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Abstract Injuries are common among athletes, and are sometimes so severe that they affect an athlete’s career in sport. As studies on sport career termination are few, we conducted a study to investigate the role of injuries as a reason for ending a sport career. The study group consisted of 574 male and female top-level cross-country skiers, swimmers, long-distance runners and soccer players who responded to a retrospective postal questionnaire in 2006. Twenty-seven athletes (4.9%, 27/548) reported ending their sport career because of injury. A follow-up interview was conducted by telephone in 2007 (n�20 volunteered to be interviewed) to confirm sport career termination and the reasons for this. Fifteen of the interviewed athletes terminated and five continued their sport on the same level as earlier. Female athletes (12/15) terminated their sport career more frequently than male athletes (3/15). Athletes who reported terminating their sport career because of injury were on average two and a half years older (24.1 years vs. 21.6 years, P�0.006) than athletes who continued the sport. All the swimmers (n�5) who were interviewed terminated their career because of a shoulder injury. All the soccer players who ended their career (n�4) were female and had a severe knee injury, such as anterior cruciate ligament injury. Most of the athletes who terminated their sport career (70.4%, 19/27) reported that the injury caused them mild or moderate permanent disability.We found that sports injuries play a significant role in terminating a career in sport, and in some sports events injuries may commonly be the main reason for sport career termination. Injury prevention and adequate treatment and rehabilitation of injuries are thus essential to avoid the long-term consequences of severe sport injuries. Keywords: Athletic injury, sport career, severe injury
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Sport injuries as the main cause of sport career
termination among Finnish top-level athletes
Leena Ristolainen a , Jyrki A. Kettunen b , Urho M. Kujala c & Ari Heinonen c
a ORTON Orthopaedic Hospital, ORTON Foundation, Tenholantie 10, Helsinki, 00280, Finland
b Arcada, University of Applied Sciences, Jan-Magnus Janssonin aukio 1, Helsinki, 00550,
Finland
c Department of Health Sciences, University of Jyväskylä, PL 35, Jyväskylä, 40014, Finland
Available online: 28 Oct 2011
To cite this article: Leena Ristolainen, Jyrki A. Kettunen, Urho M. Kujala & Ari Heinonen (2011): Sport injuries as
the main cause of sport career termination among Finnish top-level athletes, European Journal of Sport Science,
DOI:10.1080/17461391.2011.566365
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ORIGINAL ARTICLE
Sport injuries as the main cause of sport career termination among
Finnish top-level athletes
LEENA RISTOLAINEN
1
, JYRKI A. KETTUNEN
2
, URHO M. KUJALA
3
, & ARI HEINONEN
3
1
ORTON Orthopaedic Hospital, ORTON Foundation, Tenholantie 10, Helsinki 00280, Finland,
2
Arcada, University of
Applied Sciences, Jan-Magnus Janssonin aukio 1, Helsinki 00550, Finland, and
3
Department of Health Sciences, University
of Jyva
¨skyla
¨, PL 35, Jyva
¨skyla
¨40014, Finland
Abstract
Injuries are common among athletes, and are sometimes so severe that they affect an athlete’s career in sport. As studies on
sport career termination are few, we conducted a study to investigate the role of injuries as a reason for ending a sport career.
The study group consisted of 574 male and female top-level cross-country skiers, swimmers, long-distance runners and
soccer players who responded to a retrospective postal questionnaire in 2006. Twenty-seven athletes (4.9%, 27/548)
reported ending their sport career because of injury. A follow-up interview was conducted by telephone in 2007 (n20
volunteered to be interviewed) to confirm sport career termination and the reasons for this. Fifteen of the interviewed
athletes terminated and five continued their sport on the same level as earlier. Female athletes (12/15) terminated their sport
career more frequently than male athletes (3/15). Athletes who reported terminating their sport career because of injury
were on average two and a half years older (24.1 years vs. 21.6 years, P0.006) than athletes who continued the sport. All
the swimmers (n5) who were interviewed terminated their career because of a shoulder injury. All the soccer players who
ended their career (n4) were female and had a severe knee injury, such as anterior cruciate ligament injury. Most of the
athletes who terminated their sport career (70.4%, 19/27) reported that the injury caused them mild or moderate
permanent disability. We found that sports injuries play a significant role in terminating a career in sport, and in some sports
events injuries may commonly be the main reason for sport career termination. Injury prevention and adequate treatment
and rehabilitation of injuries are thus essential to avoid the long-term consequences of severe sport injuries.
Keywords: Athletic injury, sport career, severe injury
Introduction
Regular physical activity is essential for optimal
functioning and important for health (Kujala,
2004; Kujala, Orava, Parkkari, Kaprio, & Sarna,
2003; Nelson et al., 2007). Injuries are common
among athletes and, in severe cases, can terminate an
athlete?s career in sport. Only a few studies have
investigated the reasons for ending a sport career.
