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Guevara SA, Crunkhorn ML, Drew M, Waddington G, Périard JD, Etxebarria N, Toohey LA, Charlton P. Injury and illness in short-course triathletes: A systematic review. JOURNAL OF SPORT AND HEALTH SCIENCE 2024; 13:172-185. [PMID: 36898525 PMCID: PMC10980869 DOI: 10.1016/j.jshs.2023.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/04/2022] [Accepted: 01/11/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Determining the incidence and prevalence of injury and illness in short-course triathletes would improve understanding of their etiologies and therefore assist in the development and implementation of prevention strategies. This study synthesizes the existing evidence on the incidence and prevalence of injury and illness and summarizes reported injury or illness etiology and risk factors affecting short-course triathletes. METHODS This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting health problems (injury and illness) in triathletes (all sexes, ages, and experience levels) training and/or competing in short-course distances were included. Six electronic databases (Cochrane Central Register of Controlled Trials, MEDLINE, Embase, APA PsychINFO, Web of Science Core Collection, and SPORTDiscus) were searched. Risk of bias was independently assessed by 2 reviewers using the Newcastle-Ottawa Quality Assessment Scale. Two authors independently completed data extraction. RESULTS The search yielded 7998 studies, with 42 studies eligible for inclusion. Twenty-three studies investigated injuries, 24 studies investigated illnesses, and 5 studies investigated both injuries and illnesses. The injury incidence rate ranged 15.7-24.3 per 1000 athlete exposures, and the illness incidence rate ranged 1.8-13.1 per 1000 athlete days. Injury and illness prevalence ranged between 2%-15% and 6%-84%, respectively. Most injuries reported occurred during running (45%-92%), and the most frequently reported illnesses affected the gastrointestinal (7%-70%), cardiovascular (14%-59%), and respiratory systems (5%-60%). CONCLUSION The most frequently reported health problems in short-course triathletes were: overuse and lower limb injuries associated with running; gastrointestinal illnesses and altered cardiac function, primarily attributable to environmental factors; and respiratory illness mostly caused by infection.
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Affiliation(s)
- Sara A Guevara
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Bruce, ACT 2617, Australia; New South Wales Institute of Sport, Sydney, NSW 2127, Australia
| | - Melissa L Crunkhorn
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Bruce, ACT 2617, Australia; Queensland Academy of Sport, Brisbane, QLD 4111, Australia; Triathlon Australia, Gold Coast, QLD 4227, Australia.
| | - Michael Drew
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Bruce, ACT 2617, Australia
| | - Gordon Waddington
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Bruce, ACT 2617, Australia; Australian Institute of Sport, Bruce, ACT 2617, Australia
| | - Julien D Périard
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Bruce, ACT 2617, Australia
| | - Naroa Etxebarria
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Bruce, ACT 2617, Australia
| | - Liam A Toohey
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Bruce, ACT 2617, Australia; Australian Institute of Sport, Bruce, ACT 2617, Australia
| | - Paula Charlton
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Bruce, ACT 2617, Australia; Triathlon Australia, Gold Coast, QLD 4227, Australia
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Crunkhorn ML, Toohey LA, Charlton P, Drew M, Watson K, Etxebarria N. Injury incidence and prevalence in elite short-course triathletes: a 4-year prospective study. Br J Sports Med 2024:bjsports-2023-107327. [PMID: 38331566 DOI: 10.1136/bjsports-2023-107327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE To characterise the prevalence, incidence rate (IR) and burden of injuries in elite short-course triathletes over a 4-year training and competition period. METHODS Fifty elite Australian triathletes were prospectively monitored for injury during four consecutive seasons (2018-2021). Injuries requiring medical attention were prospectively recorded and further subcategorised according to time loss. The IR and burden (injury IR×mean injury severity) were calculated per 365 athlete days, with sex differences in IR compared using IR ratios (IRR) from negative binomial regression models. RESULTS Two hundred and sixty-six injuries were reported in 46 (92.0%) athletes, of which 67.3% resulted in time loss. The injury IR was 1.87 injuries per 365 athlete days (95% CI 1.70 to 2.80), and comparable between sexes (IRR 0.82, 95% CI 0.64 to 1.04, p=0.109). Most injuries (70.7%) were training related. The most frequently injured body sites were the ankle (15.8%), foot (12.4%) and lower leg (12.0%). Bone stress injuries (BSIs) were the most burdensome injury type with 31.38 days of time loss per 365 days (95% CI 24.42 to 38.34). Twenty athletes (40.0%) reported at least one bone stress injury (BSI) (range 0-3). The rate of BSIs in female athletes was three times greater compared with male athletes (IRR 2.99, 95% CI 1.26 to 7.07, p=0.013). CONCLUSION Two-thirds of injuries reported in elite short-course triathletes resulted in time loss, with the majority occurring during training activities. Foot, ankle and other lower leg injuries had the highest incidence, with BSIs carrying the highest injury burden. The considerably higher rate of BSI observed in female athletes warrants consideration for future prevention strategies in female triathletes.
