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Performance success or failure is explained by weeks lost to injury and illness in elite Australian Track and Field athletes: a 5-year prospective study
Abstract
Objectives
To investigate the impact of training modification on achieving performance goals. Previous research demonstrates an inverse relationship between injury burden and success in team sports. It is unknown whether this relationship exists within individual sport such as athletics.
Design
A prospective, cohort study (n = 33 International Track and Field Athletes; 76 athlete seasons) across five international competition seasons.
Methods
Athlete training status was recorded weekly over a 5-year period. Over the 6-month preparation season, relationships between training weeks completed, the number of injury/illness events and the success or failure of a performance goal at major championships was investigated. Two-by-two table were constructed and attributable risks in the exposed (AFE) calculated. A mixed-model, logistic regression was used to determine the relationship between failure and burden per injury/illness. Receiver Operator Curve (ROC) analysis was performed to ascertain the optimal threshold of training week completion to maximise the chance of success.
Results
Likelihood of achieving a performance goal increased by 7-times in those that completed >80% of planned training weeks (AUC, 0.72; 95%CI 0.64-0.81). Training availability accounted for 86% of successful seasons (AFE = 0.86, 95%CI, 0.46 to 0.96). The majority of new injuries occurred within the first month of the preparation season (30%) and most illnesses occurred within 2-months of the event (50%). For every modified training week the chance of success significantly reduced (OR = 0.74, 95%CI 0.58 to 0.94).
Conclusions
Injuries and illnesses, and their influence on training availability, during preparation are major determinants of an athlete's chance of performance goal success or failure at the international level.
... The training requirements for triathlon can lead to adaptations and improvements in performance or to maladaptation and health problems, 1 which may directly or indirectly affect performance. 6,7 Further, understanding the main health problems affecting short-course triathletes and the pathways by which they occur would provide valuable insight about the factors leading to injury and illness, along with potential approaches to minimize risk and maximize performance. ...
... Participants were mapped, according to their sports level, to The Foundations, Talent, Elite, Mastery (FTEM) framework, 17 which integrates phases of athlete development within active lifestyle, sport participation, and sport excellence pathways. 6 Studies conducted in non-triathlete populations or in triathletes training or competing for distances longer than short-course distances were excluded from this review, as were those that did not specify the triathlon distance. Studies were also excluded if there was no form of epidemiological data published, or if specific data were unable to be extracted from published articles, or if the outcome of an intervention, such as surgery or drug trial, was being investigated. ...
... The etiology of illness in short-course triathlon is multifactorial in most cases, with athletes reporting illness throughout the season experiencing hindered performance. 6,91 Thus, illness prevention strategies should focus on addressing the risk factors that may impact training and competition availability. 91 Environmental factors are the main contributors to illness symptoms in short-course triathletes. ...
Background:
Determining the incidence and prevalence of injury and illness in short-course triathletes would improve understanding of their etiologies and therefore assist in the development and implementation of prevention strategies. This study synthesizes the existing evidence on the incidence and/or prevalence of injury and illness and summarizes reported injury or illness etiology and risk factors affecting short-course triathletes.
Method:
This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting health problems (injury and illness) in triathletes (all sexes, ages, and experience levels) training and/or competing in short-course distances were included. Six electronic databases (Cochrane Central Register of Controlled Trials, MEDLINE, Embase, APA PsychINFO, Web of Science Core Collection, and SPORTDiscus) were searched. Risk of bias was independently assessed by 2 reviewers using the Newcastle-Ottawa Quality Assessment Scale. Two authors independently completed data extraction.
Results:
The search yielded 7998 studies, with 42 studies eligible for inclusion. Twenty-three studies investigated injury, 24 studies investigated illnesses, and 4 studies investigated both injuries and illnesses. The injury incidence rate was 15.7-24.3 per 1000 athlete exposures, and the illness incidence rate was 1.8-13.1 per 1000 athlete days. Injury and illness prevalence ranged between 2%-15% and 6%-84% respectively. Most injuries reported occurred during running (45%-92%), and the most frequently reported illnesses affected the gastrointestinal (7%-70%), cardiovascular (14%-59%), and respiratory systems (5%-60%).
Conclusion:
The most frequently reported health problems in short-course triathletes were: overuse, lower limb injuries associated with running; gastrointestinal illnesses and altered cardiac function, primarily attributable to environmental factors; and respiratory illness mostly caused by infection.
... [1][2][3] , with injury being a significant one. [4][5][6] Training availability has been shown to directly relate to success, meaning runners not available to train due to injuries have significantly decreased performance. [4][5][6] In a group of elite Australian track and field athletes, the likelihood of achieving a performance goal increased seven-fold in those who completed over 80 percent of the planned training weeks over a five-year period. ...
... [4][5][6] Training availability has been shown to directly relate to success, meaning runners not available to train due to injuries have significantly decreased performance. [4][5][6] In a group of elite Australian track and field athletes, the likelihood of achieving a performance goal increased seven-fold in those who completed over 80 percent of the planned training weeks over a five-year period. 6 In a systematic review, Drew and colleagues 4 reported that there is strong evidence that injuries have a detrimental impact on team and individual athlete success. ...
... [4][5][6] In a group of elite Australian track and field athletes, the likelihood of achieving a performance goal increased seven-fold in those who completed over 80 percent of the planned training weeks over a five-year period. 6 In a systematic review, Drew and colleagues 4 reported that there is strong evidence that injuries have a detrimental impact on team and individual athlete success. Specifically, increased athlete availability reduces the risk of failure and pre-competition, and ...
Introduction: Excessive hip adduction (HADD) and contralateral pelvis drop (CPD) angles during running are associated with running-related injuries. Their influence on performance is less known. Therefore, we aimed to determine if HADD and CPD could differentiate between high and low race performers, and if there were relationships between CPD, HADD and race performance. Methods: Twenty-six healthy male and female NCAA Division II cross-country runners participated in this prospective study. They underwent 3D motion analysis of their HADD and CPD during pre-participation physical examinations. Times from the first race of the season were converted to International Association of Athletics Federation (IAAF) points and high and low performance groups were created. Pearson correlation coefficients were used to examine the associations between HADD, CPD and IAAF points, and Independent Samples T-tests were used to determine differences in HADD and CPD between high and low performance groups. Results: There were no significant relationships between IAAF points and left HADD (r=0.11, p=0.59), right HADD (r=0.19, p=0.35), left CPD (r=-0.06, p=0.79), or right CPD (r=-0.06, p=0.76). There were no significant differences between high and low performance groups in left HADD (t(24)=0.48, p=0.64), right HADD (t(24)=0.45, p=0.33), left CPD (t(24)=0.62, p=0.27), or right CPD (t(24)=0.53, p=0.30). Conclusions: The RRI biomechanics of excessive CPD and HADD do not influence 5k race performance in collegiate distance runners.
... LEA may be one of the strongest indicators of injury risk for athletes (17,47,59), with oligomenorrheic and FHA athletes reporting higher percentages of severe musculoskeletal injuries resulting in greater durations of time lost from sport (38,39,59,61). Injuries and illnesses exert the biggest impact on training availability, with each week of modified training significantly reducing the chance of success for internationally competitive track and field athletes (47). ...
... LEA may be one of the strongest indicators of injury risk for athletes (17,47,59), with oligomenorrheic and FHA athletes reporting higher percentages of severe musculoskeletal injuries resulting in greater durations of time lost from sport (38,39,59,61). Injuries and illnesses exert the biggest impact on training availability, with each week of modified training significantly reducing the chance of success for internationally competitive track and field athletes (47). Athlete availability for training has emerged as one of the strongest predictors of optimal performance at the highest level of sport, with a 7-time increase in the likelihood of achieving performance goals by athletes that completed more than 80% of planned training weeks (47). ...
... Injuries and illnesses exert the biggest impact on training availability, with each week of modified training significantly reducing the chance of success for internationally competitive track and field athletes (47). Athlete availability for training has emerged as one of the strongest predictors of optimal performance at the highest level of sport, with a 7-time increase in the likelihood of achieving performance goals by athletes that completed more than 80% of planned training weeks (47). To this end, a reported 4.5 times increase in the prevalence of bone injuries in female and male athletes, with FHA and low testosterone respectively, resulted in a more than 4-fold increase in missed training time (23). ...
Problem:
If athletes develop low energy availability (LEA), it can lead to a Relative Energy Deficiency in Sport (RED-S) syndrome which has severe health consequences if not treated.
Methodology:
A narrative review of the most recent and pertinent literature on the topic, with special emphasis on women.
Results:
In assessing the current literature, we have synthesized: i) the scientific implications of LEA and RED-S, ii) the clinical manifestations of the conditions currently available for detection, as well as iii) the practical implications for healthcare and support for female athletes and teams in planning intervention or prevention strategies (maintaining EA >45 kcal/kg FFM/day).
Discussion:
The 'Female Athlete Triad" emerged in the 1990s as researchers understood more of the etiological adaptation of female athlete health to sports training. In the last 10 years, the scientific community has recognized that the 'Triad' approach was too narrow in focus, and the broader concept of RED-S emerged. Both the Triad and RED-S are consequences of a frequently prevalent LEA in athletes (<30 kcal/kg FFM/day). Developing LEA and RED-S compromises training adaptation, performance capacity, and health in athletes. For these reasons, it is critical that an athlete's support team recognize the behaviors that may indicate RED-S evolution. In this way, we can assist female athletes in reaching their full potential in sports while protecting their health.
... The training requirements for triathlon can lead to adaptations and improvements in performance or to maladaptation and health problems, 1 which may directly or indirectly affect performance. 6,7 Further, understanding the main health problems affecting short-course triathletes and the pathways by which they occur would provide valuable insight about the factors leading to injury and illness, along with potential approaches to minimize risk and maximize performance. ...
... Participants were mapped, according to their sports level, to The Foundations, Talent, Elite, Mastery (FTEM) framework, 17 which integrates phases of athlete development within active lifestyle, sport participation, and sport excellence pathways. 6 Studies conducted in non-triathlete populations or in triathletes training or competing for distances longer than short-course distances were excluded from this review, as were those that did not specify the triathlon distance. Studies were also excluded if there was no form of epidemiological data published, or if specific data were unable to be extracted from published articles, or if the outcome of an intervention, such as surgery or drug trial, was being investigated. ...
... The etiology of illness in short-course triathlon is multifactorial in most cases, with athletes reporting illness throughout the season experiencing hindered performance. 6,91 Thus, illness prevention strategies should focus on addressing the risk factors that may impact training and competition availability. 91 Environmental factors are the main contributors to illness symptoms in short-course triathletes. ...
... In athletics, few articles have analysed the potential relationships between performance and injuries (Raysmith and Drew, 2016;Edouard et al., 2019Edouard et al., , 2021. During eight international athletics championships, Edouard et al. (2019) reported that lower numbers of injuries per registered athlete were correlated with higher number of medals and gold medals per registered athletes, when analysing country participation grouped according to country team sizes. ...
... Edouard et al. (2021) reported that being injured during international combined event competitions was associated with lower odds of winning a medal during the respective competition. To our knowledge, only Raysmith and Drew (2016) reported results on the relationships between performances and injuries during an athletics season follow-up. They reported that injuries occurring during the 6-months preparation period of an international competition, and related loss in training time, have a negative effect on the performance success for the respective competition in international-level athletes. ...
... For the primary analysis, we only considered (i) any participation in a national championship, and (ii) any participation in an international competition. Indeed, participation at a national or international competition represents the global result of a season for an athlete, and often the goal of the season as reported by Raysmith and Drew (2016). On the contrary, a podium or a victory is the result of a single competition where several "parasitic" factors can play a role on the performance, such as for instance number of participants, climatic conditions, stress, etc., all of which are diluted by the number of competitions when considering annual participation in national or international competitions. ...
Background
Performance success or failure in athletics (Track and Field) and the capacity to succeed are driven at the adult level, like in other sports, by many factors, injury being one of them. More information regarding the potential relationships between performance and injuries in athletics is needed.
Objective
To analyse the potential association between performance and occurrence of injuries in national-level athletics athletes from sprints, jumps and combined events through several seasons.
Methods
We performed a retrospective analysis of performance and injury data collected prospectively in 8 national-level athletics athletes followed during at least five consecutive seasons from 2009 to 2019. For each athlete, injuries data [total injuries (injuries) and time-loss injuries (TLI)] were collected by the same sports medicine physician throughout the study period using a medical attention injury definition. Performances during official competitions were collected on the French Federation of Athletics website, and included (i) any participation in national championships, (ii) any participation in an international competition (i.e., being national team member for an international competition), (iii) any podium at the national championships, (iv) any podium at an international competition, and (v) performance metrics normalised to the world record (WR) of the respective athletics speciality (%WR). For each athlete, we performed a descriptive analysis of the performances and injuries. We also performed four binomial logistic regressions with (1) national championships participation (yes/no) or (2) international competition participation (yes/no) as dependent variables, and injuries (yes/no) or TLI (yes/no) as independent variables, adjusted for individual athlete and number of seasons, and in models on participation in international competitions, was also adjusted for national championship participation (yes/no), with Odd Ratios (OR) with 95% confidence intervals (95%CI).
