Article

Risk of Injuries in Paralympic Track and Field Differs by Impairment and Event Discipline: A Prospective Cohort Study at the London 2012 Paralympic Games

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Abstract

Background: The incidence rates (IRs) and factors associated with injuries in the sport of Paralympic athletics (track and field) have not been comprehensively and prospectively studied. Purpose: To determine injury IRs, characteristics of injuries, and associated factors in the sport of athletics at the London 2012 Paralympic Games. Study design: Cohort study; Level of evidence, 2. Methods: A total of 977 athletes competing in the sport of athletics were followed over a total 10-day competition period of the Paralympic Games. Daily injury data were obtained via 2 databases: (1) a custom-built, web-based injury and illness surveillance system (WEB-IISS), maintained by team medical personnel; and (2) the organizing committee database, maintained by medical providers in the medical stations operated by the London Organising Committee of the Olympic and Paralympic Games. Athlete impairment and event discipline were obtained via the International Paralympic Committee athlete database. IRs (injuries per 1000 athlete-days) by impairment, event discipline, sex, and age were examined. Results: The overall IR was 22.1 injuries per 1000 athlete-days (95% CI, 19.5-24.7). In track disciplines, ambulant athletes with cerebral palsy experienced a lower incidence of injuries (IR, 10.2; 95% CI, 4.2-16.2) when compared with ambulant athletes from other impairment categories. Athletes in seated throwing experienced a higher incidence of injuries (IR, 23.7; 95% CI, 17.5-30.0) when compared with athletes in wheelchair racing (IR, 10.6; 95% CI, 5.5-15.6). In both track and field disciplines, the majority of injuries did not result in time loss from competition or training. Ambulant athletes experienced the greatest proportion of injuries to the thigh (16.4% of all injuries; IR, 4.0), observed predominantly in track athletes. Wheelchair or seated athletes experienced the greatest proportion of injuries to the shoulder/clavicle (19.3% of all injuries; IR, 3.4), observed predominantly in field athletes. Conclusion: This is the first prospective cohort study examining injury IRs and associated factors in the sport of athletics at the Paralympic Games. Injury patterns were specific to the event discipline and athlete impairment. The majority of injuries occurred to the thigh (ambulant athletes) or shoulder/clavicle (wheelchair or seated athletes) and did not result in time loss.

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... A total of 34 studies investigated the relationship between impairment and sports-related health problem occurrence, 5,6,9,10,13,[19][20][21]29,31,36,39,40,[42][43][44]50,[52][53][54][55]57,[60][61][62]66,72,[74][75][76]78,80,85 and 18 studies investigated the relationship between the type of sports and sports-related health problem occurrence. 2,5,6,19,20,[23][24][25]29,50,54,55,59,74,78,88,89,92 Due to the large variety in the respective type of impairment and type of sports in the included studies, it was impossible to define any single representative relation between these risk factors and health problem occurrence (Appendix 4, available online). ...
... A total of 34 studies investigated the relationship between impairment and sports-related health problem occurrence, 5,6,9,10,13,[19][20][21]29,31,36,39,40,[42][43][44]50,[52][53][54][55]57,[60][61][62]66,72,[74][75][76]78,80,85 and 18 studies investigated the relationship between the type of sports and sports-related health problem occurrence. 2,5,6,19,20,[23][24][25]29,50,54,55,59,74,78,88,89,92 Due to the large variety in the respective type of impairment and type of sports in the included studies, it was impossible to define any single representative relation between these risk factors and health problem occurrence (Appendix 4, available online). Regarding injury etiology, the other reported risk factors show inconclusive results. ...
... 74,86,92 For powerlifting and track and field, a trend is seen for gradual onset injuries. 5,63,75,91,92 Of course, these results should be interpreted with caution. ...
Article
Context: Participation in sports is associated with a risk of sports-related health problems. For athletes with an impairment, sports-related health problems further burden an already restricted lifestyle, underlining the importance of prevention strategies in para-sports. Objective: To provide a comprehensive overview with quality assessment of the literature on sports-related health problems, their etiology, and available preventive measures in para-sports following the steps of the Sequence of Prevention. Data sources: A literature search (in PubMed, Embase, SPORTDiscus, CINAHL and the Cochrane Library) was performed up to December 8, 2021, in collaboration with a medical information specialist. Study selection: The search yielded 3006 articles, of which 64 met all inclusion criteria. Study design: Systematic review with quality assessment. Level of evidence: Level 3. Data extraction: Two independent researchers carried out the screening process and quality assessment. One researcher extracted data, and the Sequence of Prevention categorized evidence. Results: A total of 64 studies were included, of which 61 reported on the magnitude and risk factors of sports-related health problems, while only 3 reported on the effectiveness of preventive measures. Of these, 30 studies were of high quality. Most studies (84%) included elite-level athletes. The reported injury incidence varied widely between sports (0-91 per 1000 athlete days) and impairment categories (1-50 per 1000 athlete days). The same applies to illness incidence with regard to different sports (3-49 per 1000 athlete days) and impairment categories (6-14 per 1000 athlete days). Conclusion: This review shows the current vast range of reported sport-related health problems in para-sports. There is limited evidence concerning the severity of these sports-related health problems and inconclusive evidence on the risk factors. Lastly, the evidence regarding the development and effectiveness of preventive measures for para-athletes is sparse.
... Twenty-five out of 42 studies included reported both injury prevalence and incidence rates, 7 22-45 7 studies only reported prevalence data [46][47][48][49][50][51][52] and 10 studies only reported incidence rates. 3 53-61 Of the 35 studies with incidence data, 20 studies reported injury incidence rate per days, 3 45 54 three studies differentiated the injury incidence rate between precompetitive and competitive periods, 7 30 40 one study reported injury incidence rate per 1000 athlete exposures, 61 and one study reported injury incidence rate per 100 athlete competitions. 38 The number of participants ranged from 11 32 to 3657, 7 with a mean of 390.9 participants and median of 135.5. ...
... 38 The number of participants ranged from 11 32 to 3657, 7 with a mean of 390.9 participants and median of 135.5. Regarding sex, 2 (4.8%) studies were conducted with females, 47 Overall score (0-9) Twenty studies were sport-specific, 3 22-24 26-28 32 33 35-37 41 44 47 50 52 53 55 59 19 were multisport 7 25 29-31 38-40 42 43 45 46 48 49 54 56-58 60 and 3 studies did not report para sport modality. 34 51 61 Ten studies did not report para athlete disabilities, 26 28-30 39 42 54 57 59 61 22 studies presented information about classification level of para athletes, 3 7 22 24 26 31 35-41 43 44 48 50 52 55 57-59 23 studies specified the assistive devices used by para athletes, 3 7 22 24 26-28 30 31 33 39 40 46-48 50 51 53 55-57 59 60 and in 30 studies the injury diagnosis was confirmed by a medical practitioner. ...
... 34 51 61 Ten studies did not report para athlete disabilities, 26 28-30 39 42 54 57 59 61 22 studies presented information about classification level of para athletes, 3 7 22 24 26 31 35-41 43 44 48 50 52 55 57-59 23 studies specified the assistive devices used by para athletes, 3 7 22 24 26-28 30 31 33 39 40 46-48 50 51 53 55-57 59 60 and in 30 studies the injury diagnosis was confirmed by a medical practitioner. 3 Mean (SD) methodological quality of the included studies was 6.3 (1.8) out of 9 (ranging from 0 to 9). ...
... Investigations of community-based adaptive athletes reveal a high prevalence of shoulder pain (5,6), and epidemiological studies of elite para athletes have revealed that the shoulder is the most commonly injured anatomical region (7,8). In community-based and elite athletes with disabilities, those involved in sports that involve repetitive overhead activity are at particular risk (9,10). ...
... This effect is likely to be multifactorial, including greater strength of the shoulder girdle muscles, lower body mass reducing load in transfers, and overall pain reduction in the setting of engagement in physical activity (17). In a study of elite Paralympians competing in the sport of athletics it was demonstrated that sporting discipline impacts the incidence of shoulder injury; athletes competing in wheelchair or seated disciplines were more likely to experience upper limb injury compared to ambulatory athletes (10). ...
... The apparent protective effect of track demonstrated in this study reflects previous prospective epidemiological data in elite para sport (10). Overhead sporting activity in non-elite wheelchair users has been shown to be associated with a higher prevalence of symptomatic Copyright © 2022 by the American College of Sports Medicine. ...
Article
Purpose: To determine the relationship between shoulder pain, physical examination, and tissue pathology in manual wheelchair users competing in elite sport. Methods: Eighty elite para athletes who used a manual wheelchair for daily mobility were recruited from international track (n = 40), field (n = 19) and powerlifting (n = 21) competitions. Athletes were surveyed regarding shoulder pain history and symptoms (Wheelchair Users Shoulder Pain Index - WUSPI), while independent blind observers measured signs (Physical Examination of the Shoulder Scale - PESS) and tissue pathology (Ultrasound Shoulder Pathology Rating Scale - USPRS). Relationships between measures for the total cohort and for subgroups defined by sporting discipline were calculated. Results: A large proportion of athletes reported a history of upper limb pain (39% dominant and 35% non-dominant). For the total cohort, WUSPI score was 22.3 ± 26.9, PESS 7.4 ± 6.7 and USPRS 5.2 ± 4.0. There were no USPRS score differences between athlete subgroups, however track athletes had lower WUSPI and PESS scores, especially compared to field athletes. The first principal component explained most of the variance in the WUSPI and PESS which were strongly correlated (r = 0.71), and the second orthogonal component explained the USPRS, which did not correlate with either the PESS (r = 0.21) or WUSPI (r = 0.20). Subgroup analysis showed track athletes had lower symptom scores for a given physical examination score. Conclusions: Elite para athletes who use manual wheelchairs for daily mobility have a high prevalence of shoulder symptoms, positive signs on physical exam and ultrasound-determined tissue pathology. Ultrasound-determined tissue pathology does not correlate with symptoms or signs. This information can help to guide clinicians in managing shoulder problems in this athlete population at high risk of injury.
... A total of 34 studies investigated the relationship between impairment and sports-related health problem occurrence, 5,6,9,10,13,[19][20][21]29,31,36,39,40,[42][43][44]50,[52][53][54][55]57,[60][61][62]66,72,[74][75][76]78,80,85 and 18 studies investigated the relationship between the type of sports and sports-related health problem occurrence. 2,5,6,19,20,[23][24][25]29,50,54,55,59,74,78,88,89,92 Due to the large variety in the respective type of impairment and type of sports in the included studies, it was impossible to define any single representative relation between these risk factors and health problem occurrence (Appendix 4, available online). ...
... A total of 34 studies investigated the relationship between impairment and sports-related health problem occurrence, 5,6,9,10,13,[19][20][21]29,31,36,39,40,[42][43][44]50,[52][53][54][55]57,[60][61][62]66,72,[74][75][76]78,80,85 and 18 studies investigated the relationship between the type of sports and sports-related health problem occurrence. 2,5,6,19,20,[23][24][25]29,50,54,55,59,74,78,88,89,92 Due to the large variety in the respective type of impairment and type of sports in the included studies, it was impossible to define any single representative relation between these risk factors and health problem occurrence (Appendix 4, available online). Regarding injury etiology, the other reported risk factors show inconclusive results. ...
... 74,86,92 For powerlifting and track and field, a trend is seen for gradual onset injuries. 5,63,75,91,92 Of course, these results should be interpreted with caution. ...
Conference Paper
Background Participation is sport is associated with a risk of sports injuries and illnesses. For athletes with an impairment, sports related health issues pose further burden upon an already restricted lifestyle. This underlines the importance of injury prevention in adapted sports. Objective To provide an overview of the current evidence regarding injuries and their prevention in adapted sports. Design A systematic review with quality assessment. Setting Peer-reviewed literature on sports injuries in adapted sports. Participants Individuals with a physical impairment that affects motor function, and who are active in sports or physical activity. Assessment of Risk Factors This study was conducted in accordance with the ‘Preferred Reporting Items for Systematic Reviews and Meta-Analyses’ (PRISMA) guidelines. Main Outcome Measurements Literature and evidence was categorised by the sequence of prevention; i.e. (1) problem magnitude; (2) aetiology of injury; (3) development of preventive measures; and (4) evaluation of effectiveness. Results 52 studies were included. A total of 5 studies reported on the first step of the sequence of prevention (problem magnitude) only. 28 studies reported information on both the first and second step, 15 studies on only the second step and only 4 studies on the third and fourth step of the sequence. Most studies included participants of an elite level (82.7%). There is a wide range of injury and illness incidence between various sports (2.2 - 90.9 per 1000 athlete days) and impairment categories (0.6 - 50.0 per 1000 athlete days). Conclusions Current evidence regarding injuries in adapted sports is mostly limited to elite level athletes. The evidence regarding the development of preventive measures and their effectiveness is limited in this target group. More knowledge is needed of the aetiology and risk factors of various adapted sports, physical impairments and level of performance to develop future prevention strategies for this population.
