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Braybrook PJ, Tohira H, Birnie T, Brink D, Finn J, Buzzacott P. Types and anatomical locations of injuries among mountain bikers and hikers: A systematic review. PLoS One 2023; 18:e0285614. [PMID: 37647303 PMCID: PMC10468092 DOI: 10.1371/journal.pone.0285614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 04/26/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Mountain biking and hiking continue to grow in popularity. With new participants to these sports, it is likely the number of injuries will increase. To assist medical personnel in the management of these patients we attempted to quantify the types and locations of injuries sustained by mountain bikers and hikers. Objective The objective of this systematic review is to identify the type and anatomical location of injuries for both mountain bikers and hikers. METHODS A systematic search was undertaken using CINAHL, Cochrane, ProQuest, PubMed and Scopus databases. Reviewers assessed the eligibility of articles by a title/abstract review and final full-text review. Studies were included if the types of injuries were reported by medical personnel and contained anatomical locations. Studies were excluded if it did not take place on a trail or if the injuries were self-reported. Risk of bias was assessed utilising the Joanna Briggs Institute (JBI) checklists for study quality. No meta-analysis or comparison between mountain bikers and hikers was possible due to the high heterogeneity of the definition of injury. RESULTS A total of 24 studies met the inclusion criteria, 17 covering mountain biking and 7 hiking. This represented 220,935 injured mountain bikers and 17,757 injured hikers. The most common type of injuries sustained by mountain bikers included contusions, abrasions and minor lacerations, which made up between 45-74% of reported injuries in studies on competitive racing and 8-67% in non-competitive studies. Fractures represented between 1.5-43% of all reported injuries. The most injured region was the upper limbs reported in 10 of 17 studies. For hikers the most common injuries included blisters and ankle sprains with blisters representing 8-33% of all reported injuries. The most common body location to be injured by hikers was a lower limb in all 7 studies. CONCLUSIONS This is the first systematic review to report on the injury epidemiology of the two most common trail users; mountain bikers and hikers. For participants in both activities the majority of injuries were of minor severity. Despite this, the high proportions of upper limb fractures in mountain bikers and ankle sprains in hikers cannot be ignored. TRIAL REGISTRATION Registration: This systematic review was prospectively registered with the University of York PROSPERO database on the 12/4/2021 (CRD42021229623) https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021229623.
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Affiliation(s)
- Paul John Braybrook
- Prehospital Resuscitation and Emergency Care Research Unit, Curtin School of Nursing, Curtin University, Bentley, Western Australia
- St John Western Australia, Belmont, Western Australia
| | - Hideo Tohira
- Prehospital Resuscitation and Emergency Care Research Unit, Curtin School of Nursing, Curtin University, Bentley, Western Australia
- Discipline of Emergency Medicine, Medical School, University of Western Australia, Crawley, Western Australia
| | - Tanya Birnie
- Prehospital Resuscitation and Emergency Care Research Unit, Curtin School of Nursing, Curtin University, Bentley, Western Australia
| | - Deon Brink
- Prehospital Resuscitation and Emergency Care Research Unit, Curtin School of Nursing, Curtin University, Bentley, Western Australia
- St John Western Australia, Belmont, Western Australia
| | - Judith Finn
- Prehospital Resuscitation and Emergency Care Research Unit, Curtin School of Nursing, Curtin University, Bentley, Western Australia
- St John Western Australia, Belmont, Western Australia
- Discipline of Emergency Medicine, Medical School, University of Western Australia, Crawley, Western Australia
| | - Peter Buzzacott
- Prehospital Resuscitation and Emergency Care Research Unit, Curtin School of Nursing, Curtin University, Bentley, Western Australia
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McLarnon M, Boyce S, Heron N. A call to action: the need for concussion assessment and diagnostic protocols for use in the different elite cycling disciplines, including paracyclists. BMJ Open Sport Exerc Med 2023; 9:e001654. [PMID: 37575218 PMCID: PMC10414085 DOI: 10.1136/bmjsem-2023-001654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/15/2023] Open
Affiliation(s)
| | - Steve Boyce
- Medical Department, Scottish Sports Institute, East Kilbride, UK
- Emergency Department, Glasgow Royal Infirmary, Glasgow, UK
| | - Neil Heron
- Centre for Public Health Research, Queen's University Belfast, Belfast, UK
- Department of General Practice, Keele University, Keele, UK
- British Cycling, Manchester, UK
