Preparticipation injury complaint is a risk factor for injury: a prospective study of the Moscow 2013 IAAF Championships

Is the risk of muscle injuries higher in the finals than in previous rounds of the 100 m, 200 m and 400 m sprints of international athletics championships?

OBJECTIVES

To compare incidence rates of lower limb muscle injuries (LLMIs) and hamstring muscle injuries (HMIs) in 100 m, 200 m and 400 m sprints disciplines between finals, semi-finals and heats of international athletics championships.

DESIGN

Prospective total population study.

METHODS

We analysed in-competition LLMIs and HMIs of female and male athletes during eight championships between 2009 and 2022.

RESULTS

LLMI and HMI incidence rates in 100 m finals were significantly higher than in heats and semi-finals for female and male athletes. HMI incidence rates were significantly higher in 200 m finals than heats and semi-finals for male athletes.

CONCLUSIONS

LLMI and HMI risk was higher in finals compared to previous rounds during international athletics championships.

Risk factors for injury complaints leading to restricted participation in Athletics (Track and Field): a secondary analysis of data from 320 athletes over one season

OBJECTIVE

To investigate if several potential risk factors were associated with time to injury complaints leading to participation restriction in Athletics (ICPR).

METHODS

We performed a secondary analysis of data collected during 39 weeks of the 2017-2018 Athletics season in a cluster-randomised controlled trial ('PREVATHLE'). Univariate and multivariable analyses using Cox regression models were performed to analyse the association between the time to first ICPR and potential risk factors collected (1) at baseline: sex, age, height, body mass, discipline, the usual duration of Athletics training and non-specific sports training, ICPR in the preceding season (yes/no), ICPR at baseline (yes/no); (2) weekly during the season: duration and intensity of Athletics training and competition, and non-specific sports training, fitness subjective state, sleep duration and illness (yes/no); and (3) combined.

RESULTS

Data from 320 athletes were included; 138 (43.1%) athletes reported at least one ICPR during the study follow-up. The combined multivariable analyses revealed that the risk of ICPR at any given time was significantly higher in athletes with a pre-existing ICPR (hazard rate ratio, HRR 1.90, 95% CI 1.15 to 3.15; p=0.012) and lower in athletes with a higher fitness subjective state (HRR 0.63, 95% CI 0.55 to 0.73; p<0.001) and who had had at least one illness during the season (HRR 0.42, 95% CI 0.29 to 0.62; p<0.001).

CONCLUSIONS

Our results provide new insights into injury risk factors in Athletics that could help with potential injury risk reduction strategies. These could be to explore the pre-existing injury presence at the season's beginning and to monitor the fitness subjective state and illnesses occurrence during the season.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03307434.

Relationship between a daily injury risk estimation feedback (I-REF) based on machine learning techniques and actual injury risk in athletics (track and field): protocol for a prospective cohort study over an athletics season

INTRODUCTION

Two-thirds of athletes (65%) have at least one injury complaint leading to participation restriction (ICPR) in athletics (track and field) during one season. The emerging practice of medicine and public health supported by electronic processes and communication in sports medicine represents an opportunity for developing new injury risk reduction strategies. Modelling and predicting the risk of injury in real-time through artificial intelligence using machine learning techniques might represent an innovative injury risk reduction strategy. Thus, the primary aim of this study will be to analyse the relationship between the level of Injury Risk Estimation Feedback (I-REF) use (average score of athletes' self-declared level of I-REF consideration for their athletics activity) and the ICPR burden during an athletics season.

METHOD AND ANALYSIS

We will conduct a prospective cohort study, called Injury Prediction with Artificial Intelligence (IPredict-AI), over one 38-week athletics season (from September 2022 to July 2023) involving competitive athletics athletes licensed with the French Federation of Athletics. All athletes will be asked to complete daily questionnaires on their athletics activity, their psychological state, their sleep, the level of I-REF use and any ICPR. I-REF will present a daily estimation of the ICPR risk ranging from 0% (no risk for injury) to 100% (maximal risk for injury) for the following day. All athletes will be free to see I-REF and to adapt their athletics activity according to I-REF. The primary outcome will be the ICPR burden over the follow-up (over an athletics season), defined as the number of days lost from training and/or competition due to ICPR per 1000 hours of athletics activity. The relationship between ICPR burden and the level of I-REF use will be explored by using linear regression models.

ETHICS AND DISSEMINATION

This prospective cohort study was reviewed and approved by the Saint-Etienne University Hospital Ethical Committee (Institutional Review Board: IORG0007394, IRBN1062022/CHUSTE). Results of the study will be disseminated in peer-reviewed journals and in international scientific congresses, as well as to the included participants.

Injury acknowledgement by reduction of sports load in world-leading athletics (track and field) athletes varies with their musculoskeletal health literacy and the socioeconomic environment

Objective

Although injury burden prompts elite athletics (track and field) athletes to engage in injury management, little is known about their health literacy. We investigated musculoskeletal (MS) health literacy in world-leading athletics athletes and associations with prechampionship injury acknowledgement by reduction of training load in different socioeconomic environments.