... Twenty-five out of 42 studies included reported both injury prevalence and incidence rates, 7 22-45 7 studies only reported prevalence data [46][47][48][49][50][51][52] and 10 studies only reported incidence rates. 3 53-61 Of the 35 studies with incidence data, 20 studies reported injury incidence rate per days, 3 45 54 three studies differentiated the injury incidence rate between precompetitive and competitive periods, 7 30 40 one study reported injury incidence rate per 1000 athlete exposures, 61 and one study reported injury incidence rate per 100 athlete competitions. 38 The number of participants ranged from 11 32 to 3657, 7 with a mean of 390.9 participants and median of 135.5. ...
... 38 The number of participants ranged from 11 32 to 3657, 7 with a mean of 390.9 participants and median of 135.5. Regarding sex, 2 (4.8%) studies were conducted with females, 47 Overall score (0-9) Twenty studies were sport-specific, 3 22-24 26-28 32 33 35-37 41 44 47 50 52 53 55 59 19 were multisport 7 25 29-31 38-40 42 43 45 46 48 49 54 56-58 60 and 3 studies did not report para sport modality. 34 51 61 Ten studies did not report para athlete disabilities, 26 28-30 39 42 54 57 59 61 22 studies presented information about classification level of para athletes, 3 7 22 24 26 31 35-41 43 44 48 50 52 55 57-59 23 studies specified the assistive devices used by para athletes, 3 7 22 24 26-28 30 31 33 39 40 46-48 50 51 53 55-57 59 60 and in 30 studies the injury diagnosis was confirmed by a medical practitioner. ...
... 34 51 61 Ten studies did not report para athlete disabilities, 26 28-30 39 42 54 57 59 61 22 studies presented information about classification level of para athletes, 3 7 22 24 26 31 35-41 43 44 48 50 52 55 57-59 23 studies specified the assistive devices used by para athletes, 3 7 22 24 26-28 30 31 33 39 40 46-48 50 51 53 55-57 59 60 and in 30 studies the injury diagnosis was confirmed by a medical practitioner. 3 Mean (SD) methodological quality of the included studies was 6.3 (1.8) out of 9 (ranging from 0 to 9). ...
Article
Objective To investigate prevalence, incidence and profile of musculoskeletal injuries in para athletes. Design Systematic review. Data sources Searches were conducted in MEDLINE, EMBASE, AMED, SPORTSDiscus, CINAHL and hand searching. Eligibility criteria Studies were considered if they reported prevalence or incidence of musculoskeletal injuries in para athletes. Study selection, data extraction and analysis followed the protocol. Meta-analyses were conducted to estimate the prevalence and incidence rate among studies and subgroup analyses investigated whether methodological quality and sample size of the studies influenced on the estimated injury prevalence and incidence. The Grading of Recommendations Assessment, Development and Evaluation system determined the strength of evidence. Results Forty-two studies were included. The prevalence of musculoskeletal injuries was 40.8% (95% CI 32.5% to 49.8%). Because of imprecision, indirectness and inconsistency, the strength of evidence was very low quality. The incidence of musculoskeletal injuries was 14.3 injuries per 1000 athlete-days (95% CI 11.9 to 16.8). The strength of evidence was low quality because of imprecision and indirectness. The subgroup analyses revealed that the sample size influenced on estimated injury prevalence and methodological quality influenced on estimated incidence. Injuries were more prevalent in the shoulder, for non-ambulant para athletes, and in the lower limbs, for ambulant para athletes. Summary/conclusion Para athletes show high prevalence and incidence of musculoskeletal injuries. Current very low-quality and low-quality evidence suggests that future high-quality studies with systematic data collection, larger sample size and specificities of para athletes are likely to change estimates of injury prevalence and incidence in para athletes. PROSPERO registration number CRD42020147982.
... Powerlifting (IR: 19.3) and track & field (15.8 injuries per 1000 athlete-days) had the highest injury incidence. 17,18 Furthermore, field seated athletes were mostly affected by shoulder/clavicle injuries (19.3% of all injuries; IR: 3.4), particularly in seated thrower athletes (IR: 23.7; 95% CI: 17.5-30.0). Other disciplines also reported higher injury incidence than the overall 2012 London Paralympic Games IR (12.7) such as wheelchair fencing (18.0; 95% CI: 11.6 to 18 High force transmissions through specific body areas such as shoulder might account for a large proportion of upper limb injuries, especially in athletes with amputation and wheelchair athletes. ...
... 17,18 Furthermore, field seated athletes were mostly affected by shoulder/clavicle injuries (19.3% of all injuries; IR: 3.4), particularly in seated thrower athletes (IR: 23.7; 95% CI: 17.5-30.0). Other disciplines also reported higher injury incidence than the overall 2012 London Paralympic Games IR (12.7) such as wheelchair fencing (18.0; 95% CI: 11.6 to 18 High force transmissions through specific body areas such as shoulder might account for a large proportion of upper limb injuries, especially in athletes with amputation and wheelchair athletes. This current injury trend in para athlete has been noticeably confirmed from the 2016 Rio Paralympic Games (n = 3657) data collection 5 with a slightly lower IR (10.0) compared to London 2012 incidence rate (12.7). ...
Article
With the increasing opportunities for people with disabilities to engage in competitive Para sports, it becomes imperative to understand the injury consequences that may impact both sports participation and daily life activities. This narrative review aims to examine the intrinsic and extrinsic risk factors inherent in overhead and wheelchair summer Para sports, while also exploring prospective avenues for implementing prevention strategies. By understanding the injury epidemiology in this cohort of Para athletes, this review aims to explore the intricate interplay between the athletes’ underlying disability with sport-specific factors, such as how wheelchair use might amplify injury susceptibility. Specifically, we highlight the impact of impairment, daily activity, and workload or discipline-induced overuse on injury occurrence, as well as how surveillance methods can be tailored to this population. In this regard, we propose practical injury surveillance methods that encompass a sensitive injury definition, severity assessment, incidence rate calculation, and the recording of adaptive equipment (e.g., type of wheelchair) and workload monitoring. It is worth noting that studies of prospective injury surveillance systems coupled with workload monitoring within a dedicated Para sport web-based platform are scarce. To establish a comprehensive understanding of Para athlete health, the monitoring framework should incorporate regular athlete follow-ups and facilitate knowledge transfer.
... There is conflicting evidence as to whether athletes with cerebral palsy are at increased risk for sports injury compared with other para athletes 34,35 (see Appendix A). Much of this debate surrounds the possible detrimental versus protective effects of spasticity on muscle contractile force. ...
... On the contrary, Blauwet et al. 35 reported significantly fewer injuries in ambulant Paralympic track and field athletes with cerebral palsy compared with athletes with visual impairment and limb deficiency. They argued that spasticity may minimize forceful eccentric contraction of the lower extremity during running, thereby reducing injury rates. ...
Article
Full-text available
: Sports participation can improve gait, muscle strength, and functional abilities in patients with a wide variety of disabilities. Para athletes are also at substantial risk for injury during sports participation. ➤: Ambulant athletes with cerebral palsy are at risk for soft-tissue injuries about the knee as well as foot and ankle injuries. Wheelchair athletes are at risk for osteoporotic fractures and shoulder girdle injuries. Limb-deficient athletes are prone to low back pain and overuse injuries of the contralateral extremity. ➤: Para athletes are vulnerable to abuse during sports participation, and physicians should promptly report any possible abuse or mistreatment. ➤: Orthopaedic surgeons should understand disability and sport-specific risk factors for injury in para athletes in order to initiate early management and injury prevention protocols.
... They also reported that ambulant athletes are at risk of lower extremity injuries, and wheelchair/seated athletes who are involved in throwing are at high risk of shoulder injuries. 6) In review articles, Ferrera and Peterson presented highrisk sports (e.g., cycling, equestrian, and judo) and low-risk sports (e.g., archery, athletics, and boccia) based on the likelihood of contact with other players. 7) Fagher and Lexell stated that overuse is an important factor of non-acute sports-related injuries, in addition to the risk factors specific for the athlete's disability and discipline. ...
... This similarity suggests that clinicians and caregivers supporting athletes with disabilities who range from beginner to subelite levels can refer to the preventive strategies for Paralympians and able-bodied athletes as long as special attention is paid to the specific nature of the athlete's disability. These involve upper extremity involvement in wheelchair users, 6) skin troubles in amputees, and pressure sore and autonomic dysregulation in athletes with paraplegia. 9) Severe injuries such as joint sprains, muscle strains, fractures, or joint dislocation prevent athletes from participating in sports and disturb their activities of daily living. ...
Article
Full-text available
Objectives : This study aimed to describe the injuries and illnesses that occurred at the 18th National Sports Festival for Persons with Disabilities in Japan, which was attended by more than 3000 athletes from beginner to elite levels. Methods : Records from medical stations set up at the venues for each sport were reviewed. The incidence rates (IRs) were calculated as the number of medical station visits per 1000 athlete-days. The backgrounds of injuries and illnesses were investigated. Results : In total, 3277 athletes attended the festival, and 134 eligible medical station visits were analyzed. Overall, 102 athletes complained of injuries. For the whole schedule of the festival, IRs were 15.5 for injuries and illnesses and 11.8 for injuries alone. For injuries and illnesses, high IRs were seen in soccer (39.8), basketball (25.6), and foot baseball (22.4); for injuries alone, high IRs were also seen in soccer (33.6), basketball (25.6), and foot baseball (16.8). The most frequent symptoms were internal symptoms (n=32), contusions (n=30), and wounds (n=24). Joint sprains occurred in various sports, whereas muscle strains happened mainly in disciplines demanding sprinting or high agility. Of the 55 cases that occurred during events or public rehearsals, 45 were traumatic, whereas the relation to sports activities was not described in 51 cases. Of participants with internal symptoms, 11 were suggested to have viral infections. We identified 21 injuries caused by falls. Conclusions : Minor trauma and viral infection were the most frequently observed symptoms among injuries and illnesses, respectively. Structured medical records and organized surveillance systems should be utilized to improve data collection and understand the onset of injury and illness.
... A retrospective analysis of team-sport wheelchair falls during Rio 2016 Summer Paralympics was recently published [6], but only focused on mechanisms and characteristics of falls and did not analyze any specific injuries such as muscle injuries or fractures. Injury surveillance reports from London 2012 Summer Paralympic Games, Pyeongchang 2018 and Sochi 2014 Winter Paralympic Games have also been published [7][8][9], although there was no detailed analysis specifically related to muscle injuries. Similarly, themed injury surveillance studies in Paralympic related sports have also been published [10][11][12], although these studies were not related to any specific Paralympic Games. ...
... However, with this limitation in mind, it has been reported that lower extremity injuries (including muscle injuries) are more common in ambulatory Paralympic athletes (visually impaired, amputee, cerebral palsy) and upper extremity injuries are more frequent in athletes who use a wheelchair [18], which is not surprising given the nature of Paralympic sports. More specifically, during Summer 2012 London Paralympic Games, the most common injuries occurred to the thigh in ambulant athletes (16.4% of all injuries; Incidence Rate [IR], 4.0 injuries per 1000-athlete days), most common injury sites in wheelchair or seated athletes was the shoulder/clavicle (19.3% of all injuries; IR, 3.4) [7]. Our data also showed similar injury patterns and are thus in line with the existing literature evidence. ...
... These negative experiences and beliefs with regard to sports participation can further limit the support to allow their child to be active in sports. In addition, a previous systematic review among adult athletes with disabilities recommends longitudinal and prospective cohort studies to gain more understanding and insight into factors influencing injuries and illnesses [14][15][16][17]. ...
... Our findings are in line with results of previous studies in both healthy youth and high school athletes with disabilities [14,29], while in Paralympic athletes most of the injuries were related to overuse (tissue inflammation and pain) [30]. According to time loss by sustaining an injury, our findings are similar with several studies, in which sports injuries suffered by high school athletes with disabilities and Paralympic adult athletes resulted in no or minor loss of training time [15,[29][30][31]. According to the severity of illnesses, preliminary results in Paralympic adult athletes shows that a higher training load results in a higher number of illnesses (infections) and the type of locomotion seems related to the incidence of illness, i.e. wheelchair athletes reported a high number of upper respiratory tract infections compared to able-bodied athletes [30]. ...
Preprint
Full-text available
Background: Although sports participation leads to important health enhancement for youth with chronic diseases or physical disabilities (CDPD), it may pose an increased risk for injury or illness. This study investigated the incidence, type, severity and risks to (sports-related) injuries and illnesses among youth with CDPD. Methods: For one calendar year, every two weeks, the characteristics of injuries and illnesses were registered by an online questionnaire and phone-based interview. Physical activity level was measured with the Activ8 during one week. Complete data was available of 103 youngsters with CDPD (61 boys, 42 girls), with a mean age of 14.4 (SD=2.7) years. The personal characteristics, the injury and illness rates per 1000 hours of PA were investigated per group of organized sports participation per week (0, 1 or ≥2 times p/wk). Results: Almost half of the youngsters sustains one or more injuries or illnesses during one year, 46% and 42% resp. The injury rate per 1000 hours of PA between 0, 1 and ≥2 times per week of sports participation was 0.84, 1.88, 133 resp. and the illness rate was 1.87, 1.88 and 1.18 resp. The rates were not statistically different. Most reported health problems had no subsequent restriction (49%) or other minor consequences (21%) in school, physical education or sports participation. Most reported health problems were contusions (41%) at the lower extremity (74%) and flue plus fever (58%). Conclusions: Participation in sports ≥2 times per week does not pose a significant increased risk in the incidence of injury or illness per 1000 hours of PA in youth with CDPD compared to once weekly or no sports participation. Athletes who participate in sports at least twice weekly get injured mostly during their sporting activities, while peers who do participate in sports once a week or not at all, get injured during less intense physical activities during PE lessons, ADL or non-organized sports and play in leisure time. The social impact of injuries or illnesses was limited.