Results
Among the 8 national-level athletics athletes included in the present study, cumulated 155 injuries, including 52 TLI (33.5%). There was an average of 2.7 ± 1.7 injuries and 0.9 ± 0.6 TLI per athlete per season over the study period. The occurrence of injuries was significantly associated with higher odds of national championships participation (OR = 4.85 [95% CI 3.10 to 3050.5], p = 0.021). The occurrence of TLI was significantly associated with higher odds of national championships participation (OR = 133.6 [95% CI 4.92 to 14251.5], p = 0.013). The occurrence of injuries or TLI were associated with insignificantly lower odds of international championships participation.
Conclusions
Our present pilot study confirms that injuries are part of an athletes' life. The occurrence of at least one injury was associated with higher odds of participation in a national championship, whereas the absence of at least one injury was associated with higher odds of participation in an international championship. We hypothesised that the length of the season can play a role in the risk of injury occurrence, but if the athlete wants to reach his/her highest level, decreasing the risk of injuries seems to be of importance. Despite the caution that should be taken in the interpretation of our results, our present study confirms the interest and relevance of injury risk reduction approach in athletics.
... 3 Evidence suggests the emerging responses to short-, medium-, and long-term LEA centre around: reduced glucose concentrations, skeletal muscle glycogen, and protein synthesis, reduced circulating reproductive and anabolic hormones, disruption in markers of iron and bone metabolism, increased risk of mood disturbances and injuries all of which have potential direct or indirect performance implications. 19,30,[35][36][37] Thus, the following sections describe key aspects of direct and indirect effects or associations between some of these parameters and sports performance. Specific details on representative performance-based research studies addressing short-, medium-, and long-term LEA consequences are shown in Tables 1, 2, and 3. ...
... 83 To this end, a prospective study investigating international track and field athletes during five consecutive competitive seasons found that every week containing one or more days of modified training due to injuries and illnesses resulted in a 26% reduction in the odds of achieving key performance goals, and athletes who sustained <2 injuries or illnesses per season were three times more likely to achieve their performance goal than those who sustained ≥2 episodes of injuries or illness. 36 Therefore, it is imperative that sports medicine practitioners should direct their attention to the prevention of both injuries and illness via a multidisciplinary approach including, but not limited to, minimizing frequency of LEA in athletes. ...
Low energy availability (LEA) occurs inadvertently and purposefully in many
athletes across numerous sports; and well planned, supervised periods with
moderate LEA can improve body composition and power to weight ratio possibly enhancing performance in some sports. LEA however has the potential to
have negative effects on a multitude of physiological and psychological systems
in female and male athletes. Systems such as the endocrine, cardiovascular, metabolism, reproductive, immune, mental perception, and motivation as well as
behaviors can all be impacted by severe (serious and/or prolonged or chronic)
LEA. Such widely diverse effects can influence the health status, training adaptation, and performance outcomes of athletes leading to both direct changes (e.g.,
decreased strength and endurance) as well as indirect changes (e.g., reduced
training response, increased risk of injury) in performance. To date, performance
implications have not been well examined relative to LEA. Therefore, the intent
of this narrative review is to characterize the effects of short-, medium-, and longterm exposure to LEA on direct and indirect sports performance outcomes. In
doing so we have focused both on laboratory settings as well as descriptive athletic case-study-type experiential evidence.
... 1-3 These results highlight that injury belongs to the athletes' life. Given its negative impact on athletes' performance, 4,5,19 this again supports the interest of improving injury risk reduction approach. ...
... 4,5 We also have some evidence that injuries occurring during a season decrease the chance for an athlete to participate at international championships or achieving his/her season goal. 19,25 It would be also relevant to better understand the influence of pre-participation injury complaint on the performance during the following championship (e.g., ranking, metrics performance). ...
Objectives
To analyse the association between pre-participation health status and in-championships injuries in a large dataset from seven international athletics championships, and to determine the health status of athletes during the four weeks before the start of international athletics championships.
Design
Prospective cohort study
Methods
We used data collected from athletes of national teams with medical staff who participated i) in a pre-participation health survey (retrospective data collection) and ii) in an in-championships injury surveillance (prospective data collection) during seven international athletics championships (2013-2018). We performed a binomial logistic regression with in-championship injury (yes/no) as the dependent variable and sex, age, discipline (explosive/endurance), type of championships (outdoor/indoor) and pre-participation injury complaint (yes/no) and pre-participation illness complaint (yes/no) as independent variables, with odds ratios (OR) and 95% confidence intervals (95% CI).
Results
Out of the 1095 athletes included 31.2% reported an injury complaint during the 4 weeks before the championships and 21.6% an illness complaint. The univariate model showed that discipline, type of championships and pre-participation injury complaints (OR = 2.57, 95%CI: 1.66 to 3.97) were significantly associated with in-championships injuries, and the multivariable model showed that type of championships and pre-participation injury complaints (OR = 2.64, 95%CI: 1.60 to 4.36) remained significantly associated with in-championships injuries.
Conclusions
Our present study shows that an injury complaint during the four weeks before an international athletics championship significantly increased risk of sustaining an injury during the following championship, which was reported by about one third of athletes with differences between sex and disciplines.
... Performance might also be influenced by the loss of training time due to the illness and this might constitute a major determinant of performance of athletes in elite competition. 110 Studies show the acute effects of ARinf on sports performance parameters can reduce the likelihood to start a race if an athlete had a recent ARinf (8-12 days prior to a race), 111 compromise self-reported training ability and training capacity, 112 and impair running kinematics (measured stride length, stride frequency and joint angles). 113 Reduced training load, training mileage and a reduction in sports performance points have been reported over several months following ARinf. ...
... The likelihood of achieving success was increased by sevenfold in athletes able to complete >80% of planned training weeks. 110 Every week containing one or more days of modified training reduced the chances of achieving a key sports performance goal by 26%. Similarly, time-loss from training costs the recreational athlete highly anticipated participation in events, races, leagues, or competitions. ...
Acute illnesses affecting the respiratory tract are common and form a significant component of the work of Sport and Exercise Medicine (SEM) clinicians. Acute respiratory illness (ARill) can broadly be classified as non-infective ARill and acute respiratory infections (ARinf). The aim of this consensus is to provide the SEM clinician with an overview and practical clinical approach to ARinf in athletes. The International Olympic Committee (IOC) Medical and Scientific Commission appointed an international consensus group to review ARill (non-infective ARill and ARinf) in athletes. Six subgroups of the IOC Consensus group were initially established to review the following key areas of ARill in athletes: (1) epidemiology/risk factors for ARill, (2) ARinf, (3) non-infective ARill including ARill due to environmental exposure, (4) acute asthma and related conditions, (5) effects of ARill on exercise/sports performance, medical complications/return-to-sport and (6) acute nasal/vocal cord dysfunction presenting as ARill. Several systematic and narrative reviews were conducted by IOC consensus subgroups, and these then formed the basis of sections in the consensus documents. Drafting and internal review of sections were allocated to 'core' members of the consensus group, and an advanced draft of the consensus document was discussed during a meeting of the main consensus core group in Lausanne, Switzerland on 11 to 12 October 2021. Final edits were completed after the meeting. This consensus document (part 1) focusses on ARinf, which accounts for the majority of ARill in athletes. The first section of this consensus proposes a set of definitions and classifications of ARinf in athletes to standardise future data collection and reporting. The remainder of the consensus paper examines a wide range of clinical considerations related to ARinf in athletes: epidemiology, risk factors, pathology/pathophysiology, clinical presentation and diagnosis, management, prevention, medical considerations, risks of infection during exercise, effects of infection on exercise/sports performance and return-to-sport guidelines.
... Elite athletes who can maintain training availability at 80% have a significantly greater chance of achieving their key performance goals. 1 Therefore, in order to maximize the likelihood of success in elite athletes, attention should be paid to the prevention of both injury and illness. 1,2 Injuries within professional cycling could be classified as injuries caused by accidents (ie, trauma due to falls) or overuse injuries. ...
... Elite athletes who can maintain training availability at 80% have a significantly greater chance of achieving their key performance goals. 1 Therefore, in order to maximize the likelihood of success in elite athletes, attention should be paid to the prevention of both injury and illness. 1,2 Injuries within professional cycling could be classified as injuries caused by accidents (ie, trauma due to falls) or overuse injuries. 3 Lower back pain and knee pain are the most common overuse injuries in elite cycling. ...
Purpose:
To determine if workload and seasonal periods (preseason vs in season) are associated with the incidence of injuries and illnesses in female professional cyclists.
Methods:
Session rating of perceived exertion was used to quantify internal workload and was collected from 15 professional female cyclists, from 33 athlete seasons. One week (acute) workload, 4 weeks (chronic) workload, and 3 acute:chronic workload models were analyzed. Two workload models are based on moving averages of the ratios, the acute:chronic workload ratio (ACWR), and the ACWR uncoupled (ACWRuncoup). The difference between both is the chronic load; in ACWR, the acute load is part of the chronic load, and in ACWRuncoup, the acute and chronic load are uncoupled. The third workload model is based on exponentially weighted moving averages of the ratios. In addition, the athlete season is divided into the preseason and in season.
Results:
Generalized estimating equations analysis was used to assess the associations between the workload ratios and the occurrence of injuries and illnesses. High values of acute workload (P = .048), ACWR (P = .02), ACWRuncoup (P = .02), exponentially weighted moving averages of the ratios (P = .01), and the in season (P = .0001) are significantly associated with the occurrence of injury. No significant associations were found between the workload models, the seasonal periods, and the occurrence of illnesses.
Conclusions:
These findings suggest the importance of monitoring workload and workload ratios in female professional cyclists to lower the risk of injuries and therefore improve their performances. Furthermore, these results indicate that, in the preseason, additional stressors occur, which could lead to an increased risk of injuries.
... 98 99 BSIs and BMD Adverse changes to skeletal health (reduced BMD and BSIs) are some of the most insidious outcomes of problematic LEA because they directly impact athlete availability for training and competition, which is directly linked to the likelihood of achieving performance goals. 100 Often years of underlying problematic LEA resulting in low BMD go unnoticed until a BSI occurs. Furthermore, many athletes have surpassed the age of peak bone mass accrual, limiting the ability to achieve 'catch-up' bone mineralisation with EA improvement. ...
Relative Energy Deficiency in Sport (REDs) has various different risk factors, numerous signs and symptoms and is heavily influenced by one’s environment. Accordingly, there is no singular validated diagnostic test. This 2023 International Olympic Committee’s REDs Clinical Assessment Tool—V.2 (IOC REDs CAT2) implements a three-step process of: (1) initial screening; (2) severity/risk stratification based on any identified REDs signs/symptoms (primary and secondary indicators) and (3) a physician-led final diagnosis and treatment plan developed with the athlete, coach and their entire health and performance team. The CAT2 also introduces a more clinically nuanced four-level traffic-light (green, yellow, orange and red) severity/risk stratification with associated sport participation guidelines. Various REDs primary and secondary indicators have been identified and ‘weighted’ in terms of scientific support, clinical severity/risk and methodological validity and usability, allowing for objective scoring of athletes based on the presence or absence of each indicator. Early draft versions of the CAT2 were developed with associated athlete-testing, feedback and refinement, followed by REDs expert validation via voting statements (ie, online questionnaire to assess agreement on each indicator). Physician and practitioner validity and usability assessments were also implemented. The aim of the IOC REDs CAT2 is to assist qualified clinical professionals in the early and accurate diagnosis of REDs, with an appropriate clinical severity and risk assessment, in order to protect athlete health and prevent prolonged and irreversible outcomes of REDs.
... 4 The burden of HSI extends to athletic performance through its impacts on training and game availability, which is linked to sporting success in both team 5 and Olympic sports. 6 Despite the growing knowledge on risk factors 7 recurrence rates for HSI are high and subsequent injuries often leave the athlete with greater impairments and longer times to return to sport. 8 High prevalence of subsequent HSI suggests that current rehabilitation practices are not sufficient to minimize the burden of HSI and cannot prevent or predict re-injury. ...
Introduction
Hamstring strain injury (HSI) remains a performance, economic, and player availability burden in sport. High‐speed running (HSR) is cited as a common mechanism for HSI. While evidence exists regarding the high physical demands on the hamstring muscles in HSR, meta‐analytical synthesis of related activation and kinetic variables is lacking.
Methods
A systematic search of Medline, Embase, Scopus, CINAHL, SportDiscus, and Cochrane library databases was conducted in accordance with the PRISMA 2020 guidelines. Studies reporting hamstring activation (electromyographic [EMG]) or hamstring muscle/related joint kinetics were included where healthy adult participants ran at or beyond 60% of maximum speed (activation studies) or 4 m per second (m/s) (kinetic studies).