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Heron N, Jones N, Cardwell C, Gomes C. 'If in Doubt, Sit Them Out': How Long to Return to Elite Cycling Competition following a Sports-Related Concussion (SRC)? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085449. [PMID: 37107731 PMCID: PMC10138273 DOI: 10.3390/ijerph20085449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 05/11/2023]
Abstract
INTRODUCTION A concussion or sports-related concussion (SRC) is a traumatic brain injury induced by biomechanical forces. After a SRC diagnosis is made, a concussed individual must undergo a period away from competition while they return to their baseline level of functioning. The Union Cycliste Internationale (UCI) currently recommend a minimum of 6 days restriction from competitive cycling following a SRC but there is a growing feeling amongst those involved in brain injury research that this period is too short. Therefore, how much time should cyclists be removed from competitive sporting action following a SRC? AIMS To review the time out of competition following the diagnosis of a SRC for elite cyclists within British Cycling (BC). METHODS All medical records for elite cyclists within BC were audited for diagnoses of "concussion" or "sports-related concussions" from January 2017 until September 2022. The days out of competition following the concussion until ready to compete again (that is, returned to full training) was then calculated. All diagnoses and management of SRC were undertaken by the medical team at BC and in-keeping with current international guidelines. RESULTS Between January 2017 and September 2022, there were 88 concussions diagnosed, 54 being males and 8 in para-athletes. The median duration for time out of competition for all concussions was 16 days. There was no statistical difference between males (median 15.5 days) and females (median 17.5 days) for time out of competition (p-value 0.25). The median duration out of competition following a concussion for able-bodied athletes was 16 (80 athletes) compared to 51 days (8 athletes) in para-cyclists, which was not statistically different (p-value 0.39). CONCLUSIONS This is the first study to report SRC concussion recovery times in elite cycling, including para-athletes. Between January 2017 and September 2022, there were 88 concussions diagnosed at BC and the median duration for time out of competition for all concussions was 16 days. There was no statistically significant difference in recovery times between male and females and para- and able-bodied athletes. This data should be used to help establish minimum withdrawal times post-SRC for elite cycling participation and we call on the UCI to review this data when establishing SRC protocols for cycling, with further research required in para-cyclists.
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Affiliation(s)
- Neil Heron
- Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK
- Medical Department, British Cycling, Manchester M11 4DQ, UK
- School of Medicine, Keele University, Staffordshire ST5 5BG, UK
- Correspondence:
| | - Nigel Jones
- Medical Department, British Cycling, Manchester M11 4DQ, UK
| | | | - Clint Gomes
- Medical Department, British Cycling, Manchester M11 4DQ, UK
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Edler C, Droste JN, Anemüller R, Pietsch A, Gebhardt M, Riepenhof H. Injuries in elite road cyclists during competition in one UCI WorldTour season: a prospective epidemiological study of incidence and injury burden. PHYSICIAN SPORTSMED 2023; 51:129-138. [PMID: 34808064 DOI: 10.1080/00913847.2021.2009744] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
METHODS Fifty-four male athletes from two different teams were involved. Accidents and injuries were recorded immediately after the incident by a team physician present at every race. Exposure, location, type and cause of injury have been recorded. Incidence was calculated. Severity was measured as a cumulative severity score and burden depicted in a risk matrix. RESULTS Total time of exposure was 12537 hours over 3524 athlete days and 544002 kilometers of racing. 98 accidents were recorded, with 83 leading to injury. The total number of recorded injuries was 193. Injury incidence for all injuries was 54,8 (±SD 47,7-62,8) /1000 athlete days, 15,4 (±SD 13,4-17,7) /1000 athlete hours and 35,5 (±SD 30,8-40,8) /100.000 km raced. By far the most frequent types of injury were hematomas, contusions and bruising (n = 141, 73%) followed by lacerations (n = 22; 11,4%). Most injuries affected the arm and elbow (n = 34, 17,6%) followed by the shoulder and clavicle (n = 28, 14,5%) and occurred with contact (79%). Fractures pose a high injury burden due to long time loss, whereas hematomas, contusions and bruising showed the highest incidence numbers but comparably less time loss. CONCLUSION Road cyclists' injuries have been underestimated in previous studies. Hematomas, contusions and bruising pose the highest number of injuries with a broad degree of severity and range of injury burden. Fractures are less common but show the highest injury burden. The upper extremities are involved the most.