... These negative experiences and beliefs with regard to sports participation can further limit the support to allow their child to be active in sports. In addition, a previous systematic review among adult athletes with disabilities recommends longitudinal and prospective cohort studies to gain more understanding and insight into factors influencing injuries and illnesses [14][15][16][17]. ...
... Our findings are in line with results of previous studies in both healthy youth and high school athletes with disabilities [14,29], while in Paralympic athletes most of the injuries were related to overuse (tissue inflammation and pain) [30]. According to time loss by sustaining an injury, our findings are similar with several studies, in which sports injuries suffered by high school athletes with disabilities and Paralympic adult athletes resulted in no or minor loss of training time [15,[29][30][31]. According to the severity of illnesses, preliminary results in Paralympic adult athletes shows that a higher training load results in a higher number of illnesses (infections) and the type of locomotion seems related to the incidence of illness, i.e. wheelchair athletes reported a high number of upper respiratory tract infections compared to able-bodied athletes [30]. ...
Preprint
Full-text available
Background: Although sports participation leads to important health enhancement for youth with chronic diseases or physical disabilities (CDPD), it may pose an increased risk for injury or illness. This study investigated the incidence, type, severity and risks to (sports-related) injuries and illnesses among ambulatory youth with CDPD. Methods: Over a 12-month period, every two weeks, the characteristics of injuries and illnesses were registered by an online questionnaire and phone-based interview. Physical activity level was measured with the Activ8 during one week. Complete data was available of 103 youngsters with CDPD (61 boys, 42 girls), with a mean age of 14.4 (SD=2.7) years. The personal characteristics, the injury and illness rates per 1000 hours of PA were investigated per group of organized sports participation per week (0, 1 or ≥2 times p/wk). Results: Almost half of the youngsters sustained one or more injuries (46% ) or illnesses (42%) during one year. The injury rate per 1000 hours of PA between 0, 1 and ≥2 times per week of sports participation was 0.84, 1.88, 133 respectively and the illness rate were 1.87, 1.88 and 1.18 respectively. Differences between the rates were not statically significant. Most reported health problems had no subsequent restriction (49%) or other minor consequences (21%) in school, physical education or sports participation. Most reported health problems were contusions (41%) at the lower extremity (74%) and flu plus fever (58%). Conclusions: Participation in sports ≥2 times per week does not pose a significant increased risk in the incidence of injury or illness per 1000 hours of PA in youth with CDPD compared to their peers who participate less frequent (once weekly) and compared to non-sports participants. Athletes who participate in sports at least twice weekly get injured mostly during their sporting activities, while peers who do participate in sports once a week or not at all, get injured during less intense physical activities during physical education lessons, ADL or non-organized sports and play in leisure time. The social impact of injuries or illnesses was limited.
... These negative experiences and beliefs with regard to sports participation can further limit the support to allow their child to be active in sports. In addition, a previous systematic review among adult athletes with disabilities recommends longitudinal and prospective cohort studies to gain more understanding and insight into factors influencing injuries and illnesses [14][15][16][17]. ...
... Our findings are in line with results of previous studies in both healthy youth and high school athletes with disabilities [14,29], while in Paralympic athletes most of the injuries were related to overuse (tissue inflammation and pain) [30]. According to time loss by sustaining an injury, our findings are similar with several studies, in which sports injuries suffered by high school athletes with disabilities and Paralympic adult athletes resulted in no or minor loss of training time [15,[29][30][31]. According to the severity of illnesses, preliminary results in Paralympic adult athletes shows that a higher training load results in a higher number of illnesses (infections) and the type of locomotion seems related to the incidence of illness, i.e. wheelchair athletes reported a high number of upper respiratory tract infections compared to able-bodied athletes [30]. ...
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Background: Although sports participation leads to important health enhancement for youth with chronic diseases or physical disabilities (CDPD), it may pose an increased risk for injury or illness. This study investigated the incidence, type, severity and risks to (sports-related) injuries and illnesses among ambulatory youth with CDPD. Methods: Over a 12-month period, every two weeks, the characteristics of injuries and illnesses were registered by an online questionnaire and phone-based interview. Physical activity level was measured with the Activ8 during one week. Complete data was available of 103 youngsters with CDPD (61 boys, 42 girls), with a mean age of 14.4 (SD=2.7) years. The personal characteristics, the injury and illness rates per 1000 hours of PA were investigated per group of organized sports participation per week (0, 1 or ≥2 times p/wk). Results: Almost half of the youngsters sustained one or more injuries (46% ) or illnesses (42%) during one year. The injury rate per 1000 hours of PA between 0, 1 and ≥2 times per week of sports participation was 0.84, 1.88, 133 respectively and the illness rate were 1.87, 1.88 and 1.18 respectively. Differences between the rates were not statically significant. Most reported health problems had no subsequent restriction (49%) or other minor consequences (21%) in school, physical education or sports participation. Most reported health problems were contusions (41%) at the lower extremity (74%) and flu plus fever (58%). Conclusions: Participation in sports ≥2 times per week does not pose a significant increased risk in the incidence of injury or illness per 1000 hours of PA in youth with CDPD compared to their peers who participate less frequent (once weekly) and compared to non-sports participants. Athletes who participate in sports at least twice weekly get injured mostly during their sporting activities, while peers who do participate in sports once a week or not at all, get injured during less intense physical activities during physical education lessons, ADL or non-organized sports and play in leisure time. The social impact of injuries or illnesses was limited.
... These negative experiences and beliefs with regard to sports participation can further limit the support to allow their child to be active in sports. In addition, a previous systematic review among adult athletes with disabilities recommends longitudinal and prospective cohort studies to gain more understanding and insight into factors influencing injuries and illnesses [14][15][16][17]. ...
... Our findings are in line with results of previous studies in both healthy youth and high school athletes with disabilities [14,29], while in Paralympic athletes most of the injuries were related to overuse (tissue inflammation and pain) [30]. According to time loss by sustaining an injury, our findings are similar with several studies, in which sports injuries suffered by high school athletes with disabilities and Paralympic adult athletes resulted in no or minor loss of training time [15,[29][30][31]. According to the severity of illnesses, preliminary results in Paralympic adult athletes shows that a higher training load results in a higher number of illnesses (infections) and the type of locomotion seems related to the incidence of illness, i.e. wheelchair athletes reported a high number of upper respiratory tract infections compared to able-bodied athletes [30]. ...
Article
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Background: Although sports participation leads to important health enhancement for youth with chronic diseases or physical disabilities (CDPD), it may pose an increased risk for injury or illness. This study investigated the incidence, type, severity and risks to (sports-related) injuries and illnesses among ambulatory youth with CDPD. Methods: Over a 12-month period, every 2 weeks, the characteristics of injuries and illnesses were registered by an online questionnaire and phone-based interview. Physical activity level was measured with the Activ8 during 1 week. Complete data was available of 103 youngsters with CDPD (61 boys, 42 girls), with a mean age of 14.4 (SD = 2.7) years. The personal characteristics, the injury and illness rates per 1000 h of PA were investigated per group of organized sports participation per week (0, 1 or ≥ 2 times p/wk). Results: Almost half of the youngsters sustained one or more injuries (46%) or illnesses (42%) during 1 year. The injury rate per 1000 h of PA between 0, 1 and ≥ 2 times per week of sports participation was 0.84, 1.88, 133 respectively and the illness rate were 1.87, 1.88 and 1.18 respectively. Differences between the rates were not statically significant. Most reported health problems had no subsequent restriction (49%) or other minor consequences (21%) in school, physical education or sports participation. Most reported health problems were contusions (41%) at the lower extremity (74%) and flu plus fever (58%). Conclusions: Participation in sports ≥2 times per week does not pose a significant increased risk in the incidence of injury or illness per 1000 h of PA in youth with CDPD compared to their peers who participate less frequent (once weekly) and compared to non-sports participants. Athletes who participate in sports at least twice weekly get injured mostly during their sporting activities, while peers who do participate in sports once a week or not at all, get injured during less intense physical activities during physical eduction lessons, ADL or non-organized sports and play in leisure time. The social impact of injuries or illnesses was limited.
... Les parasportifs sont également impactés par ces TMS [Heyward et al., 2017]. Des études de recensement des blessures lors des JP montrent que les athlètes en FRM participant à des épreuves sur piste sont le plus souvent blessés à l'épaule, à la partie supérieure du bras ou à la colonne cervicale [Blauwet et al., 2016;Derman et al., 2023]. ...
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L’objectif de ce travail de thèse est de quantifier et d’analyser des asymétries biomécaniques et physiologiques des membres supérieurs des parasportifs ayant une déficience motrice et utilisant principalement le haut du corps dans leur locomotion sportive ou quotidienne. 54 parasportifs de 6 disciplines et 42 sportifs valides de 15 disciplines ont été inclus pour la partie expérimentale. Tous ont effectué un test sur ergomètre balistique. Seuls les parasportifs ont réalisé deux tests sur ergomètre à manivelles et un test en fauteuil roulant avec centrales inertielles. Les variables étudiées étaient la force, la vitesse et la puissance. Les asymétries ont été quantifiées sur des mouvements dynamiques demandant différents niveaux de technicité, et comparées en fonction de la nature de l’exercice, des caractéristiques physiques et de la spécialité sportive des participants. Les résultats ont suggéré que l’ensemble des parasportifs sont plus asymétriques que les sportifs valides, mais les capacités abdominales, absentes chez certains parasportifs, n’ont pas d’impact sur les asymétries de forces des membres supérieurs. La nature de l’exercice : maximal court (anaérobie), intermittent-répétés et long (aérobie) semble impacter l’asymétrie, mais les résultats varient entre les participants. L’asymétrie mesurée n’est pas corrélée entre les différents tests. Ce travail confirme l’importance de prendre en compte l’asymétrie inter-membre chez les parasportifs, dans l’évaluation et l’individualisation de la préparation à la performance et à la prévention des blessures.
... While the study [27] included track and field para athletes in the analysis, it was found that five-a-side football, judo, and seven-a-side football had a higher injury risk. Moreover, a previous prospective cohort study from the Paralympic games in London 2012 including track and field para athletes showed that the highest incidence rate of injuries during competitions occurred in the thigh for ambulant athletes and in the shoulder for wheelchair athletes [33], similar to previous reports [26,27]. ...
Article
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Introduction: Non-disabled throwing athletes face unique challenges related to injuries and pain in the upper-body due to high demands placed on the shoulders and upper limbs. However, there is limited research on the epidemiology of sports injuries in para athletes participating in the Para Athletics throwing events. Hence, the aim of this study was to describe the prevalence and types of injuries among Para Athletics throwers (PAT). Material and methods: The main outcome was the 12-month prevalence of sports injury. Data were collected from PAT of any level, using an online questionnaire. Median, interquartile range, frequencies, percentages, and confidence intervals (CI) were used to assess data. Chi-square and the Mann-Whitney U tests were used to analyze differences in injury prevalence and injury onset between different subgroups. Results: The study included 60 PAT (70% males, 30% females) with a variety of impairments. The 12-month period prevalence of injury was 40% (n = 24; 95% CI: 27.5-53.4), with the highest prevalence observed in athletes with blindness/low vision and intellectual impairments (75%, 95% CI: 19.4-99.4). Injuries affected primarily shoulders (22.8%) and elbows (25.3%). The most common type of injuries were muscle strains (30%) and tendinopathies (25%). No significant difference were found in the proportion of injuries between subgroups. A majority of the injuries (88.6%) occurred during training. Conclusions: Para athletic throwers report a high prevalence of injuries in the upper extremities, highlighting the importance of tailored injury prevention programs. Mitigating the risk of injuries to the complex and vulnerable shoulder girdle is crucial in athletes already having an impairment.
... 4-6 9 The few published studies that have reported injuries by impairment type show high injury incidence for Para athletes with visual impairment (VI) and limb deficiency (LD) and lower injury incidence for Para athletes with cerebral palsy (CP) and intellectual impairment (II). [10][11][12][13][14][15][16][17] However, these studies were limited by the inclusion of Para athletes from single-nationality cohorts or sporting codes. The recent International Olympic Committee (IOC) consensus statements on injury and illness reporting in Para sport have provided guidelines to overcome previous methodological limitations, including recommendations on categorising impairment types. 2 3 The aim of this study was to describe the injuries sustained by Para athletes during the London 2012 and Rio 2016 S-PGs per athlete impairment type by sex, age, Games period, chronicity and anatomical area. ...