Results
A total of 96 studies met the inclusion criteria. Run intensities were categorized as “slow,” “moderate,” or “fast” in both activation and kinetic based studies with appropriate relative, and raw measures, respectively. Meta‐analysis revealed pooled mean lateral hamstring muscle activation levels of 108.1% (95% CI: 84.4%–131.7%) of maximal voluntary isometric contraction (MVIC) during “fast” running. Meta‐analysis found swing phase peak knee flexion internal moment and power at 2.2 Newton meters/kilogram (Nm/kg) (95% CI: 1.9–2.5) and 40.3 Watts/kilogram (W/kg) (95% CI: 31.4–49.2), respectively. Hip extension peak moment and power was estimated as 4.8 Nm/kg (95% CI: 3.9–5.7) and 33.1 W/kg (95% CI: 17.4–48.9), respectively.
Conclusions
As run intensity/speed increases, so do the activation and kinetic demands on the hamstrings. The presented data will enable clinicians to incorporate more objective measures into the design of injury prevention and return‐to‐play decision‐making strategies.
... Furthermore, this research highlights that in the court sports, a large reduction in uninterrupted time to train physical, tactical and technical training within a competitive season can be attributed to injury. Track and field research has shown that missing 20 % of training across a competitive season significantly reduces your likelihood of achieving your performance goal (45). The same inference might be made for team sports, where the ability for coaches to field the best team possible is altered in those sports where the onset of injury is early (female volleyball and basketball) and the incidence is high (female wrestling, male volleyball). ...
Previous varsity sport injury research has analyzed how acute and chronic injury severity, type, and location differs between sport and sexes, with limited research in time to injury. Canadian university varsity sport injury research is especially sparse and mostly retrospective. Thus, we aimed to understand injury differences in male and female competitive university athletes competing in the same sport. Athletes who competed on the basketball, volleyball, soccer, ice hockey, football (male), rugby (female), and wrestling teams were eligible for the study. There were 182 male and 113 female athletes who provided informed consent to be prospectively followed over a season. Injury date, type, location, chronicity, and events missed due to injury were recorded on a weekly basis. Overall, the percentage of male (68.7%) and female (68.1%) athletes injured was not different. No overall sex differences (variables collapsed) were observed in injury chronicity, location, type, events lost, mean number of injuries, or time to injury. Within sport differences existed for mean number of injuries, injury location, type of injury, and events missed. Mean time to injury in female basketball (28 days) and volleyball athletes (14 days) was significantly shorter compared to male basketball (67 days) and volleyball (65 days). Time to a concussion was significantly shorter in females overall compared to males. These results indicate that Canadian female university age athletes are not inherently more susceptible to injury, but female athletes within certain sports may have increased injury risk which could shorten time to injury (basketball, volleyball) and increase the number of events missed due to injury (hockey).
... Across all studies, vigorous exercise consisted of long distance running, endurance training, swimming, triathlon, track and field, athletics, cross-country skiing, and both winter and summer Olympic sports. Of the 22 studies selected, 5 did not report the sex of the participants enrolled [39][40][41][42][43], whereas 17 enrolled both male and female subjects [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60]. Studies ranged from 20 to 11,274 total participants, and the proportion of female participants ranged from 0.12% (N=23) to 26% (N=5,089). ...
The practice of physical activity is an effective non-pharmacological strategy for preventing and treating chronic diseases. A large body of evidence has contributed to establishing a positive correlation between a physically active lifestyle and health benefits, including enhanced vaccination responses, lower numbers of senescent T-cells, increased T-cell proliferative capacity, lower levels of inflammatory cytokines, and improved neutrophil and macrophage function. While females are generally thought to exert more robust immune responses than males in response to a variety of challenges, and both male and female sex hormones have been suggested as mediators of immune function, research on this topic has not always been designed with a sex-specific lens. The goal of this review is to summarize the available experimental and clinical evidence linking exercise and immune function in male and female subjects, with an emphasis on sex differences and sex-specific mechanisms. Overall, the available evidence indicates that moderate exercise and physical activity improves immune function in both sexes, whereas prolonged and high-intensity exercise temporarily impairs immune responses at a higher degree in females. A role of male and female sex hormones in these sex-specific effects is also discussed.
... Injuries and illnesses have been consistently demonstrated to impair team and individual success [2], where pre-competition [3] and in-competition [4] injuries are negatively associated with achieving key performance indicators. Conversely, an athlete's ability to consistently train and compete without interruption is a key factor for achieving performance success as evidenced across many sports including track and field [5], football [6], and basketball [7]. ...
Background:
In high-performance sport, athlete performance health encompasses a state of optimal physical, mental, and social wellbeing related to an athlete's sporting success. The aim of this study was to identify the priority areas for achieving athlete performance health in Australia's high-performance sport system (HPSS).
Methods:
Participants across five socioecological levels of Australia's HPSS were invited to contribute to this study. Concept mapping, a mixed-methods approach incorporating qualitative and quantitative data collection, was used. Participants brainstormed ideas for what athlete performance health requires, sorted the ideas into groups based on similar meaning and rated the importance, and ease of achieving each idea on a scale from 1 (not important/easiest to overcome) to 5 (extremely important/hardest to overcome).
Results:
Forty-nine participants generated 97 unique statements that were grouped into 12 clusters following multidimensional scaling and hierarchical cluster analysis. The three clusters with highest mean importance rating were (mean importance rating (1-5), mean ease of overcoming (1-5)): 'Behavioral competency' (4.37, 2.30); 'Collaboration and teamwork' (4.19, 2.65); 'Valuing athlete wellbeing' (4.17, 2.77). The 12 clusters were grouped into five overarching domains: Domain one-Performance health culture; Domain two-Integrated strategy; Domain three-Operational effectiveness; Domain four-Skilled people; Domain five-Leadership.
Conclusion:
A diverse sample of key stakeholders from Australia's HPSS identified five overarching domains that contribute to athlete performance health. The themes that need to be addressed in a strategy to achieve athlete performance health in Australia's HPSS are 'Leadership', 'Skilled people', 'Performance health culture', 'Operational effectiveness', and 'Integrated strategy'.
... Across all studies, vigorous exercise consisted of long distance running, endurance training, swimming, triathlon, track and field, athletics, cross-country skiing, and both winter and summer Olympic sports. Of the 22 studies selected, 5 did not report the sex of the participants enrolled [39][40][41][42][43], whereas 17 enrolled both male and female subjects [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60]. Studies ranged from 20 to 11,274 total participants, and the proportion of female participants ranged from 0.12% (N=23) to 26% (N=5,089). ...
The practice of physical activity is an effective non-pharmacological strategy for preventing and treating chronic diseases. A large body of evidence has contributed to establishing a positive correlation between a physically active lifestyle and health benefits, including enhanced vaccination responses, lower numbers of senescent T-cells, increased T-cell proliferative capacity, lower levels of inflammatory cytokines, and improved neutrophil and macrophage function. While females are generally thought to exert more robust immune responses than males in response to a variety of challenges, and both male and female sex hormones have been suggested as mediators of immune function, research on this topic has not always been designed with a sex-specific lens. The goal of this review is to summarize the available experimental and clinical evidence linking exercise and immune function in male and female subjects, with an emphasis on sex differences and sex-specific mechanisms. Overall, the available evidence indicates that moderate exercise and physical activity improves immune function in both sexes, whereas prolonged and high-intensity exercise temporarily impairs immune responses at a higher degree in females. A role of male and female sex hormones in these sex-specific effects is also discussed.
... Both injury and illness play major roles in athlete health, however the latter has only recently become a focus of surveillance and monitoring (Bahr et al., 2020). With upper respiratory illnesses being the most common reason for non-injury related presentation at sports medicine clinics (Gleeson & Pyne, 2016), short-term physical illnesses, such as those affecting the dermatological, gastrointestinal and respiratory systems present a significant health burden to athletes (Raysmith & Drew, 2016). Furthermore, little is known about the lived experience of those navigating illness in sporting contexts compared to that of injury. ...
Illness prevention is essential for athlete health management, but little is known about its uptake in sport. Prior to the pandemic, the International Olympic Committee (IOC) published a consensus statement recommending illness prevention guidelines are implemented in sports. Yet, little is known about guideline uptake. Therefore, this study aimed to explore the (1) illness experiences of rugby players and athlete support personnel and (2) barriers and enablers to illness prevention guideline uptake in rugby, using the lens of behaviour change theory. In a bid to inform and enhance athlete welfare, we sought to amplify the voices of participants through qualitative inquiry. Between August 2020 and May 2021, 16 semi-structured interviews were undertaken with players and athlete support personnel working across rugby. Analysis was conducted using Braun and Clarke’s reflexive thematic analysis. Prior to COVID-19, participants deemed illness to be of little concern, with experience of illnesses and the global pandemic critical enablers to guideline uptake. The rugby environment was a barrier to illness prevention, particularly in women’s and academy teams where resource deficiency was highlighted. ‘Rugby identity’ acted as both a barrier and enabler with participants’ passion for rugby driving both guideline adherence and non-adherence. Tackling resource inequalities between men’s and women’s cohorts is critical to effectively implement guidelines. Coach and player education is essential, and emphasis must be placed on continuing preventative behaviours adopted due to COVID-19. Our findings offer new insight into illness prevention, moving away from prevailing quantitative research, and instead voicing players’ experiences.
... The introduction of injury risk reduction strategies could enable an increase in sports practice (volume and intensity) to improve performance, particularly among professional athletes, even without necessarily reducing overall risk [36]. Furthermore, given the reported negative impact of an injury on athletics performance, [37,38] and especially in championships, [39,40] the concept of health for performance could be put forward: a healthy athlete is more likely to be able to reach his/her full potential. This encourages a win-win performance-prevention approach. ...
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.
... Nous savons déjà que très souvent les lésions conduisent à un arrêt de l'entraînement [14] et constituent ainsi une perte de temps dans la préparation des échéances sportives. Or, en athlétisme, Raysmith et al. [21] ont montré que la perte de temps d'entraînement en lien avec une blessure et une maladie était un déterminant majeur du succès ou de l'échec lors des compétitions internationales avec, par exemple, une baisse de 26 % des chances d'atteindre les objectifs sportifs clés, par semaine, avec au moins un jour ou plus de modification de l'entraînement. Drew et al. [22] rapportaient dans leur revue systématique (football, basketball, rugby, athlétisme, ...
Résumé
Introduction
L’objectif principal de cette étude était d’analyser les liens éventuels entre la survenue de blessures et les performances (sélection en compétition internationale) durant une saison, chez des gymnastes pratiquant la gymnastique artistique à haut niveau au sein d’un Pôle France. L’objectif secondaire était de déterminer l’épidémiologie des blessures de ces mêmes gymnastes sur six saisons.
Méthodes
Nous avons réalisé une analyse rétrospective de données anthropométriques, de blessures et de performances, collectées prospectivement, sur six saisons sportives entre 2014 et 2020, chez les gymnastes féminines du Pôle France de Gymnastique de Saint-Etienne. Nous avons effectué une analyse par régression logistique avec, comme variable dépendante la sélection en championnat international dans la saison (oui/non), comme variable indépendante la présence de blessure(s) dans la saison (oui/non) et, comme variables d’ajustement : l’âge, la taille, le poids, les règles, les antécédents de chirurgie musculo-squelettiques, la durée de sommeil, le nombre de compétitions réalisées dans la saison et l’obtention de médaille(s) nationale(s).
Résultats
43 gymnastes ont été incluses dans cette étude, représentant 110 gymnastes-saison. Un total de 285 blessures a été collecté sur la période ciblée, soit en moyenne 2,6 blessures par gymnaste par saison. En moyenne, 91,4 % des gymnastes avaient eu au moins une blessure par saison. Le genou était l’articulation la plus touchée (16 %). Le type de blessures le plus fréquent était les pathologies dites de croissance (16 %). L’analyse par régression ne retrouvait pas d’association significative entre la sélection en championnat international dans la saison et la présence de blessure(s).
Conclusion
Les résultats de cette étude n’ont pas mis en évidence une association entre blessure et performance, mais ont permis une description de l’épidémiologie des blessures dans cette population.
... 27,28,31,61,62 Upper respiratory tract infections are commonly reported in athletes, with recurrent episodes compromising training and performance. 60,63 These infections occur more frequently in endurance exercises, such as marathons, swimming, and triathlons, than in team sports 59 and are related to the physical and psychological stress related to intense training, combined with an unbalanced diet, frequent changes in time zones, sleep disorders, and exposure to environmental extremes. 64 One of the theories is that upper respiratory tract infections can be induced by increased exposure to pathogens that occurs through higher pulmonary ventilation during exercise, greater incidence of skin abrasions, and exposure to other people, which may generate a hypersensitivity response. ...
Context
Strenuous exercise may lead to negative acute physiological effects that can impair athletic performance. Some recent studies suggest that probiotic supplementation can curtail these effects by reducing the permeability of the intestinal barrier, yet results are inconsistent.
Objective
The aim of this systematic review is to assess the effects of probiotic supplementation on athletic performance.
