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Managing the health of the elite athlete: A new integrated performance health management and coaching model

April 2014
British Journal of Sports Medicine 48(7):523-31

DOI:10.1136/bjsports-2013-093222

Source
PubMed

Authors:

Paul Dijkstra

Aspetar - Qatar Orthopaedic and Sports Medicine Hospital

Noel Pollock

Rob Chakraverty

Private Practice UK

Juan Manuel Alonso

Aspetar - Qatar Orthopaedic and Sports Medicine Hospital

Elite athletes endeavour to train and compete even when ill or injured. Their motivation may be intrinsic or due to coach and team pressures. The sports medicine physician plays an important role to risk-manage the health of the competing athlete in partnership with the coach and other members of the support team. The sports medicine physician needs to strike the right ethical and operational balance between health management and optimising performance. It is necessary to revisit the popular delivery model of sports medicine and science services to elite athletes based on the current reductionist multispecialist system lacking in practice an integrated approach and effective communication. Athlete and coach in isolation or with a member of the multidisciplinary support team, often not qualified or experienced to do so, decide on the utilisation of services and how to apply the recommendations. We propose a new Integrated Performance Health Management and Coaching model based on the UK Athletics experience in preparation for the London Olympic and Paralympic Games. The Medical and Coaching Teams are managed by qualified and experienced individuals operating in synergy towards a common performance goal, accountable to a Performance Director and ultimately to the Board of Directors. We describe the systems, processes and implementation strategies to assist the athlete, coach and support teams to continuously monitor and manage athlete health and performance. These systems facilitate a balanced approach to training and competing decisions, especially while the athlete is ill or injured. They take into account the best medical advice and athlete preference. This Integrated Performance Health Management and Coaching model underpinned the Track and Field Gold Medal performances at the London Olympic and Paralympic Games.

Mo Farah with his coach, physiotherapist and physiologist at the warm-up track, London 2012 Olympic Games.

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The Integrated Performance Health Management and Coaching Model. All the specialties operate in the performance health and coaching ‘box’. Health (injury, illness and prevention) is managed by specialist sports medicine physicians (led by the CMO/Medical Director); coaching is managed by the Head Coach. Both departments are managed by the Performance Director or (CEO) depending on the structure and size/culture of the organisation/club. The health and coaching departments operate in synergy and also ‘independently’ with appropriate autonomy at times. All professional service providers are independently registered and professionally governed by the relevant Professional Bodies like the General Medical Council and the Faculty of Sport and Exercise Medicine for physicians in the UK. CEO, Chief Executive Officer; CMO, Chief Medical Officer; GP, general practitioner.

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A model for structuring medical and science services and function—based on aspects of the current and previous (2009–2012) UK Athletics Performance Department model. CEO, Chief Executive Officer; GP, general practitioner.

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The UKA Health and Performance Passport—the 10 Golden Commandments. UKA, UK Athletics.

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A) Poster emphasising the importance of reducing the risk of untimely illness. (B) Poster emphasising the importance of quality sleep. (Photos and design: Anita Mann and Scott Davies.)

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Factors Influencing Team Performance: What Can Support Teams in High-Performance Sport Learn from Other Industries? A Systematic Scoping Review

Article

Full-text available

Dec 2022

Background The primary aim of our systematic scoping review was to explore the factors influencing team function and performance across various industries and discuss findings in the context of the high-performance sport support team setting. These outcomes may also be used to inform future research into high-performance teamwork in sport. Methods A systematic scoping review of literature published in English since 2000 reporting team-based performance outcomes and included a performance metric that was ‘team outcome based’ was conducted using search of the Academic Search Ultimate, Medline, Business Source Ultimate, APA PsycInfo, CINAHL, SPORTDiscus, and Military database (ProQuest) using the terms: ‘team’, ‘function’ OR ‘dysfunction’, ‘Perform*’ OR ‘outcome’. Results Application of the search strategy identified a total of 11,735 articles for title and abstract review. Seventy-three articles were selected for full-text assessment with the aim to extract data for either quantitative or qualitative analysis. Forty-six of the 73 articles met our inclusion criteria; 27 articles were excluded as they did not report a performance metric. Eleven studies explored leadership roles and styles on team performance, three studies associated performance feedback to team performance, and 12 studies explored the relationship between supportive behaviour and performance. Team orientation and adaptability as key figures of team performance outcomes were explored in 20 studies. Conclusions Our findings identified 4 key variables that were associated with team function and performance across a variety of industries; (i) leadership styles, (ii) supportive team behaviour, (iii) communication, and (iv) performance feedback. High-performance teams wishing to improve performance should examine these factors within their team and its environment. It is widely acknowledged that the dynamics of team function is important for outcomes in high-performance sport, yet there is little evidence to provide guidance. This inequality between real-world need and the available evidence should be addressed in future research.