Article
Objectives The relationship between sport-related injuries and Para athlete impairment type has not yet been comprehensively studied. This study aimed to describe injury incidence according to athlete impairment type during the London 2012 and Rio 2016 Summer Paralympic Games, by sex, age, Games period, chronicity and anatomical area. Methods A combined analysis of 7222 athletes was conducted comprising 101 108 athlete days, using pooled data. Internet sources were used to identify impairments of registered athletes. Impairment types: brain disorders (BD), limb deficiency, neuromuscular disorders (NMD), spinal cord-related disorders, visual impairment (VI) and ‘all others’ (OTH: impaired passive range of movement, intellectual impairment, leg length difference, short stature and unknown impairments). Results by impairment type are reported as univariate unadjusted incidences (injuries/1000 athlete days; 95% CIs). Statistical significance between impairment types was determined when 95% CIs did not overlap. Results The overall crude unadjusted incidence of injury was 11.1 (95% CI 10.4 to 11.9), significantly higher in VI (13.7 (95% CI 11.0 to 15.7)) and NMD (13.3 (95% CI 11.1 to 16.1)) compared with BD (9.1 (95% CI 7.7 to 10.8)). Acute (sudden onset) (8.6 (95% CI 7.3 to 10.1)) and lower limb (6.6 (95% CI 5.4 to 8.1)) injuries were higher among athletes with VI, while athletes with NMD had a higher incidence of repetitive (gradual onset) (5.9 (95% CI 4.3 to 8.0)) and upper limb (6.9 (95% CI 5.2 to 9.0)) injuries compared with other impairments. Conclusions Incidence and type of injuries differed between athlete impairment types. Athletes with VI or NMD sustained the highest incidence of injury, and athletes with BD had the lowest. Findings of this study can inform the management of competition-related injuries in Para athletes.
... Also, para athletes' impairment and consequently musculoskeletal deficits and biomechanical compensations during running may be partly responsible for these numbers. 11,30 These findings suggest that the para sports health team should carefully monitor the occurrence and severity of shoulder injuries in non-ambulant athletes and ankle and hip/groin injuries in para athletics. In addition, future studies should investigate the efficacy of successful strategies implemented to prevent injuries at these body locations that were successful for able-bodied athletes, such as specific muscle strengthening, joint mobility exercise, and sport gesture modification. ...
Article
Background: Para athletes experience high prevalence and incidence of health problems related to sport. Despite this, there are few longitudinal studies. Objective: To describe the characteristics, prevalence, incidence, and severity of health problems in para athletes from one of the Brazilian Paralympic Reference Centers during a sports season and to compare the prevalence of health problems between para athletics, para powerlifting, and para swimming. Methods: This prospective pilot study was conducted from October 2019 to March 2020. The Oslo Sports Trauma Research Center Questionnaire on Health Problems was used to record injuries and illnesses every week for 24 weeks. The characteristics, prevalence, incidence, and severity of health problems were described for each modality. The prevalence of health problems was compared among the three sport modalities. Results: Thirty-five para athletes participated. Most of the injuries occurred in the shoulder, and most illnesses caused respiratory and gastrointestinal symptoms. The average weekly prevalence and the incidence rate of health problems were 40.6% (95% CI 17.0-64.4) and 12.7 (95% CI 9.6-15.9) per 1000 athlete hours, respectively. Para powerlifting had the highest prevalence of all and substantial health problems; para swimming had the lowest prevalence of injuries; and para athletics had the lowest prevalence of illnesses. Conclusions: This group of Brazilian para athletes showed a high prevalence and incidence of health problems throughout the season. Para athletics, para powerlifting, and para swimming each had a different prevalence of injuries and illnesses.
... Despite the growth, only some studies have been presented on the athletic performance in para athletic events. When looking at studies related to para athletics, there is a study on the sport injury and risk of track athletes participating in Paralympic Games and performance records of specific disabled types [5,6], a study on the effects of equipment technology development including prosthetic [7,8], a study on the intrinsic variables of injury factors including disability types and physiological factors of athletes participating in the Paralympics, external factors such as environmental condition training methods and nutrition for athletes' performance [9,10], and a study on athletic performance through various training method applications for wheelchair racing athletes and users [11][12][13]. The studies targeting para athletic events were mainly related to athletic performance and centered on equipment, impairment types, nutrition, physiology, and training methods. ...
Article
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The Paralympics is a world-class sports event that inspires and impresses people around the world, of which athletics is the most medal-competitive event in the Paralympics, with more than 130 countries participating. This study aims to provide baseline data for disabled athletes’ (para athletes’) athletic performance improvement on track, by generating information on athletic performance trends through the identification of para athletics’ discipline change in each Paralympic Games (PG) held between 2004 and 2020, and by analyzing differences in records by discipline level (podium group [winners’ group] and final group [group reaching finals]). To achieve its purpose, this study collected data and analyzed athletics’ track events at five Paralympic Games (2004 Athens PG to 2020 Tokyo PG) organized by the International Paralympic Committee (IPC) and checked changes in disciplines. To analyze athletic performance differences between the podium group and the final group by dividing the disciplines in disabled athletes’ track events in the PG that were consecutively held into men’s division and women’s division, this study used Kruskal–Wallis Test, a nonparametric statistical method. Additionally, this study presented the drawn event record trends of the podium group by discipline in each class through visualization. The results drawn through this study are as follows: First, as a result of analyzing the change in disciplines of disabled athletes’ track events, the number of track disciplines in the 5 PG was Track (T) 61, T51, T52, T48, and T44, respectively. Disciplines in the men’s division showed a gradually decreasing trend. In the women’s division, the track disciplines in the 5 PG were T30, T33, T37, T40, and T36, respectively. The disciplines in the women’s division increased until the Rio 2016 PG. Second, according to an analysis of athletic performance by class of para athletes’ track disciplines by PG (2004–2020), significant differences were found in both the podium and final groups. Third, as a result of analyzing the podium group’s record change trends by para athletes’ track disciplines and classes, the following points were revealed: (1) in the mean record change in the men’s podium group records were improving in most classes; (2) according to the women’s podium group record trend analysis the record improvement was high in T37 and T53 classes. In the T11 and T12 classes improved in each PG. In conclusion, as the PG continued, the number of track events in the men’s division of para athlete disciplines decreased, but records show an improving trend. Meanwhile, the number of disciplines shows an increasing trend in the women’s division, and especially the trend was remarkable after 2012. In conclusion, as Paralympic Games continued, the number of disciplines declined in the men’s division but records show an improving trend. As the number of disciplines decreased, athletes went to other disciplines, so competition became fierce and competitiveness was judged to improve. Meanwhile, in the disciplines of the women’s division increased due to the increasing number of in disciplines available.
... When comparing disabled and able-bodied fencers, the former generates about 73% of injuries to the upper limbs, whereas among the latter, about 70% are injuries of the knee and adductor muscles [5]. Based on the report of the International Paralympic Committee published in Human Kinetics Journals [6,7] after the London 2012 Paralympic Games, 15.8% of wheelchair fencers' injuries were injuries to the shoulder and 32.6% to the elbow. The remaining 40% of injuries, mainly of overload character, occurred in the back, abdomen, neck, and spine. ...
Article
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The aim of the study was to determine the correct movement patterns of fencing techniques in wheelchair fencers. Through a comprehensive analysis, the key muscles in the kinematic chain exposed to potential injuries were identified. The study participants were 16 wheelchair fencers, divided into two groups representing two categories of disability: Group A (N = 7) comprising fencers with mild paraplegia, having freedom of movement of the trunk and arms; and Group B (N = 9) comprising fencers with a spinal cord injury and partial paresis of the arms. EMG and an accelerometer were used as the main research tools. The EMG electrodes were placed on the muscles of the sword arm as well as on the left and right sides of the abdomen and torso. The EMG signal was transformed using wavelet analysis, and the muscle activation time and co-activation index (CI) were determined. In Group A fencers, first the back and abdominal muscles were activated, while in Group B, it was the deltoid muscle. The wavelet coherence analysis revealed intermuscular synchronization at 8–20 Hz for Group A fencers and at 5–15 Hz for Group B fencers. In Group A fencers, the co-activation index was 50.94 for the right-side back and abdominal muscles, 50.75 for the ECR-FCR, and 47.99 for the TRI-BC pairs of upper limb muscles. In contrast, Group B fencers demonstrated higher CI values (50.54) only for the postural left-side muscle pairs. Many overload injuries of the shoulder girdle, elbow, postural muscles, spine, and neck have been found to be preventable through modification of current training programs dominated by specialist exercises. Modern wheelchair fencing training should involve neuromuscular coordination and psychomotor exercises. This will facilitate the individualization of training depending on the fencer’s degree of disability and training experience.
... 3 Thus, injury and illness incidence rates may underestimate the true burden given the high prevalence of pre-existing repetitive gradual onset injuries and medical conditions. Also, when collecting data in multisport events, and when exposure data are incomparable between sports, 25 36 41 we recommend expressing incidence as the number of new cases/number of athletes or athlete days. Sport-specific incidence rates may be more optimally expressed by number of health problems/1000 matches (eg, badminton, boccia, football, goalball, judo, sitting volleyball, table tennis, wheelchair basketball, wheelchair fencing, wheelchair tennis) or number of injuries/1000 competitions or events (eg, archery, athletics, canoe, cycling, equestrian, power lifting, rowing, shooting, swimming, taekwondo, dance). ...
Article
In 2020, the IOC proposed a universal methodology for the recording and reporting of data for injury and illness in sport. Para sport is played by individuals with impairment, and they have a unique set of considerations not captured by these recommendations. Therefore, the aim of this addendum to IOC consensus statement was to guide the Para sport researcher through the complexities and nuances that should be taken into consideration when collecting, registering, reporting and interpreting data regarding Para athlete health. To develop this translation, experts in the field of Para sports medicine and epidemiology conducted a formal consensus development process, which began in March 2020 with the formation of a consensus group that worked over eight phases, incorporating three virtual consensus meetings to finalise the translation. This translation is consistent with the IOC consensus statement, yet provides more detailed Para athlete specific definitions and recommendations on study population, specifically, diagnostic and eligible impairment categorisation and recording of adaptive equipment, and defining and classifying health problems in the context of Para sport. Additionally, recommendations and Para athlete specific examples are described with regards to injury mechanism, mode of onset, injury and illness classification, duration, capturing and reporting exposure and risk. Finally, methods and considerations are provided to cater to the varied needs of athletes with impairment with respect to data collection tools. This harmonisation will allow the science to develop and facilitate a more accurate understanding of injury and illness patterns for tailoring evidence-informed prevention programmes and enabling better planning of medical services for Para sport events.
... In an effort to close the injury prevention cycle [58], the IPC Medical Committee performed sport-specific follow-up analyses on the London 2012 injury surveillance data in 5-a-side and 7-aside football [17], powerlifting [16] and para-athletics [18]. The results of 5-a-side football is especially important, as this sport generates the most musculoskeletal injuries in the Summer Paralympics (Table 4). ...
Article
Background and purpose In 1994, the International Paralympic Committee (IPC) established the IPC Sport Science Committee in an effort to bring Paralympic Movement relevant research questions to the academic world. In 1996, the IPC Sport Science Committee put an application system in place, allowing scholars to conduct research at the Paralympic Games. The aim of this perspective paper is to overview the main outcomes of the fifty-six research projects conducted from Atlanta 1996 until PyeongChang 2018 during Paralympic Games’ time; and to discuss the state-of-the-art of the IPC Research Strategic Goals. Methods Research projects conducted at the Paralympic Games from Atlanta 1996 to PyeongChang 2018 were clustered according to the IPC Research Strategic Goals (publications retrieved through the following procedure: analyzing the IPC Medical & Scientific Department project file; systematic search of Pubmed and SportDiscus with “Name Principal Investigator” and “Paralympic” as search terms; email to principal investigator if no outcome retrieved). Results Games-time projects targeted Paralympic research strategic goals, such as athletes’ health, athletes’ performance, evidence-based classification, participation, Paralympic legacy, and education. Conclusion Some of the projects proved high relevance and became standard Games’ operations; however, generally, projects operate in isolation and could benefit from collaboration with expert-stakeholders (e.g., athletes, coaches, governing International Sport Federations, relevant IPC departments, network of academic scholars). Sport science research in the Paralympic Movement should move fast and collaborative to catch up on evolution. • IMPLICATIONS FOR REHABILITATION • From a health perspective, fine-tuning of the patient/athlete–equipment interface to optimize function/performance is a challenge for the rehabilitation specialist/coach. • The musculoskeletal balance of the shoulder joints is a lifelong concern for permanent wheelchair users, especially those involved in dynamic wheelchair sports. • Education about autonomic dysreflexia and boosting in patients/athletes with spinal cord injury is an integral part of the rehabilitation process. • Rehabilitation experts have an ideal educational profile to contribute to evidence-based classification, as a para-sports classifier, or as a researcher.
... In addition, more detailed studies on sports report high mean injury incidence rates such as in football 5-a-side (22.4 injuries/1000 athlete days), powerlifting (19.3 injuries/1000 athlete days) and athletics (15.8 injuries/1000 athlete days). [24][25][26] These investigations coupled with the understanding of the current situation of injuries in sports for impaired Open access athletes led to a slightly decreased injury incidence rate in the 4 Rio 2016 Paralympics (10.0 injuries/1000 athlete days), 4 and improved the injury rates during the Alpine skiing at the 5 PyeongChang 2018 Winter Paralympics. 9 However, the incidence of injuries in WR and WB, which are team sports events of the Paralympic Games, had not improved for the Paralympics in London and Rio (2012 and 2016, respectively). ...
