Injuries in synchronized skating

Performance Increases in Pair Skating and Ice Dance at International Championships and Olympic Games

In pair skating and ice dance, performance seems to have increased at international competitions, which is potentially associated with changes in athlete age. We hypothesized increasing age, numbers of total points and more complex jumps of the best elite couples at international championships in recent years. Corresponding data were assessed via the results databases of the European and World Championships, as well as the Winter Olympics since 2005. Linear regression statistics were conducted, and significance was assessed via one-way ANOVAs. There were no significant changes in age. Increases in total points were found in both disciplines (World and European Championships both p < 0.001 for both disciplines, Olympics pair skating p = 0.003, ice dance n/a). Significant increases were found in the number of double and triple twist jumps at the European Championships (Double p = 0.046, triple p = 0.041), but not at the World Championships or the Olympics. At the World Championships, single solo jumps decreased (p = 0.031) in favor of triple jumps, which increased (p = 0.020), without a similar effect at the European Championships or Olympics. In conclusion, increases in total points and more complex jumps were observed at international championships without associated changes in age. Attention should be given to possible changes in the incidence of acute and overuse injuries following this development.

Pediatric and Adolescent Figure Skating Injuries: A 15-Year Retrospective Review

OBJECTIVE

To analyze the characteristics of injuries sustained by young figure skaters who were evaluated at regional pediatric sports medicine clinics.

DESIGN

Retrospective chart review (2003-2017).

SETTING

Sports medicine clinics at a tertiary-level pediatric medical center.

PATIENTS

Two hundred ninety-four figure skaters (271 female and 23 male). Age rage: 9 to 19 years. Mean age: 14.2 ± 2.3 years.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Mechanism of injury (acute vs overuse), injured body areas, diagnoses for most commonly injured body areas, and distribution of bone stress injuries.

RESULTS

Eight hundred sixty-four figure skating-related injuries were identified. Approximately 68.9% were overuse and 31.1% were acute. In female figure skaters, the most frequently injured body areas were foot/ankle (29.6%), knee (19.3%), and back (15.8%). In male figure skaters, they were foot/ankle (25.4%), hip (16.4%), and knee (14.9%). Most common diagnoses at these body areas were tendinopathy (foot/ankle), extensor mechanism (knee), and posterior column bone stress injuries (back). All injuries to anterior knee structures, excluding bone contusions, were categorized as extensor mechanism injuries. About 11.8% of all injuries were bone stress reactions/fractures with the majority occurring at the back (42.2%), foot/ankle (32.4%), and lower leg (15.7%).

CONCLUSION

Most injuries sustained by figure skaters were overuse and occurred most commonly at the foot/ankle (29.6%), knee (19.3%), and back (15.8%). Approximately 1 in 10 injuries were bone stress reactions/fractures, and nearly 1 in every 3 skaters who presented with back pain was diagnosed with a posterior column bone stress injury. Health care providers who take care of young figure skaters need to maintain a high index of suspicion for overuse injuries, especially bone stress reactions/fractures.

Injury patterns in synchronized skating: a growing and evolving sport

BACKGROUND

Data about injuries among synchronized skating athletes are lacking while physical demands in this sport discipline continue to grow. No injury data among junior synchronized skaters exist. The purpose of this study was to investigate the frequency and pattern of injuries in junior and senior synchronized skaters.

METHODS

In this descriptive epidemiology study anonymous questionnaires were distributed to synchronized junior and senior skaters. 708 synchronized skaters (393 juniors and 315 seniors) completed the questionnaire. Male skaters were excluded from analysis.

RESULTS

Spinal conditions were reported by 148 (37.7%) juniors compared to 149 (47.3%) of senior skaters with statistically significant cumulative incidence (P=0.01); 23% of juniors and 30.2% of senior skaters reported problems with more than one spinal region; 64.4% juniors and 72.1% senior skaters reported at least one non-spinal injury during their synchronized skating career. There were 380 unique injuries reported by junior skaters and 363 by senior skaters. Lower extremity injuries were the most common injuries in both groups of skaters, followed by upper extremity, head and trunk injuries. From all the anatomical regions mentioned, there was only statistically significant difference between the groups in the occurrence of head injuries with senior skaters having 1.9 greater odds ratio to have head injury.