Most of these studies have been quantitative and
have focused on psychological factors such as self-
esteem and life satisfaction (Brown, Gilbourne, &
Claydon, 2009; Perna, Ahlgren, & Zaichkowsky,
1999; Thing, 2006). Some studies have focused on
either male or female athletes (Drawer & Fuller,
2001; So
¨derman, Pietila, Alfredson, & Werner,
2002; Thing, 2006), while studies including both
sexes are rare (Darrow, Collings, Yard, & Comstock,
2009). The role of injuries as a reason for ending a
career in sport has been little studied. Kettunen,
Kujala, Kaprio, Koskenvuo, and Sarna (2001)
reported that every fifth athlete in a sample of
former elite male athletes had terminated their career
because of an injury, and in the study by Drawer and
Fuller (2001) injuries accounted for as many as 47%
of such cases. According to Vuolle (2008), nearly
half of Finnish ice hockey players reported that one
of the reasons for ending their career in sport was an
injury. Studies on this issue have mainly concen-
trated on team sports like soccer (Drawer & Fuller,
2001; So
¨derman et al., 2002), where severe injuries,
Correspondence: Leena Ristolainen, ORTON Orthopaedic Hospital, ORTON Foundation, Tenholantie 10, Helsinki 00280, Finland.
E-mail: leena.ristolainen@orton.fi
European Journal of Sport Science
2011, 19, iFirst article
ISSN 1746-1391 print/ISSN 1536-7290 online #2011 European College of Sport Science
http://dx.doi.org/10.1080/17461391.2011.566365
Downloaded by [Leena Ristolainen] at 04:58 28 October 2011
such as anterior cruciate ligament injuries (ACL),
are more common (So
¨derman et al., 2002; Walden,
Hagglund, Werner, & Ekstrand, 2011). Studies
focusing on athletes who terminate their sport
career, and the influence of injuries on this decision,
are lacking. Our purpose was to investigate the role
of injuries as a reason for ending a sport career
among Finnish top-level athletes drawn from sports
with different types of loading (cross-country skiing,
swimming, long-distance running and soccer).
Methods
The target group of this retrospective injury study
consisted of top-level Finnish male and female
athletes (range 1535 years) representing four dif-
ferent sports and loading modalities (Ristolainen
et al., 2010). The athletes included cross-country
skiers (repetitive loading on upper and lower ex-
tremities), swimmers (repetitive loading on upper
extremities without impact loads), long-distance
runners (repetitive loading on lower extremities)
and soccer players (high risk for impact loads and
sprains). The best Finnish male and female skiers
were identified according to the ranking list of the
Finnish Ski Association. The best swimmers were
recruited according to the Fe´de´ration Internationale
de Nation (FINA) points system in 2005 over
different swimming distances in a 50 m pool and
their names taken from the website of the Finnish
Swimming Association. All the female and male
runners whose personal record in 2005 was better
than the C level in one of the running distances from
1500 m to marathon were included in the study. In
the individual sports, the selected athletes had been
top-ranking at the end of the previous season. All
male and female players who were members of
Finnish Football League teams at the beginning of
2006 were chosen from the list posted on the website
of the Finnish Football League Association (Risto-
lainen et al., 2010).
A sport injury questionnaire was sent at the end of
the competition season to 300 top-ranking cross-
country skiers, 268 swimmers, 265 long-distance
runners and 367 soccer players (21 teams). In cross-
country skiing 11 athletes over 35 years old and in
long-distance running 3 athletes over 35 years old
were excluded. From the soccer players the A
˚land
team and foreign players were excluded, as also were
three male and three female soccer teams with a low
response rate (Ristolainen et al., 2010). Altogether,
639 athletes (59%) responded. Sixty-five of them
returned an empty questionnaire. The final study
group consisted of 149 cross-country skiers, 154
swimmers, 143 long-distance runners and 128
soccer players, 548 of whom responded to this
specific question concerning the end their sport
career.
Postal questionnaire
The questionnaire included separate items on training
hours and frequency of training per week during both
training and competition seasons as well as on the
length of the training and competition seasons. On the
basis of these six questions, the total number of
exposure hours per year was calculated. Injury rates
were reported as number of injuries per 1000 hours of
exposure, combining any type of training exercise and
competition. In addition, the questionnaire included
questions about exercise habits and the specific
reasons for ending the sport career.
The term ‘‘sport career termination’’ was defined
as ending a career in sport at a level where the athlete
has practised and actively competed (Kleiber &
Brock, 1992). A sport career was also considered
terminated where an athlete continued to participate
in the same sports event but at a lower level (less
targeted), or the where the athlete had changed the
event. Severe injury was defined as loss of time from
training and competition of at least three weeks
duration (Arnason et al., 2004).
The term ‘‘acute sports injury’’ definition was
modified from the determinations of Orchard and
Seward (2002) and So
¨derman, Alfredson, and
Pietila (2001) as an injury that occurs suddenly or
accidentally, interrupting an athlete’s training or
ability to compete, or causing an identifiable trauma.