Article
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Objectives To present the fall characteristics of athletes playing wheelchair rugby (WR) and wheelchair basketball (WB) using official videos from the Rio 2016 Paralympic Games and compare the key fall characteristics among the team wheelchair sports event. Methods Eighteen WR and 10 WB game videos for men (MWB) and women (WWB), including 8 teams per sport, were obtained from the official International Paralympic Committee of the Rio 2016 Paralympic Games. The videos were analysed to assess the number of falls, playing time of fall, playing phase, contact with other athletes, the direction of the fall and the body part first in contact with the floor during the fall. Results In total, 359 falls (96 for WR, 172 for MWB and 91 for WWB) occurred with a mean of 5.3, 17.2 and 9.1 falls per match, respectively (p<0.05). Significant differences among the three sports were detected in the playing time (p=0.011), presence of contact (p=0.037), direction (p<0.001) and body part first in contact with the floor (p<0.001). For WR, the falls were primarily lateral and caused by contact, occurring in the second half of the match. WB falls tended to be in the first half for women and the second half for men. Most falls were contact falls in the forward direction. Conclusion By observing the situational details, we described that a number of falls due to contact occurred during these team sports events, especially MWB. In addition, each sport exhibited characteristics attributable to differences in gender, degree of impairment and game rules. The directions of the falls and characteristics of the affected body parts indicate differences in impairments depending on the sport. A fall to the side or back may indicate a risk of injury.
Article
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Background: Injury prevention/reduction strategies are driven by data collected through injury surveillance systems. The aim of this review was to describe injury surveillance systems that are used for ongoing surveillance in either a professional or amateur sporting environment. This was an update to a review done in 2015 to determine the gaps in injury surveillance. Methods: A systematic search process of five databases (MEDLINE, CINAHL, EMBASE, SCOPUS and ProQuest) was used to discover published research that presented methodological data about the injury surveillance systems implemented by clubs and organisations for ongoing surveillance. Inclusion criteria centred on the population under surveillance and the ongoing nature of that activity. Data extracted and summarised included the level of athlete under surveillance, the data collection mechanism and the personnel involved, the injury definitions applied and the date and country of origin to provide a comprehensive picture of the systems. Results: A total of 21 systems were documented as being used in ongoing injury surveillance, with 57% of these exclusively in the professional/elite landscapes and 33% at the amateur level. Surveillance systems cater for one sport per athlete entry so there is a gap in research for multi-sport athletes at the amateur level, especially where there is no early specialisation in a multi-sport participation environment. Conclusions: Research in this area will lead to a better understanding of subsequent injury risk for multi-sport athletes who have a higher athlete exposure than single-sport athletes.
Chapter
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Spor Alanında gerçekleştirilen İnovasyonlar
Chapter
Olympic sports have offered a platform to showcase the highest level of talent for hundreds of years. Organized Paralympic sports for athletes with impairments were first showcased with wheelchair archery in the opening ceremony of the 1948 London Olympic Games. Since that time, the growing popularity of Paralympic sports continues to bring athletes from around the world to compete in 28 different sports.
Chapter
Discus, javelin, shot put, and boccia are staples of the Paralympic Summer Games. These throwing events, like all modern-day adaptive sports, can trace their origins to the Stoke Mandeville Games of 1948, which was a competition that was organized to provide an athletic outlet for World War II veterans who had sustained spinal cord injuries. The inaugural games featured 16 participants who competed in wheelchair archery. Although the event was small, it successfully promoted adaptive sports and started the Paralympic movement. This event is still held annually (except during the Summer Olympic years) but is now known as the International Wheelchair and Amputee Sports World Games. The 1960 Games were held in Rome and featured 400 athletes from 23 countries. Historically, this event would later be recognized as the first Paralympic Games (International Paralympic Committee. International Paralympic Committee athletics rules and regulations 2014–2015. www.paralympic.org/sites/default/files/document/140715162521888_2014_01%2Bipc%2Bathletics%2Brules%2Band%2Bregulation%2B2014-2015_final%2B2014-2.pdf (June 15)). The event had expanded significantly from just archery to include javelin and shot put. Discus was later added in the 1964 Paralympic Games in Tokyo, and boccia was introduced in 1984. Most recently, the 2020 Summer Paralympics in Tokyo (postponed until 2021 due to the COVID-19 pandemic) included 4403 athletes from 162 countries, demonstrating how participation in and popularity of adaptive sports, including throwing sports, has soared over the years (Tokyo 2020 Paralympic Games. https://web.archive.org/web/20210825135207/https://olympics.com/tokyo-2020/en/paralympics/news/top-moments-from-the-opening-ceremony-of-the-tokyo-2020-paralympic-games). Adaptive discus, javelin, shot put, and boccia are derivations of similar able-bodied sports. The classifications, basic rules, and necessary adaptive equipment will be discussed, followed by a review of injury risk factors, common injuries, and prevention and treatment recommendations.
Chapter
Para sport includes any sport in which an athlete with a disability can participate. While of enormous value, para athletes introduce unique challenges regarding managing health and injury on the sidelines and during training. Many pearls gained from caring for able body athletes directly cross over to the disabled athlete; nonetheless, the astute clinician must be aware of the unique injury patterns and unique challenges faced by Paralympic athletes to ensure that their care is optimized.
Article
Background To the best of our knowledge, no studies have attempted to correlate athletic performance with muscle injuries sustained during Paralympic Games. Aim This study reports the incidence, anatomical location, anatomical site classification, and relationship between competition results and anatomical site classification in athletes who participated in the Paralympic Games. Methods All MRI images collected at the IPC polyclinic at the Tokyo 2020 Paralympic Games were reviewed to identify the presence and anatomical site of muscle injuries. The athletes’ competition results were reviewed using IPC data sources. Results Twenty-six MRI-detected muscle injuries were observed in 16 male and 10 female athletes. Muscle injuries were most commonly observed during track and field events (n = 20) and in athletes with visual impairment (n = 12). Ten of the injuries involved the tendon. Twenty-one of injured athletes (81%) completed their competition, whereas 5 athletes did not. Eight athletes won medals in the Games. The anatomical site of muscle injury did not significantly impact the proportion of athletes who did not finish competition. Conclusion Many athletes who sustained muscle injuries completed their competitions. No association was found between anatomical site classification and Paralympic athletes’ performance in this study.
Article
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Objective To describe the epidemiology of injuries at the Tokyo 2020 Paralympic Games, including injuries sustained in the new sports of badminton and taekwondo. Methods Injury data were obtained daily via the established web-based injury and illness surveillance system (WEB-IISS; 81 countries, 3836 athletes) and local organising committee medical facilities (81 countries, 567 athletes). Univariate unadjusted incidences (injuries per 1000 athlete days with 95% CIs), injury proportion (IP, %) and injury burden (days lost per 1000 athlete days) are reported. Results A total of 4403 athletes (1853 women, 2550 men) from 162 countries were monitored prospectively during the 3-day pre-competition and 12-day competition periods (66 045 athlete days). 386 injuries were reported in 352 athletes (IP=8.0%) with an incidence of 5.8 per 1000 athlete days (95% CI 5.3 to 6.5). Football 5-a-side (17.2), taekwondo (16.0), judo (11.6) and badminton (9.6) had the highest incidence. There was a higher incidence of injuries in the pre-competition period than in the competition period (7.5 vs 5.4; p=0.0053). Acute (sudden onset) injuries and injuries to the shoulder (0.7) and hand/fingers (0.6) were most common. Injury burden was 10.9 (8.6–13.8), with 35% of injuries resulting in time loss from training and competition. Conclusion Compared with previous Paralympic Games, there was a reduction in injury incidence but higher injury burden at the Tokyo 2020 Paralympic Games. The new sports of taekwondo and badminton had a high injury incidence, with the highest injury burden in taekwondo, compared with other sports. These findings provide epidemiological data to inform injury prevention measures for high-risk sports.
Article
Behavioral aspects of organized sports activity for pediatric athletes are considered in a world consumed with winning at all costs. In the first part of this treatise, we deal with a number of themes faced by our children in their sports play. These concepts include the lure of sports, sports attrition, the mental health of pediatric athletes (i.e., effects of stress, anxiety, depression, suicide in athletes, ADHD and stimulants, coping with injuries, drug use, and eating disorders), violence in sports (i.e., concepts of the abused athlete including sexual abuse), dealing with supervisors (i.e., coaches, parents), peers, the talented athlete, early sports specialization and sports clubs. In the second part of this discussion, we cover ergolytic agents consumed by young athletes in attempts to win at all costs. Sports doping agents covered include anabolic steroids (anabolic-androgenic steroids or AAS), androstenedione, dehydroepiandrostenedione (DHEA), human growth hormone (hGH; also its human recombinant homologue: rhGH), clenbuterol, creatine, gamma hydroxybutyrate (GHB), amphetamines, caffeine and ephedrine. Also considered are blood doping that includes erythropoietin (EPO) and concepts of gene doping. In the last section of this discussion, we look at disabled pediatric athletes that include such concepts as athletes with spinal cord injuries (SCIs), myelomeningocele, cerebral palsy, wheelchair athletes, and amputee athletes; also covered are pediatric athletes with visual impairment, deafness, and those with intellectual disability including Down syndrome. In addition, concepts of autonomic dysreflexia, boosting and atlantoaxial instability are emphasized. We conclude that clinicians and society should protect our precious pediatric athletes who face many challenges in their involvement with organized sports in a world obsessed with winning. There is much we can do to help our young athletes find benefit from sports play while avoiding or blunting negative consequences of organized sport activities.
Article
Background Despite the benefits of sport, it is known that, sports practice increases the exposure to and incidence of sports injuries. Therefore, studies are needed that demonstrate the injury patterns associated with parasports, which will prospectively allow the suggestion of specific preventive protocols. Objective Demonstrate the profile of injuries in parasports, in different sports and types of disability. Data sources Searches were conducted in the PubMed/MEDLINE, EMBASE, PEDro, Cochrane, SportsDiscus, and Scielo databases until March 2020. The search terms included combinations of keywords related to parasports and sports injuries. To be included, studies were required to: (1) target disabled athletes; (2) evaluate amateur or professional levels; and (3) verify measures of sports injuries. Results Thirty one studies (n = 17,608 participants) were included. It was found a higher prevalence of injuries in muscle fibers, and in modalities practiced in a standing position. The anatomical site with the highest incidence was the lower limbs, especially the thigh, while, in sitting position sports, in water and in competitions, the highest incidence was observed in upper limbs, especially the shoulder. Conclusion These findings provide clinicians and researchers with parameters to guide the prescription of specific preventive interventions, considering the type of sport submodality practiced.
Article
Objective To explore the health seeking behaviours (HSB) of athletes with limb deficiency, drawing on the experiences and perception of the SMT and athletes. Design An interpretive hermeneutic phenomenological methodology with a subtle realist paradigmatic view to investigate commonality in unique experiences within reality. Data collection was completed with two focus groups in December 2019 and March 2020. Thirteen participants took part including athletes and SMT members (Physiotherapists, Doctors, and Strength and Conditioning Coaches) working in Parasports. Focus group manuscripts were transcribed verbatim from audio recordings. An inductive, iterative process was used to identify themes and subthemes, with processes in place to establish rigour. Results Two themes and five sub themes emerged in relation to the ‘internalisation and adjustment to social identity’ and ‘the importance and impact of factors which impact the athlete social identity’. Conclusions HSB of athletes with limb deficiency were influenced by a unique blend of personal and environmental factors that contribute towards social identity. The SMT require specific awareness of factors that may diminish HSB to deliver a personalised approach and negate consequences.
Article
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Purpose Participation in elite sporting competition for athletes with a disability has seen significant growth in recent years. There are relatively few studies on sports-related injuries in this population of athletes. Thus, detailed understanding of musculoskeletal injury in this complex area of sport remains poor. The aim of this study was to determine the prevalence, pattern, and perceived risk factors of musculoskeletal injuries among wheelchair athletes in Lagos State, South West, Nigeria. Methods The study was a cross-sectional survey involving 63 wheelchair athletes, recruited from various stadia in Lagos State. Data on musculoskeletal injuries were collated by using an adapted questionnaire. Frequency and percentages were applied to summarize data. The chi-squared test served to find associations between variables. Results The career, 12-month, and point prevalence of musculoskeletal injuries among the wheelchair athletes were 93.7%, 61.9%, and 3.2%, respectively. The shoulder (66.7%) and forearm (31.7%) were the most common sites of injury. The most frequent perceived risk factors of musculoskeletal injury were fatigue (30.2%) and contact with other athletes (28.6%). No significant connections were found between the injured body parts and the 12-month injury prevalence in the wheelchair athletes ( p ≥ 0.05). Conclusions There is a high prevalence of musculoskeletal injuries among wheelchair athletes. The upper extremities are the major site of injury owing to their continuous use to propel wheelchairs during sports activities and activities of daily living, which makes them vulnerable to injury.