Athlete monitoring practices in elite sport in the United Kingdom

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Jun 2022

Athlete monitoring systems (AMS) aid performance optimisation and support illness/injury prevention. Nonetheless, limited information exists on how AMS are employed across elite sports in the United Kingdom. This study explored how athlete monitoring (AM) data, in particular athlete self-report measures, were collected, analysed and disseminated within elite sports. Thirty elite sports practitioners representing 599 athletes responded to a survey on their AM methodologies. The majority, 83%, (n = 25) utilised an AMS, and a further 84% (n = 21) stated the collection of their AMS data was underpinned by a scientific rationale. Athlete self-report measures (ASRM) were the most commonly employed tool, with muscle soreness, sleep and energy levels amongst the most frequently collected measures. The ubiquitous use of custom single-item ASRM resulted in considerable variability in the questionnaires employed, thus potentially impacting questionnaire validity. Feedback processes were largely felt to be ineffective, with 44% (n = 11) respondents indicating that athletes did not receive sufficient feedback. Some respondents indicated that AMS data was never discussed with athletes and/or coaches. Overall, significant disparities exist in the use of athlete monitoring systems between research and elite sports practice, and the athlete, coach and practitioner experience of monitoring risks being poor if these disparities are not addressed.

Time to return to full training and recurrence of rectus femoris injuries in elite track & field athletes 2010‐2019; a 9‐year study using the British Athletics Muscle Injury Classification

Article

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Jul 2022
SCAND J MED SCI SPOR

Rectus femoris (RF) injuries are common in sports requiring maximal acceleration and sprinting. The British Athletics Muscle Injury Classification (BAMIC) describes acute muscle injury based on the anatomical site of injury and has been associated with return to play in hamstring and calf muscle injury. The aim of this study was to describe and compare the time to return to full training (TRFT) and injury recurrence for BAMIC‐classified RF injuries sustained by elite track and field (T&F) athletes over a 9‐year period. All rectus femoris injuries sustained by elite T&F athletes on the British Athletics World Class Program between September 2010 and September 2019 that were investigated with an MRI within 7 days of acute onset anterior thigh pain were included. Injuries were graded from the MRI by a specialist musculoskeletal radiologist using the BAMIC, and TRFT and injury recurrence were determined by evaluation of the Electronic Medical Record. Athlete demographics and World Athletics event discipline were recorded. Specific injury details including mechanism, location of injury and whether surgical or rehabilitation management was undertaken were recorded. There were 38 RF injuries in 27 athletes (24.7±2.3 years; 10 male, 17 female). Average TRFT for rehabilitation managed cases was 20.4±14.8 days. Grade 1 injuries had significantly shorter TRFT compared to grades 2 (p=0.04) and 3 (p=0.01). Intratendinous (c) and surgically managed RF injuries each had significantly longer TRFT compared to other injury classes (p<0.001). Myofascial (a) injuries had reduced repeat injury rates compared to b or c classes (p=0.048). Grade 3 injuries had an increased repeat injury rate compared to other grades (p=0.02). There were 4 complete (4c) proximal free tendon injuries sustained during sprinting and all in female athletes. The average TRFT for RF injuries in elite T&F is similar to that previously identified in elite football and Australian Rules. Similar to previous research in hamstring and calf injury, RF injuries extending into the tendon (BAMIC class c) had delayed TRFT which may reflect the longer duration required for tendon healing and adaptation. Grade 3 injuries had in increased repeat injury rate compared to grades 1 and 2. The BAMIC diagnostic framework may provide useful information for clinicians managing rectus femoris injuries in T&F.

