Prevalence and Burden of Self-Reported Health Problems in Junior Male Elite Ice Hockey Players: A 44-Week Prospective Cohort Study

Incidence, Prevalence, and Burden of Health Problems in Elite Female Ice Hockey Players-A One-Season Prospective Study

Introduction: Epidemiological studies on elite female ice hockey players are lacking but needed to tailor preventive efforts in this growing group of athletes. Therefore, the aim of this study was to describe the incidence, prevalence, and burden of health problems in elite female ice hockey players. Methods: In this prospective cohort study, we asked all Swedish Women's Hockey League (SWHL) players (N = 207) to report their health status on the OSTRC-H2 weekly throughout the 2022/2023 season (28 weeks). Reported problems were categorized as injuries (acute or overuse) or illnesses and presented as incidence per player season and mean weekly prevalence. Results: A total of 129 players (62% of all SWHL players) provided 2286 health reports with a mean weekly response rate of 67%. Mean weekly prevalence of health problems was 21% (95% confidence interval [CI]: 19-23) (injuries: 15% [95% CI: 14-17] and illnesses: 6% [95% CI: 5-8]). Injury incidence was 2.1 (95% CI: 1.8-2.4) per player season (acute: 1.2 [95% CI: 1.0-1.5] and overuse: 0.8 [95% CI: 0.7-1.1]). Illness incidence was 1.3 per player season (95% CI: 1.1-1.6). Most reported health problems were acute injuries (59.4% of reported injuries). Most common among acute injuries where to the shoulder (15%), head (13%), and knee (11%). The hip/groin was the most reported (35%) and burdensome (49% of severity score) region among overuse injuries. Reported illnesses were mostly represented by respiratory infections (75%). Conclusions: In average, one in five elite ice hockey players reported a health problem at any given time during the season. Results of this study highlight the need to develop and test primary prevention strategies for shoulder, head, and knee injuries and secondary prevention strategies for hip and groin problems.

Why Median Severity and Ordinal Scale Severity Values should not be used for Injury Burden Results: A Critical Review

Injury burden is a composite measure of injury incidence and mean severity; this parameter has been reported as an output measure from injury surveillance studies in rugby for over 20 years. The benefits of reporting injury burden results have, more recently, been recognised in other sports. This wider use of injury burden as an output measure from injury surveillance studies has, however, highlighted misunderstandings about how to calculate, present and interpret injury burden data. The aim of this critical review is to explain why median severity and ordinal severity scales should not be used to calculate and report injury burden results in injury surveillance studies. Equations are presented to show how injury burden results should be calculated, and graphs and tables are presented to explain the errors that are introduced when median severity and ordinal scales of severity are used instead of mean severity. This critical review is intended to highlight the correct procedures for calculating, reporting and interpreting injury burden results in order to avoid incorrect results, conclusions and injury prevention recommendations being published.

Injury Prevalence Among Elite Adolescent Ballet Dancers is not Affected by Frequency of Questionnaire Administration: A 6-Month Exploratory Prospective Study

INTRODUCTION

The Oslo Sports Trauma Research Centre Questionnaire on Health Problems (OSTRC-H) is a valid and reliable registration method for self-reported injuries and is regularly used among dancer populations. Monthly questionnaire administration is acceptable in athlete populations but has not been evaluated in dancers. The aim of this exploratory study was to assess the influence of weekly versus monthly administration of the OSTRC-H on estimated injury outcomes among elite adolescent ballet dancers.

METHODS

Participants (n = 103) were prospectively followed for 6 months and completed the OSTRC-H online, evaluating perceived consequences of self-reported health problems during the previous week and the previous 4 weeks, respectively. Four definitions of dance-related injury were utilized: (1) all complaints, (2) substantial, (3) medical attention, and (4) time-loss injuries. Descriptive statistics estimated: (1) the number of injuries reported (count), (2) average injury prevalence [proportion, 95% confidence intervals (CI)], (3) average severity score (0-100), and (4) days of time loss (count) for each injury definition. The 4 outcome measures were then compared between weekly and monthly registration with paired sample t-tests (P < .05) and overlapping 95% CI.

