Acute injuries in track and field athletes: a 3-year observational study at the Penn Relays Carnival with epidemiology and medical coverage implications

Differences in Injury Profiles Between Female and Male Athletes Across the Participant Classification Framework: A Systematic Review and Meta-Analysis

BACKGROUND

Female sex is a significant determinant of anterior cruciate ligament (ACL) injury. It is not understood if sex is a key determinant of other sports-related injuries.

OBJECTIVE

The aim of this systematic review was to identify where differences in injury profiles are most apparent between the sexes in all sports across the six-tiered participant classification framework.

METHODS

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the 'implementing PRISMA in Exercise, Rehabilitation, Sport medicine and SporTs science'(PERSiST) guidance. The databases PubMed, CINAHL, Web of Science, SPORTDiscus, Medline, Scopus, Cochrane Library and EBSCO were searched from database inception to 24 April 2023. Longitudinal, prospective and retrospective cohort studies and cross-sectional and descriptive epidemiology studies that used standard injury data collection were included. Studies were excluded if injuries were not medically diagnosed and if injuries were not reported and/or analysed by sex. Two reviewers independently extracted data and assessed study quality using the Downs and Black checklist.

RESULTS

Overall, 180 studies were included (8 tier-5, 40 tier-4, 98 tier-3, 30 tier-2, 5 tier-1 studies; one study included data in two tiers). Of those, 174 studies were of moderate quality and six studies were of limited quality. In sex-comparable sports, there was moderate evidence that female athletes had greater risk of knee injury (relative risk (RR) 2.7; 95% CI 1.4-5.5), foot/ankle injuries (RR 1.25; 95% CI 1.17-1.34), bone stress injury (RR 3.4; 95% CI 2.1-5.4) and concussion (RR 8.46; 95% CI 1.04-68.77) than male athletes. Male athletes were at increased risk of hip/groin injuries (RR 2.26; 95% CI 1.31-3.88) and hamstring injuries (RR 2.4; 95% CI 1.8-3.2) compared with females, particularly in dynamic sports. Male athletes were 1.8 (1.37-2.7) to 2.8 (2.45-3.24) times more likely to sustain acute fractures than female athletes, with the highest risk in competition.

DISCUSSION

Most studies in all cohorts were of moderate quality (mean/range of scores tier-5: 17 ± 2.2 [14-20], tier-4: 16.9 ± 1.9 [11-21], tier-3: 16.9 ± 1.5 [11-20], tier-2: 16.3 ± 2.2 [11-20], tier-1 studies: 15.6 ± 1.3 [14-17] out of 28 on the Downs and Black checklist), with only six studies of limited quality. Female athletes' propensity for bone stress injuries highlights opportunities to reinforce development of optimal bone health during adolescence and to outline the effects of energy availability. Earlier strength development and exposure to neuromuscular training programmes and modification of skill development in female athletes may be effective strategies for reducing lower limb injury risk. Key components of neuromuscular training programmes could be beneficial for reducing hip/groin and hamstring injury risk in male athletes. There may be a need for sex-specific prevention and return-to-sport protocols for sports-related concussion in female athletes.

CONCLUSIONS

Female sex was a key determinant of sports-related injuries beyond ACL injury including foot/ankle injury, bone stress injury and sports-related concussion. Male sex was a key determinant of hip/groin, hamstring injury and upper limb injury.

TRIAL REGISTRY

PROSPERO registration number: CRD42017058806 (last updated on 7th June 2023).

Health challenges and acute sports injuries restrict weightlifting training of older athletes

Objectives

To quantify acute injuries sustained during weightlifting that result in training restrictions and identify potential risk factors or preventative factors in Master athletes and to evaluate potentially complex interactions of age, sex, health-related and training-related predictors of injuries with machine learning (ML) algorithms.