An acute injury is any physical injury that keeps the
athlete away from at least one training session, or
competition, or needs a physician’s care. The term
‘‘overuse injury’’ definition was modified from the
determinations of Beck (1998) and Brukner and
Bennell (1997) and was defined as an injury that
causes pain during exercise loading without any
noticeable external cause of injury. The injury
gradually causes worsening pain during or after
exercise. Pain becomes worse when loading is
continued and may stop exercise completely.
The retrospective questionnaire was validated and
reliability-tested by checking the answers to the
questionnaire at an interview held one week later
among 54 athletes in different sports events (Eloranta
& Tittonen, 2006; Karhula & Pakkanen, 2005).
The reliability of the event and training information
was good or excellent (Intraclass correlation,
ICC0.810.95, PB0.001). The questions of ca-
reer termination and the classification of career
termination were answered identically. Following
the suggestion by Karhula and Pakkanen (2005), the
details of career-terminating injuries were elicited by
interview.
2L. Ristolainen et al.
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Semi-structured telephone inter view
Athletes who reported terminating their sport career
because of injury in the postal questionnaire and
gave permission for further study of their situation
were interviewed by telephone. The interview, with a
questionnaire, was conducted seven to 11 months
after the postal questionnaire, in order to confirm
that they had terminated their sport career and to
confirm their reason for termination. Figure 1 shows
the data collection and distribution of athletes
among the different sports.
The interview included structured and open
questions. Athletes were asked about the injury
that had influenced their decision to end their sport
career, and they were also asked to state any non-
medical reasons. They were asked about possible
injury-induced disability at work, in the home, and
during leisure time, and about injury-related pain
during the previous seven days and use of painkillers.
The athletes were also asked about the frequency
and intensity of leisure time physical exercise. Pain
during the past seven days and disability at work,
home and leisure time was assessed with a 10 cm
visual analogue scale (VAS). The study protocol was
approved by the ethics committee of the University
of Jyva
¨skyla
¨.
Questionnaire, 2006. n = 574
Telephone interview, 2007
n = 20
- Cross-country skiers, n = 149
- Swimmers, n = 154
- Long-distance runners, n = 143
- Soccer players, n = 128
Female n = 312
Male n = 262
(548 athletes answered this question)
Athletes who reported
continuing their sport career
(n = 496)
Female n = 264
Male n = 232
Athletes who ended their sport career
because of injury (n = 27)
- Cross-country skiers, n = 4
- Swimmers, n = 9
- Long-distance runners, n = 7
- Soccer players, n = 7
Female n = 22
Male n = 5
Athletes who reported ending their
sport career (n = 52)
- Cross-country skiers, n = 8
- Swimmers, n = 22
- Long-distance runners, n = 12
- Soccer players, n = 10
Female n = 40
Male n = 12
Athletes who were
continuing their sport
career at the top-level
(n = 5)
Female n = 4
Male n = 1
Athletes who had ended their
sport career (n = 15)
- Cross-country skiers, n = 3
- Swimmers, n = 5
- Long-distance runners, n = 3
-Soccer players, n = 4
Female n = 12
Male n = 3
Athletes who ended their
sport career for reasons other
than injury
(n = 25)
Female n = 17,
Male n = 6
Unknown reason n = 2 (female,
male)
Figure 1. Description of the study group.
Sport injuries as the main cause of sport career termination 3
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Statistical analysis
Statistical analyses were performed with PASW
(version 18.0; SPSS Inc., Chicago, Illinois, USA).
The Pearson chi-square test, t-tests and analysis of
variance were applied to calculate statistical differ-
ences in distributions between the athletes continu-
ing and those terminating their sport career. P5
0.05, two-tailed, was considered a statistically sig-
nificant threshold.
Results
The sport injury questionnaire
According to the questionnaire, 52 (9%) out of 548
athletes reported that they had terminated their
sport career. The proportion of athletes who had
terminated their sport career was higher among the
female (13%, 40/304) than the male athletes (5%,
12/244, PB0.001). Of the athletes who had ended
their sport career, 42% were swimmers, 23% were
long-distance runners, 19% were soccer players and
15% were cross-country skiers. All the soccer players
who did not continue playing were female. Detailed
information on the study group is shown in Figure 1.
A reason for termination was given by 50 athletes.
Slightly over half of them (54%, 27/50) had termi-
nated their sport career because of an injury. Forty-
one percent (11/27) reported acute injury/injuries as
the main or as a contributory reason for termination
(Table I). These injuries comprised severe ligament
injuries and contusions. Fifty-two percent (14/27)
reported overuse injury/injuries as a reason for end-
ing their career (Table I). The injuries in this category
were mainly joint injuries. Two female athletes had
sustained both an acute and an overuse injury.
Details of the anatomical site of injuries are given in
Table I.
Athletes who reported terminating their sport
career because of injury were on average two and
a half years older (24.1 years vs. 21.6 years,
P0.006) than athletes who continued in their
sport (Table II). No difference in age was observed
between female and male athletes who had ended
their sport career. The incidence of acute (3.0 vs.