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Affiliation(s)
- Melissa Leith Crunkhorn
- University of Canberra Research Institute for Sport and Exercise, Canberra, Australian Capital Territory, Australia
- Queensland Academy of Sport, Nathan, Queensland, Australia
| | - Liam Anthony Toohey
- University of Canberra Research Institute for Sport and Exercise, Canberra, Australian Capital Territory, Australia
- AIS Performance, Australian Institute of Sport, Bruce, Australian Capital Territory, Australia
| | - Paula Charlton
- University of Canberra Research Institute for Sport and Exercise, Canberra, Australian Capital Territory, Australia
- Triathlon Australia, Gold Coast, Queensland, Australia
| | - Michael Drew
- University of Canberra Research Institute for Sport and Exercise, Canberra, Australian Capital Territory, Australia
| | - Kate Watson
- Performance Health, Queensland Academy of Sport, Nathan, Queensland, Australia
| | - Naroa Etxebarria
- University of Canberra Research Institute for Sport and Exercise, Canberra, Australian Capital Territory, Australia
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Nilssen PK, Connolly CP, Johnson KB, Cho SP, Cohoe BH, Miller TK, Laird RH, Sallis RE, Hiller WDB. Medical Encounters and Treatment Outcomes in Ironman-Distance Triathlon. Med Sci Sports Exerc 2023; 55:1968-1976. [PMID: 37332229 DOI: 10.1249/mss.0000000000003235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
PURPOSE This study aimed to examine the injury and illness characteristics, treatments, and outcomes at elite ultraendurance triathlon events. METHODS We quantified participant demographics, injury types, treatments, and disposition for medical encounters at 27 Ironman-distance triathlon championships from 1989 to 2019. We then calculated the likelihood of concurrent medical complaints in each encounter. RESULTS We analyzed 10,533 medical encounters among 49,530 race participants for a cumulative incidence of 221.9/1000 participants (95% confidence interval [CI] = 217.7-226.2). Younger (<35 yr; 259.3/1000, 95% CI = 251.6-267.2) and older athletes (70+ yr; 254.0/1000, 95% CI = 217.8-294.4) presented to the medical tent at higher rates than middle-age adults (36-69 yr; 180.1/1000, 95% CI = 175.4-185.0). Female athletes also presented at higher rates when compared with males (243.9/1000, 95% CI = 234.9-253.2 vs 198.0/1000, 95% CI = 193.4-202.6). The most common complaints were dehydration (438.7/1000, 95% CI = 426.2-451.6) and nausea (400.4/1000, 95% CI = 388.4-412.6). Intravenous fluid was the most common treatment (483/1000; 95% CI = 469.8-496.4). Of the athletes who received medical care, 116.7/1000 (95% CI = 110.1-123.4) did not finish the race, and 17.1/1000 (95% CI = 14.7-19.8) required hospital transport. Athletes rarely presented with an isolated medical condition unless their injury was dermatologic or musculoskeletal in nature. CONCLUSIONS Ultraendurance triathlon events have high rates of medical encounters among female athletes, as well as both younger and older age categories. Gastrointestinal and exertional-related symptoms are among the most common complaints. Intravenous infusions were the most common treatment after basic medical care. Most athletes entering the medical tent finished the race, and a small percentage were dispatched to the hospital. A more thorough understanding of common medical occurrences, including concurrent presentations and treatments, will allow for improved care and optimal race management.
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Affiliation(s)
- Paal K Nilssen
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
| | | | - Kasey B Johnson
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
| | - Stephanie P Cho
- College of Education, Washington State University, Pullman, WA
| | - Blake H Cohoe
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
| | | | | | | | - W Douglas B Hiller
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
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Yagi M, Kasanami R, Tarumi Y, Dohi K. Medical Care Management Based on Disaster Medicine for the Triathlon Events at the XXXII Olympiad and Tokyo 2020 Paralympic Games. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6891. [PMID: 37835161 PMCID: PMC10572578 DOI: 10.3390/ijerph20196891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/23/2023] [Accepted: 09/29/2023] [Indexed: 10/15/2023]
Abstract
Planning the medical services for the triathlon competition at the 2020 Tokyo Olympic and Paralympic Games was predicted to be challenging because of possible last-minute changes related to the COVID-19 pandemic and abnormally high temperatures. Therefore, event planners organized and executed a disaster medical care plan, a plan for providing care during emergencies. Based on the basic medical plan for all venues provided by the Tokyo 2020 Organizing Committee, planners for the triathlon venue prepared a medical care plan according to the CSCATTT principles: Command and control, Safety, Communication, Assessment, Treatment, Triage, and Transport. After the event, planners evaluated the number of COVID-19, heatstroke, and injury cases at the venue. The events were conducted without spectators in July and August 2022 because at the last minute, planners held the event without spectators. The triathlon competition involved 638 individuals, including athletes and staff. In total, 7 cases of injuries, 3 cases of mild heatstroke, and 13 other cases were reported, with only 2 requiring emergency transportation. No cases of COVID-19 were reported from the triathlon venue, including during the observation period after the event. This medical plan was effective in preventing heatstroke and COVID-19 cases during the big event. Efficiently and effectively responding to various situations is possible in a shorter period by planning large-scale medical services for such special circumstances according to CSCATTT, a principle of disaster medical care.
