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The Epidemiology of Injuries in Football at the London 2012 Paralympic Games
Abstract
Abstract
Background: The epidemiology of injury in Paralympic football has received little attention. A study of all sports at the London
2012 Paralympic Games identified football 5-a-side as the sport with the highest injury rate, meriting further detailed analysis,
which may facilitate the development of strategies to prevent injuries.
Objective: To examine the injury rates and risk factors associated with injury in Paralympic football.
Design: Secondary analysis of a prospective cohort study of injuries to football 5-a-side and football 7-a-side athletes.
Setting: London 2012 Paralympic Games.
Participants: Participants included 70 football 5-a-side athletes and 96 football 7-a-side athletes. Athletes from all but one
country chose to participate in this study.
Methods: The Paralympic Injury and Illness Surveillance System was used to track injuries during the Games, with data entered by
medical staff.
Main Outcome Measurements: Injury incidence rate (IR) and injury incidence proportion (IP).
Results: The overall IR for football 5-a-side was 22.4 injuries/1000 athlete-days (95% confidence interval [CI], 14.1-33.8) with an
IP of 31.4 injuries per 100 athletes (95% CI, 20.9-43.6). In 5-a-side competition, 62.5% of injuries were associated with foul play.
The overall IR for football 7-a-side was 10.4 injuries/1000 athlete-days (95% CI, 5.4-15.5), with an IP of 14.6 injuries per 100
athletes (95% CI, 7.5-21.6). The most commonly injured body region in both sports was the lower extremity.
Conclusions: To our knowledge, this study is the first to examine IR and risk factors associated with injury in Paralympic football.
Future studies are needed to determine mechanisms of injury and independent risk factors for injury, thus informing prevention
strategies.
... Twenty-one systems are listed, and their methods expanded, in Table 1. These were identified through searches and subsequent review of papers and are included in this review: Twelve of the systems record data on elite or professional athletes [4,[10][11][12][21][22][23][28][29][30][31][32][33][34][35][36][37][38][39][40][42][43][44][45][46][47][48][49][50][51]54]. Seven of the systems record data on amateur or community athletes [6,8,9,16,18,19,[24][25][26][27]41,52,53] and two of the systems record for both amateur and elite athletes [4,41]. ...
... Eleven of the surveillance systems record data within various football codes (American Football: n = 4, Rugby: n = 3, Soccer: n = 3, Gaelic: n = 1) [10][11][12]25,38,40,42,45,[49][50][51]53,54]. Seven of the systems record data within multiple sport disciplines [8,9,[21][22][23][24]26,[28][29][30][31][32][33][34][35][36][37]41,43,44,52]. Two of the systems record data for hockey (Ice Hockey: n = 1, Field Hockey; n = 1) [4,[18][19][20]47] with one each for baseball [46], mountain biking [6,16], basketball [9], cricket [48] and ultimate frisbee [39]. ...
... There are still no systems aimed specifically at recording injury data in children. Eight of the systems are US-based [6,12,16,24,26,27,39,46,52], six are based in Europe [10,[21][22][23]47,[49][50][51]53,54], three in Australia [40][41][42][43][44]48], one in Canada [4,[18][19][20], one in Qatar [11,45] and two with no unique national affiliations [28][29][30][31][32][33][34][35][36][37][38]54]. Sixteen of the systems provide for consensus sampling [4,6,[8][9][10][11][12]16,42,43,[45][46][47][48]53,54] and five of the systems record data on a convenience sample of their target data population [41,44,[49][50][51][52]. ...
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.
... Although the impact speed in Blind Football is much slower than downhill Para Alpine, for instance, the collision potential remains quite high considering all outfield players have no light perception on the field of play and are unable to see incoming objects or other athletes [9]. Athletes with VI must rely substantially on their hearing ability to know where the ball, equipped with a sound system inside it, is and where other players around them are on the field of play [21]. As outfield players are completely blind, the athlete's ability to brace for or block impact to the head is reduced [21]. ...