CONCLUSIONS

This study presents new data on the current injury pattern seen in synchronized skating since the inclusion of new skills. The number of head injuries and spinal conditions show statistically significant cumulative incidence in senior compared to junior skaters.

The Annual Trip to the Ice-rink: A Seasonal Cause of Wrist Trauma in Irish Hospitals

Fractures of the distal radius are a common orthopaedic presentation in Irish emergency departments. As a nation, Irish people tend to ice-skate seasonally with a peak of interest seen during the Winter months in temporary ice-rinks. This case series describes winter ice-skating as a significant cause of wrist fractures in the younger patient, including five cases of distal radius fractures, four of which ultimately required internal fixation, under general anaesthesia, over a single weekend in the month of December. Despite all five patients being amateur ice-skaters, all denied ever having taken ice-skating lessons. This demonstrates the dangers of wrist trauma in the inexperienced or beginner ice-skaters on temporary ice-rinks; the seasonal morbidity suffered as a result.

Effect of Sports and Growth on Hamstrings and Quadriceps Development in Young Female Athletes: Cross-Sectional Study

Context: Lower extremity muscular strength may vary by different sport participation during growth process. Objective: To investigate effect of sport participation and growth by comparing strength of the hamstrings, quadriceps, and hamstrings to quadriceps strength ratio (H:Q ratio) between young female figure skaters and soccer players. Design: Cross-sectional. Settings: Laboratory affiliated with regional sports medicine center. Participants: pediatric and adolescent female athletes. Procedures: Isometric hamstrings and quadriceps strength were measured. Main Outcome Measures: Strength of the hamstrings, quadriceps, and hamstrings to quadriceps strength ratio (H:Q ratio). Statistical Analysis: Effect of sport participation and growth was analyzed through a two-way (two sports: figure skaters and soccer players; three age groups: <12 years, 13–16 years, and >17 years) analysis of covariance. Results: Hamstrings strength was significantly greater in figure skaters than soccer players. Also, hamstring strength of 13–16 years and >17 years was higher compared to <12 years. Additionally, significantly higher H:Q ratio in figure skaters compared to soccer players. Conclusions: There is effect of growth on hamstrings strength among 13–16 years and >17 years compared to <12 years. Figure skaters showed greater hamstrings strength and H:Q ratio than female soccer players.

Sideline Coverage of Figure Skating Events

The sport of figure skating has evolved to include various disciplines and athletes continue to push the limits of the skills they perform, thus increasing the potential for injury in practice, as well as in competition. To provide optimal rink side coverage, health care professionals must be aware of the elements skaters perform and the injuries to be expected. Appropriate planning and coordination of medical services is required to ensure adequate and timely care of injured figure skaters. Protocols developed for local, national, and international events are available to assist in this process.

Epidemiology of Figure Skating Injuries: A Review of the Literature

Context:

As the popularity and technical demands of figure skating increase, so will the number of athletes presenting with sport-related problems.

Evidence Acquisition:

Searches were performed across PubMed from 1980 to 2017. The keywords searched were skating, skaters, incidence, and injuries. The search was limited to English-language articles and human participants. Relevant articles were cross-referenced.

Study Design:

Clinical review.

Level of Evidence:

Level 5.

Results:

Previous studies suggest an increase in incidence of figure skating injuries from 1982 to 2003. When combining all disciplines of figure skating, there is a similar proportion of acute and overuse injuries. Within disciplines, overuse injuries appear to be more common in singles skating, while acute injuries are more common in pairs skating, ice dancing, and synchronized skating. Lower extremity injuries are more common than upper extremity injuries in all disciplines, and pairs skating accounts for the majority of upper extremity injuries. Ankle sprains are the most common skating injury, and patellar tendinitis is the most common overuse injury across all disciplines. Stress fractures are the most common overuse injury in female singles skaters.