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Affiliation(s)
- Masaharu Yagi
- Department of Emergency, Disaster and Critical Care Medicine, School of Medicine, Showa University, Tokyo 142-8666, Japan; (Y.T.); (K.D.)
| | - Ryoji Kasanami
- Department of Health and Physical Education, Faculty of Education, Nara University of Education, Nara 630-8301, Japan;
| | - Yoko Tarumi
- Department of Emergency, Disaster and Critical Care Medicine, School of Medicine, Showa University, Tokyo 142-8666, Japan; (Y.T.); (K.D.)
| | - Kenji Dohi
- Department of Emergency, Disaster and Critical Care Medicine, School of Medicine, Showa University, Tokyo 142-8666, Japan; (Y.T.); (K.D.)
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Health status of recreational runners over 10-km up to ultra-marathon distance based on data of the NURMI Study Step 2. Sci Rep 2022; 12:10295. [PMID: 35717392 PMCID: PMC9206639 DOI: 10.1038/s41598-022-13844-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 05/16/2022] [Indexed: 12/27/2022] Open
Abstract
Endurance running is well-documented to affect health beneficially. However, data are still conflicting in terms of which race distance is associated with the maximum health effects to be obtained. Therefore, the aim of this study was to compare the health status of endurance runners over different race distances. A total of 245 recreational runners (141 females, 104 males) completed an online survey. Health status was assessed by measuring eight dimensions in two clusters of health-related indicators (e.g., body weight, mental health, chronic diseases and hypersensitivity reactions, medication intake) and health-related behaviors (e.g., smoking habits, supplement intake, food choice, healthcare utilization). Each dimension consisted of analytical parameters derived to a general domain score between 0 and 1. Data analysis was performed by using non-parametric ANOVA and MANOVA. There were 89 half-marathon (HM), 65 marathon/ultra-marathon (M/UM), and 91 10-km runners. 10-km runners were leaner than both the HM and M/UM runners (p ≤ 0.05). HM runners had higher health scores for six dimensions (body weight, mental health, chronic diseases and hypersensitivity reactions, medication intake, smoking habits, and health care utilization), which contributed to an average score of 77.1% (score range 62–88%) for their overall state of health. Whereas 10-km and M/UM runners had lesser but similar average scores in the overall state of health (71.7% and 72%, respectively). Race distance had a significant association with the dimension “chronic diseases and hypersensitivity reactions” (p ≤ 0.05). Despite the null significant associations between race distance and seven (out of eight) multi-item health dimensions, a tendency towards better health status (assessed by domain scores of health) among HM runners was found compared to other distance runners. However, the optimal state of health across all race distances supported the notion that endurance running contributed to overall health and well-being. Trial registration number: ISRCTN73074080. Retrospectively registered 12th June 2015.
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Feletti F, Saini G, Naldi S, Casadio C, Mellini L, Feliciani G, Zamprogno E. Injuries in Medium to Long-Distance Triathlon: A Retrospective Analysis of Medical Conditions Treated in Three Editions of the Ironman Competition. J Sports Sci Med 2022; 21:58-67. [PMID: 35250334 PMCID: PMC8851118 DOI: 10.52082/jssm.2022.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 12/07/2021] [Indexed: 06/14/2023]
Abstract
Triathlon's popularity is rapidly increasing, and epidemiological data relating to its related medical conditions is crucial to the development of proper medical plans and safety guidelines for it. This study examined the data from the medical reports collected during three consecutive editions of Ironman Italy, from 2017 to 2019. Out of 10,653 race-starters, 3.3% required medical attention sustaining 472 medical conditions. A significantly higher injury risk was found for females versus males (χ2 = 9.78, p = 0.02) and in long-distance (IR: 4.09/1,000hours) rather than in Olympic/middle distance races (IR: 1.75/1,000hours). Most (68.4%) conditions (including muscular exhaustion, hypothermia, and dehydration) were systemic, whilst only 10.2% were acute traumatic injuries. Of a total of 357 triathletes requiring medical assistance, 8.1% were a candidate for hospitalisation. The equipment and personnel that are required for the medical assistance in future triathlon events were estimated based on Maurer's algorithm, and ten practical recommendations for triathlon medical support were formulated.
