Injury and Illness in Elite Athletics: A Prospective Cohort Study Over Three Seasons

Endurance Sporting Events

Endurance sports encompass a broad range of events from marathons and triathlons to ultramarathons, long-distance cycling, skiing, and swimming. As these events have experienced a surge in popularity, we have a greater need to understand the associated medical risks. This article reviews the history of endurance races, reviews the most critical and common causes of cardiovascular, heat, electrolyte, and musculoskeletal injuries/illnesses, and discusses considerations for medical directors/personnel associated with such events.

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.

Epidemiology, etiology and prevention of injuries in competitive ice speed skating-limited current evidence, multiple future priorities: A scoping review

Long-track and short-track ice speed skating are integral to the Winter Olympics. The state of evidence-based injury prevention in these sports is unclear. Our goals were to summarize the current scientific knowledge, to determine the state of research, and to highlight future research areas for injury prevention in ice speed skating. We conducted a scoping review, searching all injury and injury prevention studies in competitive ice speed skaters. The six-stage Translating Research into Injury Prevention Practice (TRIPP) framework summarized the findings. The systematic search yielded 1109 citations. Nineteen studies were included, and additional searches yielded another 13 studies, but few had high-quality design. TRIPP stage 1 studies (n = 24) found competition injury rates from 2% to 18% of participants with various injury locations and types. Seasonal prevalence of physical complaints was up to 84% (for back pain) in long- and short-track. Ten studies covered information on TRIPP stage 2, with two small etiological studies linking injuries to functional strength deficits (short-track) and training load (long-track). Questionnaire studies identified various perceived risk factors for injuries but lacked further scientific evidence. Most TRIPP stage 3 studies (five out of eight) focused on developing protective measures, while two studies found short-track helmets performed poorly compared to helmets used in other sports. No study evaluated the efficacy, the intervention context, or the effectiveness (TRIPP stages 4-6) of the measures. Scientific knowledge on injury prevention in ice speed skating is limited. Future research should prioritize high-quality studies on injury epidemiology and etiology in the sports.

Epidemiology of bone injuries in elite athletics: A prospective 9-year cohort study

OBJECTIVES

To describe bone injury patterns in elite track and field athletes. To investigate relationships between bone injury and athlete characteristics to inform future injury prevention strategies.

DESIGN

Descriptive epidemiology study.

SETTING

Elite athletics training centres across the United Kingdom and internationally, observed between 2012 and 2020.

PARTICIPANTS

207 Olympic programme senior track and field athletes.

MAIN OUTCOME MEASURES

Injury number, Incidence, Severity, Burden, Time Loss.

RESULTS

There were 78 fractures during the study period. Gradual repetitive bone injuries were the most common type of injury mode. The foot, pelvis and the lumbar spine were the regions with the highest number of bone stress injuries. Stress fractures had a higher burden overall compared to stress reactions. Average return to full training was 67.4 days (±73.1) for stress reactions and 199 (±205.2) days for stress fractures. There was no relationship between bone injury type and age, sex, ethnicity, side dominance or event group.

CONCLUSION

Bone stress injuries in athletics have a high severity and burden warranting continued efforts to prevent their occurrence and optimize management. Age, sex, ethnicity, side dominance and event region do not have any relationship with bone injury occurrence and are therefore unlikely to increase risk in this cohort.

"Biofeedback-based return to sport": individualization through objective assessments

Elite athletes are regularly exposed to high and repetitive mechanical stresses and impacts, resulting in high injury rates. The consequences of injury can range from time lost from training and competition to chronic physical and psychological burden, with no guarantee that the athlete will return to preinjury levels of sport activity and performance. Prominent predictors include load management and previous injury, highlighting the importance of the postinjury period for effective return to sport (RTS). Currently, there is conflicting information on how to choose and assess the best reentry strategy. Treating RTS as a continuum, with controlled progression of training load and complexity, seems to provide benefits in this process. Furthermore, objectivity has been identified as a critical factor in improving the effectiveness of RTS. We propose that assessments derived from biomechanical measurements in functional settings can provide the objectivity needed for regular biofeedback cycles. These cycles should aim to identify weaknesses, customize the load, and inform on the status of RTS progress. This approach emphasizes individualization as the primary determinant of RTS and provides a solid foundation for achieving it.

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

Objective

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

Methods

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

Results

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

Conclusions

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

Injuries and Illnesses Across 10 Years of Canada Games Competitions: 2009 - 2019

Background

The Canada Games are a national level competition held every two years alternating between Summer and Winter Games. Participation in elite level athletics, like the Canada Games, have an inherent risk of injury and illness.

Purpose

To analyze the incidence and characteristics of injuries and illnesses during Canada Games competitions from 2009-2019 (primarily) and to understand sex differences in odds of musculoskeletal injury for Summer and Winter Canada Games athletes (secondarily).

Study Design

Descriptive Epidemiology Study.

Methods

Using a retrospective cohort, data were abstracted from medical incident reports generated during Canada Games from 2009 - 2019. Data were coded for body part injured and injury type or illness system; injuries were also categorized as acute or chronic.

Results

Across all 10 years of competition, 3160 injuries reported in 8710 male athletes and 3272 injuries reported in 8391 female athletes. Injury incidence was 362.8 and 389.9 and illness incidence was 47.8 and 64.5 per 1000 male and female athletes, respectively. Female athletes had a 1.12 (95% CI: 1.06; 1.19) greater odds of injury and 1.37 (95% CI: 1.20; 1.57) greater odds of illness compared to male athletes. Overall, injury (399.31 vs. 360.31; p < 0.001) and illness (68.67 vs. 47.30; p < 0.001) incidences were higher in Winter Games, compared to Summer Games, per 1000 athletes. When comparing male and female athletes participating in similar sports, sex specific differences exist in odds of both injury and illness.

Conclusions

Male and female athletes competing in Canada Games competitions demonstrate differences in injury and illness incidence and odds of injury. This suggests a need to examine if additional modifiable risk factors may exist, which could contribute to prevention strategies to reduce injury and illness during Canada Games competition.

Level of Evidence

3.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Sports Obstetrics: Implications of Pregnancy in Elite Sportswomen, a Narrative Review

Increasing numbers of females are participating in elite sports, with a record number having competed at the Tokyo Olympic Games. Importantly, the ages of peak performance and fertility are very likely to coincide; as such, it is inevitable that pregnancy will occur during training and competition. Whilst there is considerable evidence to promote regular exercise in pregnancy, with benefits including a reduction in hypertensive disorders, gestational diabetes, and reduced rates of post-natal depression, few studies have been conducted which include elite athletes. Indeed, there are concerns that high-intensity exercise may lead to increased rates of miscarriage and preterm labour, amongst other pregnancy-related complications. There is minimal guidance on the obstetric management of athletes, and consequently, healthcare professionals frequently adopt a very conservative approach to managing such people. This narrative review summarises the evidence on the antenatal, intrapartum, and postpartum outcomes in elite athletes and provides recommendations for healthcare providers, demonstrating that generally, pregnant athletes can continue their training, with a few notable exceptions. It also summarises the physiological changes that occur in pregnancy and reviews the literature base regarding how these changes may impact performance, with benefits arising from pregnancy-associated cardiovascular adaptations at earlier gestations but later changes causing an increased risk of injury and fatigue.