RESULTS

A significant difference between the number of all complaints injuries (weekly: 133; monthly: 94; P < .001) and substantial injuries (weekly: 64; monthly: 45; P = .012) was found. Regardless of injury definition, there were no significant differences between injury prevalence, severity scores, and days of time loss when reported weekly versus monthly.

CONCLUSION

Monthly administration of the OSTRC-H is an acceptable method to estimate injury prevalence, severity scores, and days of time loss amongst elite adolescent ballet dancers.

Real-world implementation of the Copenhagen Adduction Exercise: what do football teams modify and why?

Objectives

To evaluate the use and modification of the Copenhagen Adduction Exercise in football (soccer) teams, including the reasons for modification and alternate injury-prevention strategies.

Methods

In this cross-sectional study, staff members from a convenience sample of 50 male elite, academy and amateur football teams in Norway, Germany and Austria completed an online questionnaire focussing on the implementation of the Copenhagen Adduction Exercise. Fourteen of the staff members also completed an interview.

Results

Forty-two teams (84%) reported using the Copenhagen Adduction Exercise, but the majority (65%) had modified the original programme. Modifications included changes to sets, repetitions, progressions and frequency and were particularly common among elite teams. The main reasons for modifications were managing overall player load, experiences and beliefs and individualisation. Despite modifications, all teams followed the basic principles of the original programme.

Conclusion

The adoption of the Copenhagen Adduction Exercise by football teams is high, but the vast majority of teams modify the programme. Despite these modifications, the basic principles of the programme are maintained.

A prospective study of injuries and illnesses among 910 amateur golfers during one season

ABSTRACT

Objectives

Our aims were (a) to describe the prevalence and incidence of self-reported injuries and illnesses of amateur golfers over a 5-month period and (b) to investigate potential risk factors for injury.

Methods

We recruited 910 amateur golfers (733 males [81%] and 177 females [19%]) from golf clubs in the USA and Switzerland. The median age was 60 (IQR: 47-67) and the median golfing handicap was 12 (IQR: 6-18). Participants' health was monitored weekly for 5 months using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems. Players also completed a baseline questionnaire on personal and golf-specific characteristics and their medical history.

Results

We distributed 19 406 questionnaires and received 11 180 responses (57.6%). The prevalence of injuries was 11.3% (95% CI: 9.8 to 12.8) and of illnesses was 2% (95% CI 1.7 to 2.2). The incidence of injuries and illnesses was 3.79 (95% CI 3.54 to 4.06) and 0.94 (95% CI 0.81 to 1.07) per golfer per year, respectively. The injury regions with the highest burden of injury (time-loss days per player per year) were lumbosacral spine (5.93), shoulder (3.47) and knee (2.08). Injury risk was higher with increased age, osteoarthritis and previous injury.

Conclusion

The prevalence and incidence of injury and illness in amateur golf were low compared with many other sports. To further reduce the burden of injury, future research attention should be directed towards the lumbosacral spine, knee and shoulder.

What is the Injury Incidence and Profile in Professional Male Ice Hockey? A Systematic Review

BACKGROUND

Professional male ice hockey is characterized by a congested in-season match schedule and by different scenarios where the whole body is exposed to great internal and external forces. Consequently, injuries occur from head to toe. However, there is a lack of data synthesis regarding the injury incidence and profile in this population.

PURPOSE

The aim of this study was to conduct a systematic review to quantify the injury incidence rates in professional male ice hockey.

STUDY DESIGN

Systematic Review.

METHODS

The electronic databases PubMed, CINAHL, Web of Science, ProQuest-Sport medicine & Education Index, and Pro-Quest Dissertation and Thesis were searched utilizing terms related to ice hockey and injuries. Studies were included if they provided the incidence of injury in professional male hockey players and reported injuries in terms of time lost. The modified Newcastle Ottawa Scale for cohort studies and the Strengthening the Reporting of Observational Studies in Epidemiology - Sports Injury and Illness Surveillance Statement were used to assess the methodological quality of the studies.

RESULTS

Eleven studies were included in the review. Match injury incidence ranged from 38 to 88.6 injuries/1000 hours of exposure, whereas training injury incidence varied from 0.4 to 2.6 injuries/1000 hours of exposure. Injuries of traumatic origin accounted for 76% to 96.6% of all injuries, with contusions and lacerations being the most common. Severe injuries accounted for 7.8% - 20% of all injuries. The lower extremities were the most susceptible to injury, comprising 27% to 53.7% of all reported injuries.