Leadership experiences of elite football team physicians during the COVID-19 pandemic: a pilot study

Article

Full-text available

Jul 2022

Objectives The purpose of this study was to explore the leadership experiences of elite football team physicians during the COVID-19 pandemic. Methods A pilot-study based on a cross-sectional design by means of an electronic survey was conducted. The survey relied on 25 questions divided into distinct sections including among others professional and academic experience, leadership experiences and perspectives. Results A total of 57 physicians (91% male; mean age: 43 years) gave their electronic informed consent and completed the survey. All participants agreed that the demands of their role had increased during the COVID-19 pandemic. Fifty-two (92%) participants reported that they felt they were expected to take more of a leadership role during the COVID-19 pandemic. Eighteen (35%) reported feeling under pressure to make clinical decisions which were not in keeping with best clinical practice. Additional roles, duties and demands expected of team doctors during the COVID-19 pandemic were subdivided into communication, decision-making, logistical, and public health demands. Conclusion The findings from this pilot study suggest that the way in which team physicians at professional football clubs operate has altered since the onset of the COVID-19 pandemic, with greater demands placed on leadership skills including decision-making, communication and ethical stewardship. This has potential implications for sporting organisations, clinical practice and research.

Part 1 - Identifying the Current State and Improvement Opportunities in the Information Flows Necessary to Manage Professional Athletes: A Case Study in Rugby Union

Article

Full-text available

Jun 2022

In sporting environments, the knowledge necessary to manage athletes is built on information flows associated with player management processes. In current literature, there are limited case studies available to illustrate how such information flows are optimized. Hence, as the first step of an optimization project, this study aimed to evaluate the current state and the improvement opportunities in the player management information flow executed within the High-Performance Unit (HPU) at a professional rugby union club in England. Guided by a Business Process Management framework, elicitation of the current process architecture illustrated the existence of 18 process units and two core process value chains relating to player management. From the identified processes, the HPU management team prioritized 7 processes for optimization. In-depth details on the current state (As-Is) of the selected processes were extracted from semi-structured, interview-based process discovery and were modelled using Business Process Model and Notation (BPMN) and Decision Model and Notation (DMN) standards. Results were presented for current issues in the information flow of the daily training load management process, identified through a thematic analysis conducted on the data obtained mainly from focus group discussions with the main stakeholders (physiotherapists, strength and conditioning coaches, and HPU management team) of the process. Specifically, the current state player management information flow in the HPU had issues relating to knowledge creation and process flexibility. Therefore, the results illustrate that requirements for information flow optimization within the considered environment exist in the transition from data to knowledge during the execution of player management decision-making processes.

New Opportunities to Advance the Field of Sports Nutrition

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Feb 2022

Sports nutrition is a relatively new discipline; with ~100 published papers/year in the 1990s to ~3,500+ papers/year today. Historically, sports nutrition research was primarily initiated by university-based exercise physiologists who developed new methodologies that could be impacted by nutrition interventions (e.g., carbohydrate/fat oxidation by whole body calorimetry and muscle glycogen by muscle biopsies). Application of these methods in seminal studies helped develop current sports nutrition guidelines as compiled in several expert consensus statements. Despite this wealth of knowledge, a limitation of the current evidence is the lack of appropriate intervention studies (e.g., randomized controlled clinical trials) in elite athlete populations that are ecologically valid (e.g., in real-life training and competition settings). Over the last decade, there has been an explosion of sports science technologies, methodologies, and innovations. Some of these recent advances are field-based, thus, providing the opportunity to accelerate the application of ecologically valid personalized sports nutrition interventions. Conversely, the acceleration of novel technologies and commercial solutions, especially in the field of biotechnology and software/app development, has far outstripped the scientific communities' ability to validate the effectiveness and utility of the vast majority of these new commercial technologies. This mini-review will highlight historical and present innovations with particular focus on technological innovations in sports nutrition that are expected to advance the field into the future. Indeed, the development and sharing of more “big data,” integrating field-based measurements, resulting in more ecologically valid evidence for efficacy and personalized prescriptions, are all future key opportunities to further advance the field of sports nutrition.

Psycho-Social Challenges of Iranian Paralympic Athletes

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

Article

Full-text available

Apr 2022
Int J Sports Phys Ther

Background: Athletics (also known as track and field) is one of the most popular sports in the world and is the centrepiece of the Summer Olympic Games. Participation in athletics training and competition involves a risk of illness and injury. Purpose: To describe injury and illness in British Olympic track and field athletes over three full training and competition seasons. Study design: Descriptive Epidemiology Study. Methods: A total of 111 athletes on the British national program were followed prospectively for three consecutive seasons between 2015-2018. Team medical personnel recorded all injuries and illnesses during this time, following current consensus-based methods. All data pertaining to these records were reviewed and analyzed for sports injury and illness epidemiological descriptive statistics. Results: The average age of the athletes was 24 years for both males and females (24 years, +/- 4). Total exposure for the three seasons was 79 205 athlete days (217 athlete years). Overuse injuries (56.4%) were more frequent than acute injuries (43.6%). The thigh was the most common injury location (0.6 per athlete year), followed by the lower leg (0.4 per athlete year) and foot (0.3 per athlete year). Muscle and tendon were the most commonly injured tissues, while strains and tears were the most common pathology type. Hamstring muscle strain was the most common diagnosis causing time loss, followed by Achilles tendinopathy and soleus muscle strain. Respiratory illness was the most common illness type (0.3 per athlete year). Conclusion: Hamstring strains, Achilles tendinopathy, and soleus strains are the most common injuries in athletics and have highest burden. Respiratory illness is the most common illness and has the highest burden. Knowledge of this injury and illness profile within athletics could be utilised for the development of targeted prevention measures within the sport at the elite level. Level of evidence: 3.