Data Sources
The PubMed/MEDLINE, Cochrane, and Scopus databases were searched for articles that assessed the effects of probiotic supplementation on athletic performance.
Data Extraction This systematic review is reported according to
PRISMA guidelines. Risk of bias was assessed through the Cochrane RoB 2.0 tool. Seventeen randomized clinical trials assessing athletic performance as the primary outcome were included. In total, 496 individuals (73% male) comprising athletes, recreationally trained individuals, and untrained healthy individuals aged 18 to 40 years were investigated.
Data Analysis
Three studies showed an increase or an attenuation of aerobic performance (decline in time to exhaustion on the treadmill) after supplementation with probiotics, while 3 found an increase in strength. However, most studies (n = 11) showed no effect of probiotic consumption on aerobic performance (n = 9) or muscular strength (n = 2). The most frequently used strain was Lactobacillus acidophilus, used in 2 studies that observed positive results on performance. Studies that used Lactobacillus plantarum TK10 and Lactobacillus plantarum PS128 also demonstrated positive effects on aerobic performance and strength, but they had high risk of bias, which implies low confidence about the actual effect of treatment.
Conclusion
There is not enough evidence to support the hypothesis that probiotics can improve performance in resistance and aerobic exercises. Further well-controlled studies are warranted.
... 19 This is especially important in those periods of the season with a high concentration of training and/or competition loads, which can cause an increase in the number of injured players at key moments of the season, 13,34 with its possible repercussion on the competition results. 35,36 Therefore, the purpose of this systematic review is (1) to analyze how the periodization of workloads can induce states of accumulated fatigue in the short, medium and long term in indoor team sports and (2) to identify these periods of fatigue through the interpretation internal and external performance variables. This study can help coaches develop the necessary strategies to minimize periods of excessive accumulation of fatigue throughout the season, improving the quality of athletes' adaptations and reducing the probability of suffering non-functional overloads, injuries and illnesses. ...
The aims of this study were: (1) to analyze how the periodization of workloads can induce states of accumulated fatigue in the short, medium and long term in indoor team sports and (2) to identify these periods of fatigue through the interpretation internal and external performance variables. This systematic review was carried out under PRISMA guidelines. The Web of Science, PubMed and Scopus databases were searched for relevant published studies between 1st January 2010 and 25th April 2021. The STROBE scale and MINORS checklist were used to assess the reporting and methodological risk of bias, respectively. Of the 2219 studies initially identified, 20 were selected for a full review. The main conclusions were that a periodic and integrative evaluation of monitoring variables of a different nature is needed to identify states of fatigue accurately and rigorously. The end of the preparatory periods (PPs) and the second phase of the competitive periods (CPs) seem to be the most exhausting moments of the season (high values of RPE, CK, LDH, and oxidative stress markers, and decrease in the T/C ratio). Specifically, congested weeks promote the development of high levels of acute and subacute fatigue (high levels of DOMS and fatigue along with low levels of RPE). Therefore, it is recommended to extend the duration of the preseason and the implementation of more active recovery days during congested weeks, in order to improve resistance to acute and subacute fatigue, and therefore avoid reaching a state of overtraining.
... Significant findings support previous anecdotal evidence of effective planning and monitoring of individual training response [12]. The availability of consistent training increases the athlete"s ability to work on both the team and each sport [14]. ...
International result-oriented performance in sports requires systematic scientific training. A proper pedagogical approach is required for systematic loading of the athletes in order to record-breaking performance. The performance of an athlete largely depends upon a progressive training load for a relatively long period of time. The degree of mechanical tension, subcellular damage, and metabolic stress can all play a role in exercise-induced muscle adaptations. The process of adaptation largely depended upon the ratio of load and recovery stimulus. Thus the load dynamics and proper adaptation is reflected in the achievement of an athlete. The present research review-based article discussed systematically the procedure of training load, importance of recovery, and adaptation of load.
... sore throat, headache, runny nose, and cough) are the most common illnesses reported in both military and athlete populations [1,3]. URTS diminish the athlete's training availability, performance, and success [3][4][5]. URTS also have negative implications for military personnel, accounting for a high proportion of non-combat related medical visits and missed service days [1,6]. Thus, in these high-performance occupations, it is vital to keep individuals healthy [7]. ...
Heat acclimation (HA) protocols repeatedly expose individuals to heat stress. As HA is typically performed close to the pinnacle event, it is essential that the protocol does not compromise immune status, health, or wellbeing. The purpose of this study was to examine the effect of HA on resting salivary immunoglobulin-A (s-IgA) and salivary cortisol (s-cortisol), self-reported upper-respiratory tract symptoms, and self-reported wellness parameters. Seventeen participants (peak oxygen uptake 53.2 ± 9.0 mL·kg-1·min-1) completed a 10-day controlled-hyperthermia HA protocol, and a heat stress test both before (HST1) and after (HST2) HA (33°C, 65% relative humidity). Resting saliva samples were collected at HST1, day 3 and 7 of the HA protocol, HST2, and at 5 ± 1 days post-HA. Upper-respiratory tract symptom data were collected weekly from one week prior to HA until three weeks post HA, and wellness ratings were reported daily throughout HA. HA successfully induced physiological adaptations, with a lower end-exercise rectal temperature and heart rate and higher whole-body sweat rate at HST2 compared to HST1. In contrast, resting saliva flow rate, s-IgA concentration, s-cortisol concentration, and s-cortisol secretion rate remained unchanged (n = 11-14, P = 0.10-0.48). Resting s-IgA secretion rate increased by 39% from HST1 to HST2 (n = 14, P = 0.03). No changes were observed in self-reported upper respiratory tract symptoms and wellness ratings. In conclusion, controlled-hyperthermia HA did not negatively affect resting s-IgA and s-cortisol, self-reported upper-respiratory tract symptoms, and self-reported wellness parameters in recreational athletes.
... The relationship between injury burden and a team's success has been documented in elite football where athlete availability was associated with league rankings (H€ agglund et al., 2013). In an individual sport context, a loss of training time due to injury was shown to be a determining factor in the obtainment of an athlete's performance goals in athletics (Raysmith & Drew, 2016). Studies of this nature may help educate and engage technical staff in the injury surveillance and prevention process. ...
Objective
The purpose of this study was to identify the injury surveillance practices being used in competitive swimming environments. It explored the nature of the data collected, the injury definitions used and the perceived effectiveness of injury surveillance. Finally, this study also examined barriers to injury surveillance.
Design
Online cross-sectional.
Participants
Twenty-two responders working in competitive swimming.
Outcome measures
Injury surveillance methods, data collected, perceived level of effectiveness and barriers associated with injury surveillance.
Results
Fifteen responders participated in injury surveillance, with 13 responders using a recognised definition for injury. Ten responders did not use any sports injury classification system. Ten responders found injury surveillance to be very effective at identifying injury trends, while previous injury history and training load data were perceived to be most influential in preventing injury. Limited time, funding and compliance were common obstacles, while poor staff communication and engagement were barriers to the effective implementation of injury surveillance.
Conclusions
The implementation of injury surveillance is related to the system objectives, competitive level of those under surveillance and the resources available. This implementation requires the balance of adhering to the principles outlined in prominent consensus statements and overcoming the barriers associated with implementing a system effectively.
... [1] Indeed, about two-thirds of athletes incur at least one injury during a season, a number that is slightly affected by age, gender, and athletic discipline [1][2][3][4][5][6][7]. Injuries in athletics were found to negatively influence athletes' chance of performance success in competition [8][9][10], and to be one of the main reasons for a forced cessation of sports [11]. However, it is not clear whether injury prevention is perceived as necessary by stakeholders in athletics (i. ...
This study aimed to explore how stakeholders in athletics perceived the relevance of injury prevention, determine their communication preferences, and describe their expectations regarding injury prevention. We conducted a cross-sectional study using an exploratory online survey with high-level athletes (i.e., listed by the French ministry of sports), non-high-level athletes (i.e., all competitive level except high-level athletes), coaches, and health professionals licensed with the French Federation of Athletics. There were 2,864 responders to the survey. Almost all responders found that injury prevention is relevant (97.7% [95% CI 97.0% to 98.2%]), without any significant differences in the distribution between stakeholders’ age, experience and sex (p > 0.05). About three-quarters of the stakeholders preferred to find injury prevention information on a website (77.4%) without significant differences between stakeholders’ categories (p > 0.05); other media to find injury prevention information was chosen by less than 50% of responders. Expectations about injury prevention were mainly explanations, advice and tips about injury knowledge, management and prevention, based on expert opinion and/or scientific research. In conclusion, these results confirm that injury prevention is a challenge shared by numerous stakeholders in athletics, within France, and provide some orientation on how and what information to disseminate to these stakeholders
... Unpublished data from within this group found that URTIs accounted for 50% off missed training sessions in the 2016-2017 swimming season, with 56% of the world-class cohort experiencing at least one URTI instance. Therefore, fewer URTI cases would increase the consistency of training intensity, subsequently enabling greater training-induced adaptations over time [32]. Conversely, no direct ergogenic effects are expected with vitamin D 3 supplementation unless it involves the correction of neuromuscular defects caused by de ciency [2,3,33]. ...
British swimmers are at a heightened risk of vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D): <50 nmol∙L − 1 ) as their large indoor training volumes often restrict sunlight exposure, especially during the winter when daylight hours are reduced. Previous research has recommended 4000 IU∙day − 1 vitamin D 3 from October to March to offset vitamin D losses. However, no current study has analysed this approach over multiple seasons to assess if this is an appropriate strategy. Twenty-nine world-class British swimmers (aged 16–30 years) provided a 10 mL venous blood sample as part of their routine haematological screening in the September of three consecutive years (2018, 2019, 2020). Serum 25(OH)D was determined by radioimmunoassay and this result determined the length of the standardised vitamin D 3 protocol (< 30 nmol∙L − 1 : 4000 IU∙day − 1 from September to March, 30–79 nmol∙L − 1 : 4000 IU∙day − 1 from October to March, > 75 nmol∙L − 1 : no supplementation). Mean serum 25(OH)D concentrations increased each year (2018: 76.4 ± 28.4 nmol∙L − 1 , 2019: 91.5 ± 24.8 nmol∙L − 1 , 2020: 115.0 ± 36.6 nmol∙L − 1 , p < 0.001), which coincided with the eradication of vitamin D deficiency after one season (prevalence, 2018: 10%, 2019: 0%, 2020: 0%). In September 2020, 35% of swimmers had a serum 25(OH)D > 125 nmol∙L − 1 , although it is currently debated whether this is a concern or a benefit for athletic populations. Supplementing with 4000 IU∙day − 1 of vitamin D 3 throughout the winter can therefore increase the vitamin D status of swimmers. However, more frequent testing may be required to ensure that serum 25(OH)D remains within the sufficient across the season (75–125 nmol∙L − 1 ).
... [1][2][3]6,7 Injury has a detrimental impact on performance, with high levels of time lost from training being associated with athletes not reaching their performance goals. 8 Robust data is required on injury and illness to inform the development of effective prevention measures within a sport. 9,10 Across 16 major international athletics championships, muscle injuries were the most common injury type, representing 41% of all injuries. ...
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.
... Calf muscle strain injuries (CMSI) are prevalent in elite sports [1,2] and contribute to the negative impact that any injury can have on team success [3][4][5]. The burden of CMSI can also be significant, with > 3 months time-loss reported for some cases in American football [6], football (soccer) [1] and Australian Football [7]. ...
Background
Despite calf muscle strain injuries (CMSI) being problematic in many sports, there is a dearth of research to guide clinicians dealing with these injuries. The aim of this study was to evaluate the current practices and perspectives of a select group of international experts regarding the assessment, management and prevention of CMSI using in-depth semi-structured interviews.
Results
Twenty expert clinicians working in elite sport and/or clinician-researchers specialising in the field completed interviews. A number of key points emerged from the interviews. Characteristics of CMSI were considered unique compared to other muscle strains. Rigor in the clinical approach clarifies the diagnosis, whereas ongoing monitoring of calf capacity and responses to loading exposure provides the most accurate estimate of prognosis. Athlete intrinsic characteristics, injury factors and sport demands shaped rehabilitation across six management phases, which were guided by key principles to optimise performance at return to play (RTP) while avoiding subsequent injury or recurrence. To prevent CMSI, periodic monitoring is common, but practices vary and data are collected to inform load-management and exercise selection rather than predict future CMSI. A universal injury prevention program for CMSI may not exist. Instead, individualised strategies should reflect athlete intrinsic characteristics and sport demands.
Conclusions
Information provided by experts enabled a recommended approach to clinically evaluate CMSI to be outlined, highlighting the injury characteristics considered most important for diagnosis and prognosis. Principles for optimal management after CMSI were also identified, which involved a systematic approach to rehabilitation and the RTP decision. Although CMSI were reportedly difficult to prevent, on- and off-field strategies were implemented by experts to mitigate risk, particularly in susceptible athletes.