Methods

A total of 976 Masters weightlifters from Australia, Canada, Europe and the USA, ages 35–88 (51.1% women), completed an online survey that included questions on weightlifting injuries, chronic diseases, sport history and training practices. Ensembles of ML algorithms were used to identify factors associated with acute weightlifting injuries and performance of the prediction models was evaluated. In addition, a subgroup of variables selected by six experts were entered into a logistic regression model to estimate the likelihood of an injury.

Results

The accuracy of ML models predicting injuries ranged from 0.727 to 0.876 for back, hips, knees and wrists, but were less accurate (0.644) for shoulder injuries. Male Master athletes had a higher prevalence of weightlifting injuries than female Master athletes, ranging from 12% to 42%. Chronic inflammation or osteoarthritis were common among both men and women. This was associated with an increase in acute injuries.

Conclusions

Training-specific variables, such as choices of training programmes or nutrition programmes, may aid in preventing acute injuries. ML models can identify potential risk factors or preventative measures for sport injuries.

Injury patterns among national-level athletes in Lebanon: a retrospective study

Objectives:This study aims to assess the annual prevalence, associated factors, and characteristics of musculoskeletal disorders among Lebanese national-level athletes.Methods: Lebanese athletes aged 18 and over and who competed in a top-level national championship during an entire athletics season were invited to participate in the study. Data were collected through questionnaire assessing self-reported injury during the past year. Injury, dependent variable of the study, was defined as a musculoskeletal condition that made the athlete partially or completely abstains from training or competition for a 1-week minimum injury period.Results: Among the 250 eligible athletes, 210 (84.0%) (25.5±6.7 years) completed the questionnaire. The 1-year retrospective injury prevalence was 51.9% (95% confidence interval, 45.1%-58.7%). Injured athletes reported 150 injuries: 128 (85.3%) affected the lower extremities, and 111 (74.0%) occurred during training. The most common type was muscle cramps/spasm (n=53; 35.3%); and overuse (n=121; 80.7%) was the predominant cause. Athletes who mainly practiced endurance disciplines (-p-value=0.042), who participated in international athletics championships (-p-value=0.047), and who were taking chronic medications (-p-value=0.049) had more injuries in the past year.Conclusion: These findings may help inform potential injury prevention programs, which should target injuries affecting the lower extremities, and consider the factors associated with injury risk among Lebanese athletes.

Features of the performance exposure in girls involved in cyclic and acyclic sports

According to the definition adopted by the international biological program, physical performance is characterized by maximum oxygen consumption (MOC). Profession, lifestyle, and sport affect the value of the MOC. For anatomy and physiology, oxygen delivery to muscle tissue depends on the state of the respiratory and cardiovascular system, the amount and composition of blood. In this case, the leading role belongs to the cardiac activity, namely to the magnitude of the shock and minute volumes of blood in working conditions. High values of MOC and, consequently, a large work capacity are characteristic of athletes specializing in cyclic sports with moderate and high power. The purpose of the research was to evaluate the adaptive response of the cardiovascular system of girls involved in cyclic and acyclic sports as well as those not involved in sports. The study was conducted in 2018. During the research, we used pulse oximetry and determination of blood pressure according to N.S. Korotkov, as well as an assessment of the adaptation of the cardiovascular system according to the Ruffier Index. Studies have shown differences in the level of performance of girls involved in cyclic sports (athletics) and acyclic sports (karate and taekwondo), as well as non-sports. During the experiments, heart rate and blood pressure indicators were recorded at rest and after exercise, and the Ruffier Index, which reflects the level of performance of the participants, was calculated.

Injuries in Collegiate Track and Field Jumping: A 2-Year Prospective Surveillance Study

Background:

Athletes participating in track and field jumping events (long jump, triple jump, high jump, and pole vault) are exposed to ground-reaction forces on the takeoff leg that are several times their body weight. This can cause injuries specific to such activities.

Purpose:

To determine the incidence of injuries in collegiate jumpers using the guidelines set forth by a 2014 consensus statement on injury surveillance during track and field events.