1.4, P0.015) and overuse injuries (2.8 vs. 1.4,
P0.015) per 1000 exposure hours was higher in
athletes who had terminated their career than in
those who had continued. However, athletes who
had terminated their sport career had participated
in fewer competitions during the past year
(PB0.001) and in fewer training camp days
(P0.008) than those who had continued their
sport career (Table II). Athletes who had ended
their career also reported slightly more time away
from training and competition because of acute
injury (P0.055) and significantly more time away
because of overuse injury (PB0.001) than athletes
who had continued with their sport (Table II).
There were no differences in warming up, cooling
down and stretching between athletes who had
continued their sport and athletes who had ended
their sport because of injury (Table II). Some of the
athletes had to end their career despite a good
ranking position.
Semi-structured telephone inter view
Twenty of the 27 athletes (who had ended their
sport career because of injury) agreed to a tele-
phone interview (Figure 1). Anthropometric, train-
ing, and injury details are shown in Table II. Eleven
of these athletes had terminated their sport career
completely and four athletes had made a come-back
but on a lower level. Five of the twenty athletes
(25%) had subsequently continued their sport
career on the same level as earlier. Two of these
reported minor injuries only, and three had under-
gone surgery and recovered well enough to be able
to continue their sport career. Five of the athletes
who had terminated their sport career had received
surgery, one skier because of a stress fracture, one
swimmer because of injury in the knee region and
three soccer players had undergone ACL surgery.
Table I. Twenty-seven athletes reported an injury as the main or
as a contributory reason for ending their sport career (results from
the questionnaire)
Injury type and anatomical site n%
Acute injuries
No. of injured athletes 11 (40.7)
No. of injuries* 18
Knee$6 (33.3)
Shoulder 2 (11.1)
Low back 2 (11.1)
Ankle 2 (11.1)
Hip 1 (5.6)
Shin 1 (5.6)
Overuse injuries
No. of injured athletes 14 (51.9)
No. of injuries 20
Shoulder 6 (30.0)
Knee 5 (25.0)
Ankle 2 (10.0)
Foot 2 (10.0)
Hip 1 (5.0)
Shin 1 (5.0)
Calf 1 (5.0)
Sole 1 (5.0)
Achilles tendon 1 (5.0)
* One athlete had two acute injuries, but she reported only one
anatomical site for her two acute injur y.
$Three athletes had a recurrent knee injury.
Two female athletes had both an acute and an overuse injur y and
in the case of two athletes the injury type was unknown.
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Altogether, 15 athletes (12 female, 3 male) were
interviewed in detail (Figure 1).
All the swimmers who had ended their career had
sustained a shoulder injury. The diagnoses of
these injuries were various (i.e. fracture/luxation,
nerve compression). One of them also had knee
problems, which might have influenced her decision
to end top-level swimming. All the soccer players
who had terminated were female and all had
sustained an acute knee ligament injury. Three of
them had an ACL injury in both knees. Among the
cross-country skiers the main reason for termination
was stress fracture in the shin or hip region. In the
long-distance runners the injuries had been sus-
tained mainly in the knee or low back. The reasons
for termination were recurrent knee meniscal injury
and patella luxation. Among the athletes who
reported permanently ending their sport career (9/
15) contributory reasons for termination, in addition
to injury, included studying (n4), lack of motiva-
tion (n4) and pregnancy (n1). In 12 athletes
severe acute or overuse injury caused absence from
training and competition of over 30 days duration,
the average being 132 days/year [d/y] (range 30270
days). Details of the athletes terminating their career
are given in Table III.
The athletes had on average visited a physician 1.7
times during the past year because of injury, the most
common of which was a knee injury. Although
two-thirds of the athletes reported pain because of
injury, only 40% reported taking painkillers during
the past twelve months. Only one-third of the athletes
had taken painkillers more than once a week. The
athletes who had ended their career had an average
Table II. Characteristics of athletes who have continued and those who have terminated their sport career because of injury, adjusted for
gender (mean with 95% CI [condence interval])
Athletes who reported to
continue their sport
Postal questionnaire,
in 2006 n=496
Athletes who reported to stop
their sport because of injury
Postal questionnaire,
in 2006 n=27
Mean 95% CI Mean 95% CI P
Age (years) 21.6 21.222.0 24.1 22.425.8 0.006
Height (cm) 174.4 173.9174.9 174.5 172.2176.7 0.966
Weight (kg) 66.3 65.666.9 65.8 62.868.7 0.747
BMI (kg×m
-2
) 21.6 21.521.8 21.6 20.822.3 0.827
Starting training (age) 8.6 8.38.9 10.0 8.611.5 0.064
Active training years (years) (at
least 2 times per week)
11.2 10.811.6 12.0 10.313.6 0.363
Exposure hours (hours/year) 617 592642 622 519726 0.922
Competitions (n/year) 22.6 21.523.7 13.4 8.818.0 B0.001
Camping days (days/year) 21.4 19.423.4 9.2 0.518.0 0.008
Resting days during training
season (days/week)
1.0 0.91.0 1.0 0.81.2 0.906
Resting days during competition
season (days/week)
1.3 1.21.3 1.4 1.11.6 0.436
Acute injuries per 1000
exposure hours
1.4 1.11.7 3.0 1.74.2 0.015
Overuse injuries per 1000
exposure hours
1.4 1.11.6 2.8 1.73.9 0.015
Time-loss because of acute
injuries (average)
33.5 26.141.0 66.0 33.898.1 0.055
Time-loss because of overuse
injuries (average)
27.4 20.933.8 82.7 54.8110.5 B0.001
Warming up before training n(%)* 0.197
Yes 450 (90.9) 24 (88.9)
Occasionally 42 (8.5) 2 (7.4)
No 3 (0.6) 1 (3.7)
Cooling down after training n(%)* 0.140
Yes 408 (82.4) 19 (70.4)
Occasionally 78 (15.8) 8 (29.6)
No 9 (1.8) 0 (0.0)
Stretching* 0.134
Daily 200 (40.6) 6 (22.2)
13 times/week 177 (35.9) 13 (48.1)
Less than 13 times/week 94 (19.1) 5 (18.5)
No stretching 22 (4.5) 3 (11.1)
* without gender adjustment
Sport injuries as the main cause of sport career termination 5
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VAS pain score at the site of injury of 2.9 during the
last seven days.