... The list is neither exhaustive nor universal; other performance outcomes may be caused by LEA, while not all those with RED-S may experience all the listed impairments. Generally, more severe LEA and its consequences can cause lost training days due to injury or illness, and lost training days compromise performance 97 . Overall, coaches must internalize these basic considerations: proper training loads combined with adequate nutrition are two critical and inseparable factors for achieving peak athletic performance. ...
The Female Athlete Triad (Triad) and the more encompassing Relative Energy Deficiency in Sport (RED-S) are disorders caused by low energy availability (LEA). LEA is a state of insufficient energy intake by an athlete relative to their energy expenditure. Persistent LEA results in the deleterious consequences to health and performance that comprise RED-S. With respect to both the Triad and RED-S, researchers have called for more education of those involved with sport, particularly coaches, to help reduce the incidence of these disorders. Recent studies have shown that as few as 15% of coaches are aware of the Triad, with up to 89% unable to identify even one of its symptoms. RED-S is a more recently established concept such that coach knowledge regarding it has only begun to be assessed, but the results of these initial studies indicate similar trends as for the Triad. In this review, we synthesize research findings from 1986 to 2021 that pertains to LEA and RED-S, which coaches should know so they can better guide their athletes.
... This methodology has provided reliable and comparable data for this particular context of international championships [8,23]. However, if we broaden the focus to the whole track and field season, we find that only a few studies exist and that they use different methods [4,[24][25][26][27][28][29][30][31][32][33], which does not allow a true comparison of the data, and could explain why injury data should now be presented separately between championships and whole season. A method was developed in 2014 at a consensus meeting of international and national athletics federations [11], and the IOC recently updated a consensus statement on methods for recording and reporting of epidemiological data on injury and illness in sport 2020 [10], that are expected to implement long-term cohort follow-ups over one or more seasons with a comparison between studies. ...
Track and field (athletics) is an Olympic sport composed of several different disciplines: sprints, hurdles, jumps, throws, combined events, middle and long distances, marathon, and race walking. The practice of track and field leads to a risk of injuries. A clear knowledge of the epidemiology of injuries is of great interest as a first step of injury prevention in track and field. During the context of international championships, several studies provide a clear view of the “risks” of injuries, and injury number, incidence, and characteristics varied with sex and disciplines. During the whole season, which represents a significantly larger period of exposure, there are currently and to our knowledge only few studies reporting injury data, but with consistent findings. About two third of athletes had at least one injury during the whole season. As an overview of the injury characteristics in track and field, the most common injury problems experienced are hamstring muscle injuries (especially in sprints, hurdles, and jumps), Achilles tendinopathies (in sprints, middle and long distances, and jumps), knee overuse injuries (in sprints, middle and long distances), shin splints and/or stress fractures (in sprints, middle and long distances), ankle sprains (in jumps), and low back pain (in jumps and throws).
... Calf muscle strain injuries (CMSI) are prevalent in elite sports [1,2] and contribute to the negative impact that any injury can have on team success [3][4][5]. The burden of CMSI can also be significant, with > 3 months time-loss reported for some cases in American football [6], football (soccer) [1] and Australian Football [7]. ...
Background
Despite being a common cause of time loss, information regarding best practice for calf muscle strain injuries (CMSI) in sport is scarce.
Objective
To establish best practice for the assessment and management of CMSI.
Design
Qualitative.
Setting
In-depth interviews.
Patients (or Participants)
20 expert medical professionals working in elite sport and/or researchers specialising in the field; representing seven countries and seven sports.
Interventions (or Assessment of Risk Factors)
Semi-structured interviews using a schedule of questions canvassing pre-identified topics. Thematic coding to analyse findings.
Main Outcome Measurements
Data were evaluated in three key areas: (i) injury characteristics, (ii) injury management, and (iii) injury prevention.
Results
CMSI have unique injury characteristics compared to other common muscle strain injuries (e.g. hamstring), but a criteria-based approach can assist forming the most accurate impression of prognosis. Similarly, a structured approach should be followed to ensure the athlete returns to a high level of performance and the risk of re-injury is minimized, focusing on: re-strengthening, plyometric and ballistic exercises, as well as running-based reconditioning specific to the sport. For the best chance to prevent index CMSI, strategies should span multiple domains of athlete management: screening and monitoring, field-based exposure (e.g. workload data), and off-field interventions (e.g. strengthening). Injury prevention strategies should be tailored to the individual, considering extrinsic (the sport, position played, club culture/coach expectations) and intrinsic (previous injury history, age, training history) factors that may increase susceptibility to CMSI.
Conclusions
Knowledge about the unique injury characteristics of CSMI can clarify the likely prognosis and best approach to rehabilitation. Practitioners attempting to prevent CMSI should use a multi-faceted approach given that the aetiology of CMSI is complex and often unique to the individual.
... The previous study that goes against the results of this current study defined injuries as all injuries that occurred, even if the athlete continued to play, whereas in our current study injuries were defined as when an athlete missed a game due to injury (7). Also, it should be noted that one study investigating Australian track and field athletes found that there was a relationship between injuries and finish places at major events (31). Though a different definition, it is a similar concept that supporting the influence injuries can have on a team's success each season. ...
An expert strength and conditioning coach can be an important component of a sports performance and medicine staff that will train their athletes to help them become more resilient to injury. Previous research in a variety of sports has shown that teams with players that have fewer games missed due to injury have achieved greater success. The purpose of this study was to determine if a relationship exists between games missed due to injury by offensive and defensive starters on National Football League (NFL) rosters and a NFL team's ability to win during the 2010-19 NFL seasons. A Spearman rank-order correlation analysis set at (p ≤ 0.01) level of significance indicated that fewer games missed by starters in the NFL is correlated with multiple variables associated with winning such as games won per season and playoff appearances. These results were obtained after analyzing all 32 NFL teams from the 2010-19 seasons. Descriptive statistics were also used to further analyze the data set and found that teams ranked in the top-five in terms of fewest injuries outperformed the remainder of the teams in the NFL according to multiple variables associated with winning. The data in this study supports that NFL organizations that have fewer games missed due to injury of their athletes may have a better opportunity of achieving success.
In the past decade, the study of relationships among nutrition, exercise and the effects on health and athletic performance, has substantially increased. The 2014 introduction of Relative Energy Deficiency in Sport (REDs) prompted sports scientists and clinicians to investigate these relationships in more populations and with more outcomes than had been previously pursued in mostly white, adolescent or young adult, female athletes. Much of the existing physiology and concepts, however, are either based on or extrapolated from limited studies, and the comparison of studies is hindered by the lack of standardised protocols. In this review, we have evaluated and outlined current best practice methodologies to study REDs in an attempt to guide future research.
This includes an agreement on the definition of key terms, a summary of study designs with appropriate applications, descriptions of best practices for blood collection and assessment and a description of methods used to assess specific REDs sequelae, stratified as either Preferred , Used and Recommended or Potential . Researchers can use the compiled information herein when planning studies to more consistently select the proper tools to investigate their domain of interest. Thus, the goal of this review is to standardise REDs research methods to strengthen future studies and improve REDs prevention, diagnosis and care.
Objectives
To evaluate the effectiveness of a trainer-supervised judo-specific injury prevention warm-up programme on overall injury prevalence.
Methods
We conducted a two-arm, cluster randomised controlled trial; the Injury Prevention and Performance Optimization Netherlands (IPPON) study. Judo athletes aged≥12 years were randomised by judo school to IPPON intervention or control group who performed their usual warm-up. Primary outcome was overall injury prevalence (%) over the follow-up period (16–26 weeks) measured fortnightly with the Oslo Sports and Trauma Research Centre Questionnaire. A modified intention-to-treat analysis was performed due to COVID-19, with estimates for the primary outcome obtained using generalised linear mixed models. Secondary outcomes included: prevalence of severe injuries, overall incidence, time-loss injuries, exposure, adherence and experiences of trainers and athletes.
Results
269 judo athletes (IPPON: 117, Control: 152) were included. Mean injury prevalence over 16–26 weeks was 23% (95% CI 20% to 26%) in the IPPON and 28% (95% CI 25% to 30%) in the control group. We observed no significant difference of all reported injuries (OR 0.72 in favour of the IPPON group; 95% CI 0.37 to 1.39). Secondary outcomes also demonstrated no significant differences between groups. Specifically, no significant difference of severe injuries was reported (OR 0.80 in favour of the IPPON group; 95% CI 0.36 to 1.78). All trainers and 70% of athletes perceived the IPPON intervention as successful.
Conclusion
The IPPON intervention did not significantly reduce the overall and severe injury prevalence. Despite this, we suggest the IPPON intervention be considered as an useful alternative to regular judo warm-up, given the high adherence and the positive clinical experiences of trainers and athletes.
Trial registration number
NTR7698.
Objectives
This study presents seven seasons of injury surveillance data for both elite Australian male and female cricket players, revealing injury statistics and allowing for comparison between sexes.
Design
Retrospective cohort.
Methods
Participants were elite Australian male and female cricket players who were contracted to play for a national and/or state/territory team and/or T20 franchise between 2015 and 16 and 2021–22 (7 seasons). Injury data was recorded in Cricket Australia's Athlete Management System database and combined with match data. The STROBE-SIIS statement was used as the relevant guideline for this study.
Results
Data for 1345 male player seasons and 959 female player seasons revealed sex-related differences in the injury incidence rates and prevalence. Males had higher incidence (average 136 vs 101 injuries per 1000 match days) and prevalence of match time-loss injuries (average 10.4% vs 6.5% players unavailable). However, the overall incidence of all medical attention injuries were similar between sexes (Incidence Rate Ratio (IRR) 0.9, 95%CI 0.8–1.0). The most frequent match time-loss injuries for males were hamstring strains (7.4 new injuries per 100 players per season), side and abdominal strains (5.5), concussion (5.0), lumbar stress fractures (4.3), and wrist and hand fractures (3.9). The most frequent match time-loss injuries for females over the 7 seasons were hamstring strains (3.1), concussion (2.3), quadriceps strains (2.4) and shin/ft/ankle stress fractures (2.0). The IRR of medical attention injuries for males compared to females was higher for lumbosacral stress fractures (IRR 2.3), elbow and forearm injuries (1.5), and concussion (1.4), and lower for lower leg, foot, and ankle stress fractures (0.6), shoulder and upper arm injuries (0.7), and quadriceps strains (0.6).
Conclusions
Robust long-term injury surveillance enabled the injury profiles of elite Australian male and female cricket players to be understood and compared. Males had a higher incidence and prevalence of match time-loss injuries, likely reflecting a higher match exposure.
At the most primitive level, humans were made to run. The ability to run long distances may have given humans a competitive advantage in persistence hunting that provided essential food for survival (Lieberman et al., 2007). In modern times, most distance running is performed for athletic competition, physical fitness or play. Participation in the sport of running has seen a steady upward trend over the last few decades, including in adolescents. This trend creates a specific opportunity for pediatric clinicians. Running can be beneficial for health and wellness, however a significant proportion of habitual runners sustain an overuse injury annually. Running can improve mental health by decreasing symptoms of anxiety and depression, but it can play a role in exercise addiction and eating disorders (Paluska and Schwenk, 2000; Yates et al., 1983). For clinicians to effectively care for the adolescent runner, knowledge of the unique developmental physical, physiologic, and psychological aspects of their patients must be applied to optimize their health and wellness.
Any individual can enhance his/her performance by engaging in deliberate practice and training during optimal periods of development. Nonetheless, the initial level of performance at first exposure to a sport varies greatly between individuals, as some individuals show a higher response to training than others. Furthermore, some athletes are repeatedly afflicted with injuries, but some athletes are not injured at all. Numerous twin and family studies have demonstrated that genetic factors contribute significantly to the variation in physical performance. Further, it has been demonstrated that several genetic variants significantly affect the susceptibility of sports-related injuries. Since an insertion (I)/deletion (D) polymorphism in the angiotensin I-converting enzyme gene (ACE) was first reported to have an impact on human physical performance, numerous studies have attempted to identify genetic variants influencing sports performance. To date, at least 100 genetic markers have been reported to be linked to the status of an athlete’s endurance, and at least 69 genetic markers have been reported to be linked to the status of an athlete’s power. Nevertheless, there is limited evidence of the genetic factors involved in sports performance and vulnerability to sport-related injuries in Asian populations. In order to perform genetic testing for individual training to improve sport performance and reduce injury risk, reliable and valid evidence is required, in addition to careful consideration of ethical issues. To achieve such individualized training in Japanese athletes, we need to develop a strong scientific foundation on this topic in the Asian population through large-scale collaborative projects.
Objective
Few long-term prospective studies have investigated health problems in elite competitive cross-country (XC) skiers. Hence, our objective was to compare the prevalence of health problems in national team XC skiers over a competitive season.
Methods
Forty national team XC skiers participated in this prospective, observational study. Two groups were characterised according to performance level: senior (n=18, ~26 years old, 9 women) and development (n=22, ~21 years old, 9 women). The skiers reported all and substantial injuries and illnesses weekly for 17 consecutive weeks throughout the 2019/2020 competitive season using the Oslo Sports Trauma Research Center Questionnaire on Health Problems.