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The aim of the study was to determine the frequency, type and origin of the occurrence of injuries in amputee football. The studied group comprised all members of the Polish national amputee football team (n = 25). During the 9-month observation period, 13 players incurred 22 injuries. The incidence proportion was 48.0 per 100 athletes (95% Cl, 28.4-67.6) and the incidence rate was 5.73 per 1000 athlete-days (95% Cl, 3.33-8.12). The study showed that 32.8% of the injuries were to the thigh, 13.6% to the ankle, and 9.1% to the knee. The obtained results indicate that amputee football players rather frequently incur play-related injuries, but a single athlete incurs relatively few of them, with the lower limb being most commonly injured.
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BACKGROUND: Sports for people with disabilities and injuries have been the subject of discourse in the professional literature in the fields of traumatology and sports medicine. OBJECTIVE: This research aims to elucidate the injury characteristics of athletes in the Indonesian national team. The subject of this study were nine athletes (male=5, female=4) with males around the age of 28±9.13 and females 28±5.66 years. METHOD: The method approach is descriptive with a cross-sectional study technique using a questionnaire about injury history, types of injury, injury factors, and injury management for Indonesian Para Athletics Athletes who have competed in the 2020 Tokyo Olympics. Data analysis is depicted in numbers and percentages and Fisher's exact test to determine the relationship between variables. RESULTS: The study results reported that Indonesian athletes suffered injuries of the lower limbs (70%), part of the body that is frequently injured was the thigh (28%) and the type of injury that was often experienced sprain/twist. CONCLUSION: The injury characteristics in the sprint (track) category form a pattern of injuries to the thigh, Achilles tendon, ankle, and knee. There appears to be no correlation between gender, training frequency, injury share, match number, and warm-up type. The implication is that injury management is necessary before and during competition by considering biomechanics, pathophysiology, and psychosocial problems. Injury prevention strategies by coaches and medical teams should lead to more significant injury reduction and optimize athletes' health, safety, and well-being.
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Objective To describe the illness and injury pattern of Norwegian Para athletes over five consecutive Paralympic Summer and Winter Games cycles and to identify which health problems should be targeted in risk management plans with respect to impairment types. Methods We monitored athletes from 12 to 18 months prior to each Game using a weekly online questionnaire (Oslo Sports Trauma Research Center-H2 (OSTRC-H2)). We asked them to report all health problems they had experienced in the preceding 7 days, irrespective of their consequences on their sports participation or performance and whether they had sought medical attention. Results Between 2011 and 2020, 94 candidate athletes were included in this monitoring programme and prepared to represent Norway; of these, 66 (71%) were finally selected for multiple Paralympic Games. The overall response rate to the weekly questionnaires was 87%. At any given time during the five observation cycles, 37% of the athletes (95% CI 36% to 38%) reported having at least one health problem. Athletes with neurological impairments (n=51) lost 10 days per year due to respiratory problems (95% CI 9 to 11) compared with 9 days (8-10) among those with musculoskeletal impairments (n=37). Gastrointestinal problems caused a time loss of on average 4 days per year in athletes with neurological impairments versus 1 day in athletes with musculoskeletal impairments (mean difference 2.7 days, 2.1–3.3). Musculoskeletal injuries generated a high burden for both athlete groups, in particular, to the elbow, shoulder and lumbosacral regions. Conclusion At any given time, nearly two out of five elite Norwegian Para athletes reported at least one health problem. Respiratory tract and other infections; gastrointestinal problems, injuries to the shoulder, elbow and lumbosacral regions represented the greatest health burden. Our findings can help guide the allocation of clinical resources, which should include a broad network of medical specialists, together with dieticians and physiotherapists, to meet the health challenges in Para athletes.
Article
Context: Training loads, injury, and injury prevention in the Para sports population has not been well established. Objective: The purpose of this study was to survey elite-level swimming, cycling, and athletic Para sport athletes in the United States who were competing in the 2016 US Paralympic trials to better understand common injuries among athletes in each sport and to determine whether injury prevention programs were being utilized. Design: Cross-sectional, survey study. Setting: The 2016 US Paralympic trials for swimming, cycling, and athletics. Participants: Athletes who competed in swimming, cycling, and/or athletics at the 2016 US Paralympic trials (N = 144; 83 males and 61 females). Main outcome measures: Participants completed electronic survey using Qualtrics XM (Qualtrics, Provo, UT) with questions pertaining to average number of hours trained per week, number of cross-training hours performed each week, descriptive information regarding sport-related injuries, pain, whether athletes received treatment for injuries, and descriptive information regarding whether the athletes had participated in an injury prevention program. Results: Over 64% of respondents reported training greater than or equal to 11 hours per week, and 45% of athletes reported spending greater than or equal to 6 hours per week cross-training. Forty-two percent of athletes reported currently having pain with 34% reporting missing a competition because of injury. Only 24% of respondents reported having participated in an injury prevention program. Conclusions: Many Para sport athletes train at similar durations as able-bodied counterparts and have pain that interferes with their ability to train and compete, however, only a small percentage consistently perform injury prevention programs.
Article
Introduction Shoulder pain is one of the most common musculoskeletal complaints in manual wheelchair users including among athletes. However, there is a paucity of research characterizing both shoulder pain and shoulder pathology in this population. Objective To characterize and compare the prevalence of current shoulder pain and ultrasound metrics of shoulder pathology between wheelchair athletes, non-athletic wheelchair users, and non-wheelchair users. Design Cross-sectional Setting Chicago-area adaptive sport teams/programs and musculoskeletal clinics This article is protected by copyright. All rights reserved.
Article
Purpose: Few studies have reported the influence of environmental factors that may act as barriers or facilitators to participation in parasports. The aim of this study was to describe and analyse the relationship between environmental factors present in parasports (attitudes, support, services, assistive technology and policies). In addition, we present the concurrent validation of the Assistive Technology Device Predisposition Assessment (ATD PA-Br). Materials and methods: Sixty-three adult Paralympic athletes with physical and/or visual impairment who practiced goalball, wheelchair tennis, table tennis, sitting volleyball, rugby, swimming, equestrianism, weightlifting, track and field, archery, bocce ball and parabadminton were analysed. Sociodemographic questionnaires, ATDPA-Br and QUEST B were used for data collection and analysed by 5% significance level (p < 0.05). Results: The findings showed a predominance of athletes with spinal cord injury playing rugby (11) and parabadminton (9), 25.4% exhibited low sociodemographic levels, 36.5% required a wheelchair and 9.6% used prostheses. Although 90.5% of participants reported that assistive technology helped them in their sport, they also expressed dissatisfaction with the services provided. There was a significant correlation between satisfaction with the device in the QUEST instrument and the positive psychosocial factors of the ATDPA-Br, meaning the larger the number of positive factors, the greater the satisfaction with the device. Conclusion: This study showed the predominance of low-income parathletes and that environmental factor as access to the benefits of public policies, it may be a barrier to participation in parasports. Also, the technology and the services provided should act as facilitators to parasport performance.Implications for rehabilitationUnderstand the objectives of assistive technology in paralympic sports.Identify the environmental factors present in parasports (attitudes, support, services, assistive technology, and policies).Analyze the relationship between environmental factors present in parasports (attitudes, support, services, assistive technology, and policies).Have access to the concurrent validation of the Assistive Technology Device Predisposition Assessment (ATD PA-Br).
Article
Zusammenfassung Bereits in den 90er Jahren wurde die Erforschung wirksamer Präventionsstrategien im Nicht-Behindertensport zu einem wichtigen Forschungsthema. Im Para-Sport hingegen begann die systematische Erfassung von Erkrankungen und Verletzungen erst viel später, obwohl Verletzungen bei Para-Athleten noch schwerwiegendere Konsequenzen haben können, da sie häufig die Mobilität, Selbstversorgung und die sportliche Karriere nachhaltig bedrohen. Dieser narrativer Übersichtsartikel hat zum Ziel, Kliniker und Forscher für die Thematik zu sensibilisieren. Nach einer Einführung in den Para-Sport wird die aktuelle Studienlage zur Epidemiologie zusammengefasst, um mögliche Präventionsstrategien aufzuzeigen. Der Schwerpunkt liegt dabei auf Schulterverletzungen bei Rollstuhlathleten.
Article
Background: To provide information regarding injury incidence, injury pattern, and associated injury risk factors in elite Paralympic judokas. Methods: Participants in this observational research were elite judokas taking part in the IBSA 2018 World Judo Championship. The entire championship was videotaped, and all injuries were prospectively documented using an all-complaints definition. Results: The tournament featured 267 judokas, (B1 = 58; B2 = 105; B3 = 104). The injury proportion was estimated at 18.9 injuries/100 fighters (B1 = 13.8; B2 = 22.3; B3 = 18.5). A total of 745 athletic exposures were registered. The overall injury rate was 68.5 (95% CI, 52.5-89.2); 62.5 (95% CI, 32-122.3); 79.6 (95% CI, 53.8-17.8); and 61.2 (95% CI, 40-93.5) for the total sample, B1, B2, and B3 judokas, respectively. When only injuries resulting in medical attention were analyzed, the overall injury rate was calculated to be 22.8 (95% CI, 14.3-36.5), and the injury proportion was estimated at 6.3 injuries/100 fighters. No significant differences were found for sex, weight, and visual class regarding injury proportion and injury rates. Conclusion: Paralympic judokas show a high injury rate. However, when only injuries that needed medical attention were taken into account, the proportion of athletes injured was low. The degree of visual impairment was not considered as an injury risk factor.
Article
Zusammenfassung Einleitung Trotz der Größe der Paralympischen Spiele und der Vielzahl der Menschen mit Behinderung besteht ein Mangel an Studien zum Thema (Hoch-) Leistungssport mit Behinderung. Major-Verletzungen im deutschen paralympischen Ski Alpin sollten im Rahmen einer Kohortenstudie erfasst und retrospektiv analysiert und dargestellt werden. Patienten und Methoden Über 25 Jahre wurden im deutschen paralympischen Ski-Team im Wettkampf und Training sämtliche Verletzungen, die mit einem strukturellen Schaden einhergingen, dokumentiert. Es erfolgte eine deskriptive statische Auswertung. Ergebnisse 22 von 94 Athleten (23 %) zogen sich Major-Verletzungen zu. Dies waren 12 (55 %) Sportler der Kategorie „sitzend“, 9 (41 %) der Kategorie „stehend“ und 1 Athlet (5 %) der Kategorie „sehbehindert“. Am häufigsten waren Verletzungen der oberen Extremität (n = 9,41 %), insbesondere der Schulter (n = 8,36 %). Vor allem sitzende Athleten zogen sich Schulterverletzungen zu. Die mit Abstand verletzungsträchtigsten Disziplinen waren die Speed-Disziplinen Abfahrtslauf und Super G (n = 17,77 %). Die Verletzungsrate betrug durchschnittlich 7 % der Athleten/Jahr. In unserer Kohorte verletzten sich absolut die meisten Athleten während der Paralympischen Spiele in Nagano 1998 (n = 4). Die höchste Verletzungsrate hingegen beobachteten wir während der Paralympischen Spiele in Sotchi 2014 (33 %). Diskussion Die aktuelle Datenlage weist darauf hin, dass, anders als bisher angenommen, das Verletzungsrisiko paralympischer Athleten höher zu sein scheint als bei olympischen Athleten. Insbesondere sitzende Athleten haben ein erhöhtes Risiko für Verletzungen. Diesen sollte bei Präventionsmaßnahmen eine besondere Beachtung zukommen. Ein intensiviertes Training der Rumpfmuskulatur erscheint sinnvoll. Technische Hilfsmittel wie der Monoskibob verdienen besondere Aufmerksamkeit, um eine sichere Funktion zu gewährleisten. Schulterverletzungen sind bei sitzenden Athleten gleichzeitig besonders häufig und besonders fatal. Ein sorgsames Krafttraining der Schulter erscheint unabdingbar. Zur Reduzierung der Verletzungshäufigkeit und -schwere ist die Weiterentwicklung von Präventionsmaßnahmen unabdingbar. Die weitere Professionalisierung des paralympischen Wettkampfs und Trainings erachten wir als sinnvoll. Schlussfolgerung Sitzende Sportler weisen eine erhöhte Verletzungsrate auf und neigen zu Schulterverletzungen. Gerade diese sind für die Athleten im Alltag häufig fatal. Die Weiterentwicklung von Präventionsmaßnahmen erachten wir als essenziell für die Zukunft des paralympischen Sports.
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Background: Longitudinal monitoring data of para athletes is sparse. Objective: To describe the weekly prevalence and incidence of injuries and illnesses among German athletes preparing for the 2016 Rio de Janeiro Paralympic Games. Methods: Athletes were invited to weekly report on medical problems, their severity/burden and training load, using the OSTRC Questionnaire on Health Problems (OSTRC-H). In case of any health problem, athletes were contacted and medical support offered. Data were analyzed with regard to impairment type. The acceptance of the monitoring program was evaluated. Results: 58 athletes were followed for 29 weeks, 10.927 athlete-days. At any given time, 28% (95% CI 26-30%) of athletes reported health problems, and 12% (11-14%) substantial health problems. The prevalence of health and illness problems diminished over time by 20.9±4.1% and 16.1±2.9%, P<.001, respectively, based on the means of the first and final five weeks. Paraplegic athletes reported a significantly higher prevalence of all health problems (33%, 29-37%) than non-paraplegic athletes (26%, 23-29%) (P=0.007). Illnesses were in general more severe and resulted in more time loss days. Athletes reported a high satisfaction with the program. Conclusions: At any given time, 28% of German Paralympic athletes reported health problems, and 12% suffered from substantial health problems. For a health team, illnesses seem to be more important to handle than injuries. The OSTRC-H is a suitable method for injury and illness surveillance in para athletes.