In 70% of the athletes (19/27) who reported
terminating their sport career because of an injury,
the injury caused them mild or moderate permanent
disability. The VAS scores averaged 1.5 for work-
related and 2.9 for the leisure-related disability.
Although most of the athletes did not have to change
their occupation because of their injury, they had
been on injury-related sick leave for 11.5 days on
average during the past year.
Discussion
Based on our questionnaire study conducted at the
end of the studied season, 27 athletes (5% of the
subjects) reported that they had ended their sport
career because of an injury. More female than male
athletes reported terminating their sport career.
Among the different sport groups, swimmers were
the most prone to end their career and in all cases the
reason was a shoulder injury. Because the swimmers
were young, another common contributory reason
for ending their sport career was to enrol in further
or higher education. All the soccer players who
terminated their sport career were females with
severe knee injuries. The first author interviewed
by telephone 20 of the 27 athletes, who had reported
ending their career, 7 to 11 months after the postal
questionnaire. Five of these (25%) were continuing
their sport career on the same level as earlier. Severe
acute and overuse injuries to the large joints,
shoulder and knee were the most common reasons
for career termination. Seventy percent of the
athletes ending their career reported that injury
caused them mild or moderate permanent disability
in performing activities of daily life.
Nine percent of our athletes reported ending their
sport career after one season, and in 5% of these
athletes the reason for career termination was mainly
or partially an injury. In the study by Kleiber and
Brock (1992) 13% of their sample of athletes had a
career-ending injury. Kettunen et al. (2001) found
that 20% of former male athletes in different sport
events reported that an injury was the main reason
for ending their athletic career. Their follow-up time,
15 years, was much longer than ours, which explains
the larger number of athletes terminating because of
injury. During an athletic career multiple injuries or
recurrent injuries at the same sites may be sustained,
leading eventually to termination of the sport as a
career. In our study we asked athletes about their
sport career covering a 12 month follow-up of
occurrence of injuries with a 7 to 11 month interval
between the postal questionnaire and interview; this
relatively short follow-up may explain the low
number of terminating athletes. Drawer and Fuller
(2001) in their study of male former soccer players
reported that nearly half of the responders had ended
their sport career because of injury, most commonly
an overuse injury. Their study comprised purely
soccer players and soccer players incur more injuries,
especially acute and severe ones, than athletes in
individual sports (Ristolainen et al., 2010). In
Drawer and Fuller (2001) the self-report question-
naire was returned by only 37% of soccer players,
which may influence the results. Most of the injuries
in their study that led to early retirement from sport
were knee injuries. In our study the reasons for
ending the sport were divided equally between acute
and overuse injuries; however, in all the soccer
players the reason was an acute knee injury. Overall,
our findings are in line with the earlier view that
injuries play a significant role in terminating a career
in sport, and in some sports events injuries may
commonly be the main reason for sport career
termination.
Although a high number of sport injuries occur in
different sports each year, such injuries are not
usually severe (Kujala et al., 2003). Severe injury
rates and patterns varied by sport, gender and type of
exposure (Darrow et al., 2009). Nevertheless, severe
injuries also cause considerable loss of training and
competition time (Hagglund, Walden, & Ekstrand,
2006; Ristolainen et al., 2010). Our athletes who
ended their career had significantly more injuries per
1000 exposure hours than those who continued with
the sport. On average they lost over four months
training and competition time during the previous
twelve months. Long absence from a regular exercise
program because of severe injuries may be frustrat-
ing for an athlete. Based on the exposure hours
reported, the injured athletes who had ended their
sport career had continued to train despite their
Table III. Description of the athletes who terminated their sport career (results from the telephone interview)
Sport event Gender Anatomical site Average time-loss from training and competition (days/year)
CCS Female2, Male 1 shin, hip, pelvis 40
Swimming Female4, Male 1 shoulder region, knee 24
LDR Female2, Male 1 low back, hip, knee 80
Soccer Female4 knee 110
CCS: cross-country skiing.