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Affiliation(s)
- Francesco Feletti
- Department of Diagnostic Imaging, Ausl Romagna, S. Maria delle Croci Hospital, Ravenna Italy
| | - Gaia Saini
- Department of Emergency, Ausl Romagna, S. Maria delle Croci Hospital, Ravenna, Italy
| | - Stefano Naldi
- Department of Surgery, Unit of Emergency Surgery, S. Maria delle Croci Hospital, Ravenna, Italy
| | - Carlo Casadio
- Associazione dietetica e nutrizione clinica italiana, Rome, Italy
- Comitato di Ravenna, Croce Rossa Italiana, Ravenna, Italy
| | - Lorenzo Mellini
- Department of Diagnostic Imaging, Ausl Romagna, S. Maria delle Croci Hospital, Ravenna Italy
| | - Giacomo Feliciani
- Istituto Scientifico Romagnolo per lo studio e la cura dei tumori - IRCCS, Meldola (FC), Italy
| | - Emanuela Zamprogno
- Critical Care Team I-Help BSO
- Confederazione Nazionale Misericordie d'Italia
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Finch CF, Staines C. Guidance for sports injury surveillance: the 20-year influence of the Australian Sports Injury Data Dictionary. Inj Prev 2017; 24:372-380. [PMID: 29282213 PMCID: PMC6173824 DOI: 10.1136/injuryprev-2017-042580] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 11/21/2017] [Accepted: 11/27/2017] [Indexed: 01/21/2023]
Abstract
Background Injury prevention requires information about how, why, where and when injuries occur. The Australian Sports Injury Data Dictionary (ASIDD) was developed to guide sports injury data collection and reporting. Sports Medicine Australia (SMA) disseminated associated data collection forms and an online tool to practitioners and the sports community. This paper assesses the long-term value, usefulness and relevance of the ASIDD and SMA tools. Methods A systematic search strategy identified both peer-reviewed and grey literature that used the ASIDD and/or the SMA tools, during 1997–2016. A text-based search was conducted within 10 electronic databases, as well as a Google Image search for the SMA tools. Documents were categorised according to ASIDD use as: (1) collected injury data; (2) informed data coding; (3) developed an injury data collection tool and/or (4) reference only. Results Of the 36 peer-reviewed articles, 83% directly referred to ASIDD and 17% mentioned SMA tools. ASIDD was mainly used for data coding (42%), reference (36%), data collection (17%) or resource development (14%). In contrast, 86% of 66 grey literature sources referenced, used or modified the SMA data collection forms. Conclusions The ASIDD boasts a long history of use and relevance. Its ongoing use by practitioners has been facilitated by the ready availability of specific data collection forms by SMA for them to apply to directly their settings. Injury prevention practitioners can be strongly engaged in injury surveillance activities when formal guidance is supported by user-friendly tools directly relevant to their settings and practice.
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Affiliation(s)
- Caroline F Finch
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia
| | - Carolyn Staines
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia
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Abstract
Background: The Ironman 70.3 race is also called a half Ironman, and consists of 1.9 km of swimming, 90.1 km of cycling, and 21.1 km of running. The authors provide practical insights that may be useful for medical support in future events by summarizing the process and results of on-scene medical care. Methods: The medical post was established at the transition area between the cycling and running courses, which was close to the finish line, and staffed with the headquarters team comprised of an emergency physician, an EMT, two nurses, and an ambulance with a driver. The other five ambulances were located throughout the course. The medical staff identified participants according to their numbers when providing medical support, and described complaints, treatment provided, and disposition. When treating non-participants, gender and age were recorded instead of numbers. The treatment records were analyzed after the race. Results: The medical team treated a total of 187 participants. One suffered cramps in the calf muscles during the swimming part of the course. Nineteen were treated for injuries suffered during the cycling race. A total of 159 were treated for injuries on the running course. Five casualties, all of which occurred during the cycling race, required transport to hospital. Conclusions: Medical directors preparing medical support during a triathlon event should expect severe injuries in the cycling course. In hot climates, staff may also suffer from heat injuries as well as runners, and proper attention should be paid to these risks.
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Affiliation(s)
- Hae-Rang Yang
- Department of Emergency Medicine , Dong-A University Hospital , 49201 Seo-Gu DaesinGongwon-Ro 26, Busan, Korea, South
| | - Jinwoo Jeong
- Department of Emergency Medicine , Dong-A University Hospital , 49201 Seo-Gu DaesinGongwon-Ro 26, Busan, Korea, South.,Department of Emergency Medicine , College of Medicine, Dong-A University 49201 Seo-Gu DaesinGongwon-Ro 26, Busan, Korea, South
| | - Injoo Kim
- Department of Emergency Medical Technology, Dong-Eui Institute of Technology, 47230 Busanjin-Gu Yangi-Ro 54, Busan, Korea, South
| | - Ji Eun Kim
- Department of Emergency Medicine , Dong-A University Hospital , 49201 Seo-Gu DaesinGongwon-Ro 26, Busan, Korea, South
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Laskowski-Jones L, Caudell MJ, Hawkins SC, Jones LJ, Dymond CA, Cushing T, Gupta S, Young DS, Starling JM, Bounds R. Extreme event medicine: considerations for the organisation of out-of-hospital care during obstacle, adventure and endurance competitions. Emerg Med J 2017; 34:680-685. [PMID: 28784607 DOI: 10.1136/emermed-2017-206695] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/28/2017] [Accepted: 06/04/2017] [Indexed: 11/03/2022]
Abstract
Obstacle, adventure and endurance competitions in challenging or remote settings are increasing in popularity. A literature search indicates a dearth of evidence-based research on the organisation of medical care for wilderness competitions. The organisation of medical care for each event is best tailored to specific race components, participant characteristics, geography, risk assessments, legal requirements, and the availability of both local and outside resources. Considering the health risks and logistical complexities inherent in these events, there is a compelling need for guiding principles that bridge the fields of wilderness medicine and sports medicine in providing a framework for the organisation of medical care delivery during wilderness and remote obstacle, adventure and endurance competitions. This narrative review, authored by experts in wilderness and operational medicine, provides such a framework. The primary goal is to assist organisers and medical providers in planning for sporting events in which participants are in situations or locations that exceed the capacity of local emergency medical services resources.