Methods

Adult and youth athletics athletes (n=1785) preparing for World Championships were invited to complete the Literacy in Musculoskeletal Problems instrument and report acknowledgement of injury by reduction in training load during prechampionship tapering. Their socioeconomic standing was estimated through the Human Development Index of their home country. Demographic differences were examined using χ2tests and determinants of injury acknowledgement assessed using logistic regression.

Results

Complete data were obtained from 780 athletes (43.7%) with 26% demonstrating sufficient MS health literacy, higher in adult (41%) than youth (13%) athletes (p<0.001). Adult athletes at the uppermost socioeconomic level showed higher MS health literacy than athletes at lower socioeconomic levels (p<0.001). At the uppermost socioeconomic level, adult athletes with sufficient MS health literacy had increased likelihood of acknowledging an injury by reduction in training load compared with peers demonstrating insufficient MS health literacy (OR=2.45; 95% CI 1.33–4.53). Athletes at middle socioeconomic levels with sufficient MS health literacy had decreased likelihood for acknowledging an injury during tapering (OR=0.29; 95% CI 0.11–0.78).

Conclusions

The prevalence of sufficient MS health literacy in world-leading athletics athletes is low. Associations between MS health literacy and injury acknowledgement in these athletes vary with the resourcefulness of the socioeconomic environment, implying that health literacy and resources for medical and performance support should be ascertained concurrently.

Pain and Psychological Readiness to Return to Sport in Elite Volleyball Players: A Cross-Sectional Study

Pain is modulated by multiple factors. A relevant psychological process peculiar to athletes and which could be associated with pain is Psychological Readiness to Return to Sport (PRRS). The analysis of this association in competition context is particularly important.

OBJECTIVE

To determine the correlation between the PRRS and pain intensity in elite volleyball players during their participation in a continental sporting event.

METHODS

A cross-sectional study was conducted. Data from 107 male volleyball players (23.50 ± 4.08 years of age) participating in the South American Volleyball Championship were used. The athletes answered a self-report questionnaire on the day the championship began regarding their history of injuries in the previous six months. The athletes who declared injuries were asked about the current pain intensity using the Pain Numeric Rating Scale (NRS) and Psychological Readiness to Return to Sport using the Injury-Psychological Readiness to Return to Sport scale (I-PRRS).

RESULTS

43.93% (n = 47) of the athletes (23.70 ± 3.54 years) reported an injury in the six months prior to the championship. They presented a median on the NRS of three (interquartile range (IQR), 2-5), and 54 (IQR, 46-58) on the I-PRRS. The Spearman's Rho correlation test showed an inversely and moderate correlation (r_s = -0.36; p = 0.011; CI: -0.64--0.08) between pain intensity and PRRS.

CONCLUSIONS

In male elite volleyball players who participate in a Continental Championship in South America, higher levels of PRRS was correlated to lower pain intensity.

What Contributes to Athlete Performance Health? A Concept Mapping Approach

BACKGROUND

In high-performance sport, athlete performance health encompasses a state of optimal physical, mental, and social wellbeing related to an athlete's sporting success. The aim of this study was to identify the priority areas for achieving athlete performance health in Australia's high-performance sport system (HPSS).

METHODS

Participants across five socioecological levels of Australia's HPSS were invited to contribute to this study. Concept mapping, a mixed-methods approach incorporating qualitative and quantitative data collection, was used. Participants brainstormed ideas for what athlete performance health requires, sorted the ideas into groups based on similar meaning and rated the importance, and ease of achieving each idea on a scale from 1 (not important/easiest to overcome) to 5 (extremely important/hardest to overcome).

RESULTS

Forty-nine participants generated 97 unique statements that were grouped into 12 clusters following multidimensional scaling and hierarchical cluster analysis. The three clusters with highest mean importance rating were (mean importance rating (1-5), mean ease of overcoming (1-5)): 'Behavioral competency' (4.37, 2.30); 'Collaboration and teamwork' (4.19, 2.65); 'Valuing athlete wellbeing' (4.17, 2.77). The 12 clusters were grouped into five overarching domains: Domain one-Performance health culture; Domain two-Integrated strategy; Domain three-Operational effectiveness; Domain four-Skilled people; Domain five-Leadership.

CONCLUSION

A diverse sample of key stakeholders from Australia's HPSS identified five overarching domains that contribute to athlete performance health. The themes that need to be addressed in a strategy to achieve athlete performance health in Australia's HPSS are 'Leadership', 'Skilled people', 'Performance health culture', 'Operational effectiveness', and 'Integrated strategy'.

Hamstring Muscle Injuries and Hamstring Specific Training in Elite Athletics (Track and Field) Athletes

OBJECTIVE

We aimed to describe hamstring muscle injury (HMI) history and hamstring specific training (HST) in elite athletes. A secondary aim was to analyse the potential factors associated with in-championships HMI.