CONCLUSION

Professional male ice hockey players are exposed to a substantial risk of injury during competitions, with lower extremities being the most commonly affected body part. The majority of injuries are traumatic and severe injuries account for a notable portion of overall injury cases.

Injury patterns in Swedish elite female and male ice hockey - A cross-sectional comparison of past-season's injuries

OBJECTIVES

To describe and compare seasonal prevalence, anatomical location, severity, and onset of injuries between female and male elite ice hockey players.

DESIGN

Cross-sectional survey study.

SETTING

Elite ice hockey.

PARTICIPANTS

Swedish elite ice hockey players (170 females & 190 males).

MAIN OUTCOME MEASURES

Past season injuries reported on a modified version of the Oslo Sports Trauma Research Center overuse injury questionnaire. Proportions of players who experienced any and substantial problems, as well as respective injury severity scores were presented and compared between sexes.

RESULTS

Highest seasonal prevalence was reported for hip/groin [31.1% (n = 112)], lower back [24.2% (n = 87)], and shoulder injuries [23.6% (n = 85)]. Prevalence of injuries was approximately similar between sexes. Substantial injuries were most prevalent in the hip/groin (13.3% [n = 48]) and knee (18.6% [n = 67]) region. Females reported a higher proportion of substantial hip/groin injuries. Most reported injuries were acute except for hip/groin and lower back injuries (74.4% and 81.8% due to overuse).

CONCLUSION

Seasonal prevalence of injuries in elite ice hockey players were comparable between sexes. Acute injuries were most common but hip/groin as well as lower back injuries were predominantly due to overuse. The highest reported prevalence was found for hip and groin-, lower back-, and shoulder injuries.

Two Minutes for Roughing: A National Analysis of Ice Hockey Injuries from American Trauma Centers

BACKGROUND

Hockey is a high-impact sport that carries a risk of injury. No national-level studies defining the burden of injury in this sport have yet been performed. This study sought to analyze patient demographics, injury types and severity, and outcomes after trauma sustained while playing hockey.

METHODS

Retrospective analysis of hockey-related injuries was performed using the National Trauma Data Bank (NTDB) (2007-2018). Patients were identified based on ICD-9 and -10 codes without exclusions. Demographics, clinical/injury data, and outcomes were examined using univariate analysis. Subgroup analysis was performed by patient sex.

RESULTS

Hockey injuries (n = 306) comprised <1% of the NTDB. Median age was 15 years [IQR 13-25] (range 5-71). Most patients (n = 279, 91%) were male. Lower extremities were the most frequently injured body region (n = 88, 29%). Head injuries occurred in 19% (n = 57). Facial injuries occurred in 6% (n = 17). Tooth loss was infrequent (n = 2, 1%). One (<1%) death occurred after a hockey-related brain injury. Clinical/injury data between male and female hockey players were comparable apart from a significantly higher rate of upper extremity fractures among the female cohort (22% vs 4%, P < .001).

CONCLUSION

Perceptions that hockey players may frequently sustain head, face, and tooth injuries from collisions, fighting, or stick/puck impacts were not supported by this national-level study, in which lower extremity fractures were the most common injury. While hockey injury prevention equipment has primarily focused on head/face protection (eg, helmets and mouthguards), this analysis suggests increased focus on extremity protective measures is warranted.

#ReadyToPlay: health problems in women's football-a two-season prospective cohort study in the Norwegian premier league

OBJECTIVES

To describe the prevalence, incidence and burden of all health problems in the Norwegian women's premier league.

METHODS

During the 2020 and 2021 seasons, players in the Norwegian women's premier league reported all health problems (sudden-onset injuries, gradual-onset injuries and illnesses) weekly, using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems. Team medical staff diagnosed reported problems using the Sport Medicine Diagnostic Coding System. We calculated average weekly prevalence, incidence and burden of all health problems reported.