Results
The average weekly prevalence of all and substantial health problems was 19% (95% CI: 16% to 22%) and 12% (95% CI: 9% to 15%), respectively, and was similar between senior and development level skiers (p>0.05). The injury prevalence was higher in senior versus development level skiers (12%, 95% CI: 9% to 15% vs 5%, 95% CI: 3% to 7%; p<0.001), while illnesses were less common (8%, 95% CI: 3% to 13% vs 13%, 95% CI: 9% to 17%, respectively; p=0.031). Illnesses accounted for 72% of all problems. The prevalence of all health problems was higher in female than in male skiers (23%, 95% CI: 19% to 27% vs 15%, 95% CI: 11% to 19%; p<0.003).
Conclusions
Health problems, especially illnesses, were relatively common, with approximately one in five skiers (19%) reporting at least one problem in any given week. Both performance level and sex influenced the prevalence of different types of health problems.
Objectives
To investigate the prevalence, incidence rate (IR) and burden of health problems (injuries and illnesses) in Australian Olympic class and State Sailing Pathway Program (SSPP) athletes over 12-months of training and competition.
Design
Descriptive epidemiological study.
Methods
Ninety-two Australian Sailing and SSPP athletes were prospectively followed during the 2019–2020 season. Medical attention injuries and illnesses were prospectively recorded, and further sub-categorised according to time loss. The IR and burden were calculated per 365 athlete-days, with differences in IR between sexes compared using negative binomial generated rate ratios.
Results
Three hundred and forty-nine injuries were reported in 53 athletes (57.6 %), with 14.3 % resulting in time loss. Injury IR was 3.71 (95%CI = 3.33–4.12) injuries per 365 athlete–days, with no difference overserved between sex (IRR = 1.64; 95%CI = 0.81–3.34). Shoulder injuries were found to have the greatest burden. Fifty-four illnesses were reported in 27 athletes (29.3 %), with 39.0 % resulting in time loss. Respiratory infection (n = 22, 40.7 %) was the most common illness reported. Illness IR was 0.57 (95%CI = 0.43–0.75) illnesses per 365 athlete days, with females found to have a 3.6 fold increase in illness compared to males (IRR = 3.6; 95%CI = 2.0–6.7).
Conclusions
The majority of health problems reported in sailing athletes did not result in time loss. There were no differences in the injury IR between sexes, however females had a 3.6-fold increase in reported illness. These results can inform future strategies to reduce key health problems in sailors. Future research investigating whether performance is impacted by the high rate of non-time loss health problems is warranted.
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Objective:
1) Describe overall illness, and COVID-19-specific illness in high school athletes in the 2019-2020 and 2020-2021 academic school years; and 2) describe and assess the risk of musculoskeletal injury following general infection, and after COVID-19.
Design:
Ecological study.
Methods:
High schools (6 states; 176 high schools) were matched between the 2019-2020 and 2020-2021 academic school years, based on 2020-2021 high school sport participation. Illness and injury data were collected from the high school athletic trainers. Illness was stratified by overall illness, general infection, and COVID-19. Injuries following moderate or severe infections or COVID-19 were recorded. Illness and injury incidence rate per 100 athletes per year with 95% confidence intervals (95% CI) were calculated. Negative binomial models comparing injury following general infections and COVID-19 infections were calculated.
Results:
98,487 and 72,521 athletes participated in the 2019-2020 and 2020-2021 years. Illness incidence rate was less in the 2019-2020 [0.30 (95% CI: 0.27-0.34)] than 2020-2021 [1.1 (1.0-1.2)] year, resulting in a difference of 0.8 (95% CI: 0.7, 0.9). COVID-19 incidence rate was 0.52 (0.47-0.58) in the 2020-2021 year. Injury following general infection incidence rate was 27.9 injuries (21.4-34.5) per 100 athletes in 2019-2020, and 22.5 injuries (19.3-25.7) per 100 athletes in 2020-2021. There was no difference in injury risk following general infection and COVID-19 [Rate Ratio: 1.2 (95% CI: 0.7-2.4)].
Conclusions:
The incidence rate for all illnesses in high school athletes was slightly (0.8) greater in the 2020-2021 academic compared to the 2019-2020 year. Most of the incidence increase was due to infections and COVID-19. Subsequent injury incidence following moderate and severe infections were similar between years and between general infections and COVID-19.
Acute respiratory infections (ARinf) are common in athletes, but their effects on exercise and sports performance remain unclear. This systematic review aimed to determine the acute (short-term) and longer-term effects of ARinf, including SARS-CoV-2 infection, on exercise and sports performance outcomes in athletes. Data sources searched included PubMed, Web of Science and EBSCOhost, from January 1990 to 31 December 2021. Eligibility criteria included original research studies published in English, measuring exercise and/or sports performance outcomes in athletes/physically active/military aged 15–65 years with ARinf. Information regarding the study cohort, diagnostic criteria, illness classification and quantitative data on the effect on exercise/sports performance were extracted. Database searches identified 1707 studies. After full-text screening, 17 studies were included (n = 7793). Outcomes were acute or longer-term effects on exercise (cardiovascular or pulmonary responses), or sports performance (training modifications, change in standardised point scoring systems, running biomechanics, match performance or ability to start/finish an event). There was substantial methodological heterogeneity between studies. ARinf was associated with acute decrements in sports performance outcomes (four studies) and pulmonary function (three studies), but minimal effects on cardiorespiratory endurance (seven studies in mild ARinf). Longer-term detrimental effects of ARinf on sports performance (six studies) were divided. Training mileage, overall training load, standardised sports performance-dependent points and match play can be affected over time. Despite few studies, there is a trend towards impairment in acute and longer-term exercise and sports outcomes after ARinf in athletes. Future research should consider a uniform approach to explore relationships between ARinf and exercise/sports performance.
PROSPERO (CRD42020159259)
• Highlights
• Cardiorespiratory endurance is largely unaffected by recent mild SARS-CoV-2 infection and upper ARinf (rhinovirus) infection, however more severe ARinf is associated with a negative impact on exercise and sports performance.
• An upper ARinf (rhinovirus) and SARS-CoV-2 infection caused marked reductions in pulmonary function tests (FEV1.0/FVC), with greater reductions observed in more severe ARinf. However, the results remained within normal ranges.
• Self-reported training ability and training capacity can be reduced during an upper ARinf, and an ARinf with fever could alter running kinematics.
• Training mileage and overall training load can be impaired over time post-ARinf. Analysis of initial studies indicates a trend for a reduction in standardised sports performance-dependent points in athletes with respiratory infection.
Objective
To describe weekly illness prevalence and illness symptoms by sex in youth floorball players during one season.
Design
Prospective cohort study.
Setting
Players who were registered to play community level floorball during the 2017–2018 season (26 weeks) in two provinces in southern Sweden.
Participants
471 youth players aged 12–17 years. Mean (SD) age for 329 male players 13.3 (1.0) years and 142 female players 13.7 (1.5) years.
Primary and secondary outcome measures
Weekly self-reported illness prevalence and illness symptoms according to the 2020 International Olympic Committee’s consensus recommendations.
Results
61% of youth floorball players reported at least one illness week during the season, with an average weekly illness prevalence of 12% (95% CI 10.8% to 12.3%). The prevalence was slightly higher among females (13%, 95% CI 11.6% to 14.3%) than males (11%, 95% CI 9.9% to 11.7%), prevalence rate ratio 1.20 (95% CI 1.05 to 1.37, p=0.009). In total, 49% (53% male, 43% female) of illness reports indicated that the player could not participate in floorball (time loss), with a mean (SD) absence of 2.0 (1.7) days per illness week. Fever (30%), sore throat (16%) and cough (14%) were the most common symptoms. Female players more often reported difficulty in breathing/tight airways and fainting, and male players more often reported coughing, feeling tired/feverish and headache. Illness prevalence was highest in the peak winter months (late January/February) reaching 15%–18% during this period.
Conclusions
Our novel findings of the illness prevalence and symptoms in youth floorball may help direct prevention strategies. Athletes, coaches, parents and support personnel need to be educated about risk mitigation strategies.
Trial registration number
NCT03309904 .
Introduction: Team sport athletes have increased susceptibility to upper respiratory symptoms (URS) during periods of intensified training and competition. Reactivation of Epstein–Barr Virus (EBV) may be a novel marker for risk of upper respiratory illness (URI) in professional athletes. Aims: To investigate changes in salivary EBV DNA (in addition to the well-established marker, salivary secretory immunoglobulin A), and incidence of URS in professional footballers. Methods: Over a 16-week period (August to November 2016), 15 male players from a professional English football League 1 club provided weekly unstimulated saliva samples (after a rest day) and recorded URS. Saliva samples were analyzed for secretory IgA (ELISA) and EBV DNA (qPCR). Results: Whole squad median (interquartile range) saliva IgA concentration and secretion rate significantly decreased (p < .05) between weeks 8 and 12 (concentration, 107 (76–150) mg/L healthy baseline to 51 (31–80) mg/L at week 12; secretion rate 51 (30–78) µg/min healthy baseline to 22 (18–43) µg/min at week 12). Two players reported URS episodes during week 10, both after IgA secretion rate decreased below 40% of the individual’s healthy baseline. EBV DNA was detected in the weeks before URS but also at other times and in healthy players (overall frequency 40%, range 11–78%) and frequency was similar between the URS and healthy group. Conclusion: These findings confirm salivary IgA as a useful marker of URS risk but EBV DNA was not. Further research capturing a greater number of URS episodes is required, however, to fully determine the utility of this marker.
Objectives
This study aimed to describe the injury epidemiology of domestic and international level male New Zealand cricketers from seasons 2009–2010 to 2014–2015 across all match formats given the increasing popularity of T20 cricket.
Methods
Match exposure and injury surveillance data collected prospectively by New Zealand Cricket was analysed using international consensus recommendations for injury surveillance and reporting in cricket. Relationships between playing level, role and injury were statistically analysed.
Results
A total of 268 elite male New Zealand cricketers from seasons 2009–2010 to 2014–2015 were analysed from the New Zealand Cricket injury surveillance system. Total new match injury incidence rates were 37.0 and 58.0 injuries per 10 000 player hours in domestic and international cricket, respectively. Total new and recurrent match injury incidence in international cricket was approximately 1.7 times higher than domestic cricket (277.6 vs 162.8 injuries per 1000 player days). Injury prevalence rates were 7.6% and 10.0% in domestic and international cricket. The hamstring (8.2%) in domestic cricket and the groin (13.5%) in international cricket were the most injured body sites. Most match days lost in domestic cricket were to the lumbar spine (417 days), and groin in international cricket (152 days). There were statistically significant differences in injury between domestic and international level cricketers (χ ² =4.39, p=0.036), and playing role (χ ² =42.29, p<0.0001).
Conclusions
Total injury incidence rates in elite New Zealand cricket increased in 2009–2015 compared with previous data. International-level players and pace bowlers were the most injured individuals.
Objective:
To test the efficacy of the Athletics Injury Prevention Programme (AIPP) to reduce the percentage of athletes presenting at least one injury complaint leading to participation restriction (ICPR) over an athletics season.
Methods:
During the 2017-2018 athletics season, we included in this cluster randomised controlled trial (ClinicalTrials.gov Identifier: NCT03307434) 840 athletes randomly assigned (randomisation unit: athletic clubs) to a control group (regular training) or to an intervention group (regular training plus the AIPP 2/week). Using a weekly online questionnaire, athletes reported the ICPR, training and competition exposures, and, for the intervention group, the compliance with the AIPP. The primary outcome was the percentage of athletes presenting at least one ICPR over the study follow-up.
Results:
A total of 449 and 391 athletes were included in the intervention and control groups, respectively. From them, 68 (15.1%) and 100 (25.6%) athletes, respectively, provided 100% of the requested information during the follow-up (39 weeks). A total of 6 (8.8%) performed the AIPP 2/week or more. The proportion of athletes who had at least one ICPR over the follow-up period was similar in the intervention (64.7%) and control groups (65.0%), with adjusted odds ratios: 0.81 (95% CI 0.36 to 1.85). There were no between-group differences when comparing separately the subgroups corresponding with the different compliance levels.
Conclusion:
This cluster randomised controlled trial reported no efficacy of the AIPP. However, the overall response proportion and the compliance with the AIPP in the intervention group were low. In individual sports especially, efforts should be first made to improve the implementation and adoption of interventions.
To determine the health status of athletes before the start of an international athletics championship and to determine whether preparticipation risk factors predicted in-championship injuries.
At the beginning of the 2013 International Association of Athletics Federations (IAAF) World Championships, all registered athletes (n=1784) were invited to complete a preparticipation health questionnaire (PHQ) on health status during the month preceding the championships. New injuries that occurred at the championships were prospectively recorded.