METHODS

We conducted a prospective cohort study to collect data before and during the 2018 European Athletics Championships. Injury and illness complaints during the month before the championship, HMI history during the entire career and the 2017-18 season, HST (strengthening, stretching, core stability, sprinting), and in-championship HMI were recorded. We calculated proportions of athletes with HMI history, we compared HST according to sex and disciplines with Chi2 tests or ANOVA, and analysed factors associated with in-championship HMI using simple model logistic regression.

RESULTS

Among the 357 included athletes, 48% reported at least one HMI during their career and 24% during the 2017-18 season. Of this latter group, 30.6% reported reduced or no participation in athletics' training or competition at the start of the championship due to the hamstring injury. For HST, higher volumes of hamstring stretching and sprinting were reported for disciplines requiring higher running velocities (i.e., sprints, hurdles, jumps, combined events and middle distances). Five in-championship HMIs were recorded. The simple model analysis showed a lower risk of sustaining an in-championships HMI for athletes who performed more core (lumbo-pelvic) stability training (OR = 0.49 (95% CI: 0.25 to 0.89), p = 0.021).

CONCLUSIONS

Our present study reports that HMI is a characteristic of the athletics athletes' career, especially in disciplines involving sprinting. In these disciplines, athletes were performing higher volumes of hamstring stretching and sprinting than in other disciplines. Further studies should be conducted to better understand if and how HST are protective approaches for HMI in order to improve HMI risk reduction strategies.

Epidemiology of injuries in track and field athletes: a cross-sectional study of specific injuries based on time loss and reduction in sporting level

OBJECTIVES

To prevent the occurrence of injury in a sport, exact knowledge of injury patterns is needed. To synthesize sport-specific injuries in track and field comparing elite and recreational level athletes, as well as gender. Furthermore, analyze the time loss due to injury and reduction in athletic performance.

METHODS

Injury type-specific frequencies were recorded according to discipline, gender and performance level. Injury severity was assessed by time loss duration and performance reduction.

RESULTS

64% of athletes suffered at least one injury. In the top 10 ranking, 83% (n = 524) were located in the lower extremities. A muscle strain of the thigh had the highest prevalence in sprint (34%, n = 41), jump (15%, n = 15) and middle-distance running (16%, n = 6). More injuries occurred during training (75%, n = 165) as compared to competition (25%, n = 56). The longest time loss was documented in throwing with a downtime of 36 weeks after a ligament injury of the elbow and 39 weeks after a muscle injury of the elbow. The injury with the highest number of athletes with a reduced level of performance was the foot ligament injury in sprint athletes at 100%.

CONCLUSION

Assessing time loss and performance reduction in athletics, there are discipline-specific injury patterns. This study points out the high prevalence of training injuries, highlighting the need for future investigations to adapt training management, improve medical care and rehabilitation with respect to every discipline.

Validity and Reliability of the Sport Readiness Questionnaire Focused on Musculoskeletal Injuries

Background: The pre-participation physical evaluation (PPE), which includes a musculoskeletal system evaluation, identifies factors that may be a risk for athletes while practicing sport. Thus, the Sport Readiness Questionnaire, focused on musculoskeletal injuries (MIR-Q) was developed to screen athletes at risk of future injuries or worsening pre-existing injuries during training or competition. However, the criterion-related validity and reliability of the MIR-Q have not yet been analyzed. Objectives: To test the criterion-related validity and reliability (internal consistency and test-retest) of the MIR-Q. Methods: One hundred and twenty adult athletes from different sports (17 women) completed the MIR-Q and underwent a physical orthopedic examination (POE) performed by an orthopedic physician. At least one affirmative answer on the MIR-Q, as well as one positive finding on the POE, was considered “a risk factor for sport injury”. The validity was assessed from sensitivity, specificity, and accuracy measurements. Internal consistency was obtained through the KR-20 test. Reliability was measured using the test-retest method in a 7-14-day interval with a sub-sample (n = 41) and verified by the Kappa index. Results: Eighty-one (67.5%) questionnaires contained positive responses. The sensitivity of the MIR-Q against POE was high (84.4%), while specificity and accuracy were considered moderate, with values of 42.7% and 58.0%, respectively. Internal consistency was moderate (KR-20 = 0.57), and test-retest was reduced (K = 0.30; P = 0.02). Conclusions: The MIR-Q was associated with high values of validity and low values of reliability. The questionnaire may be an alternative tool for musculoskeletal screening during PPE in limited medical settings (sports OR orthopedic physician) conditions. Future studies should investigate the predictive validity of the MIR-Q, and psychometric properties of the questionnaire with younger athletes.