Throwing in the deep end: athletes, coaches and support staff experiences, perceptions and beliefs of upper limb injuries and training load in elite women’s water polo

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Full-text available

Mar 2022

To understand elite athlete, coach and support staff experiences, perceptions and beliefs in women’s water polo with managing upper limb injuries and monitoring training loads. Inductive qualitative design. Twenty athletes, coaches and support staff were purposively recruited and participated in semistructured interviews. Participants either had experienced an upper limb injury or had experience managing athletes with upper limb injuries. Interviews were conducted in-person or virtually, audio-recorded, deidentified, transcribed verbatim and cleaned to ensure accuracy. Data were thematically analysed. Analysis identified five cohesive themes: (1) upper limb injury management is adequate—but prevention, communication and knowledge need improving, (2) current training load monitoring generates uncertainty and lack of consistency of processes—due to reliance on internal, and lack of external load monitoring, (3) optimal training load monitoring requires objective measurement of training load—that accurately measures the external load of athletes’ upper limbs, (4) athlete-centred philosophy matters—including athlete-centred care to facilitate individually tailored rehabilitation programmes and their inclusion in management decisions, (5) mental, social and emotional aspects of upper limb injury management matter—acknowledging feelings of loss of team inclusion, fear of missing out and frustration felt by athletes as well as the emotional labour felt by coaches when supporting athletes with an upper limb injury. Upper limb injury management and training load monitoring are evolving areas where objective measurement of training load may assist in increasing consistency of communication, collaboration and coordination between all stakeholders, and to address uncertainty. Stakeholders placed value in intangible qualities such as trust and care in their relationships with other collaborators—facilitating athlete physical, mental and emotional recovery following upper limb injuries.

Lineamientos Unidad de Ciencias Aplicadas al Deporte 2022-2028: El qué, el cómo y el por qué hacemos lo que hacemos

Book

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Mar 2022

Libro que describe el qué, el cómo y el por qué se hace lo que se hace en relación a las Ciencias Aplicadas al Deporte en el Deporte de Alto Rendimiento en Chile. Estas ciencias apoyan el proceso de preparación y competencia de los atletas chilenos, con el propósito de mejorar el rendimiento deportivo a nivel internacional.

Low 25(OH) vitamin D concentrations in international UK track and field athletes

Article

Full-text available

Jan 2012
SAJSM

Objective . While it is recognised that vitamin D deficiency is common in the general population, there have been no studies in elite athletes in the UK. This observational study aimed to assess the 25 hydroxy-vitamin D (25(OH)D) status of elite athletes on the Great Britain track and field team. Methods . A cross-sectional observational study was performed by analysing blood results from elite athletes on the British athletics team (N=63; mean ± standard deviation (SD) age 24.9±4.2 years). Athletes on the elite programme were offered blood tests through the winter and summer of 2009 and were eligible for inclusion in the study. Results . Nineteen per cent (n=12) of athletes in the current study can be classified as 25(OH)D deficient (<20 mcg/l), while a further 29% (n=18) can be classified as having insufficient serum 25(OH)D levels (20 - 30 mcg/l). Female sex (insufficent and deficient OH(D) prevalence 58%, n=18) and dark skin (prevalence 65%, n=20) were found to be independent predictors of serum 25(OH)D levels of <30 mcg/l. Conclusion . This study reveals a notable prevalence of low serum 25(OH)D levels in elite athletes and subsequent management of deficient athletes is likely to be of importance for athlete health. The impact of these results on athletic performance remains to be determined, and clinical trials to assess performance, particularly muscular performance, following correction of 25(OH)D status in deficient athletes are required.