LDR: long-distance running.
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injuries, but they had participated in fewer competi-
tions and training camp days than the athletes who
had continued with their sport. Might it be possible
to focus more specifically on helping athletes who are
physically active but spend long periods away from
competitions and hard training and are consequently
at risk of ending their sport career, to reduce that
risk? Is there a need for better rehabilitation pro-
grams or overall training methods which would
improve the recovery process? This is an issue which
calls for more research.
So
¨derman et al. (2002) reported that 78% of
young female soccer players after 27 years of an
ACL injury had stopped playing soccer, most
commonly because of symptoms in their injured
knee. Among our career-ending athletes all the ACL
injuries had been incurred by female soccer players.
Two of them had an ACL injury in both knees and
three out of five athletes had undergone a knee
operation because of such an injury. Most of our
career-ending athletes with a knee injury reported
pain and disability in squatting, and also difficulty in
jumping. Despite their injuries and symptoms, most
of the athletes continued at least to engage in regular
leisure-time physical activity after ending their sport
career.
In all the sport groups the athletes who terminated
their career were somewhat older than those who
continued. While the mean age of all the cross-
country skiers was high, the oldest age at career
termination was reported by the runners. The
athletes who ended their career had more acute
and overuse injuries that those who continued their
career. The different loading patterns in the different
sports were also associated with the injuries sus-
tained: swimmers had shoulder region injuries,
soccer players knee region injuries, and long-
distance runners and cross-country skiers lower
extremity injuries; the latter were mainly overuse
injuries such as stress fractures. It seems that older
athletes with sport event-specific injuries are at
increased risk for terminating their career.
Previous studies have reported on strategies for
preventing athletic injuries (Hupperets, Verhagen, &
van Mechelen, 2009; Pasanen et al., 2008). The
proper care and management of injured athletes is
essential. This is also a challenge for the athletes
team members: how can rehabilitation and training
programmes be tailored to suit the needs of the
injured athlete? However, if we consider health from
the viewpoint of an athletes later years, it may be
that in the case of some sports injuries the decision to
end a sport career is preferable to rehabilitation and
thus continuation in elite sport. In this connection it
is important for the athlete to know what he/she can
do to reduce the risk of injury. However, one of the
most crucial issues is to find and deploy methods of
preventing severe injuries that may terminate an
athletes career.
The impact of an athletic injury is dependent on a
number of factors such as the nature and severity of
the injury and the importance of sport in the
athletes life. Studies on athletesfear of re-injury
are few and have generally investigated athletes
recovering from severe ACL injury (Chimielewski
et al., 2008; Kvist, Ek, Sporrstedt, & Good, 2005;
Lee, Karim, & Chang, 2008). However, fear of re-
injury is an important psychological factor for
athletes not returning to sport, especially for those
who have sustained a severe injury (Chimielewski
et al., 2008; Kvist et al., 2005; Lee et al., 2008).
Increased fear of movement of an injured anatomical
site could have a negative effect on the efficacy of
exercise treatment and hence on rehabilitation and
recovery (Silbernagel, Brorsson, & Lundberg, 2011).
Athletes who reported a career-ending injury ex-
pressed significantly lower levels of life satisfaction
than their non-injured counterparts (Kleiber &
Brock, 1992; Petitpas & Danish, 1995). However,
other studies, such as that by Perna et al. (1999),
have concluded that athletes with a severe athletic
injury were no less satisfied with their lives than non-
injured or moderately injured athletes. In this study
we did not investigate the effects of the injury on self-
esteem or life satisfaction. However, many athletes
reported decreased motivation as an important
reason to end their sport career alongside their
injury. One reason for loss of motivation may be
the length of the rehabilitation process. It may not
have been effective or may have taken a long time,
and in consequence prevented the athlete from fully
participating in training and competitions. More-
over, many athletes find that they are unable to
return to their previous physical activity level (Ny-
land, Johnson, Caborn, & Brindle, 2002) and are
therefore dissatisfied. It is possible that such athletes
may have overly high or unrealistic expectations of
the effects surgery for a severe injury will have and
therefore are not mentally prepared for the post-
operative demands of rehabilitation (Dekker,
Groothoff, van der Sluis, Eisma, & Ten Duis,
2003; Thomee et al., 2006).
It may also be that gender and other factors such
as embarking on further education may influence the
decision to terminate a career in sport. It may be
hard to combine a strict training regime with
academic studies, and if an athletes performance
has been impaired as a result of injury, choosing to
be educated for an alternative occupation in later life
is understandable. It is also natural for athletes to
want to have a family and children. For female
athletes this means absence from sport during
pregnancy, while after having a child only a few
female athletes retain sufficient enthusiasm to
Sport injuries as the main cause of sport career termination 7
Downloaded by [Leena Ristolainen] at 04:58 28 October 2011
continue their sport career at the top level. In our
study, all the terminating athletes reported that
injury was the main reason for quitting their sport
career. However, because the reasons were the
subjective opinions of the athletes themselves we
cannot be sure that they wholly explain their early
retirement from professional sport.