Thesis
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The current thesis focuses on the impact of sports participation on health and fitness in youngsters with CDPD. Chapter 2 describes the design of the Health in Adapted Youth Sports study, a cross-sectional study comparing youngsters with CDPD who participate in organized sports at least twice weekly with their non-sporting peers or those who participate in sports once a week. Chapter 3 introduces the criterion validity of the Activ8 for quantifying and promoting physical activity in youngsters with typical development and youngsters who are ambulatory but have motor disability. Chapter 4, 5, 6 and 7 addresses the results of the HAYS study. Chapter 4 shows the results of sports participation on health-related fitness and physical activity in youngsters with CDPD; Chapter 5, the associations of sports participation with self-perception, exercise selfefficacy, and quality of life. Chapter 6 summarizes the association of cardiorespiratory fitness, adiposity and sports participation with arterial stiffness. Chapter 7 shows the risks of (sports-related) injuries and illnesses among youngsters with CDPD. Chapter 8 presents a systematic review that summarizes the evidence of instruments measuring physical activity in persons who use a wheelchair. Finally, Chapter 9 comprises the general discussion of this thesis including: the main findings, theoretical considerations, interpretation of results, methodological considerations, practical implementation, future perspectives, recommendations and conclusions.
Technical Report
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Esta guía contiene los aspectos mas relevantes en relación a la práctica deportiva como actividad profesional desde el punto de vista de la medicina del trabajo. En la misma se tratan temas como conceptos y normativa básica, prevención, riesgos inherentes a la actividad deportiva profesional, vigilancia de la salud en el deportista, incapacidad laboral, dopaje, el menor en el deporte, mujer y deporte, discapacidad y deporte, deporte paralímpico, etc.
Thesis
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https://portal.research.lu.se/portal/en/publications/sportsrelated-injuries-and-illnesses-in-paralympic-athletes(ac2429cd-eee1-4747-8e93-b1475b1d69b1).html
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Adaptive sports and recreation have an important role in the lifestyle of individuals with cerebral palsy (CP). This article discusses the history of adaptive sports and the benefits of adaptive sports and recreation. Barriers and medical challenges are also thoroughly discussed, including common musculoskeletal issues, methods to prevent musculoskeletal injury, pain, fatigue, maximal exertion, and other medical comorbidities and illness. The role of health care providers such as physiatrists is emphasized to provide support to individuals with CP who either are interested in starting exercise or a sport or are already an athlete.
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The International Association of Athletics Federation has systematically surveyed all Athletics injuries in their competitions since 2007 in order to develop strategies for health protection of their athletes. Analysis of frequency and characteristics of injuries during 13 international Athletics championships from 2007 to 2012 regarding different types of championships and discipline categories. The team physicians and the Local Organizing Committee reported daily all injuries on a standardised injury report form during each championship. A total of 1470 injuries were reported, equivalent to 81.1±4.2 injuries per 1000 registrations of which 36.7±2.9 were expected to result in absence from sports. The incidence of time-loss injuries was significantly higher in competition (29.0±2.6) than in training (5.8±1.9), and in outdoor (46.4±4.0) than in indoor (23.7±6.2) or youth/junior championships (13.2±4.0). While most in-competition time-loss injuries were reported during short distance events (32.5%), combined events had the highest incidence of in-competition time-loss injuries (106±26.5). The most frequent diagnosis was thigh strain (28.2%), followed by lower leg strain and ankle sprain. Injury location varied between different discipline categories: in long distances the lower leg, in Marathon the foot and in throws the upper extremity were mainly affected. The incidence of injuries varied substantially between different types of Athletics championships and between discipline categories. Special attention should be paid to combined events, running disciplines and (thigh) strain to better understand the injury mechanisms and risk factors and develop related preventive measures.
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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.
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Background: In this study we describe (1) the implementation of a novel web-based injury and illness surveillance system (WEB-IISS) for use by a team of physicians at multisport events and (2) the incidence and characteristics of injuries and illness in athletes during the London 2012 Paralympic Games. Methods: Overall, 3565 athletes from 160 of the 164 participating countries were followed daily over a 14-day period, consisting of a precompetition period (3 days), and a competition period (11 days) (49 910 athlete-days). Daily injury and illness data were obtained from teams with their own medical support (78 teams, 3329 athletes) via the WEB-IISS, and without their own medical support through the London Organising Committee of the Olympic Games and Paralympic Games database (82 teams and 236 athletes). Results: There were no differences between incidence rates (IR) of injury and illness, or between the precompetition and competition periods. The IR of injury during the competition period was 12.1/1000 athlete-days, with an incidence proportion (IP) of 11.6% (95% CI 11.0% to 13.3%). Upper limb injuries (35%), particularly of the shoulder (17%) were most common. The IR of illness during the competition period was 12.8/1000 athlete-days (95% CI 12.18 to 1421), with an IP of 10.2%. The IP was highest in the respiratory system (27.4%), skin (18.3%) and the gastrointestinal (14.5%) systems. Conclusions: During the competition period, the IR and IP of illness and injury at the Games were similar and comparable to the observed rates in other elite competitions. In Paralympic athletes, the IP of upper limb injuries is higher than that of lower limb injuries and non-respiratory illnesses are more common.
Article
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Background The incidence and factors associated with illness in Paralympic athletes have not been documented. Aim To determine the factors associated with illness in athletes participating in the London 2012 Paralympic Games. Methods A cohort of 3565 athletes from 160 of the 164 participating countries in the London 2012 Paralympic Games were followed over a 14-day period (precompetition period=3 days, competition period=11 days; 49 910 athlete-days). Daily illness data were obtained from (1) teams with their own medical support who completed a daily illness log (78 teams, 3329 athletes) on a novel web-based system and (2) teams without their own medical support through the local organising committee database (82 teams, 236 athletes). Illness information from all athletes included age, gender, type of sport and the main system affected. Main outcome measurement Incidence rate (IR) of illness (illness per 1000 athlete-days) and factors associated with IR (time period, gender, age and sport). Results The IR of illness was 13.2 (95% CI 12.2 to 14.2). The highest IR of illness was in the respiratory system, followed by the skin, digestive, nervous and genitourinary systems. The IR in the precompetition period was similar to that in the competition period, but the IR was significantly higher in athletics compared with other sports. Age and gender were not independent predictors of illness. Conclusions Illness is common in Paralympic athletes and the main factor associated with higher IR of illness was the type of sport (athletics).
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Background The characteristics and incidence of injuries at the Summer Paralympic Games have not previously been reported. A better understanding of injuries improves the medical care of athletes and informs future injury prevention strategies. Objective The objective of this prospective cohort study was to characterise the incidence and nature of injuries during the London 2012 Summer Paralympic Games. Methods Injury information was obtained from two databases. One database was populated from medical encounter forms completed by providers at the time of assessment in one of the medical stations operated by the Organising Committee. The second database was populated daily with information provided by team medical personnel who completed a comprehensive, web-based injury survey. Results The overall injury incidence rate was 12.7 injuries/1000 athlete-days. Injury rates were similar in male and female athletes. The precompetition injury rates in women were higher than those in the competition period. Higher injury rates were found in older athletes and certain sports such as football 5-a-side (22.4 injuries/1000 athlete-days). Overall, 51.5% of injuries were new onset acute traumatic injuries. The most commonly injured region (percentage of all injuries) was the shoulder (17.7%), followed by the wrist/hand (11.4%), elbow (8.8%) and knee (7.9%). Conclusions This is the largest and most comprehensive epidemiological report examining injuries in Paralympic athletes. Injury rates differ according to age and sport. Upper limb injuries are common. The knowledge gained from this study will inform future injury surveillance studies and the development of prevention strategies in Paralympic sport. The Epidemiology of Injuries at the London 2012 Paralympic Games.
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To determine the incidence and characteristics of newly incurred injuries and illnesses during international Athletics Championships, by improving the medical surveillance coverage, in order to determine future prevention strategies. Prospective recording of newly occurred injuries and illnesses. 13th International Association of Athletics Federations World Championships in Athletics 2011 in Daegu, Korea. National team and Local Organising Committee physicians; and 1851 registered athletes. Incidence and characteristics of newly incurred injuries and illnesses. 82% of athletes were covered by medical teams participating with a response rate of 94%. A total of 249 injuries were reported, representing an incidence of 134.5 injuries per 1000 registered athletes, and 119 (48%) resulted in time loss from sport. A total of 185 injuries affected the lower limb (74%). Hamstring strain was the main diagnosis and 67% resulted in absence from sport. Overuse (n=148; 59%) was the predominant cause. A total of 126 illnesses were reported, signifying an incidence of 68.1 per 1000 registered athletes. Upper respiratory tract infection was the most common reported diagnosis (18%), followed by exercise-induced dehydration (12%), and gastroenteritis/diarrhoea (10%). The highest incidences of injuries were found in combined events and middle and long-distance events, and of illness in race walking events. During elite Athletics World Championships, 135 injuries, 60 time-loss injuries and 68 illnesses per 1000 registered athletes were reported. Higher risks of injuries were found in combined events and long-distance runs. Preventive interventions should focus on overuse injuries and hamstring strains, decreasing the risk of transmission of infectious diseases, appropriate event scheduling and heat acclimatisation.
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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.
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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.
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Hamstring injuries are common in sprinters. Identifying preseason risk factors is essential to target injury-prone athletes and develop injury preventive measures. To investigate the incidence of hamstring muscle injury in sprinters over an athletic season and to explore the preseason predictor of this injury. Prospective cohort study. 44 sprinters from the Hong Kong Sports Institute, the Hong Kong Amateur Athletic Association and intercollegiate athletic teams were recruited. Preseason assessment of hamstring flexibility, concentric and eccentric isokinetic peak torque and peak torque angle were obtained at the beginning of an athletic season. The athletes were followed over 12 months and were asked to report all injuries resulting from training and competition. Eight athletes sustained hamstring injuries over the season. The injury rate was 0.87 per 1000 h of exposure. The incidence of injuries was higher at the beginning of the season, with 58.3% injuries occurring in the first 100 h of exposure. Cox regression analysis revealed that athletes with a decrease in the hamstring : quadriceps peak torque ratio of less than 0.60 at an angular velocity of 180 degrees/s have a 17-fold increased risk of hamstring injury. Performing preseason hamstring : quadriceps peak torque ratio assessments may be useful to identify sprinters susceptible to hamstring injury.
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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.
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The protection of athletes' health by preventing injuries is an important task for international sports federations. Standardised injury surveillance provides not only important epidemiological information, but also directions for injury prevention, and the opportunity for monitoring long-term changes in the frequency and circumstances of injury. Numerous studies have evaluated sports injuries during the season, but few have focused on injuries during major sport events such as World Championships, World Cups or the Olympic Games. To provide an injury surveillance system for multi-sports tournaments, using the 2008 Olympic Games in Beijing as an example. A group of experienced researchers reviewed existing injury report systems and developed a scientific sound and concise injury surveillance system for large multi-sport events. The injury report system for multi-sport events is based on an established system for team sports tournaments and has proved feasible for individual sports during the International Association of Athletics Federations World Championships in Athletics 2007. The most important principles and advantages of the system are comprehensive definition of injury, injury report by the physician responsible for the athlete, a single-page report of all injuries, and daily report irrespective of whether or not an injury occurred. Implementation of the injury surveillance system, all definitions, the report form, and the analysis of data are described in detail to enable other researchers to implement the injury surveillance system in any sports tournament. The injury surveillance system has been accepted by experienced team physicians and shown to be feasible for single-sport and multi-sport events. It can be modified depending on the specific objectives of a certain sport or research question; however, a standardised use of injury definition, report forms and methodology will ensure the comparability of results.
Article
Hamstring strain is a common injury in sprinters and jumpers, and therefore time to return to sport and secondary prevention become of particular concern. To compare the effectiveness of two rehabilitation protocols after acute hamstring injury in Swedish elite sprinters and jumpers by evaluating time needed to return to full participation in the training process. Prospective randomised comparison of two rehabilitation protocols. Fifty-six Swedish elite sprinters and jumpers with acute hamstring injury, verified by MRI, were randomly assigned to one of two rehabilitation protocols. Twenty-eight athletes were assigned to a protocol emphasising lengthening exercises, L-protocol, and 28 athletes to a protocol consisting of conventional exercises, C-protocol. The outcome measure was the number of days to return to full training. Re-injuries were registered during a period of 12 months after return. Time to return was significantly shorter for the athletes in the L-protocol, mean 49 days (1SD±26, range 18-107 days), compared with the C-protocol, mean 86 days (1SD±34, range 26-140 days). Irrespective of protocol, hamstring injuries where the proximal free tendon was involved took a significantly longer time to return than injuries that did not involve the free tendon, L-protocol: mean 73 vs 31 days and C-protocol: mean 116 vs 63 days, respectively. Two reinjuries were registered, both in the C-protocol. A rehabilitation protocol emphasising lengthening type of exercises is more effective than a protocol containing conventional exercises in promoting time to return in Swedish elite sprinters and jumpers.