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Affiliation(s)
- Christopher Edler
- Department of Prevention, Rehabilitation and Interdisciplinary Sports Medicine, Bg Hospital Hamburg - Teaching Hospital of the University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan-Niklas Droste
- Department of Prevention, Rehabilitation and Interdisciplinary Sports Medicine, Bg Hospital Hamburg - Teaching Hospital of the University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Medicine and Sports Science RB Leipzig Football Club, Leipzig Germany
| | - Ruben Anemüller
- Department of Trauma, Orthopedic Surgery and Sports Traumatology, BG Hospital Hamburg - Teaching Hospital of the University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Aki Pietsch
- Department of Prevention, Rehabilitation and Interdisciplinary Sports Medicine, Bg Hospital Hamburg - Teaching Hospital of the University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Gebhardt
- Department of Surgery and Sports Traumatology, Park Clinic Manhagen, Großhansdorf, Germany
| | - Helge Riepenhof
- Department of Prevention, Rehabilitation and Interdisciplinary Sports Medicine, Bg Hospital Hamburg - Teaching Hospital of the University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Medicine and Sports Science RB Leipzig Football Club, Leipzig Germany
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McLarnon M, Boyce SH, Fisher N, Heron N. 'It's All Downhill from Here': A Scoping Review of Sports-Related Concussion (SRC) Protocols in Downhill Mountain Biking (DHI), with Recommendations for SRC Policy in Professional DMB. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12281. [PMID: 36231582 PMCID: PMC9566347 DOI: 10.3390/ijerph191912281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Downhill mountain biking (DHI) is a form of cycling and does not currently have a specific sports-related concussion (SRC) assessment. OBJECTIVE To review the extent, range and nature of research investigating SRC in DMB, provide a summary of key literature findings relating to its identification and management, and then develop a SRC protocol specific to DMB. DESIGN Scoping review as per recognised methods. SETTING Literature-based. The following databases were searched: MEDLINE, EMBASE, Scopus and Web of Science, with no restrictions on date. Results were limited to the English language. PARTICIPANTS Six articles were included in the review from 64 identified articles. The article had to specifically include an analysis of adult downhill riders for inclusion. OUTCOME MEASURES Study type, study group (amateur/professional), concussion incidence, concussion assessment and recommendations. MAIN RESULTS Concussion incidence was identified as between 5-23%. No study outlined a trackside assessment of cyclists or a protocol for return to play where SRC was identified. Several authors identified that riders often continued to participate despite the presence of a concussion. No sport-specific SRC assessment was determined for DHI, and a SRC assessment was therefore developed. CONCLUSIONS This review illustrates the lack of studies and formal protocol in SRC assessment for DHI. In light of this, we propose a three-stage framework specific to the sport to best identify a concussion and act where appropriate while minimising disruption to competition. This framework involves assessing the cyclist on the 'sideline', a second assessment post-event in the medical room and a third assessment the following day. A SRC consensus meeting specific for DHI is suggested with an identified need for updated guidance from UCI, requiring possible rule changes for the sport.