Effect of an Unsupervised Exercises-Based Athletics Injury Prevention Programme on Injury Complaints Leading to Participation Restriction in Athletics: A Cluster-Randomised Controlled Trial

Objective: To test the efficacy of the Athletics Injury Prevention Programme (AIPP) to reduce the percentage of athletes presenting at least one injury complaint leading to participation restriction (ICPR) over an athletics season. Methods: During the 2017–2018 athletics season, we included in this cluster randomised controlled trial (ClinicalTrials.gov Identifier: NCT03307434) 840 athletes randomly assigned (randomisation unit: athletic clubs) to a control group (regular training) or to an intervention group (regular training plus the AIPP 2/week). Using a weekly online questionnaire, athletes reported the ICPR, training and competition exposures, and, for the intervention group, the compliance with the AIPP. The primary outcome was the percentage of athletes presenting at least one ICPR over the study follow-up. Results: A total of 449 and 391 athletes were included in the intervention and control groups, respectively. From them, 68 (15.1%) and 100 (25.6%) athletes, respectively, provided 100% of the requested information during the follow-up (39 weeks). A total of 6 (8.8%) performed the AIPP 2/week or more. The proportion of athletes who had at least one ICPR over the follow-up period was similar in the intervention (64.7%) and control groups (65.0%), with adjusted odds ratios: 0.81 (95% CI 0.36 to 1.85). There were no between-group differences when comparing separately the subgroups corresponding with the different compliance levels. Conclusion: This cluster randomised controlled trial reported no efficacy of the AIPP. However, the overall response proportion and the compliance with the AIPP in the intervention group were low. In individual sports especially, efforts should be first made to improve the implementation and adoption of interventions.

A descriptive prospective study of sports medicine practices for athletes in Uganda

BACKGROUND

Many international sporting organizations have recommended practices to reduce the risk of injury. These practices include screening for injury, having appropriate emergency medical care, and protocols for managing injury before return-to-play. The extent of the uptake of these practices in a developing country such as Uganda, is unknown.

METHODOLOGY

Using a descriptive case study approach, this investigation focused on a sample of injured athletes (n = 75) in Uganda from four main sports associations (football, athletics, basketball and rugby). The data were collected through observations and interviews after the injury. Using a best medical practice framework the phases of emergency, intermediate, rehabilitative, and return-to-sports participation were described.

RESULT

Nine conditions/types of injury were included. The results revealed a lack of specific pre-season screening or return-to-play readiness for all the injured athletes. Further, there was a lack of application of best practice principles for most of the injury types. For athletes who received medical care, the results show inconsistencies and inadequacies from the acute stage of the injury to return-to-sports participation.

CONCLUSION

This study identified barriers such as up-to-date knowledge among the sports resource providers; the gaps for appropriate and adequate specific facilities for managing injured athletes, and policies to mandate care of injured athletes. These barriers detract from applying best medical practices.

Frequency of Injury and Illness in the Final 4 Weeks before a Trail Running Competition

We aimed to (i) determine self-reported injury and illness frequency in trail runners 4 weeks preceding competition; (ii) compare athletes with and without injury/illness by sex, age, body mass index (BMI) and competition distance; (iii) describe mechanism of injury, anatomical region (injury)/organ system (illness) involved, consequences of injury on preparation and self-perception of injury severity; (iv) compare anatomical region (injury) and organ system (illness) by sex. A total of 654 trail runners (age 36.2, IQR 30.6-43.0; 36.9% females) participated in this retrospective cross-sectional study by completing a self-reported questionnaire. Injury and illness frequency rates were 31.3% (n = 205, CI: 27.7-35.0%) and 22.3% (n = 146, CI: 19.1-25.7%), respectively. No significant difference was found between injured vs. non-injured or ill vs. non-ill study participants by sex, age, BMI and competition distance. Regarding injuries, gradual onset (41.6%) and knee (33.2%) were the most indicated mechanism and anatomical region of injury. At least 85.4% of trail runners changed their training following injury and 79% indicated that their injury would affect their competition performance. Regarding illness, the respiratory tract was the most frequent organ system involved (82.9%). Male and female participants reported similar proportions of anatomical regions (injury) and organ systems (illness) affected. These results could help to generate education strategies and appropriate medical support before and during these competitions.

Psychological risk profile for overuse injuries in sport: An exploratory study

Overuse injuries account for a substantial part of sport injury incidence among athletes of various sports and levels. Despite the gradual onset of symptoms, athletes often persevere in training and competing. The present exploratory study aimed to identify a psychological risk profile for overuse injury. One hundred and forty-nine athletes competing in various sports responded to a range of questionnaires measuring the following psychological variables: negative life stress, perfectionistic concerns, perfectionistic strivings, athletic identity, and the coach-athlete relationship. Participants subsequently answered the OSTRC Overuse Injury Questionnaire on a weekly basis during a 10-week period. Using a latent profile analysis, athletes were classified into three latent profiles regarding their psychological characteristics. Athletes in the second profile, characterized by a combination of high athletic identity, perfectionistic concerns and negative life stress and poor coach-athlete relationship, were found to be significantly more often affected by overuse injuries (74% of the time) than individuals in the two other profiles (52% and 48% of the time, respectively). In conclusion, psychological factors may contribute to the risk of overuse injuries through complex interactions (i.e. accounting for interdependencies within a specific configuration of variables) rather than through their independent influences.