Conclusion:

The predominance of overuse injuries in singles disciplines reflects their increasing technical difficulty, with more difficult jumps and longer training hours. Partner disciplines are more likely to involve acute injuries and upper extremity injuries due to high-risk throws and lifts. Emphasis should be placed on properly fitting skating boots, intrinsic foot and ankle strengthening, and lower extremity flexibility, which may prevent many of the common lower extremity and back injuries in figure skating.

Lower Extremity Overuse Conditions Affecting Figure Skaters During Daily Training

Background

Most ice figure skaters train and compete with ongoing issues in the lower extremities, which are often overlooked by the skaters and considered injuries only when they prevent the athletes from skating. Although not severe, these conditions impair the quality of daily training and compromise the skaters’ state of mind and performances.

Purpose

(1) To determine the point prevalence of the ongoing lower extremity overuse conditions in a population of ice figure skaters of all ages and levels and (2) to identify the risk factors contributing to the development of the most common ongoing conditions.

Study Design

Cross-sectional study; Level of evidence, 3.

Methods

A total of 95 skaters of all ages and skating levels were evaluated in a single examination in the middle of the competitive season. Data collection consisted of a questionnaire, clinical examination, and measurement of the skaters’ characteristics and the equipment used.

Results

Retrocalcaneal bursitis was the most common problem, affecting at least 1 foot in 34% of the skaters evaluated, followed by posterior heel skin calluses and superficial calcaneal bursitis, which affected 29% and 28% of skaters, respectively. The prevalence of the majority of these conditions was 10% to 32% higher in elite skaters than in nonelite skaters. Higher boot–foot length difference was associated with greater risk of superficial calcaneal bursitis in the landing foot of elite skaters, while higher body weight and greater in-skate ankle flexibility were associated with the development of retrocalcaneal bursitis in nonelite skaters. Only 30 skaters (32%) wore the appropriate boot size, while 57 skaters (51%) could not dorsiflex their ankles properly while wearing skates.

Conclusion

The heel represents a major area of concern for the high prevalence of calcaneal bursitis and calluses in proximity of the Achilles tendon, suggesting that improvements on the boot heel cup design should take priority. The association of bursitis with higher in-skate ankle flexibility suggests that these conditions may be the results of a process developing when the ankle is bending within the boot. Also, since wearing oversized boots is a major risk factor for the development of subcutaneous bursitis and skin abrasions, boot retailers should be better educated to sell the appropriate boot size to the skaters.

Injuries and disorders among young ice skaters: relationship with generalized joint laxity and tightness

This study retrospectively investigated 192 teenage speed and figure skaters with prior injuries documented by an athletes’ questionnaire, who underwent a physical examination to assess their muscle tightness and generalized joint laxity. In all athletes, the degree of muscle tightness and joint laxity were measured by a standardized physical examination. A descriptive report of the types of injuries showed a predominance of fractures, ligament injuries, enthesitis, and lower back pain. Approximately 5% of all skaters tested positive for tightness, while 25.8% of figure skaters and 15.2% of speed skaters had generalized ligamentous laxity. Statistical testing showed an association between ankle sprains and muscle tightness, and an association between knee enthesitis and muscle tightness in skating athletes. There was also an association between lower back pain and generalized joint laxity, which held true only for the male skaters.

Injury severity in ice skating: an epidemiologic analysis using a standardised injury classification system

PURPOSE

Although injuries sustained during ice skating have been reported to be more serious than other forms of skating, the potential injury risks are often underestimated by skating participants. The purpose of this study was to give a descriptive overview of injury patterns occurring during ice skating. Special emphasis was put on injury severity by using a standardised injury classification system.

METHODS

Over a six month period, all patients treated with ice-skating-related injuries at Europe's largest hospital were included. Patient demographics were collected and all injuries categorised according to the Abbreviated Injury Scale (AIS) 2005. A descriptive statistic and logistic regression analysis was performed.