RESULTS

We included 294 players (age: 22±4 years) from 11 teams. Response rate to the weekly questionnaire was 79%. On average, 32% (95% CI: 31% to 33%) of the players reported at least one health problem at any time and 22% (95% CI: 21% to 23%) reported a substantial health problem negatively affecting their training volume or performance. The overall incidence was 10.7 health problems per 1000 hours of football exposure. Sudden-onset injuries were most severe (68% of the total time loss), followed by gradual-onset injuries (25%) and illnesses (8%). Thigh was the most common injury location (26%), while knee injuries were most severe, causing 42% of the total injury time loss. Anterior cruciate ligament (ACL) injuries alone caused 30% of the total injury time loss.

CONCLUSION

One in five players had a health problem negatively affecting their training volume or performance at any time. Sudden-onset injuries represented the most burdensome health problem. Thigh injuries were most frequent, while knee injuries, ACL injuries especially, were most severe.

Perceived social pressure and intention to play through injuries in junior ice hockey: The sporting environment matters

Playing when injured is a risky yet common business among ice hockey players. Conceptualized within the framework of the theory of planned behaviour, the current cross-sectional study aimed to test a multiple-mediator model linking players' perceived social pressure to their intention to play when injured. We tested whether social pressure is directly and indirectly (via attitudes, subjective norms, perceived behavioural control avoidance, and situational temptation) related to intention to play when injured. We recruited 186 junior players aged 16-20 years (mean age = 17.85; standard deviation = 1.35) from two Norwegian ice hockey leagues (under 18 and under 20 years of age). The data were analysed using a linear regression procedure and a bias-corrected bootstrapping technique to measure indirect effects. The results revealed a positive direct and indirect (via attitudes, subjective norms, and situational temptation) relationship between players' perceived social pressure and their intention to play when injured. In conclusion, players that perceived pressure to play despite being injured, who perceived positive consequences of doing so, who believed that people close or important to them approved of them doing so, and who perceived game-specific temptations, were more likely to report a stronger intent to play the game when injured.

Epidemiology of Acute and Overuse Injuries in Underwater Rugby

Background

Underwater rugby (UWR) is a team sport. Athletes require a high degree of strength, endurance, speed, and coordination involving intense physical contact. Currently, a paucity of literature exists regarding injury occurrence in UWR.

Purpose

To examine the nature and prevalence of acute and overuse injuries in UWR.

Study Design

Descriptive epidemiology study.

Methods

Between November 2020 and March 2021, a total of 720 German UWR athletes were invited to take an online survey developed by orthopaedic specialists with UWR athletes. Data were recorded regarding general and health-related information, training habits, acute injuries that necessitated an interruption in training and/or doctor consultation, as well as overuse injuries. Overuse injuries were evaluated using the Oslo Sports Trauma Research Centre Overuse Injury Questionnaire. Statistical analyses included t tests or rank sum tests depending on normality of distribution. A nonparametric Kruskal-Wallis 1-way analysis of variance on ranks was used for nonnormally distributed data among several groups.

Results

This study included 161 active athletes (mean ± SD, 36.1 ± 11.9 years old; 75.3% male) for analysis, of whom 90.1% were competing regularly. The performance-level distribution was as follows: first German national league (n = 73), second German national league (n = 46), state league (n = 17), district league (n = 1), and no league (n = 24). The mean ± SD sport-specific training workload was 5.6 ± 3.0 h/wk, including UWR training, additional swimming (n = 71; 44.1%), strength (n = 70; 43.5%), and/or endurance training (n = 102; 63.4%). Acute injuries were recorded in 78.9% of all athletes. The most typical locations for acute injuries were hand/finger (42.4%), head/face (concussion, ruptured eardrum; 18.1%), wrist (5.5%), or spine (5.0%). Overuse injuries were reported by 42.9% of the participants. The predominant locations for overuse injuries were hand/finger (18.8%), shoulder/clavicle (14.1%), spine and wrist (10.7% each), head/face (8.7%), and ankle joint and knee (6.7% each).

Conclusion

In the current study, 3 of 4 athletes reported at least 1 acute injury, and 2 of 5 athletes reported at least 1 overuse injury. Leading injury regions were the hand/finger, head/ear, wrist, and spine.