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Affiliation(s)
- Linda Laskowski-Jones
- Department of Emergency Medicine, Christiana Care Health System, Newark, Delaware, USA
| | - Michael J Caudell
- Augusta University Medical College of Georgia, Center of Operational Medicine, Augusta, Georgia, USA
| | - Seth C Hawkins
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Lawrence J Jones
- Appalachian Center for Wilderness Medicine, Morganton, North Carolina, USA
| | - Chelsea A Dymond
- University of Queensland Ochsner Clinical Foundation New Orleans, Los Angeles, California, USA
| | - Tracy Cushing
- University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Sanjey Gupta
- Long Island Jewish Medical Center, Emergency Medicine, New Hyde Park, New York, USA
| | - David S Young
- Rush University Medical Center, Chicago, Illinois, USA
| | - Jennifer M Starling
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Richard Bounds
- Department of Emergency Medicine, Christiana Care Health System, Newark, Delaware, USA
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Asplund CA, Miller TK, Creswell L, Getzin A, Hunt A, Martinez J, Diehl J, Hiller WD, Berlin P. Triathlon Medical Coverage: A Guide for Medical Directors. Curr Sports Med Rep 2017; 16:280-288. [PMID: 28696992 DOI: 10.1249/jsr.0000000000000382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Interest and participation in triathlon has grown rapidly over the past 20 yr and with this growth, there has been an increase in the number of new events. To maximize the safety of participation, triathlons require medical directors to plan and oversee medical care associated with event participation. Provision of proper medical care requires knowledge of staffing requirements, common triathlon medical conditions, impact of course design, communication skill, and a familiarity of administrative requirements. These guidelines serve as a tool for triathlon medical and race directors to improve race safety for athletes.
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Affiliation(s)
- Chad A Asplund
- 1Georgia Southern University, Statesboro, Statesboro, GA; 2Sports Medicine, Carilion Clinic; 3Virginia Tech/Carilion School of Medicine; 4Division of Cardiothoracic Surgery, University of Mississippi Medical Center, Jackson, MS; 5Sports Medicine and Athletic Performance Cayuga Medical Center Ithaca, NY; 6University of Chicago Pritzker School of Medicine/Northshore University Healthcare; 7TriRock San Diego, ITU San Diego World Championships Kaiser Permanente Sports Medicine, San Diego, CA; 8Riverside Methodist Sports Medicine, Columbus, OH; 9 ITU Medical Committee, University of Hawaii Medical School, Honolulu, HI; and 10Ironman Triathlon World Championship
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Adherence to Follow-Up Recommendations by Triathlon Competitors Receiving Event Medical Care. Emerg Med Int 2017; 2017:1375181. [PMID: 28203462 PMCID: PMC5288540 DOI: 10.1155/2017/1375181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 09/28/2016] [Accepted: 01/04/2017] [Indexed: 11/23/2022] Open
Abstract
Introduction. We sought to investigate triathlete adherence to recommendations for follow-up for participants who received event medical care. Methods. Participants of the 2011 Ironman Syracuse 70.3 (Syracuse, NY) who sought evaluation and care at the designated finish line medical tent were contacted by telephone approximately 3 months after the initial encounter to measure adherence with the recommendation to seek follow-up care after event. Results. Out of 750 race participants, 35 (4.6%) athletes received event medical care. Of these 35, twenty-eight (28/35; 80%) consented to participate in the study and 17 (61%) were available on telephone follow-up. Of these 17 athletes, 11 (11/17; 65%) of participants reported that they had not followed up with a medical professional since the race. Only 5 (5/17; 29%) confirmed that they had seen a medical provider in some fashion since the race; of these, only 2 (2/17; 12%) sought formal medical follow-up resulting from the recommendation whereas the remaining athletes merely saw their medical providers coincidentally or as part of routine care. Conclusion. Only 2 (2/17; 12%) of athletes who received event medical care obtained postrace follow-up within a one-month time period following the race. Event medical care providers must be aware of potential nonadherence to follow-up recommendations.
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Knechtle B, Nikolaidis PT. [Not Available]. PRAXIS 2017; 106:97-102. [PMID: 28103172 DOI: 10.1024/1661-8157/a002586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Zusammenfassung. Wir berichten über einen 52-jährigen Ironman-Triathleten, der über länger anhaltende Schmerzen im Bereich des linken Gesässes klagte. Therapeutische Bemühungen bei Verdacht auf ein blockiertes Sakroiliakalgelenk bleiben erfolglos. Ein MRI des Beckens zeigte dann eine Fraktur des linken Os ilium. Aufgrund der Bildgebung gehen wir von einem zweizeitigen Geschehen aus mit Frakturbildung nach Manipulation.