Article
Sports participation for the physically disabled is rapidly growing in popularity and competitiveness, but little is known about the sports medicine needs of these unique athletes. We wished to determine the medical needs and injury profiles of a group of elite disabled athletes competing at an international level. The Canadian team that competed at the 1988 Seoul Paralympic Games consisted of 151 athletes: 58 in wheelchair, 39 blind, 30 with cerebral palsy, and 24 amputees. Analysis of the records of treatment provided by the Canadian medical contingent showed that 82% of the athletes received medical attention. Fifty-one percent of the conditions observed were musculoskeletal (MSS) and 49% were acute (developed at the Paralympics), whereas 51% were chronic (developed before the Paralympics). The shoulder was the most common site of MSS injury, and rotator cuff impingement syndrome was the most common clinical diagnosis. Upper extremity injuries were most prevalent in athletes participating in "arm-dominant" sports, whereas lower extremity injuries were significantly more common in leg-dominant sports. A disproportionately high number of leg injuries were incurred by blind athletes, whereas most of the back injuries occurred in cerebral palsy athletes. Forty-nine percent of medical treatment was for general medical problems, the most common of which were upper respiratory tract infection and gastroenteritis. Medical conditions specific to the particular athlete's disability were also noted. We conclude that sports medicine services are important for this group of athletes and that care providers should be prepared to deal with MSS injury, general medical illnesses, and disorders specific to each disability. The injury profiles suggest that both type of sport and type of disability are factors in injury location. (C) Lippincott-Raven Publishers.
Chapter
IntroductionWho Is Affected by Injury?Where Does Injury Occur?When Does Injury Occur?What Is the Outcome?What Are the Risk Factors?What Are the Inciting Events?Injury PreventionFurther ResearchReferences
Article
Many anatomic, physiological, and biomechanical alterations have been observed in overhead athletes who present with painful shoulders. This is probably due to the complex kinetic chain mechanics required in the overhead throwing or serving motion. Any alteration along the kinetic chain can result in deficits in force production or increase in joint loads in other parts of the chain. The "disabled throwing shoulder" (DTS) is a general term that describes the limitations in function that exist in symptomatic overhead athletes. DTS typically results from a "cascade to injury" with alterations in the kinetic chain. Evaluation of athletes with the DTS should include examination of the local and distant anatomic injuries and screening for physiological (muscle inflexibilities, weakness, or imbalances) or biomechanical (motions, positions) alterations.
Article
Notwithstanding the healthy influence of sporting activities on risk factors, in particular those of cardiovascular disease, it is becoming increasingly apparent that sports can present a danger to health in the form of sports injuries. The extent of the sports injury problem calls for preventative action based on the results of epidemiological research. For the interpretation of these facts uniform definitions are needed and limitations of research designs should be known. Measures to prevent sports injuries form part of what is called the ‘sequence of prevention’. Firstly the extent of the sports injury problem must be identified and described. Secondly the factors and mechanisms which play a part in the occurrence of sports injuries have to be identified. The third step is to introduce measures that are likely to reduce the future risk and/or severity of sports injuries. This measure should be based on the aetiological factors and the mechanism as identified in the second step. Finally the effect of the measures must be evaluated by repeating the first step. In this review some aspects of the first and second step of the sequence of prevention are discussed. The extent of the sports injury problem is often described by injury incidence and by indicators of the severity of sports injuries. Sports injury incidence should preferably be expressed as the number of sports injuries per exposure time (e.g. per 1000 hours of sports participation) in order to facilitate the comparability of research results. However, one should realise that the outcome of research applying this definition of sports injury incidence is highly dependent on the definitions of ‘sports injury’ and ‘sports participation’. The outcome of such research also depends on the applied research design and research methodology. The incidence of sports injuries depends on: the method used to count injuries (e.g. prospective vs retrospective); the method used to establish the population at risk; and on the representativeness of the sample. Severity of sports injuries can be described on the basis of 6 criteria: the nature of the sports injury; the duration and nature of treatment; sporting time lost; working time lost; permanent damage; and cost. Here also uniform definitions are important and necessary in order to enhance the comparability of research data. In the second step of the ‘sequence of prevention’ the aetiological factors that play a role in the occurrence of a sports injury have to be identified by epidemiological studies. Epidemiological research on the aetiology of sports injuries requires a conceptual model. The most commonly applied model is a stress/capacity model in which internal (personal) and external (environmental) aetiological factors are identified. In this model stress and capacity must be in balance and preventative measures must be designed to achieve or maintain this balance. However, merely to establish the aetiological factors is not enough; the mechanism by which sports injuries occur must also be identified. Athletes are in constant interaction with their environment and aetiological factors must be approached from this point of view. In a second, more dynamic, conceptual model on the aetiology of sports injuries, the importance of the determinants of sports behaviour, as well as the interaction between the various aetiological factors, is discussed. Whether or not a sports injury results from sports behaviour largely depends on the extent to which ‘prevention’ is incorporated in the determinants of sports behaviour. The drawback of both conceptual models is the fact that neither of them incorporate a time perspective. They can therefore not be applied to research on the aetiology of overuse injuries. In this perspective the application of a stress/strain/capacity model can be useful. This is a more dynamic and time-based 3-phase sequential model in which behaviour, amongst other aetiological factors, plays an important role. In this model an athlete is seen as an active manipulator of stress by whom the amount of strain evoked by sports participation can be altered, thereby influencing the capacity to perform in a certain sports situation, but also influencing the risk to sustain a sports injury, either acute or long term. Finally, despite the importance of the model of choice in studying the aetiology of sports injuries one should realise that again the choice of research design influences the outcome of such research. Case series usually give no information on the underlying population at risk, so they are of no value in drawing valid conclusions on the risk factors of injuries. Only by relating the injuries to corresponding population denominators can one estimate injury rates and identify important risk factors and high risk sportspeople. As in research on sports injury incidence; research on risk factors should be undertaken on groups that are homogeneous with regard to age, sex, level of competition and type of sport.
Article
Twelve hundred wheelchair athletes were surveyed to determine commonly experienced athletic injuries, sports participation and training patterns associated with injuries. Soft tissue trauma, blisters, lacerations, decubiti and joint disorders were the most commonly reported injuries of the 128 respondents. Over 70 per cent of all reported injuries occurred during wheelchair track, road racing and basketball. Common mechanisms of injury were also identified. A significantly higher number of reported injuries were associated with increased sports participation (p less than 001), with the 21-30 year-old age group (p less than .01), and with a high number of training hours per week (p less than .05). There was no significant relationship between number of reported injuries and disability type, National Wheelchair Athletic Association classification, or sex. Decubitus ulcers and temperature regulation disorders were identified as particular risks for the spinal cord injury population. Educating the athlete and coach in means to prevent injury is necessary to promote optimal performance and safe participation.
Article
This study investigates the incidence of sports injuries in athletes who participate in wheelchair racing in the UK. Wheelchair racing has been identified as one of the top 'injury risk' sports but little information is available as to the incidence or type of injury sustained by British athletes. A questionnaire was used to collect information about injuries sustained in the last 12 months. Members of the British Wheelchair Racing Association (BWRA) were sent questionnaires. Most subjects (72%) reported having at least one injury within the previous 12 months. Training variables such as the distance pushed per week (Mann-Whitney U = 61, P > 0.05), the amount of speed training (Mann-Whitney U = 110, P > 0.05), the number of weight training sessions (Mann-Whitney U = 26, P > 0.05) or the length of time the athlete had been involved in wheelchair racing (Mann-Whitney U = 103, P > 0.05) were not associated with the occurrence of an injury. Overuse injuries were common and recurred more often than other types of injuries (chi 2 = 3.95, P < 0.05). Those athletes with recurring injuries also tended to be those who restarted training before they were pain-free from their injury (chi 2 = 5.31, P < 0.05). There appears to be a link between overuse injuries, the presence of pain during training and the recurrence of injuries. A lack of knowledge about sports injuries, what causes them and what to do following an injury may contribute to the high incidence of overuse injuries in this group of athletes.
Article
The British Team at the 9th Paralympic Games in September 1992 in Barcelona comprised 151 men and 54 women athletes in a total of 15 sports. They were supported by a staff of 86 including a 12-strong medical team. The athletes were selected from the National Championships of the five disability organizations: British Wheelchair Sports Federation; British Blind Sport; Cerebral Palsy Sport; British Amputee Sports Association; and the British Les Autres Sports Association. This article outlines the organization and experience of the medical support team. The injury/illness profile was similar to those in able bodied sport. The team went on to achieve 40 gold, 47 silver and 41 bronze medals, maintaining third place on the medal table as achieved in Seoul in 1988.
Article
To report the soft tissue injuries sustained by the members of four disabled sports organizations (DSOs) who competed as the USA Team at the 1996 Paralympic Games. 1996 Paralympic Games, Atlanta, Georgia. Soft tissue (strain, sprain, tendonitis, bursitis, or contusion) injury frequencies sustained by Disabled Sports USA (DSUSA, n = 66), the United States Association for Blind Athletes (USABA, n = 53), the United States Cerebral Palsy Athletic Association (USCPAA, n = 56), and Wheelchair Sports USA (WSUSA, n = 129) athletes were compared by body region with chi-square tests (p<.05) and standardized residual assessment. A total of 254 soft tissue injuries (67% acute onset, 170/254) were sustained by the participant DSO members. Statistical design limitations and poor USCPAA athlete homogeneity prompted their exclusion from group comparisons (descriptive results are reported). The most common injury regions for specific DSOs were shoulder (26%), hip-thigh (14%), and ankle (12%) for DSUSA; hip-thigh (21%), cervicothoracic region (19%), and shoulder (17%) for USABA; lumbar region (14%), foot-toe (13%), and ankle (9%) for USCPAA; and shoulder (18%), arm-elbow (12%), forearm-wrist (12%), and lumbar region (9%) for USUSA. Chi-square residual analysis showed that the USABA athletes contributed more to cervicothoracic and lower leg region injury frequencies than DSUSA or WSUSA athletes. The WSUSA athletes contributed more to elbow-arm and forearm-wrist region injury frequencies than DSUSA or USABA athletes. The DSUSA athletes contributed more to ankle region injury frequencies than USABA or WSUSA athletes. Differences in soft tissue injury frequency among athletes of differing DSOs suggest that the competitive use of adaptive or assistive devices, in combination with sport-specific stressors and the athletes' disabilities, is related to the development of predictable soft tissue injury patterns. The decreased incidence of shoulder injury among WSUSA athletes suggests that the injury prevention advice provided by previous studies is being implemented among athletes at this competitive level. The increased incidence of ankle injuries among DSUSA athletes suggests lower extremity load imbalances (prosthetic vs. uninvolved) during running. The increased incidence of lower leg injuries among USABA athletes suggests "overuse" injury patterns typical of nondisabled runners, or inadvertent contacts (contused shins), whereas the increased incidence of cervicothoracic injuries suggests injuries related to falls, "near falls," or sudden directional changes prompted by guidance aids.
Sports medicine for the physically disabled: the Canadian team experience at the 1998 Seoul Paralympic Games
  • R Burnham
  • E Newell
  • R Steadward
Burnham R, Newell E, Steadward R. Sports medicine for the physically disabled: the Canadian team experience at the 1998 Seoul Paralympic Games. Clin J Sport Med. 1991;1(3):193-196.
Athletics rules and regulations 2014-2015 Available at: http://www.paralympic.org/athletics/rulesand-regulations/rules
  • International Paralympic Committee
International Paralympic Committee. Athletics rules and regulations 2014-2015. Available at: http://www.paralympic.org/athletics/rulesand-regulations/rules. Accessed February 9, 2015.
Epidemiology of Injury in Olympic Sports: An IOC Medical Commission Publication
  • N Webborn
  • Paralympic
Webborn N. Paralympic sport. In: Caine D, Peter H, Schiff M, eds. Epidemiology of Injury in Olympic Sports: An IOC Medical Commission Publication. London: Wiley-Blackwell; 2009:475-491.
Acute hamstring injuries in Swedish elite sprinters and jumpers: a prospective randomised controlled clinical trial comparing two rehabilitation protocols
  • C Askling
  • M Tangvar
  • O Tarassova
  • A Thorstensson
Askling C, Tangvar M, Tarassova O, Thorstensson A. Acute hamstring injuries in Swedish elite sprinters and jumpers: a prospective randomised controlled clinical trial comparing two rehabilitation protocols. Br J Sports Med. 2014;48(7):532-539.
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Factors associated with illness in athletes participating in the London
  • M Schwellnus
  • W Derman
  • E Jordaan
Schwellnus M, Derman W, Jordaan E, et al. Factors associated with illness in athletes participating in the London 2012 Paralympic Games: a prospective cohort study involving 49,910 athletes days.