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Affiliation(s)
| | - Stephen H. Boyce
- Emergency Department, Glasgow Royal Infirmary, Glasgow G4 0SF, UK
- Scottish Institute of Sport, Stirling FK9 5PH, UK
| | - Neil Fisher
- UK Athletics, Birmingham B42 2BE, UK
- British Cycling, Manchester M11 4DQ, UK
| | - Neil Heron
- British Cycling, Manchester M11 4DQ, UK
- Centre for Public Health Research, Queen’s University, Belfast BT7 1NN, UK
- Department of General Practice, Keele University, Newcastle ST5 5BG, UK
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Daly E, Pearce AJ, Finnegan E, Cooney C, McDonagh M, Scully G, McCann M, Doherty R, White A, Phelan S, Howarth N, Ryan L. An assessment of current concussion identification and diagnosis methods in sports settings: a systematic review. BMC Sports Sci Med Rehabil 2022; 14:125. [PMID: 35818048 PMCID: PMC9275058 DOI: 10.1186/s13102-022-00514-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/23/2022] [Indexed: 12/04/2022]
Abstract
Background Concussion in sport is an ongoing global concern. The head injury assessment (HIA) by the field of play is acknowledged as the first step in recognising and identifying concussion. While previous systematic literature reviews have evaluated the sensitivity of side-line screening tools and assessment protocols, no systematic review has evaluated the research designs and assessments used in a field setting. This systematic review investigated existing screening and diagnostic tools used in research as part of the HIA protocol to identify concussion that are currently used in professional, semi-professional and amateur (club) sports settings. Methods A systematic searching of relevant databases was undertaken for peer-reviewed literature between 2015 and 2020. Results Twenty-six studies met the inclusion criteria. Studies were of moderate to good quality, reporting a variety of designs. The majority of studies were undertaken in professional/elite environments with medical doctors and allied health practitioners (e.g., physical therapists) involved in 88% of concussion assessments. While gender was reported in 24 of the 26 studies, the majority of participants were male (77%). There was also a variety of concussion assessments (n = 20) with the sports concussion assessment tool (SCAT) used in less than half of the included studies. Conclusion The majority of studies investigating concussion HIAs are focused on professional/elite sport. With concussion an issue at all levels of sport, future research should be directed at non-elite sport. Further, for research purposes, the SCAT assessment should also be used more widely to allow for consistency across studies. Supplementary Information The online version contains supplementary material available at 10.1186/s13102-022-00514-1.
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Affiliation(s)
- Ed Daly
- Department of Sport, Exercise and Nutrition, School of Science and Computing, Atlantic Technological University, Galway, Ireland
| | - Alan J Pearce
- College of Sport, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Emma Finnegan
- Department of Sport, Exercise and Nutrition, School of Science and Computing, Atlantic Technological University, Galway, Ireland
| | - Ciara Cooney
- Department of Sport, Exercise and Nutrition, School of Science and Computing, Atlantic Technological University, Galway, Ireland
| | - Maria McDonagh
- Department of Sport, Exercise and Nutrition, School of Science and Computing, Atlantic Technological University, Galway, Ireland
| | - Grainne Scully
- Department of Sport, Exercise and Nutrition, School of Science and Computing, Atlantic Technological University, Galway, Ireland
| | - Michael McCann
- Atlantic Technological University, Port Road, Letterkenny, Ireland
| | - Rónán Doherty
- Atlantic Technological University, Port Road, Letterkenny, Ireland
| | - Adam White
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, England
| | - Simon Phelan
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, England
| | - Nathan Howarth
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, England
| | - Lisa Ryan
- Department of Sport, Exercise and Nutrition, School of Science and Computing, Atlantic Technological University, Galway, Ireland.
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