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Turris SA, Lund A, Bowles RR, Camporese M, Green T. Patient Presentations and Medical Logistics at Full and Half Ironman Distance Triathlons. Curr Sports Med Rep 2017; 16:137-143. [DOI: 10.1249/jsr.0000000000000367] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Hawley A, Mercuri M, Hogg K, Hanel E. Obstacle course runs: review of acquired injuries and illnesses at a series of Canadian events (RACE). Emerg Med J 2016; 34:170-174. [PMID: 27633344 DOI: 10.1136/emermed-2016-206012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/09/2016] [Accepted: 08/26/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND The growing popularity of obstacle course runs (OCRs) has led to significant concerns regarding their safety. The influx of injuries and illnesses in rural areas where OCRs are often held can impose a large burden on emergency medical services (EMS) and local EDs. Literature concerning the safety of these events is minimal and mostly consists of media reports. We sought to characterise the injury and illness profile of OCRs and the level of medical care required. METHODS This study analysed OCR events occurring in eight locations across Canada from May to August 2015 (total 45 285 participants). Data were extracted from event medical charts of patients presenting to the onsite medical team, including injury or illness type, onsite treatment and disposition. RESULTS There were 557 race participants treated at eight OCR events (1.2% of all participants). There were 609 medical complaints in total. Three quarters of injuries were musculoskeletal in nature. Eighty-nine per cent returned to the event with no need for further medical care. The majority of treatments were completed with first aid and basic medical equipment. Eleven patients (2% of patients) required transfer to hospital by EMS for presentations including fracture, dislocation, head injury, chest pain, fall from height, and abdominal pain. CONCLUSIONS We found that 1.2% of race participants presented to onsite medical services. The majority of complaints were minor and musculoskeletal in nature. Only 2% of those treated were transferred to hospital through EMS. This is consistent with other types of mass gathering events.
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Affiliation(s)
- Alana Hawley
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Mathew Mercuri
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Kerstin Hogg
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Erich Hanel
- Division of Emergency Medicine, Department of Family Medicine, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada
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Decock M, De Wilde L, Vanden Bossche L, Steyaert A, Van Tongel A. Incidence and aetiology of acute injuries during competitive road cycling. Br J Sports Med 2016; 50:669-72. [PMID: 26968218 DOI: 10.1136/bjsports-2015-095612] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2016] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Despite the ever-increasing popularity of bicycle racing, the high perceived risk of acute injuries and the recent media attention, studies of acute injuries in road cyclists are rather scarce. The goal of this study is to evaluate the incidence, aetiology and patterns of acute injuries in non-professional competitive road cyclists during cycling races in Flanders. MATERIAL AND METHODS All acute injuries that occurred during competition in Flanders in 2002 and 2012, collected in the injury registry, were analysed. The incidence, injury rate, diagnosis, circumstances and level of performance were evaluated. RESULTS A total of 777 documented reports of accidents (1230 injuries) were retrieved for the years 2002 and 2012. There was no significant difference between incidence and injury rate between 2002 and 2012. There was a strong significant difference in the incidence between the different levels of performance in both seasons. Severe injuries were seen in 29.5% in 2002 and in 30.1% in 2012. The most common location of a severe injury was the hand. Collision with another rider was the most common cause of injury. CONCLUSIONS Almost 1 out of 6 non-professional competitive road cyclists had an accident during cycling races in 2002 and 2012 in Flanders and collision with other riders was the most important cause of a crash. The most common lesion was abrasion, but almost one out of three riders had a severe injury.
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Affiliation(s)
- Mathieu Decock
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Lieven De Wilde
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Luc Vanden Bossche
- Physical and Rehabilitation Medicine, Sports Medicine Centre, Ghent University Hospital, Belgium
| | - Adelheid Steyaert
- Physical and Rehabilitation Medicine, Sports Medicine Centre, Ghent University Hospital, Belgium
| | - Alexander Van Tongel
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
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Abstract
Although the sport of triathlon provides an opportunity to research the effect of multi-disciplinary exercise on health across the lifespan, much remains to be done. The literature has failed to consistently or adequately report subject age group, sex, ability level, and/or event-distance specialization. The demands of training and racing are relatively unquantified. Multiple definitions and reporting methods for injury and illness have been implemented. In general, risk factors for maladaptation have not been well-described. The data thus far collected indicate that the sport of triathlon is relatively safe for the well-prepared, well-supplied athlete. Most injuries 'causing cessation or reduction of training or seeking of medical aid' are not serious. However, as the extent to which they recur may be high and is undocumented, injury outcome is unclear. The sudden death rate for competition is 1.5 (0.9-2.5) [mostly swim-related] occurrences for every 100,000 participations. The sudden death rate is unknown for training, although stroke risk may be increased, in the long-term, in genetically susceptible athletes. During heavy training and up to 5 days post-competition, host protection against pathogens may also be compromised. The incidence of illness seems low, but its outcome is unclear. More prospective investigation of the immunological, oxidative stress-related and cardiovascular effects of triathlon training and competition is warranted. Training diaries may prove to be a promising method of monitoring negative adaptation and its potential risk factors. More longitudinal, medical-tent-based studies of the aetiology and treatment demands of race-related injury and illness are needed.