According to Gabbe, Finch, Bennell, and
Wajswelner (2003) recall accuracy declines as the
level of detail requested increases. However, termi-
nating a sport career is such a ‘‘big thing’’ in an
athletes life that it is unlikely to be forgotten. A
further strength of this study was the telephone
interview by semi-structured questionnaire, which
gave more specific information about the reasons for
ending a sport career. The response rate to the postal
questionnaire was low and it is to be considered a
limitation in this study. Because of the low number
of career-ending athletes there was insufficient power
to perform many statistical analyses.
Conclusion
We found that sports injuries play a significant role in
terminating a career in sport, and, in some sports
events, injuries may commonly be the main reason
for sport career termination. Injury prevention and
adequate treatment and rehabilitation of the injuries
are thus essential to avoid the long-term conse-
quences of severe sport injuries.
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... Identifying the factors associated with injury occurrence is crucial to prevention, allowing the use of appropriate and effective methods to reduce injuries. This issue is especially important for young athletes for whom an injury may impair development or even prematurely end their sports careers [1,2]. They are a particularly vulnerable group due to the increased exposure to injuries [3]. ...
... It is also important to take a multifactorial approach that considers many factors that may contribute to injuries. Minimizing the frequency of injuries is essential for young athletes, for whom an injury at this crucial time in their sport development can significantly inhibit or even disrupt their career [1,2]. Therefore, this study showed an injury connection with movement quality combined with physical performance. ...
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Identifying the factors associated with the injuries is crucial to prevention, enabling apply effective methods to reduce injuries frequency. This is especially important for young athletes for whom an injury may impair development or prematurely end a sports career. Therefore, the objective of this study is to examine if the movement patterns quality and physical performance simultaneously affected injury occurrence in young athletes. The participants were 176 athletes aged 22.44 ± 1.64. The injury data were collected from the 12 months retrospective period. The functional movement screen test was conducted to assess the quality of movement patterns, and the physical performance tests were done for assessing strength, power, flexibility, and balance. Results showed relationships between movement patterns quality and flexibility with injuries. The receiver operating characteristic curve demonstrated growing injury frequency for 14 ≥ FMS and 21 cm ≥ Sit-and-reach test. Rank Transform ANOVA revealed a simultaneous effect of movement quality (F = 11.5361; p = 0.0008) and flexibility (F = 8.0514; p = 0.0050) on an injury. Post-hoc tests indicated that the group with low-quality movement patterns combined with a low level of flexibility is the most frequently injured (p < 0.05). It is recommended to include in training, routine exercises improving movement patterns and flexibility to prevent injuries.
... Along with the physical changes associated with the transition between the state of injury and health, athletes also experience psychosocial changes (Slimani et al., 2018). Common feelings experienced by these athletes include fear of reinjury and losses of identity, support, or motivation, all of which might persist through RTS or even cause the termination of their sports career (Nyland et al., 2002;Kvist et al., 2005;Ristolainen et al., 2012). Research shows that in about 5% of female and male athletes (Ristolainen et al., 2012) to 20% (Kettunen et al., 2001) of elite male athletes, injury is the main reason for career termination, although some studies also report a higher percentage, such as 40 (Drole, 2020) and 50% (Drawer and Fuller, 2001). ...
... Common feelings experienced by these athletes include fear of reinjury and losses of identity, support, or motivation, all of which might persist through RTS or even cause the termination of their sports career (Nyland et al., 2002;Kvist et al., 2005;Ristolainen et al., 2012). Research shows that in about 5% of female and male athletes (Ristolainen et al., 2012) to 20% (Kettunen et al., 2001) of elite male athletes, injury is the main reason for career termination, although some studies also report a higher percentage, such as 40 (Drole, 2020) and 50% (Drawer and Fuller, 2001). ...
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... Injured athletes are at risk of a number of mental health complaints, including anxiety disorder, disordered eating, depression and suicidal ideations (Putukian, 2016). Sport injury is also a leading cause of athletic career termination (Ristolainen et al., 2012). From a competitive standpoint, more injuries equal fewer competitions won (Hägglund et al., 2013). ...
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... One of those reasons is an early career injury that halts the athlete's development. While the field of sports medicine has uncovered a great deal about injury types that affect career trajectories, [46][47][48][49] there remains a scarcity of studies that consider injury as a confounding variable when assessing draft accuracy. Conducting more of such research, whether in the peer-review system or internally by teams, may lead to a better understanding of the factors underlying the success of draft selections. ...
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... It has been suggested that most of these LE-ST injuries occur when the resilience of soft tissue to injury is not enough to enable athletes to tolerate the loading patterns produced during the execution of high intensity dynamic tasks (e.g., cutting, sprinting, and landing) (Kalkhoven et al., 2020). Research has shown that LE-ST injuries can have major negative consequences on a team sport athlete's career (e.g., career termination) (Ristolainen et al., 2012) and can severely affect his/her well-being (Lohmander et al., 2007). Furthermore, when several injuries are sustained, team success (Eirale et al., 2013) and club finances can suffer (Fair and Champa, 2019;Eliakim et al., 2020). ...