Study Design:

Descriptive epidemiology study.

Methods:

A total of 51 jumpers between April 2016 and March 2017 and 54 jumpers between April 2017 and March 2018 participated in this study. All athletes were from a single college in Japan. Baseline information on athletes participating in the long jump, triple jump, high jump, and pole vault was collected at study enrollment. Practice and competition exposures were reported by the team trainer. Injury incidence was calculated as the number of injuries per 1000 athlete-exposures (AEs).

Results:

A total of 147 injuries were reported among 16,998 exposures (8.65 injuries per 1000 AEs). The most common injury locations were the posterior thigh and lateral ankle (17.0%), followed by the posterior foot or toe (12.9%); the most frequent type of injury was strain/muscle rupture/tear (21.1%). The most common injury for long jumpers was ankle sprain (23.3%); for high jumpers, flexor hallucis longus tendinosis (15.8%); and for pole vaulters, hamstring strain (13.2%).

Conclusion:

The overall characteristics are different for each event; therefore, injuries for each event need to be investigated.

Athlete availability and incidence of overuse injuries over an athletics season in a cohort of elite Swedish athletics athletes - a prospective study

Background

Athletics is a sport with a high incidence of injury, where most injuries are caused by overuse. Research on injury incidence and the occurrence of overuse injuries during a season in athletics is scarce. An athlete availability (unrestricted ability to participate in training or competition) of less than 80% has been linked with athletes being less likely to reach their performance goals. The purpose of this study was to estimate the monthly injury incidence rates, athlete availability, and the overuse injury incidence rate per 1000 athletics-hours of training in a cohort of Swedish elite athletics athletes.

Methods

The cohort consisted of 59 male and female elite athletes competing in either middle or long-distance running, sprint, or jumping events. Injury and training data were collected during one athletics season, from October to the end of August. All injury data were collected by medical professionals. Training data were collected monthly, and consisted of event-specific training diaries covering training sessions, training days, and non-training or non-competition days. Monthly injury incidence rates were based on the number of new injuries per month in relation to the number of exposed (injury-free) athletes.

Results

The overall injury incidence rate for all athletes was highest in October (22.0%). Monthly injury incidence rate for middle and long-distance runners was highest in October (26.1%), for sprinters in April (19.0%), and for jumpers in October (21.4%). The overall athlete availability was 78.0% for the cohort. Sprinters had the lowest athlete availability (71.4%), followed by jumpers (77.3%), and middle-distance and long-distance runners (82.7%). Female athletes (76.5%) had a lower athlete availability than male athletes (79.7%). The injury incidence rate was 1.81 injuries per 1000 athletics hours of training. Middle and long-distance runners had the highest injury incidence rate (2.38), followed by jumpers (1.62), and sprinters (1.34).

Conclusion

Monthly injury incidence rates during a season appears to correspond to periods of high training volume (conditioning phases and training camps). The low overall athlete availability (> 80%) indicates that many Swedish elite athletes are less likely to reach their full potential.

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.

Masters or pawns? Examining injury and chronic disease in male Masters Athletes and chess players compared to population norms from the Canadian Community Health Survey

Background

Identifying the optimal type and amount of activity for the maintenance of function in older adults has proved challenging. On the one hand, Masters Athletes have been proposed as the ideal model of successful aging but most of this research has focused on physical functioning. On the other hand, the importance of cognitive engagement has been emphasized, which may be more strongly related to activities such as playing chess. The current study aimed to compare physical health outcomes (i.e., prevalence of physical injury and chronic disease) among older athletes and chess players. Masters Athletes and chess players were recruited from track and field and chess competitions within the province of Ontario. In addition to these primary groups, moderately active and inactive older adults from Canadian Community Health Survey were also included for comparison.