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Affiliation(s)
- Veronica Vleck
- CIPER, Faculty of Human Kinetics, University of Lisbon, Estrada da Costa, Cruz Quebrada-Dafundo, 1499-002, Portugal,
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Cong Y, Lam WK, Cheung JTM, Zhang M. In-shoe plantar tri-axial stress profiles during maximum-effort cutting maneuvers. J Biomech 2014; 47:3799-806. [PMID: 25468303 DOI: 10.1016/j.jbiomech.2014.10.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 10/20/2014] [Accepted: 10/21/2014] [Indexed: 12/30/2022]
Abstract
Soft tissue injuries, such as anterior cruciate ligament rupture, ankle sprain and foot skin problems, frequently occur during cutting maneuvers. These injuries are often regarded as associated with abnormal joint torque and interfacial friction caused by excessive external and in-shoe shear forces. This study simultaneously investigated the dynamic in-shoe localized plantar pressure and shear stress during lateral shuffling and 45° sidestep cutting maneuvers. Tri-axial force transducers were affixed at the first and second metatarsal heads, lateral forefoot, and heel regions in the midsole of a basketball shoe. Seventeen basketball players executed both cutting maneuvers with maximum efforts. Lateral shuffling cutting had a larger mediolateral braking force than 45° sidestep cutting. This large braking force was concentrated at the first metatarsal head, as indicated by its maximum medial shear stress (312.2 ± 157.0 kPa). During propulsion phase, peak shear stress occurred at the second metatarsal head (271.3 ± 124.3 kPa). Compared with lateral shuffling cutting, 45° sidestep cutting produced larger peak propulsion shear stress (463.0 ± 272.6 kPa) but smaller peak braking shear stress (184.8 ± 181.7 kPa), of which both were found at the first metatarsal head. During both cutting maneuvers, maximum medial and posterior shear stress occurred at the first metatarsal head, whereas maximum pressure occurred at the second metatarsal head. The first and second metatarsal heads sustained relatively high pressure and shear stress and were expected to be susceptible to plantar tissue discomfort or injury. Due to different stress distribution, distinct pressure and shear cushioning mechanisms in basketball footwear might be considered over different foot regions.
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Affiliation(s)
- Yan Cong
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Wing Kai Lam
- Li Ning Sports Science Research Center, Beijing, China
| | | | - Ming Zhang
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
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Orchard JW, Blanch P, Paoloni J, Kountouris A, Sims K, Orchard JJ, Brukner P. Fast bowling match workloads over 5-26 days and risk of injury in the following month. J Sci Med Sport 2014; 18:26-30. [PMID: 25245426 DOI: 10.1016/j.jsams.2014.09.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 07/18/2014] [Accepted: 09/01/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES This study examined whether high match fast bowling workloads in the short to medium term were associated with increased bowling injury rates. DESIGN Prospective cohort study. METHODS Over a 15 year period, workload patterns for 235 individual fast bowlers during time periods from 5 to 26 days were examined to consider whether there was an increased injury rate during the month (28 days) subsequent to the workload. RESULTS Fast bowlers who bowled more than 50 match overs in a 5 day period had a significant increase in injury over the next month compared to bowlers who bowled 50 overs or less RR 1.54 (95% CI 1.04-2.29). For periods ranging from 12 to 26 days, there was no statistically-significant increase in injury over the next month from exceeding thresholds of certain amounts of overs, although bowlers who bowled more than 100 overs in 17 days had a non-significant increase in injury over the next month RR 1.78 (95% CI 0.90-3.50). CONCLUSION There were no statistically-significant increases in subsequent injury risk for high workloads for periods of 12-26 days, although exceeding 100 overs in 17 days (or less) was associated with higher injury rates. Compression of cricket fixtures is likely to have only a minimal contribution to increased fast bowling injury rates being seen in the T20 era (along with sudden workload increases due to transferring between forms of the game, which has been previously established as a major contributor).
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Affiliation(s)
- John W Orchard
- School of Public Health, University of Sydney, Australia; Cricket Australia, Melbourne, Australia.
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Influence of individual energy cost on running capacity in warm, humid environments. Eur J Appl Physiol 2013; 113:2587-94. [PMID: 23877484 DOI: 10.1007/s00421-013-2696-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 07/10/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Challenging environmental conditions including heat and humidity are associated with particular risks to the health of runners and triathletes during prolonged events. The heat production of a runner is the product of its energy cost of running (C r) by its velocity. Since C r varies greatly among humans, those individuals with high C r are more exposed to heat stress in warm and humid conditions. Although risk factor awareness is crucial to the prevention of heat stroke and potential fatalities associated therewith, how C r affects the highest sustainable velocity (V) at which maximal heat loss matches heat production has not been quantified to date. METHODS Here, we computed in virtual runners weighting 45-75 kg, the influence of C r variability from 3.8 to 4.4 J·m(-1)·kg(-1) on V. Heat loss by radiation, convection, and conduction was assessed from known equations including body dimensions, running velocity (3.4-6.2 m·s(-1)), air temperature (T a, 10-35 °C) and relative humidity (r h, 50, 70 and 90 %). RESULTS We demonstrated a marked and almost linear influence of C r on V in hot and humid conditions: +0.1 J·kg(-1)·m(-1) in C r corresponded to -4 % in V. For instance, in conditions 25 °C r h 70 %, 65-kg runners with low C r could sustain a running speed of 5.7 m·s(-1) as compared to only 4.3 m·s(-1) in runners with high C r, which is huge. CONCLUSION We conclude that prior knowledge of individual C r in athletes exposed to somewhat warm and humid environments during prolonged running is one obvious recommendation for minimizing heat illness risk.