Athlete health and safety at large sporting events: the development of consensus-driven guidelines

All sport events have inherent injury and illness risks for participants. Healthcare services for sport events should be planned and delivered to mitigate these risks which is the ethical responsibility of all sport event organisers. The objective of this paper was to develop consensus-driven guidelines describing the basic standards of services necessary to protect athlete health and safety during large sporting events. By using the Knowledge Translation Scheme Framework, a gap in International Federation healthcare programming for sport events was identified. Event healthcare content areas were determined through a narrative review of the scientific literature. Content experts were systematically identified. Following a literature search, an iterative consensus process was undertaken. The outcome document was written by the knowledge translation expert writing group, with the assistance of a focus group consisting of a cohort of International Federation Medical Chairpersons. Athletes were recruited to review and provide comment. The Healthcare Guidelines for International Federation Events document was developed including content-related to (i) pre-event planning (eg, sport medical risk assessment, public health requirements, environmental considerations), (ii) event safety (eg, venue medical services, emergency action plan, emergency transport, safety and security) and (iii) additional considerations (eg, event health research, spectator medical services). We developed a generic standardised template guide to facilitate the planning and delivery of medical services at international sport events. The organisers of medical services should adapt, evaluate and modify this guide to meet the sport-specific local context.

The Athletics Injury Prevention Programme Can Help to Reduce the Occurrence at Short Term of Participation Restriction Injury Complaints in Athletics: A Prospective Cohort Study

We aimed to determine whether an Athletics Injury Prevention Programme (AIPP), targeting the most common athletics injuries, can reduce the occurrence of injury complaints that lead to restrictions in athletics participation (participation restriction injury complaints) in the short (12 weeks) and long (40 weeks) terms. For our 40-week prospective cohort study (level of evidence 2), we invited inter-regional and national-level athletes to regularly perform the AIPP, which included 8 exercises addressing core stability, hamstring, leg and pelvic muscles strengthening and stretching, and balance exercises. A Cox regression was used to analyse the influence of AIPP on the occurrence of participation restriction injury complaint, adjusted to sex, age, height, body mass, discipline, and history of injury complaints during the preceding season, individual response rate, mean weekly training time, mean weekly number of competition, presented by hazard ratio (HR) with 95% confidence interval (95% CI). At 12 weeks (n = 62 athletes), the AIPP was significantly associated with a lower risk of participation restriction injury complaint HR = 0.36 (95%CI: 0.15 to 0.86), p = 0.02 and HR = 0.29 (95%CI: 0.12 to 0.73), p = 0.009, with cumulative weeks and cumulative training time as time scale, respectively, while at 40 weeks (n = 53 athletes) there was no significant association. An 8-exercise injury prevention programme can effectively help to reduce occurrence of injury complaints that would restrict an athlete's participation in athletics in the short term.

Health complaints and heat stress prevention strategies during taper as predictors of peaked athletic performance at the 2015 World Athletics Championship in hot conditions

OBJECTIVES

To investigate whether self-reported health complaints and choice of heat stress prevention strategies during the taper predicted peaking at an athletics championship in hot conditions.

DESIGN

Cohort study.

METHODS

Data on health and heat stress prevention were collected before the 2015 World Athletics Championship in Beijing, China. Peaking was defined using the athlete's pre-competition ranking and final competition rank. Baseline and endpoint data were fitted into multiple logic regression models.

RESULTS

Two hundred forty-five (29%) of 841 eligible athletes participated. Both sprint/power (Odds ratio (OR) 0.33 (95% Confidence interval (CI) 0.11 to 0.94), P=0.038) and endurance/combined events (OR 0.38 (95% CI 0.14 to 1.00), P=0.049) athletes having sustained concern-causing health complaints during the taper were less likely to peak. Endurance/combined events athletes who chose pre-cooling to mitigate heat stress were less likely to peak (OR 0.35 (95% CI 0.15 to 0.80), P=0.013), while sprint/power athletes reporting a sudden-onset injury complaint during the taper displayed increased peaking (OR 4.47 (95% CI 1.28 to 15.59), P=0.019).

CONCLUSIONS

Health complaints that caused the athlete concern during the taper were predictive of failure to peak at a major athletics competition. Sprint/power athletes who experienced an acute injury symptom during the taper appeared to benefit from rest. Pre-cooling strategies seem to require further validation during real-world endurance/combined events. It appears that athletics athletes' self-reported health should be monitored during the taper, concerns addressed, and heat stress prevention strategies individually tested before championships in hot conditions.

Injury frequency and characteristics (location, type, cause and severity) differed significantly among athletics ('track and field') disciplines during 14 international championships (2007-2018): implications for medical service planning

OBJECTIVE

To analyse differences between athletic disciplines in the frequency and characteristics of injuries during international athletics championships.

METHODS

Study design, injury definition and data collection procedures were similar during the 14 international championships (2007-2018). National medical teams and local organising committee physicians reported all newly incurred injuries daily on a standardised injury report form. Results were presented as number of injuries and number of injuries per 1000 registered athletes, separately for male and female athletes, and for each discipline.