The PHQ was completed by 698 (39%) athletes; 204 (29.2%) reported an injury complaint during the month before the championships. The most common mode of onset of preparticipation injury complaints was gradual (43.6%). Forty-nine athletes in the study reported at least one injury during the championships. Athletes who reported a preparticipation injury complaint were at twofold increased risk for an in-championship injury (OR=2.09; 95% CI 1.16 to 3.77); p=0.014). Those who reported a preparticipation gradual-onset injury complaint were at an almost fourfold increased risk for an in-championship time-loss injury (OR=3.92; 95% CI 1.69 to 9.08); p=0.001). Importantly, the preparticipation injury complaint severity score was associated with the risk of sustaining an in-championship injury (OR=1.14; 95% CI 1.06 to 1.22); p=0.001).
About one-third of the athletes participating in the study reported an injury complaint during the month before the championships, which represented a risk factor for sustaining an injury during the championship. This study emphasises the importance of the PHQ as a screening tool to identify athletes at risk of injuries before international championships.
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The expectation that training enhances performance is well explored in professional sport. However, the additional challenges of physical and cognitive maturation may require careful consideration when determining workloads to enhance performance in adolescents.
The objective of this study was to determine the state of knowledge on the relationship between workloads, physical performance, injury and/or illness in adolescent male football players.
A systematic review of workloads, physical performance, injury and illness in male adolescent football players was conducted. Studies for this review were identified through a systematic search of six electronic databases (Academic Search Complete, CINAHL, PsycINFO, PubMed, SPORTDiscus, and Web of Science). For the purpose of this review, load was defined as the cumulative amount of stress placed on an individual from multiple training sessions and games over a period of time, expressed in terms of either the external workloads performed (e.g., resistance lifted, kilometres run) or the internal response (e.g., heart rate, rating of perceived exertion) to that workload.
A total of 2,081 studies were initially retrieved from the six databases, of which 892 were duplicates. After screening the titles, abstracts and full texts, we identified 23 articles meeting our criteria around adolescent football players, workloads, physical performance, injury and/or illness. Seventeen articles addressed the relationship between load and physical performance, four articles addressed the relationship between load and injury and two articles addressed both. A wide range of training modalities were employed to improve the physical performance of adolescent football players, with strength training, high-intensity interval training, dribbling and small-sided games training, and a combination of these modalities in addition to normal football training, resulting in improved performances on a wide range of physiological and skill assessments. Furthermore, there was some (limited) evidence that higher workloads may be associated with the development of better physical qualities, with one study demonstrating enhanced submaximal interval shuttle run performance with each additional hour of training or game play. Of the few studies examining negative consequences associated with workloads, increases in training load led to increases in injury rates, while longer training duration was associated with a greater incidence of illness.
The combined capacity for adolescent males to grow, train and improve physical performance highlights and underscores an exciting responsiveness to training in the football environment. However, the capacity to train has some established barriers for adolescents experiencing high workloads, which could also result in negative consequences. Additional research on stage-appropriate training for adolescent male footballers is required in order to address the knowledge gaps and enhance safe and efficient training practices.
Movement towards sport safety in Athletics through the introduction of preventive strategies requires consensus on definitions and methods for reporting epidemiological data in the various populations of athletes.
To define health-related incidents (injuries and illnesses) that should be recorded in epidemiological studies in Athletics, and the criteria for recording their nature, cause and severity, as well as standards for data collection and analysis procedures.
A 1-day meeting of 14 experts from eight countries representing a range of Athletics stakeholders and sport science researchers was facilitated. Definitions of injuries and illnesses, study design and data collection for epidemiological studies in Athletics were discussed during the meeting. Two members of the group produced a draft statement after this meeting, and distributed to the group members for their input. A revision was prepared, and the procedure was repeated to finalise the consensus statement.
Definitions of injuries and illnesses and categories for recording of their nature, cause and severity were provided. Essential baseline information was listed. Guidelines on the recording of exposure data during competition and training and the calculation of prevalence and incidences were given. Finally, methodological guidance for consistent recording and reporting on injury and illness in athletics was described.
This consensus statement provides definitions and methodological guidance for epidemiological studies in Athletics. Consistent use of the definitions and methodological guidance would lead to more reliable and comparable evidence.
To determine if the comparison of acute and chronic workload is associated with increased injury risk in elite cricket fast bowlers.
Data were collected from 28 fast bowlers who completed a total of 43 individual seasons over a 6-year period. Workloads were estimated by summarising the total number of balls bowled per week (external workload), and by multiplying the session rating of perceived exertion by the session duration (internal workload). One-week data (acute workload), together with 4-week rolling average data (chronic workload), were calculated for external and internal workloads. The size of the acute workload in relation to the chronic workload provided either a negative or positive training-stress balance.
A negative training-stress balance was associated with an increased risk of injury in the week after exposure, for internal workload (relative risk (RR)=2.2 (CI 1.91 to 2.53), p=0.009), and external workload (RR=2.1 (CI 1.81 to 2.44), p=0.01). Fast bowlers with an internal workload training-stress balance of greater than 200% had a RR of injury of 4.5 (CI 3.43 to 5.90, p=0.009) compared with those with a training-stress balance between 50% and 99%. Fast bowlers with an external workload training-stress balance of more than 200% had a RR of injury of 3.3 (CI 1.50 to 7.25, p=0.033) in comparison to fast bowlers with an external workload training-stress balance between 50% and 99%.
These findings demonstrate that large increases in acute workload are associated with increased injury risk in elite cricket fast bowlers.
Background:
The influence of injuries on team performance in football has only been scarcely investigated.
Aim:
To study the association between injury rates and team performance in the domestic league play, and in European cups, in male professional football.
Methods:
24 football teams from nine European countries were followed prospectively for 11 seasons (2001-2012), including 155 team-seasons. Individual training and match exposure and time-loss injuries were registered. To analyse the effect of injury rates on performance, a Generalised Estimating Equation was used to fit a linear regression on team-level data. Each team's season injury rate and performance were evaluated using its own preceding season data for comparison in the analyses.
Results:
7792 injuries were reported during 1 026 104 exposure hours. The total injury incidence was 7.7 injuries/1000 h, injury burden 130 injury days lost/1000 h and player match availability 86%. Lower injury burden (p=0.011) and higher match availability (p=0.031) were associated with higher final league ranking. Similarly, lower injury incidence (p=0.035), lower injury burden (p<0.001) and higher match availability (p<0.001) were associated with increased points per league match. Finally, lower injury burden (p=0.043) and higher match availability (p=0.048) were associated with an increase in the Union of European Football Association (UEFA) Season Club Coefficient, reflecting success in the UEFA Champions League or Europa League.
Conclusions:
Injuries had a significant influence on performance in the league play and in European cups in male professional football. The findings stress the importance of injury prevention to increase a team's chances of success.
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.
Objective
Sports injuries are often recurrent and there is wide recognition that a subsequent injury (of either the same or a different type) can be strongly influenced by a previous injury. Correctly categorising subsequent injuries (multiple, recurrent, exacerbation or new) requires substantial clinical expertise, but there is also considerable value in combining this expertise with more objective statistical criteria. This paper presents a new model, the subsequent injury categorisation (SIC) model, for categorising subsequent sports injuries that takes into account the need to include both acute and overuse injuries and ten different dependency structures between injury types.
Methods
The suitability of the SIC model was demonstrated with date ordered sports injury data from a large injury database from community Australian football players over one playing season. A subsequent injury was defined to have occurred in the subset of players with two or more reported injuries.
Results
282 players sustained 469 subsequent injuries of which 15.6% were coded to categories representing injuries that were directly related to previous index injuries. This demonstrates that players can sustain a number of injuries over one playing season. Many of these will be unrelated to previous injuries but subsequent injuries that are related to previous injury occurrences are not uncommon.
Conclusion
The handling of subsequent sports injuries is a substantial challenge for the sports medicine field—both in terms of injury treatment and in epidemiological research to quantify them. Application of the SIC model allows for multiple different injury types and relationships within players, as well as different index injuries.
Objectives:
To examine the relationship between combined training and game loads and injury risk in elite Australian footballers.
Design:
Prospective cohort study.
Methods:
Forty-six elite Australian footballers (mean±SD age of 22.2±2.9 y) from one club were involved in a one-season study. Training and game loads (session-RPE multiplied by duration in min) and injuries were recorded each time an athlete exerted an exercise load. Rolling weekly sums and week-to-week changes in load were then modelled against injury data using a logistic regression model. Odds ratios (OR) were reported against a reference group of the lowest training load range.
Results:
Larger 1 weekly (>1750 AU, OR=2.44-3.38), 2 weekly (>4000 AU, OR=4.74) and previous to current week changes in load (>1250 AU, OR=2.58) significantly related (p<0.05) to a larger injury risk throughout the in-season phase. Players with 2-3 and 4-6 years of experience had a significantly lower injury risk compared to 7+ years players (OR=0.22, OR=0.28) when the previous to current week change in load was more than 1000 AU. No significant relationships were found between all derived load values and injury risk during the pre-season phase.
Conclusions:
In-season, as the amount of 1-2 weekly load or previous to current week increment in load increases, so does the risk of injury in elite Australian footballers. To reduce the risk of injury, derived training and game load values of weekly loads and previous week-to-week load changes should be individually monitored in elite Australian footballers.
Little is known of injury patterns in track and field (athletics). Injury prevalence has been proposed as the most appropriate measure of the injury rate in sports where athletes are at risk for overuse problems.
To ascertain 1-year retrospective and current prevalence of injury in elite track and field athletes to help plan injury prevention programs for this sport.
Descriptive epidemiology study.
Two hundred seventy-eight youth (16 years old) and adult athletes from an eligible study population of 321 athletes were included.
The 1-year retrospective injury prevalence was 42.8% (95% confidence interval [CI], 36.9%-49.0%); the point prevalence was 35.4% (95% CI, 29.7%-41.4%). The diagnosis group displaying the highest injury prevalence was inflammation and pain in the gradual onset category (1-year prevalence, 20.9%; 95% CI, 16.2%-26.2%; and point prevalence, 23.2%; 95% CI, 18.4%-28.7%). A strong tendency for higher 1-year prevalence of 16.5% (95% CI, 12.2%-21.4%) than point prevalence of 8.5% (95% CI, 5.5%-12.5%) was recorded for sudden onset injuries in the diagnosis group sprain, strain, and rupture. The body region showing the highest injury prevalence was the knee and lower leg with 15.0% (95% CI, 11.0%-19.8%) 1-year prevalence and 13.7% (95% CI, 9.8%-18.3%) point prevalence, followed by the Achilles tendon, ankle, and foot/toe with 11.7% (95% CI, 8.2%-16.1%) 1-year prevalence and 11.4% (95% CI, 7.9%-15.8%) point prevalence.
The injury prevalence is high among Swedish elite track and field athletes. Most of the injuries affect the lower extremities and are associated with a gradual onset. Although it is associated with a potential recall bias, the 1-year retrospective prevalence measure captured more sudden onset injuries than the point prevalence measure. Future prospective studies in track and field are needed to identify groups of athletes at increased risk.
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.
Standardized assessment of sports injuries provides important epidemiological information and also directions for injury prevention.
To analyze the frequency, characteristics, and causes of injuries incurred during the Summer Olympic Games 2008.
Descriptive epidemiology study.
The chief physicians and/or chief medical officers of the national teams were asked to report daily all injuries newly incurred during the Olympic Games on a standardized injury report form. In addition, injuries were reported daily by the physicians at the medical stations at the different Olympic venues and at the polyclinic in the Olympic Village.
Physicians and/or therapists of 92 national teams covering 88% of the 10,977 registered athletes took part in the study. In total, 1055 injuries were reported, resulting in an incidence of 96.1 injuries per 1000 registered athletes. Half of the injuries (49.6%) were expected to prevent the athlete from participating in competition or training. The most prevalent diagnoses were ankle sprains and thigh strains. The majority (72.5%) of injuries were incurred in competition. One third of the injuries were caused by contact with another athlete, followed by overuse (22%) and noncontact incidences (20%). Injuries were reported from all sports, but their incidence and characteristics varied substantially. In relation to the number of registered athletes, the risk of incurring an injury was highest in soccer, taekwondo, hockey, handball, weightlifting, and boxing (all >or=15% of the athletes) and lowest for sailing, canoeing/kayaking, rowing, synchronized swimming, diving, fencing, and swimming.
The data indicate that the injury surveillance system covered almost all of the participating athletes, and the results highlight areas of high risk for sport injury such as the in-competition period, the ankle and thigh, and specific sports. The identification of these factors should stimulate future research and subsequent policy change to prevent injury in elite athletes.
The aim of this study was to analyze all sports injuries incurred in competitions and/or training during the 2007 World Athletics Championships and to prove the feasibility of the injury surveillance system developed for the 2008 Olympic Games for individual sports.
Prospective recording of injuries.
11 IAAF World Championships in Athletics 2007 in Osaka, Japan.
All national team physicians and physiotherapists; Local Organising Committee (LOC) physicians working in the Medical Centres at the stadium and warm-up area.