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Rendos NK, Harrison BC, Dicharry JM, Sauer LD, Hart JM. Sagittal plane kinematics during the transition run in triathletes. J Sci Med Sport 2013; 16:259-65. [DOI: 10.1016/j.jsams.2012.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 04/02/2012] [Accepted: 06/23/2012] [Indexed: 10/28/2022]
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Abstract
OBJECTIVE To explore stakeholder perceptions of triathlon competition safety and injury risk. DESIGN Qualitative focus group study. SETTING Triathlon stakeholders from Melbourne, Australia. PARTICIPANTS Competition organizers, coaches, and competitors of various skill levels, age, gender, and experience (n = 18). INTERVENTIONS Focus groups were conducted, recorded, and transcribed for analysis. MAIN OUTCOME MEASURES Key themes were identified using content analysis. RESULTS The perceived risk of serious injury was highest for cycling. Running was most commonly linked to minor injuries. Physical and environmental factors, including course turning points, funneling of competitors into narrow sections, and the weather, were perceived as contributing to injury. Experience, skill level, feelings of vulnerability, personal awareness, club culture, and gender issues were perceived as the competitor-related factors potentially contributing to injury. The cycling mount/dismount area, cycling, and swim legs were the race sections perceived as the riskiest for competitors. Competition organizers were considered to generally have the competitors' best interest as a priority. Triathlons were acknowledged as risky activities and individual competitors accepted this risk. CONCLUSIONS This study has highlighted the main risks and concerns perceived by triathlon competitors, coaches, and competition organizers, which will help identify potential, context-relevant intervention strategies to reduce injury risk.
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Health professionals' perceptions of musculoskeletal injury and injury risk factors in Australian triathletes: a factor analysis. Phys Ther Sport 2012. [PMID: 23177357 DOI: 10.1016/j.ptsp.2012.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study investigated health professional perceptions of triathlon-related injury risk factors and injury prevention strategies, to inform prospective cohort studies investigating injury in triathletes. DESIGN Exploratory factor analysis. METHODS A questionnaire was developed and distributed to Australian sports medicine health professionals (n = 504). Information was collected about their perceptions of factors contributing to injury and injury prevention strategies relating to Sprint/Olympic (S/O) and Ironman/Long Course (I/LC) athletes. Factor analysis was performed to identify the number and nature of the constructs (factors) underlying the responses to the questions, and to ascertain whether these factors were similar for S/O and I/LC athletes. RESULTS The response rate was 22.4% (n = 113). Five factors were extracted for injury risk accounting for 53% (S/O) and 56% (I/LC) of the variance. The factors were common across S/O and I/LC groups; biomechanics and technique, training factors, demographics, injury prevention and personal factors. Three common factors accounted for 54% (S/O) and 55% (I/LC) of the variance for injury prevention strategies; designated training regimes, health and medical monitoring and preparation of the triathlete. CONCLUSIONS These results indicate that future studies into triathlon injuries should include, at a minimum, detailed training load and demographic factors to test their impact as injury risk factors in triathlete populations.
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Abstract
OBJECTIVE To (1) classify types and severity of injuries, (2) establish a temporal model for both the incidence and prevalence of injuries, and (3) identify the most appropriate medical manpower needed for nonelite triathlon competition. DESIGN Prospective observational study. SETTING Oklahoma City Redman Triathlon. PARTICIPANTS One hundred four triathletes seeking medical care (575 race starters). MAIN OUTCOME MEASURES Prevalence and diagnoses of athletes seeking medical care, 15-minute injury incidence reports with severity classification, and duration of treatment. RESULTS The prevalence of injuries sustained was 37.7% and 10.8% in the Ironman and half Ironman events, respectively. 72.2% of half Ironman injuries were sustained during hours 6 and 7, with a presentation rate of 78 per 1000 race starters during this time interval. The Ironman had a much higher rate of severe injuries at 38.2% ± 6.0% (95% confidence interval) and a longer average duration of treatment culminating in hour 14 at 62.3 minutes. CONCLUSIONS Triathlon medical support should be modified to fit the temporal flow of injuries sustained throughout nonelite Ironman events. Previous studies have made recommendations from data collected from elite competitions that may not be ideal for nonelite races due to the higher rate of injuries, injury severity, and longer duration competition. Therefore, we recommend increasing support by 20% during the latter stages of triathlons, starting at hour 14, to 3 physicians and 9 nurses and other medical volunteers per 100 competitors. Further research into the implementation of these strategies should be performed before these data should be applied as common practice.
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Current world literature. Curr Opin Allergy Clin Immunol 2011; 11:150-6. [PMID: 21368622 DOI: 10.1097/aci.0b013e3283457ab0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Migliorini S. Risk factors and injury mechanism in Triathlon. JOURNAL OF HUMAN SPORT AND EXERCISE 2011. [DOI: 10.4100/jhse.2011.62.11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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