Sport injuries and illnesses during the London Summer Olympic Games 2012

Article

Full-text available

Mar 2013
BRIT J SPORT MED

Background: The Olympic Movement Medical Code encourages all stakeholders to ensure that sport is practised without danger to the health of the athletes. Systematic surveillance of injuries and illnesses is the foundation for developing preventive measures in sport. Aim: To analyse the injuries and illnesses that occurred during the Games of the XXX Olympiad, held in London in 2012. Methods: We recorded the daily occurrence (or non-occurrence) of injuries and illnesses (1) through the reporting of all National Olympic Committee (NOC) medical teams and (2) in the polyclinic and medical venues by the London Organising Committee of the Olympic and Paralympic Games' (LOCOG) medical staff. Results: In total, 10 568 athletes (4676 women and 5892 men) from 204 NOCs participated in the study. NOC and LOCOG medical staff reported 1361 injuries and 758 illnesses, equalling incidences of 128.8 injuries and 71.7 illnesses per 1000 athletes. Altogether, 11% and 7% of the athletes incurred at least one injury or illness, respectively. The risk of an athlete being injured was the highest in taekwondo, football, BMX, handball, mountain bike, athletics, weightlifting, hockey and badminton, and the lowest in archery, canoe slalom and sprint, track cycling, rowing, shooting and equestrian. 35% of the injuries were expected to prevent the athlete from participating during competition or training. Women suffered 60% more illnesses than men (86.0 vs 53.3 illnesses per 1000 athletes). The rate of illness was the highest in athletics, beach volleyball, football, sailing, synchronised swimming and taekwondo. A total of 310 illnesses (41%) affected the respiratory system and the most common cause of illness was infection (n=347, 46%). Conclusions: At least 11% of the athletes incurred an injury during the games and 7% of the athletes' an illness. The incidence of injuries and illnesses varied substantially among sports. Future initiatives should include the development of preventive measures tailored for each specific sport and the continued focus among sport bodies to institute and further develop scientific injury and illness surveillance systems.

Occurrence of injuries and illnesses during the 2009 IAAF World Athletics Championships

Article

Full-text available

Dec 2010
BRIT J SPORT MED

To analyse the frequency and characteristics of sports injuries and illnesses incurred during the World Athletics Championships. Prospective recording of newly occurred injuries and illnesses. Twelfth International Association of Athletics Federations World Championships in Athletics 2009 in Berlin, Germany. National team physicians and physiotherapists and 1979 accredited athletes; Local Organising Committee physicians working in the Medical Centres. Incidence and characteristics of newly incurred injuries and illnesses. 236 injury incidents with 262 injured body parts and 269 different injury types were reported, representing an incidence of 135.4 injuries per 1000 registered athletes. Eighty percent affected the lower extremity. Thigh strain (13.8%) was the main diagnosis. Overuse (44.1%) was the predominant cause. Most injuries were incurred during competition (85.9%). About 43.8% of all injury events were expected to result in time-loss. 135 illnesses were reported, signifying an incidence of 68.2 per 1000 registered athletes. Upper respiratory tract infection was the most common condition (30.4%) and infection was the most frequent cause (32.6%). The incidence of injury and illnesses varied substantially among the events. The risk of injury varied with each discipline. Preventive measures should be specific and focused on minimising the potential for overuse. Attention should be paid to ensure adequate rehabilitation of previous injuries. The addition of the illness part to the injury surveillance system proved to be feasible. As most illnesses were caused by infection of the respiratory tract or were environmentally related, preventive interventions should focus on decreasing the risk of transmission, appropriate event scheduling and heat acclimatisation.

The Team Physician and the Return-to-Play Decision

Article

Dec 2012
MED SCI SPORT EXER

Team Clinician Variability in Return-to-Play Decisions

Article

Jun 2013

To describe the variability in the return-to-play (RTP) decisions of experienced team clinicians and to assess their clinical opinion as to the relevance of 19 factors described in a RTP decision-making model. Survey questionnaire. Advanced Team Physician Course. Sixty seven of 101 sports medicine clinicians completed the questionnaire. Results were analyzed using descriptive statistics. For categorical variables, we report percentage and frequency. For continuous variables, we report mean (SD) if data were approximately normally distributed and frequencies for clinically relevant categories for skewed data. The average number of years of clinical sports medicine experience was 13.6 (9.8). Of the 62 clinicians who responded fully, 35% (n = 22) would "clear" (vs "not clear") an athlete to participate in sport even if the risk of an acute reinjury or long-term sequelae is increased. When respondents were given 6 different RTP options rather than binary choices, there were increased discrepancies across some injury risk scenarios. For example, 8.1% to 16.1% of respondents who chose to clear an athlete when presented with binary choices, later chose to "not clear" an athlete when given 6 graded RTP options. The respondents often considered factors of potential importance to athletes as nonimportant to the RTP decision process if risk of reinjury was unaffected (range, n = 4 [10%] to n = 19 [45%]). There is a high degree of variability in how different clinicians weight the different factors related to RTP decision making. More precise definitions decrease but do not eliminate this variability.