Results

Masters Athletes had significantly higher rates of injury with the lowest rates of chronic disease, compared to all other activity groups. In contrast, chess players reported lower rates of injury compared to Masters Athletes as well as lower prevalence of chronic diseases compared to the moderately active and inactive groups. The normative groups reported the lowest rate of injury, but increased prevalence of chronic diseases compared to Masters Athletes and chess players.

Conclusions

Findings from this study indicate that both athletic and cognitive engagement may be positively related to the physical health of older adults, since Masters Athletes and chess players reported a lower prevalence of chronic disease. Importantly, the results expand our current understanding of health by providing evidence for physical health outcomes associated with an activity that is primarily associated with cognitive health.

Overuse injuries in Swedish elite athletics- a study protocol for a prospective multifactorial cohort study

BACKGROUND

Overuse injuries (OI) are common in elite athletics. Previous studies have had athletes self-report injuries rather than having a medical professional provide a clear diagnosis. This might be a major reason for the inconsistencies in reported incident proportions of OI in elite athletics, in addition to the varying definitions of OI in current literature. Risk factors or combinations of risk factors (biomechanical, clinical, and training-related) have been shown to be important in the developmental process of OI. However, no studies have examined these relationships using a multifactorial and prospective approach in elite athletics. The purpose of this study protocol is to describe OI incidence proportion, injury severity, location, and occurrence during a complete athletics season. Moreover, possible discipline specific and injury specific risk factors that might be associated with OI will be examined.

METHODS

This study will be an explorative prospective cohort study including approximately 120 elite athletes. All athletes will be screened twice during one complete athletics season. The screening will consist of a body composition scan to measure muscle mass, fat free mass, lean mass, bone density, and bone mineral content. In addition, clinical examination will measure range of motion for the lower back, hip, knee, shoulder, and elbow and ankle joints. A running analysis will measure the 3D motions of the hip, knee, and ankle joints. Finally, maximal isometric strength tests of the main core and lower extremity muscles will be carried out. To record injuries, each athlete will consult a physiotherapist or sports medicine doctor affiliated with the study to get a clear diagnosis. Injury data will be recorded according to the previously published athletics consensus statement.

DISCUSSION

Results from this study protocol will contribute more insight and detailed knowledge regarding the extent of OI occurrence among elite athletes during a complete athletics season. It will also provide further insights into which risk factors are associated with the development of OI in elite athletics.

Injury Incidence and Patterns Among Dutch CrossFit Athletes

Background:

CrossFit is a strength and conditioning program that has gained widespread recognition, with 11,000 affiliated gyms worldwide. The incidence of injuries during CrossFit training is poorly analyzed.

Purpose:

To investigate the incidence of injuries for persons participating in CrossFit. Risk factors for injury and injury mechanisms were also explored through athlete demographics and characteristics.

Study Design:

Descriptive epidemiology study.

Methods:

A questionnaire that focused on injury incidence in CrossFit in the past year and included data on athlete demographics and characteristics was distributed to all 130 CrossFit gyms in the Netherlands and was also available online in active Facebook groups. Data were collected from July 2015 to January 2016. Inclusion criteria consisted of age ≥18 years and training at a registered CrossFit gym in the Netherlands. A total of 553 participants completed the survey. Univariable and multivariable generalized linear mixed models were used to identify potential risk factors for injury.

Results:

A total of 449 participants met the inclusion criteria. Of all respondents, 252 athletes (56.1%) sustained an injury in the preceding 12 months. The most injured body parts were the shoulder (n = 87, 28.7%), lower back (n = 48, 15.8%), and knee (n = 25, 8.3%). The duration of participation in CrossFit significantly affected the injury incidence rates (<6 months vs ≥24 months; odds ratio, 3.687 [95% CI, 2.091-6.502]; P < .001). The majority of injuries were caused by overuse (n = 148, 58.7%).

Conclusion:

The injury incidence for athletes participating in CrossFit was 56.1%. The most frequent injury locations were the shoulder, lower back, and knee. A short duration of participation (<6 months) was significantly associated with an increased risk for injury.