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... Shoulder pain is a common musculoskeletal condition 1,2 that may cause functional limitation, 3 impact work productivity and sports performance, 4,5 cause premature sports career termination, 6 and it may be associated with a substantial economic burden. 7 This condition is considered the third most common musculoskeletal disorder, 8 with an estimated annual incidence in the primary medical care of 20.6 per 1000 individuals, and prevalence between 20% and 33% in the general population. ...
Article
Objective To systematically review the effectiveness of electromyographic biofeedback interventions to improve pain and function of patients with shoulder pain. Design Systematic review of controlled clinical trials. Literature search Databases (Medline, EMBASE, CINAHL, PEDro, CENTRAL, Web of Science, and SCOPUS) were searched in December 2020. Study selection criteria Randomized clinical trials that investigated the effects of electromyographic biofeedback for individuals with shoulder pain. Patient-reported pain and functional outcomes were collected and synthesized. Data synthesis The level of evidence was synthesized using GRADE and Standardized Mean Differences and 95% confidence interval were calculated using a random-effects inverse variance model for meta-analysis. Results Five studies were included with a total sample of 272 individuals with shoulder pain. Very-low quality of evidence indicated that electromyographic biofeedback was not superior to control for reducing shoulder pain (standardized mean differences = −0.21, 95% confidence interval: −0.67 to 0.24, P = 0.36). Very-low quality of evidence indicated that electromyographic biofeedback interventions were not superior to control for improving shoulder function (standardized mean differences = −0.11, 95% confidence interval: −0.41 to 0.19, P = 0.48). Conclusion Electromyographic biofeedback may be not effective for improving shoulder pain and function. However, the limited number of included studies and very low quality of evidence does not support a definitive recommendation about the effectiveness of electromyographic biofeedback to treat individuals with shoulder pain.
... Tal y como hemos reflejado anteriormente, los deportistas profesionales y de alto nivel presentan una gran incidencia de lesiones (Leadbetter y Wayne, 2001) que generan una serie de consecuencias negativas; entre ellas el riesgo de sufrir una discapacidad (Jiménez y Huete, 2011), el abandono de la práctica deportiva (Ristolainen et al., 2012), las pérdidas relacionadas con puesto en el equipo, becas, patrocinadores y status (Olmedilla, García y Martínez, 2006), junto al gasto económico que implican para los estados, así en la Unión Europea se estima que anualmente más de diez millones de personas tienen una lesión deportiva que requiere asistencia médica, lo que supone un coste superior a diez billones de euros (Petridou et al., 2003). ...
Chapter
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Las causas principales de las lesiones deportivas tienen como base fundamentalmente los factores físicos (sobreentrenamiento, fatiga, falta de preparación física, caídas, entradas de adversarios, etc.), pero cada vez mayor número de estudios científicos muestran la creciente importancia que los factores psicológicos tienen, tanto en el riesgo de lesionarse, como en la recuperación de la lesión.
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Penelitian ini bertujuan untuk menguji apakah terdapat pengaruh grit terhadap self-determination pada atlet yang memutuskan kembali pasca mengalami cedera berat. Self-Determination Theory memaparkan perkembangan kebutuhan dasar psikologis individu yang sifatnya melekat (inherent) dan dibawa sejak lahir (innate) sebagai faktor motivasi pada perilaku individu. Sedangkan grit mengukur ketertarikan seseorang apakah ia mampu fokus dan bertahan terhadap suatu bidang atau sering berganti-ganti ketertarikan pada suatu bidang tertentu. Partisipan dalam penelitian ini merupakan atlet yang memutuskan kembali pasca cedera berat. Metode yang digunakan dalam penelitian ini merupakan kuantitatif eksplanatori. Pengambilan data diambil menggunakan survei google form dan mendapatkan 72 responden. Hasil dari penelitian ini menunjukan bahwa terdapat pengaruh yang signifikan pada grit terhadap self-determination atlet yang memutuskan kembali pasca cedera berat.
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In the last 30 years, few advances have been made in the management of tibial stress injuries such as tibial stress fracture and medial tibial stress syndrome (MTSS). Tibial overuse injuries are a recognised complication of the chronic, intensive, weight-bearing training commonly practised by athletic and military populations. Generally, the most effective treatment is considered to be rest, often for prolonged periods. This is a course of action that will significantly disrupt an active lifestyle, and sometimes end activity-related careers entirely. There is now considerable knowledge of the nature of tibial stress injuries, such that presently accepted management practices can be critically evaluated and supplemented. Most recent investigations suggest that tibial stress injuries are a consequence of the repetitive tibial strain imposed by loading during chronic weight-bearing activity. Evidence is presented in this article for an association between repeated tibial bending and stress injury as a function of: (i) strain-related modelling (in the case of MTSS), and (ii) a strain-related positive feedback mechanism of remodelling (in the case of stress fracture). Factors that influence the bending response of the tibia to loading are reviewed. Finally, a guide for injury prevention and management based on research observations is presented.
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