RESULTS

From a total of 8925 male and 7614 female registered athletes, 928 injuries were reported in male and 597 in female athletes. The discipline accounting for the highest proportion of injuries was sprints, for both men (24%) and women (26%). The number of injuries per 1000 registered athletes varied between disciplines for men and women: highest in combined events for male athletes (235 (95% CI 189 to 281)) and female athletes (212 (95% CI 166 to 257)), and lowest for male throwers (47 (95% CI 35 to 59)) and female throwers (32 (95% CI 21 to 43)) and for female race walkers (42 (95% CI 19 to 66)). Injury characteristics varied significantly between disciplines for location, type, cause and severity in male and female athletes. Thigh muscle injuries were the main diagnoses in the disciplines sprints, hurdles, jumps, combined events and race walking, lower leg muscle injuries in marathon running, lower leg skin injury in middle and long distance running, and trunk muscle and lower leg muscle injuries in throws.

CONCLUSIONS

Injury characteristics differed substantially between disciplines during international athletics championships. Strategies for medical service provision (eg, staff, facilities) during athletics championships should be discipline specific and be prepared for targeting the main injuries in each discipline.

Injuries and Illness Prevalence Prior to Competition in Goalball Players

Introduction:

Goalball is a sport specifically created for persons with visual impairments. In spite of all benefits that participating in sport-related activities brings to athletes with visual impairments, there is also the inherent, associated risk of being injured. Competing presenting injuries or illnesses or both not only decrease performance in contests but also increase the risk of acquiring new injuries. There is no information available regarding prior-to-competition injuries or illnesses in athletes with visual impairments. The objective of this research is to determine prevalence of injuries and diseases in athletes prior to a sport-competitive event.

Method:

A cross-sectional and descriptive study was conducted in 39 athletes (12 women; 41.02 ± 14.96 years old [15.4–71.5]) of Southern Chilean teams participating in the Goalball National Championship. Seven questions from a questionnaire about injuries and illnesses during 4 weeks prior to the competition were analyzed through frequency distribution and measures of key trends.

Results:

The prevalence of prior injuries was determined as 64.1% ( n = 25), which influenced training in different ways. Sixty percentage of athletes thought these injuries would affect their performance during the championship. Finally, 25.64% ( n = 10) reported having a disease.

Conclusions:

To our knowledge, this is the first study determining past injuries and illnesses in athletes with visual impairments. This information is important to elaborate preventive strategies and to provide better medical support during competitions.

Implications for practitioners:

The multidisciplinary teams preparing athletes with visual impairments can use this information to develop preventive strategies to reduce injuries, improve sport performance, and provide better medical support during competitions.

Ten Tips to Hurdle the Injuries and Illnesses During Major Athletics Championships: Practical Recommendations and Resources

Participating or winning a medal in major track and field (athletics) competitions is the goal of every athlete. However, health problems can impair sports performance and affect this dream. Therefore, we present ten tips to help hurdle the challenges of illness/injury at major athletics championships: (1) Prepare for travel (medical checking, vaccine, time-zone, jet lag, culture, food habits…), (2) Respect athlete characteristics and discipline specificity (sex, endurance/explosive), (3) Educate athletes and their entourages regarding prevention, (4) Vigilance of painful symptoms and subclinical illness markers, (5) Avoid infection risk (washing hands, safe food and drink, avoid contact with sick people…), (6) Train appropriately and optimally (physical conditioning, technical training, load management, and psychological preparation), (7) Health status (history of previous injuries, well-being in the month before championships), (8) Lifestyle (good sleep, regular hydration and nutrition with safe water/food, regular fruits and vegetables, improve recovery strategies…), (9) Environmental considerations (heat, cold, air cleaning, changes or climatic conditions…), (10) Safety (equipment, rules, own-practice in athletics, and extra-sport activities). These ten tips “PREVATHLES” are based on our field experience in addition to existing epidemiological and experimental literature in athletics and other sports. Although there is currently no scientific evidence for their efficacy, sound judgement, and logical practice provide a strong basis, and given the low risk of using them in the benefit/risk balance, we suggest athletes and those around them follow these ten tips to limit the impact of injury/illness on championship performance.

Close encounters of the US kind: illness and injury among US athletes at the PyeongChang 2018 Winter Olympic Games

Aim

To describe injury and illness incidence during the 2018 Winter Olympic Games (WOG) by Team USA.

Methods

A descriptive observational study. We used registered Team USA Olympic athletes’ electronic medical records to review preparticipation health histories and medical encounters immediately prior to and throughout the 2018 WOG. Medical encounters were defined as all medical services provided by a healthcare provider, including evaluation, treatment and prophylactic services. All medical conditions were described according to International Olympic Committee injury and illness reporting criteria.

Results

Team USA included 134 men and 108 women, aged 18–39 years, who represented 17 sport federations. The 47 Team USA medical staff documented 1744 medical encounters on 242 registered athletes (7.2 medical encounters per athlete). Forty-seven illnesses (194.2/1000 athletes) and 32 time loss injuries (132.2/1000 athletes) were recorded during the Games.