Injury patterns in Swedish elite athletics: Annual incidence, injury types and risk factors

Article

Mar 2013
BRIT J SPORT MED

Objective To estimate the incidence, type and severity of musculoskeletal injuries in youth and adult elite athletics athletes and to explore risk factors for sustaining injuries. Design Prospective cohort study conducted during a 52-week period. Setting Male and female youth and adult athletics athletes ranked in the top 10 in Sweden (n=292). Results 199 (68%) athletes reported an injury during the study season. Ninety-six per cent of the reported injuries were non-traumatic (associated with overuse). Most injuries (51%) were severe, causing a period of absence from normal training exceeding 3 weeks. Log-rank tests revealed risk differences with regard to athlete category (p=0.046), recent previous injury (>3 weeks time-loss; p=0.039) and training load rank index (TLRI; p=0.019). Cox proportional hazards regression analyses showed that athletes in the third (HR 1.79; 95% CI 1.54 to 2.78) and fourth TLRI quartiles (HR 1.79; 95% CI 1.16 to 2.74) had almost a twofold increased risk of injury compared with their peers in the first quartile and interaction effects between athlete category and previous injury; youth male athletes with a previous serious injury had more than a fourfold increased risk of injury (HR=4.39; 95% CI 2.20 to 8.77) compared with youth females with no previous injury. Conclusions The injury incidence among both youth and adult elite athletics athletes is high. A training load index combing hours and intensity and a history of severe injury the previous year were predictors for injury. Further studies on measures to quantify training content and protocols for safe return to athletics are warranted.

Doctoring risk: Responding to risk-taking in athletes

Article

Aug 2007
Sport Ethics Philos

Lynley C Anderson

Athletes who wish to compete in spite of high risk of injury can prove a challenge for sports doctors. Overriding an athlete’s choices could be considered to be unnecessarily overbearing or paternalistic. However simply accepting all risk-taking as the voluntary choice of an individual fails to acknowledge the context of high-level sport and the circumstances in which an athlete may be being coerced or in some other way be making a less than voluntary choice. Restricting the voluntary choices of an athlete may still be possible but under very limited circumstances. This article explores the ways a sports doctor might respond in ensuring a choice is indeed voluntary and, if so, under what circumstances limits might be placed. Responding to such risk-taking by, for example, limiting the actions of an athlete or assisting them to compete, involves attempting to balance the athlete’s aims against some set of ideals of good health or medical ends.

A Risk/Tolerance Approach to the Preparticipation Examination

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Jun 2012

Evidence, Preferences, Recommendations — Finding the Right Balance in Patient Care

Article

May 2012
NEW ENGL J MED

Much progress has been made in applying scientific evidence to medical practice; less progress has been made in rendering care “patient-centered.” A five-step framework for reconciling the tension between “evidence-based” and “preference-based” medicine may help.

The prevalence and current opinion of treatment of allergic rhinitis in elite athletes

Article

Apr 2011
CURR OPIN ALLERGY CL

The aim of this review is to highlight the prevalence of allergic rhinitis in athletes and the impact this condition may have on their athletic performance. Furthermore, the optimal management of medical conditions in the elite athlete forms an important part of protecting the health of the athlete. The use of pharmacological intervention in the treatment of allergic rhinitis in elite athletes requires careful planning. A variety of factors must be considered prior to prescription such as drug efficacy and safety both at rest and in conjunction with strenuous exercise, associated side effects on athletic performance and well being and whether the chosen drug is on the World Anti-Doping Agency (WADA) banned list. Allergic rhinitis is common in elite athletes and may impair athletic performance and recovery. We advise that all elite and professional athletes should be screened for allergic rhinitis using validated questionnaire such as the Allergy Questionnaire for Athletes (AQUA) alongside skin prick testing or specific IgE blood tests for inhalant allergens. Intranasal corticosteroids are highly recommended as the management drug of choice for athletes in conjunction with second-generation antihistamines (severity dependant) and when practicable, allergen avoidance.