Epidemiology of injuries and illnesses in elite wheelchair basketball players over a whole season - a prospective cohort study

BACKGROUND

Wheelchair basketball is an adaptation of pedestrian basketball and one of the most popular Paralympic sports worldwide. The epidemiology of health problems in wheelchair basketball has been prospectively studied only during the Paralympic Games, the 2018 World Championships, the 2021 South America Wheelchair Basketball Championship, and one season of two American intercollegiate wheelchair basketball teams. The objective of the study was to prospectively monitor and analyze the prevalence, incidence, burden, and characteristics of injuries and illnesses in a wheelchair basketball league during an entire season for the first time.

METHODS

All players of the highest German wheelchair basketball league (Bundesliga) were invited to participate in the study. Included players completed the Oslo Sports Trauma Research Center Questionnaire once a week during the entire season 2020/21 to report health problems. Exposure was captured by self-reported training time and officially-recorded competition time.

RESULTS

Sixty of 117 players (51%, 47 male, 13 female) of the national league participated with an average response of 93%. Seventy health problems (5.5/1000 exposure hours [95% CI: 4.9-6.1]) were reported, including 54 injuries and 16 illnesses. Prevalence of health problems was 60% (95% CI: 48-72). Most injuries affected the shoulder (32% of all injuries), cervical spine/neck (17%), and hand (13%). More overuse injuries (2.9/1000 exposure hours [95% CI: 2.5-3.3]) than acute injuries (1.3/1000 exposure hours [95% CI: 1.0-1.6]) occurred. Of all health problems, 53% were associated with time-loss. The incidences of all health problems, illnesses, injuries, and overuse injuries were higher in women than in men.

CONCLUSIONS

Characteristics and frequency of injuries and illnesses during wheelchair basketball season differed from those during major wheelchair basketball tournaments. The high proportion of overuse injuries and the higher injury rates in women should be regarded in the development of individualized prevention measures. Since results from previous studies during major tournaments are only partially comparable to wheelchair basketball league play, further studies should follow.

Why Median Severity and Ordinal Scale Severity Values should not be used for Injury Burden Results: A Critical Review

Injury burden is a composite measure of injury incidence and mean severity; this parameter has been reported as an output measure from injury surveillance studies in rugby for over 20 years. The benefits of reporting injury burden results have, more recently, been recognised in other sports. This wider use of injury burden as an output measure from injury surveillance studies has, however, highlighted misunderstandings about how to calculate, present and interpret injury burden data. The aim of this critical review is to explain why median severity and ordinal severity scales should not be used to calculate and report injury burden results in injury surveillance studies. Equations are presented to show how injury burden results should be calculated, and graphs and tables are presented to explain the errors that are introduced when median severity and ordinal scales of severity are used instead of mean severity. This critical review is intended to highlight the correct procedures for calculating, reporting and interpreting injury burden results in order to avoid incorrect results, conclusions and injury prevention recommendations being published.

Association of Training and Game Loads to Injury Risk in Junior Male Elite Ice Hockey Players: A Prospective Cohort Study

Background

Training and game loads are potential risk factors of injury in junior elite ice hockey, but the association of training and game loads to injuries is unknown.

Purpose

To investigate the association of chronic training and game loads to injury risk in junior male elite ice hockey players.

Study Design

Cohort study; Level of evidence, 2.

Methods

In this prospective cohort study, we monitored all health problems among 159 male junior ice hockey players (mean age, 16 years; range, 15-19 years) at sports-specific high schools during the 2018-2019 school year. Players reported their health problems every week using the Oslo Sports Trauma Research Center Overuse Questionnaire on Health Problems (OSTRC-H2). The number of training sessions and games was reported for 33 weeks. We calculated the previous 2-week difference in training/game loads as well as the cumulative training/game loads of the previous 2, 3, 4, and 6 weeks and explored potential associations between training/game loads and injury risk using mixed-effects logistic regression.

Results

The players reported 133 acute injuries, 75 overuse injuries, and 162 illnesses in total, and an average of 8.8 (SD ±3.9) training sessions and 0.9 (SD ± 1.1) games per week. We found no association between the difference of the two previous weeks or the previous 2- 3- and 4-week cumulative, training or game load and acute injuries, nor the difference of the two previous weeks, or the previous 4- and 6-week cumulative, training or game load and overuse injuries (OR, ∼1.0; P > .05 in all models).

Conclusion

In the current study of junior elite ice hockey players, there was no evidence of an association between cumulative exposure to training/game loads and injury risk.