RESULTS

Three hundred and forty-one patients (134 M, 207 F) were included in this study. Statistical analysis revealed that age had a significant influence on injury severity. People > 50 years had a higher risk of sustaining a more severe injury according to the AIS compared with younger skaters. Furthermore, the risk of head injury was significantly lower for people aged between 18 and 50 years than for people < 18 years (p = 0.0007) and significantly higher for people > 50 years than for people aged between 18 and 50 years (p = 0.04).

CONCLUSION

The severity of ice-skating injuries is associated with the patient's age, showing more severe injuries in older patients. Awareness should be raised among the public and physicians about the risks associated with this activity in order to promote further educational interventions and the use of protective gear.

Epidemiology of ankle and foot overuse injuries in sports: A systematic review

Studies regarding ankle and foot overuse injuries are quite diverse in research methodology, data reporting, and outcomes. The aims of this systematic review were to analyze the methodology of published studies regarding ankle and foot overuse injuries in different sports disciplines and to summarize epidemiological data of ankle and foot overuse injuries. Four electronic databases, PubMed (MEDLINE), EMBASE, CINAHL, and SPORTDiscus(®) were systematically searched up to June 2011. A total of 89 articles on 23 sports disciplines were included in this review. Soccer, running, and gymnastics were the most frequently studied sports. Achilles tendinopathy, plantar fasciitis, and stress fracture were the most frequently studied injuries. Study design and reporting methods were heterogeneous. Most studies suffered from a weak methodology and poor reporting. The most common weaknesses were lack of a clear case definition, describing assessment procedures and reporting sample characteristics. Due to methodological heterogeneity of studies, inter-sports and intra-sports comparisons and meta-analysis were not possible. Methodology of most studies on incidence and prevalence of ankle and foot overuse injuries is insufficient. Based on the results, we recommend authors to clearly define cases, describe assessment procedures and report sample characteristics adequately.

Skin conditions in figure skaters, ice-hockey players and speed skaters: part I - mechanical dermatoses

Figure skaters, ice-hockey players and speed skaters experience a range of dermatologic conditions and tissue-related injuries on account of mechanical trauma, infectious pathogens, inflammatory processes and environmental factors related to these competitive pursuits. Sports medicine practitioners, family physicians, dermatologists and coaches should be familiar with these skin conditions to ensure timely and accurate diagnosis and management of affected athletes. This review is Part I of a subsequent companion review and provides a comprehensive review of mechanical dermatoses experienced by ice-skating athletes, including skater's nodules and its variants, pump bumps, piezogenic pedal papules, talon noir, skate/lace bite, friction bullae, corns and calluses, onychocryptosis, skater's toe and skate blade-induced lacerations. These injuries result from friction, shear forces, chronic pressure and collisions with surfaces that occur when athletes endure repetitive jump landings, accelerated starts and stops and other manoeuvres during rigorous training and competition. Ill-fitting skates, improper lacing techniques and insufficient lubrication or protective padding of the foot and ankle often contribute to the development of skin conditions that result from these physical and mechanical stresses. As we will explain, simple measures can frequently prevent the development of these conditions. The treatment of skater's nodules involves reduction in chronic stimulation of the malleoli, and the use of keratolytics and intralesional steroid injections; if malleolar bursitis develops, bursa aspirations may be required. Pump bumps, which result from repetitive friction posteriorly, can be prevented by wearing skates that fit correctly at the heel. Piezogenic pedal papules may be treated conservatively by using heel cups, compressive stockings and by reducing prolonged standing. Talon noir usually resolves without intervention within several weeks. The treatment of skate bite is centred on reducing compression by the skate tongue of the extensor tendons of the anterior ankle, which can be accomplished by use of proper lacing techniques, increasing pliability of the skate tongue and using protective padding, such as Bunga Pads™. Anti-inflammatory medications and cold compresses can also help reduce inflammation. Friction bullae are best managed by careful lancing of painful blisters and application of petrolatum or protective dressings to accelerate healing; preventative measures include the use of well fitting skates, proper lacing techniques and moisture-wicking socks. Corns and calluses are similarly best prevented by the use of well fitted skates and orthotic devices. Symptomatic, debridement reduces the irritant effect of the thick epidermis, and can be accomplished by soaking the area in warm water followed by paring. Application of creams with high concentrations of urea or salicylic acid can also soften callosities. Cases of onychocryptosis benefit from warm soaks, antibiotic ointments and topical steroids to reduce inflammation, but sometimes chemical or surgical matricectomies are required. Preventative measures of both onychocryptosis and skater's toe include cutting toenails straight across to allow for a more equal distribution of forces within the toe box. Finally, the prevention and treatment of lacerations, which constitute a potentially fatal type of mechanical injury, require special protective gear and acute surgical intervention with appropriate suturing. The subsequent companion review of skin conditions in ice skaters will discuss infectious, inflammatory and cold-induced dermatoses, with continued emphasis on clinical presentation, diagnosis, treatment and prevention.