Conclusions

An injury surveillance programme consisting of an electronic preparticipation health history and surveillance of medical encounters during the WOG was used to describe the health status of Team USA. We noted limitations to the surveillance process that can be addressed at future events.

Relation of Team Size and Success With Injuries and Illnesses During Eight International Outdoor Athletics Championships

Introduction: The number of injuries and illnesses during major athletics championships vary according to sex and discipline. They may also differ between countries (national teams) given the differences in training, medical care, nutrition, lifestyle habits, and in travel to the championships. In addition, injuries and illnesses may influence the performance during the championships. Therefore, the aim was to analyse the differences in the injury and illness occurrence during international outdoor athletics championships with regards to the athlete's country, as well as establishing the potential relationships with the success of the country during the respective championships. Method: The national medical teams and the local organizing committee physicians reported all injuries and illnesses daily on a standardized injury and illness report form during 4 World and 4 European outdoor championships from 2007 to 2018. Results were presented as number of registered athletes, injuries, illnesses and medals (absolute and per 1000 registered athletes), and for countries of different team size. Results: During these 8 championships, a total of 219 different countries participated with a total of 13059 registered athletes who incurred 1315 injuries and 550 illnesses. The number of injuries and illnesses per championships varied between countries. Countries with higher numbers of registered athletes had a higher number of injuries and illnesses, as well as a higher number of medals and gold medals. There were significant positive correlations between number of injuries/illnesses and number of registered athletes, medals, gold medals. Injury and illness numbers per 1,000 registered athletes differed between countries and team sizes. Analyzing country participation grouped according to the number of registered athletes, there were significant negative correlations between injury/illness and medals/gold medals per 1,000 registered athletes. Conclusions: Given the correlation between health problems and country size, we suggest that medical services provision and staff should be adapted to the team size. In groups of different country team sizes, lower number of injuries and illnesses per registered athletes were correlated with higher number of medals and gold medals per registered athletes, which can support that injury and illness prevention should be recognized as a win-win performance-prevention strategy.

Sports injury and illness incidence in the PyeongChang 2018 Olympic Winter Games: a prospective study of 2914 athletes from 92 countries

Objective

To describe the incidence of injuries and illnesses sustained during the XXIII Olympic Winter Games, hosted by PyeongChang on 9–25 February 2018.

Methods

We recorded the daily number of athlete injuries and illnesses (1) through the reporting of all National Olympic Committee (NOC) medical teams and (2) in the polyclinic and medical venues by the PyeongChang 2018 medical staff.

Results

In total, 2914 athletes (1210 women, 42%; 1704 men, 58%) from 92 NOCs were observed for occurrence of injury and illness. NOC and PyeongChang 2018 medical staff reported 376 injuries and 279 illnesses, equalling 12.6 injuries and 9.4 illnesses per 100 athletes over the 17-day period. Altogether, 12% of the athletes incurred at least one injury and 9% at least one illness. The injury incidence was highest in ski halfpipe (28%), snowboard cross (26%), ski cross (25%), snowboard slopestyle (21%) and aerials (20%), and lowest in Nordic combined, biathlon, snowboard slalom, moguls and cross-country skiing (2%–6%). Of the 376 injuries recorded, 33% and 13% were estimated to lead to ≥1 day and >7 days of absence from sport, respectively. The highest incidences of illness were recorded in biathlon (15%), curling (14%), bobsleigh (14%) and snowboard slalom (13%). Thirty per cent of the illnesses were expected to result in time loss, and 70% affected the respiratory system. Women suffered 61% more illnesses than men.

Conclusion

Overall, 12% of the athletes incurred at least one injury during the Games and 9% an illness, incidences that are similar to the Olympic Winter Games of 2010 and 2014.

Injury Surveillance and Evaluation of Medical Services Utilized During the 2016 Track and Field Olympic Trials

Background:

Injury surveillance systems have been implemented at world championships, yet no previous work has determined the burden of injuries during the United States Track and Field Olympic Trials. Additionally, the type of medical service providers utilized throughout the meet has not been reported, leaving it unclear whether optimal staffing needs are being met.

Purpose:

To describe the incidence of injuries presenting to the medical team at the 2016 US Track and Field Olympic Trials (Eugene, Oregon) by event type and competitor demographics.

Study Design:

Descriptive epidemiology study.

Methods:

A retrospective review was performed of all documented injuries and treatments recorded from June 28 through July 10, 2016. Descriptive statistics and the prevalence of newly incurred injuries were calculated for registered athletes and nonathlete (ie, support) staff. The incidence of acute injuries was analyzed for registered athletes, as stratified by athlete sex and event type.

Results:

A total of 514 individuals were seen during the trials: 89% were athletes and 11% were supporting staff. Physicians treated 71 injuries and 14 illnesses. Of diagnosed injuries, 85% (n = 60) occurred among athletes, with hamstring strains (16.7%, n = 10) being the most prevalent. A mean of 124 medical services (median, 137; interquartile range, 65.5-179.5) were provided each day of the trials. Among medical services, 41.8% were attributed to massage therapists for athletes, while chiropractic services were the most utilized service (47.1%) by the support staff. There was an overall incidence of 59.7 injuries per 1000 registered athletes, with jumpers (109.4 per 1000) and long-distance athletes (90.4 per 1000) being the most commonly seen athletes.

