1RM). In power, the NL had better results (40%, 45%, 50%, 60% and 95% 1RM). Conclusion: RL athletes tend to present better results with regard to velocity, however in power, NL athletes tend to present better performances.

Injuries and Illnesses Observed in Athletes from Beginner to Elite Levels at the 18th National Sports Festival for Persons with Disabilities in Japan

Objectives

: This study aimed to describe the injuries and illnesses that occurred at the 18th National Sports Festival for Persons with Disabilities in Japan, which was attended by more than 3000 athletes from beginner to elite levels.

Methods

: Records from medical stations set up at the venues for each sport were reviewed. The incidence rates (IRs) were calculated as the number of medical station visits per 1000 athlete-days. The backgrounds of injuries and illnesses were investigated.

Results

: In total, 3277 athletes attended the festival, and 134 eligible medical station visits were analyzed. Overall, 102 athletes complained of injuries. For the whole schedule of the festival, IRs were 15.5 for injuries and illnesses and 11.8 for injuries alone. For injuries and illnesses, high IRs were seen in soccer (39.8), basketball (25.6), and foot baseball (22.4); for injuries alone, high IRs were also seen in soccer (33.6), basketball (25.6), and foot baseball (16.8). The most frequent symptoms were internal symptoms (n=32), contusions (n=30), and wounds (n=24). Joint sprains occurred in various sports, whereas muscle strains happened mainly in disciplines demanding sprinting or high agility. Of the 55 cases that occurred during events or public rehearsals, 45 were traumatic, whereas the relation to sports activities was not described in 51 cases. Of participants with internal symptoms, 11 were suggested to have viral infections. We identified 21 injuries caused by falls.

Conclusions

: Minor trauma and viral infection were the most frequently observed symptoms among injuries and illnesses, respectively. Structured medical records and organized surveillance systems should be utilized to improve data collection and understand the onset of injury and illness.