Frequency, characteristics, and incidence of injuries.
192 injuries were reported, resulting in an incidence of 97 injuries per 1000 registered athletes. More than half of the injuries (56%) were expected to prevent the athlete from participating in competition or training. Eighty percent affected the lower extremity; the most common diagnosis was thigh strain (16%). In most cases, the injury was caused by overuse (44%). A quarter of the injuries were incurred during training and 137 (71%) in competition. On average, 72.4 injuries per 1000 competing athletes were incurred in competitions. The incidence of injury varied substantially among the disciplines. The risk of a time-loss injury was highest in heptathlon, women's 10,000 m, women's 3000 m steeplechase, decathlon, and men's marathon.
The injury surveillance system proved feasible for individual sports. Risk of injury varied among the disciplines, with highest risk in combined disciplines, steeplechase, and long-distance runs. Preventive interventions should mainly focus on overuse injuries and adequate rehabilitation of previous injuries.
To determine the incidence of lower-extremity injury among high school cross-country runners and to identify risk factors for injury, the authors prospectively monitored a cohort of 421 runners competing on 23 cross-country teams in 12 Seattle, Washington, high schools during the 1996 cross-country season. Collected were daily injury and athletic exposure (AE) reports, a baseline questionnaire on prior running and injury experience, anthropometric measurements, and coaches' training logs. The overall incidence rate of injury was 17.0/1,000 AEs. Girls had a significantly higher overall injury rate (19.6/1,000 AEs) than boys did (15.0/1,000 AEs) (incidence rate ratio = 1.3, 95% confidence interval: 1.0, 1.6). Compared with boys, girls had significantly higher rates of injuries resulting in >or=15 days of disability. For the overall sample and for girls, Cox regression revealed that a quadriceps angle of >or=20 degrees and an injury during summer running prior to the season were the most important predictors of injury. For boys, a quadriceps angle of >or=15 degrees and a history of multiple running injuries were most associated with injury. Results suggest that the incidence of lower-extremity injuries is high for cross-country runners, especially girls. Preseason screening to determine risk factors should be examined as a preventive approach for identifying high-risk runners.
Consistency in routines for reporting injury has been a focus of development efforts in sports epidemiology for a long time. To gain an improved understanding of current reporting practices, we applied the Injury Definitions Concept Framework (IDCF) in a review of injury reporting in a subset of the field.
Meta-narrative review, An analysis of injury definitions reported in consensus statements for different sports and studies of injury epidemiology in athletics (track and field) published in PubMed between 1980 and 2013 was performed. Separate narratives for each of the three reporting contexts in the IDCF were constructed from the data.
Six consensus statements and 14 studies reporting on athletics injury epidemiology fulfilled the selection criteria. The narratives on sports performance, clinical examination, and athlete self-report contexts were evenly represented in the eligible studies. The sports performance and athlete self-report narratives covered both professional and community athletes as well as training and competition settings. In the clinical examination narrative, data collection by health service professionals was linked to studies of professional athletes at international championships.
From an application of the IDCF in a review of injury reporting in sports epidemiology we observed a parallel usage of reporting contexts in this field of research. The co-existence of reporting methodologies does not necessarily reflect a problematic situation, but only provided that firm precautions are taken when comparing studies performed in the different contexts.
Copyright © 2014 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.
Introduction The Australian Institute of Sport (AIS) has recently invested in an online data management system (AMS) which incorporates injury and illness data, clinical notes, training loads, wellness reporting, as well as many other performance-related variables. This management system has been adopted by 19 National Sporting Organisations (NSO) with four more planned later in 2014 and 4 State Institutes of Sport/Academies of Sport (SISSAS) have formally agreed, with implementation at various stages throughout 2014. The adoption of this monitoring system has grown exponentially with current estimations indicating approximately 10,000 injuries will be recorded over the next 5 years. Clinically, it is understood that any injury will disrupt training and exposes the athlete to risk of injury on return competition due to the relative shift in training volume and modality, thus injury prevention programs and ongoing monitoring systems are imperative for the success of Australian athletes. This presentation outlines the methodology that the AIS is undertaking to monitor and prevent subsequent injuries. Methods Monitoring of injuries and illness was undertaken across the 19 NSOs over a 6 month period. A data dictionary was created with common definitions of injury and illness. The definition of injury and illness was defined as “Any physical or medical complaint that results in an athlete being unable to participate in training or competition, as planned by coaching staff, for greater than 24 hours”. Subsequent injuries were defined as an injury sustained following an index injury (SIC model). Index injuries were defined as the first new injury within this period. Results 2318 athletes were monitored with 577 injuries recorded (new, n=414; recurrent, n=163; insidious onset, n=164; overuse, n=208, trauma, n=205). Thirty-seven percent of all injuries recorded were subsequent to an index injury (n=216, median=2/injured athlete, range=0-6). The overall servicing cost of all injuries equated to 2187 physiotherapy treatments, 1980 “maintenance” treatments (treatment in the absence of current injury) and 1121 soft-tissue therapy treatment (21% directly related to injury management) spread across 60 physiotherapy staff nationally. The estimated financial cost of these treatments was estimated as $650,000AU. Discussion The results of this study show a comparatively high subsequent injury rate compared to previous studies. It highlights the need to monitor and implement injury prevention programs for subsequent injuries. This study presents the methodology the Australian Institute of Sport is undertaking to monitor subsequent injuries in Australian National Sporting Organisations.
Objectives
To explore the performance of retrospective health data collected from athletes before Athletics championships for the analysis of risk factors for in-competition injury and illness (I&I).
Methods
For the 2013 European Athletics Indoor Championships, a self-report questionnaire (PHQ) was developed to record the health status of 127 athletes during the 4 weeks prior to the championship. Physician-based surveillance of in-competition I&I among all 577 athletes registered to compete was pursued during the championships.
Results
74 athletes (58.3%) from the sample submitted a complete PHQ. 21 (28%) of these athletes sustained at least one injury and/or illness during the championships. Training more than 12h/week predisposed for sustaining an in-competition injury, and a recent health problem for in-competition illness. Among the 577 registered athletes, 60 injuries (104/1000 registered athletes) were reported. 31% of injuries were caused by the track, and 29% by overuse. 29 illnesses were reported (50/1000 registered athletes); upper respiratory tract infection and gastro-enteritis/diarrhoea were the most reported diagnoses.
Conclusions
Pre-participation screening using athletes’ self-report PHQ showed promising results with regard to identification of individuals at risk. Indoor injury types could be attributed to extrinsic factors, such as small track size, track inclination, and race tactics.
Objectives
To survey injury/illness in the National Basketball Association (NBA) over a 25-year period and examine the relationship of injury/illness to team performance.
Design
A retrospective correlational design.
Method
Trends were examined in reported numbers of players injured/ill during a season and games missed due to injury/illness from seasons ending in 1986 through 2005. This period was compared to years 2006-2010, when NBA teams were allowed to increase the total number of players on the team from 12 to 15.
Results
There was a highly significant trend (p <0.0001) of increasing numbers of players injured/ill and games missed from 1986 through 2005. After the team expansion in 2006, these rates fell abruptly by 13% and 39% respectively (both p <0.0001 compared to the previous 5-year period). We also found a significant inverse association between games missed due to injury/illness and percent games won (r = -0.29, p <0.0001).
Conclusions
Results demonstrate an increased rate of injury in the NBA up until the expansion of team size in 2006. Following 2006, team expansion was positively associated with decreased injury/illness rates. The latter finding suggests the importance of maintaining a healthy roster with respect to winning outcomes.
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.
Tukey's jackknife estimate of variance for a statistic $S(X_1, X_2, \cdots, X_n)$ which is a symmetric function of i.i.d. random variables $X_i$, is investigated using an ANOVA-like decomposition of $S$. It is shown that the jackknife variance estimate tends always to be biased upwards, a theorem to this effect being proved for the natural jackknife estimate of $\operatorname{Var} S(X_1, X_2, \cdots, X_{n-1})$ based on $X_1, X_2, \cdots, X_n$.
Methods of evaluating and comparing the performance of diagnostic tests are of increasing importance as new tests are developed and marketed. When a test is based on an observed variable that lies on a continuous or graded scale, an assessment of the overall value of the test can be made through the use of a receiver operating characteristic (ROC) curve. The curve is constructed by varying the cutpoint used to determine which values of the observed variable will be considered abnormal and then plotting the resulting sensitivities against the corresponding false positive rates. When two or more empirical curves are constructed based on tests performed on the same individuals, statistical analysis on differences between curves must take into account the correlated nature of the data. This paper presents a nonparametric approach to the analysis of areas under correlated ROC curves, by using the theory on generalized U-statistics to generate an estimated covariance matrix.
Sixty runners belonging to two clubs were followed for 1 year with regard to training and injury. There were 55 injuries in 39 athletes. The injury rate per 1,000 hours of training was 2.5 in long-distance/marathon runners and 5.6 to 5.8 in sprinters and middle-distance runners. There were significant differences in the injury rate in different periods of the 12 month study, the highest rates occurring in spring and summer. In marathon runners there was a significant correlation between the injury rate during any 1 month and the distance covered during the preceding month (r = 0.59). In a retrospective analysis of the cause of injury, a training error alone or in combination with other factors was the most common injury-provoking factor (72%). The injury pattern varied among the three groups of runners: hamstring strain and tendinitis were most common in sprinters, backache and hip problems were most common in middle-distance runners, and foot problems were most common in marathon runners.
The training programmes and competitive performances of 147 track and field athletes, from many different clubs within the UK, were analysed retrospectively in order to study the incidence, severity and types of injuries which they had suffered during the year September 1989-September 1990. This information was then related to the particular event in which they specialized as well as a number of hypothetical risk factors proposed for making them more prone to injury. Of the athletes 96 (65.3%) were male and 51 (34.7%) were female, and their ages ranged from 14 to 32 years, with their levels of competition ranging from 'competitive spectators' to UK internationals. A marked correlation was noted between their age, level of competition, number of supervised training sessions which they attended, and their incidence of injuries. However, certain other factors which were studied, such as their sex, the hours they trained, and the particular event in which they specialized appeared to provide no obvious relationship.
This study evaluated the incidence, distribution and types of musculoskeletal injuries sustained by 95 track and field athletes in a 12 month period using a retrospective cohort design, and analysed selected training, anthropometric, menstrual and clinical biomechanical risk factors. Overall, 72 athletes sustained 130 injuries giving an athlete incidence rate of 76% and an injury exposure rate of 3.9 per 1000 training hours. The majority of injuries were overuse in nature and approximately one-third of all injuries were recurrent. The risk of injury was not influenced by gender or event group. The most common sites of injury were the leg (28%), thigh (22%) and knee (16%) with the most common diagnoses being stress fractures (21%) and hamstring strains (14%). Injury patterns varied between event groups with middle-distance and distance runners sustaining more overuse injuries, and sprinters, hurdlers, jumpers and multi event athletes more acute injuries (p < 0.05). Increasing age, greater overall flexibility and a greater prevalence of menstrual disturbances were associated with a greater likelihood of injury. The results of this study show that track and field athletes are at high risk for musculoskeletal injury and that it may be possible to identify those who are more likely to sustain an injury.
Injury classification systems are generally used in sports medicine (1) to accurately classify diagnoses for summary studies, permitting easy grouping into parent categories for tabulation and (2) to create a database from which cases can be extracted for research on specific injuries. Clarity is most important for the first purpose, whereas diagnostic detail is particularly important for the second. An ideal classification system is versatile and appropriate for all sports and all data collection scenarios. The Orchard Sports Injury Classification System (OSICS) was developed in 1992 primarily for the first purpose, a specific study examining the incidence of injury at the elite level of football in Australia. As usage of the OSICS expanded into different sports, limitations were noted and therefore many revisions have been made. A recent study found the OSICS-8, whilst superior to the International Classification of Diseases Australian Modification (ICD-10-AM) in both speed of use and 3-coder agreement, still achieved a lower level of agreement than expected. The study also revealed weaknesses in the OSICS-8 that needed to be addressed. A recent major revision resulted in the development of the new 4-character OSICS-10. This revision attempts to improve interuser agreement, partly by including more diagnoses encountered in a sports medicine setting. The OSICS-10 should provide far greater depth in classifications for the benefit of those looking to maintain diagnostic information. It is also structured to easily collapse down into parent classifications for those wanting to preserve basic information only. For those researchers wanting information collected under broader injury headings, particularly those not using fully computerized systems, the simplicity of the OSICS-8 system may still suffice.
Data dictionary for the national injury and illness database.
- Drew M.K.
- Wallis M.
- Hughes D.
Drew MK, Wallis M, Hughes D. Data dictionary for the national injury and illness database, In: AIS best practice handbook. 1st ed. Canberra, Australian Sports
Commission, 2014. p. 1-9.
Preparticipation injury complaint is a risk factor for injury: a prospective study of the Moscow 2013 IAAF Championships.
- Alonso J.-M
- Jacobsson J.
- Timpka T.