Conclusion:

Throughout the trials, athletes participating in jumping and long-distance events were the most commonly seen by physicians, creating the potential need for an increase in staffing of physicians during meet periods when these events occur. The provided medical services appeared to follow the number of athletes competing during the trials and the need for recovery treatments after competition. Findings from this study should inform future strategy for staffing and policy development at Olympic Trials and other elite-level track and field events in the United States.

Gymnastics injury incidence during the 2008, 2012 and 2016 Olympic Games: analysis of prospectively collected surveillance data from 963 registered gymnasts during Olympic Games

OBJECTIVE

To determine the incidence and characteristics of injuries in female and male gymnastics disciplines (artistic, rhythmic and trampoline) during three Olympic Games with a view to ultimately improving injury prevention.

METHODS

The National Olympic Committee's head physicians and the medical teams of the Local Organising Committee of the Olympic Games reported daily the occurrence (or non-occurrence) of newly sustained injuries in artistic, rhythmic and trampoline gymnastics on a standardised report form during the 2008, 2012 and 2016 Summer Olympic Games.

RESULTS

During the three Olympic Games, 81 injuries were reported in a total of 963 registered gymnasts, corresponding to an incidence of 84 injuries (95% CI 67 to 102) per 1000 registered gymnasts, with no difference in injury incidence between female and male gymnasts. Thirty-eight per cent of injuries led to time-loss from sport. The most frequent injury location and injury type were the ankle (22%) and sprain (35%), respectively. The most common diagnosis was ankle sprain (14% of all injuries and 23% of time-loss injuries). The injury incidence was highest in female (107±35) and male artistic gymnastics (83±32), followed by female rhythmic gymnastics (73±30), and lower in male (63±69) and female (43±43) trampoline gymnastics.

CONCLUSIONS

Research should focus on preventing injuries in artistic gymnastics and of the condition of ankle sprain. Injury surveillance studies should be continued during major championships and throughout the entire competitive season as the Olympic Games provides only a snapshot (although an important one).

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.

QUESTIONÁRIO DE PRONTIDÃO PARA O ESPORTE COM FOCO NAS LESÕES MUSCULOESQUELÉTICAS

RESUMO Introdução: As lesões esportivas são desordens que têm grande impacto no desempenho do atleta. Objetivo: Desenvolver e validar um questionário de pré-participação em esportes que identifique atletas com fatores de risco ou probabilidade de lesão musculoesquelética, a fim de selecioná-los para avaliação médica especializada. Métodos: Utilizou-se a técnica Delphi, que consiste em reunir informações e chegar a um consenso de especialistas sobre um tema não encontrado na literatura pertinente. A versão inicial do questionário de prontidão para o esporte com foco nas lesões musculoesqueléticas (MIR-Q) foi embasada na experiência do pesquisador nas áreas de ortopedia/traumatologia esportiva e medicina do exercício e do esporte (MEE) e amparada por referenciais teóricos. Resultados: Na fase piloto realizou-se a análise de conteúdo do MIR-Q com avaliação de nove especialistas em MEE. Das sete questões iniciais, houve a retirada da questão cinco. Na primeira rodada da técnica Delphi, 25 especialistas avaliaram as seis questões do MIR-Q. As rodadas de avaliação foram programadas para repetição, caso não se alcançasse o mínimo de concordância de 75% entre as respostas da maioria dos especialistas (mais de 50%) para cada questão, utilizando-se uma escala tipo Likert, com variação de 1 a 5. Na rodada um, três questões foram modificadas, e obteve-se consenso (concordância de 80% a 100%), índice que variou de 75% a 87,5% quanto à reprodutibilidade. A medida da consistência interna do MIR-Q (alfa de Cronbach) foi satisfatória tanto na primeira rodada (0,70) quanto na reprodutibilidade (0,88). Conclusão: Considera-se que o MIR-Q é um instrumento simples e válido, do ponto de vista da validade do conteúdo, para triagem de atletas com possíveis lesões musculoesqueléticas e encaminhamento ao médico especialista.

How much is too much? (Part 1) International Olympic Committee consensus statement on load in sport and risk of injury

Athletes participating in elite sports are exposed to high training loads and increasingly saturated competition calendars. Emerging evidence indicates that poor load management is a major risk factor for injury. The International Olympic Committee convened an expert group to review the scientific evidence for the relationship of load (defined broadly to include rapid changes in training and competition load, competition calendar congestion, psychological load and travel) and health outcomes in sport. We summarise the results linking load to risk of injury in athletes, and provide athletes, coaches and support staff with practical guidelines to manage load in sport. This consensus statement includes guidelines for (1) prescription of training and competition load, as well as for (2) monitoring of training, competition and psychological load, athlete well-being and injury. In the process, we identified research priorities.

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.