Skating on thin ice: a study of the injuries sustained at a temporary ice skating rink

In recent years, ice skating and temporary ice skating rinks have become increasingly popular. Regular elite competitors are known to be at risk of both acute and chronic injuries. It may be postulated that skaters at the temporary rinks are at high risk of acute injuries from falls due to both their lack of expertise and the inherent dangers of ice skating. Injuries sustained at skating rinks present a significant burden to local healthcare resources, in particular orthopaedic departments. For the first time, Cambridge hosted such a facility from November 24, 2007 through January 6, 2008. We sought to identify the most common injuries encountered and to quantify the orthopaedic burden. All Emergency Department or Fracture Clinic attendances for an eight-week period from the opening of the rink were investigated. Details of age, sex, injury and management were recorded for the 84 patients who sustained ice rink related injuries. A total of 85 injuries were recorded in 84 patients. Of these injuries 58% were fractures, of which 98% involved the upper limbs. Seven patients (8% of all injuries) required admission for operative fixation. On average, two injuries per day were seen in the Emergency Department or Fracture Clinic, with an average of one orthopaedic admission per week. It is evident that the ice rink in Cambridge has had an impact on local healthcare resources. The vast majority of injuries affected the upper limbs and were sustained following a fall on the out-stretched hand. We therefore encourage the education of skaters as to how to break their falls more safely and recommend the use of wrist protectors as a primary preventative measure.

Stress fractures of the base of the metatarsal bones in young trainee ballet dancers

Classical ballet is an art form requiring extraordinary physical activity, characterised by rigorous training. These can lead to many overuse injuries arising from repetitive minor trauma. The purpose of this paper is to report our experience in the diagnosis and treatment of stress fractures at the base of the second and third metatarsal bones in young ballet dancers. We considered 150 trainee ballet dancers from the Ballet Schools of "Teatro Alla Scala" of Milan from 2005 to 2007. Nineteen of them presented with stress fractures of the base of the metatarsal bones. We treated 18 dancers with external shockwave therapy (ESWT) and one with pulsed electromagnetic fields (EMF) and low-intensity ultrasound (US); all patients were recommended rest. In all cases good results were obtained. The best approach to metatarsal stress fractures is to diagnose them early through clinical examination and then through X-ray and MRI. ESWT gave good results, with a relatively short time of rest from the patients' activities and a return to dancing without pain.

On thin ice: preparing and caring for the ice skater during competition

The competitive sport of figure skating has changed in many ways over the last few decades with the advent of increasingly difficult programs, the additions of new disciplines within the sport, and changes to the types of injuries seen. With increased numbers of participants, there is more need for medical coverage at many skating events throughout the country. The sports medicine physician responsible for the care of skaters at a competition will need a working knowledge of the basics of skating and the injuries these athletes sustain in order to provide exceptional care to the skaters. This article reviews the basics of figure skating along with the common injuries and medical conditions often experienced by figure skaters to allow a physician to feel comfortable dealing with potential rinkside emergencies and issues. It also provides guidance on the preparation required to provide medical coverage at an ice skating competition.