... Athletes with VI must rely substantially on their hearing ability to know where the ball, equipped with a sound system inside it, is and where other players around them are on the field of play [21]. As outfield players are completely blind, the athlete's ability to brace for or block impact to the head is reduced [21]. Observations from Blind Football indicate that athletes with VI tend to play with a more anterior posture compared to their non-disabled counterparts, which could expose athletes with VI to an even greater risk of head-to-head collision [21,22]. ...
... As outfield players are completely blind, the athlete's ability to brace for or block impact to the head is reduced [21]. Observations from Blind Football indicate that athletes with VI tend to play with a more anterior posture compared to their non-disabled counterparts, which could expose athletes with VI to an even greater risk of head-to-head collision [21,22]. These risk factors are coupled with the fact that no head protection is worn in Blind Football. ...
Concussion in para athletes with vision impairment (VI) is poorly understood. Recently published studies have suggested that athletes with VI may be more likely to sustain sport-related concussions compared to non-disabled athletes and athletes with other impairment types. There is a critical need for objective concussion incidence measures to determine concussion injury rates and risks more accurately. The aim of this review was to examine the limited available evidence of concussion incidence rates across six different para sports for athletes with VI and encourage the future collection of concussion incidence data and the adoption of injury prevention strategies in VI para sport. A literature search was conducted using four unique databases, which formed the basis of this narrative review. Injury prevention strategies such as modifying sport rules, introducing protective equipment, and incorporating additional safety measures into the field of play have been introduced sporadically, but the effectiveness of most strategies remains unknown. More prospective, sport-specific research examining mechanisms of injury and risk factors for concussion injuries in athletes with VI in both training and competition is needed. This research will help inform the development of targeted injury prevention strategies to reduce the likelihood of concussion for athletes with VI.
... During the competitions, the players of both teams, except for the goalkeepers, all wear a mask to provide similar conditions [9,11]. One of the most significant adaptations of Fa5 is that the ball has been modified to make a jingling sound, which allows players to know their location during the game [12]. ...
... The current investigations that analyse the injuries of athletes with disabilities do not usually focus specifically on Fa5 players. However, Fa5 at the London 2012 Paralympic Games had the highest incidence of sports injuries [12]. This may be due to the high load and intensity of training, the game's characteristics, the players' qualities [21], and the reduced size of the field [22]. ...
... From a descriptive point of view, it is observed that the incidence of injuries increases as the tournament progresses; this incidence being 0% in the first match, 50% in the second match, and 90% in the last match. As in previous studies [12], it may be due to the accumulation of impacts. The tournament is developed in a single weekend, where three games are played, which may compromise the correct physical recovery of the players. ...
Five-a-side football for blind people is the only adapted football modality present at the Paralympic games. Fa5 is a collaborative-opposition sport in which its participants play with no vision, which causes numerous impacts. At the London 2012 Paralympic Games, it was the sport with the highest incidence of sports injuries. The main objective of this work is to analyse the association between pain perception; spatio-temporal, mechanical, and metabolic workload with injuries; and wellness in players during an international Fa5 competition. The following variables, monitored during an International Fa5 Tournament, were analysed: general well-being, perception of pain and injuries, and the spatio-temporal and metabolic workload. The results show that the incidence of injuries increases as the tournament progresses, where injured players reported greater muscle pain and stress before the matches started. Besides, the players’ internal and external load did not explain the incidence of injury. Still, the values obtained in the wellness questionnaire, the perception of pain, and stress suggested they contributed to the incidence of injury.
... de vida (Dehghansai et al., 2020;Legg, 2018). A adesão pela prática esportiva resultou anos depois como uma prática com caráter competitivo, culminando na primeira edição dos JPV realizada em Roma no ano de 1960 (Blauwet & Willick, 2012;Brittain, 2018;Legg, 2018;Webborn & Van de Vliet, 2012;Webborn et al., 2016). ...
... Os JPV são considerados um dos maiores eventos esportivos do mundo para pessoas com deficiência (Legg, 2018) e que está em constante evolução em diferentes indicadores como, aumento do número de Comitês Paralímpicos Nacionais (NPC's, sigla em inglês) participantes por edição, número de atletas, elegibilidade de diferentes deficiências (classificação esportiva paralímpica 1 ), de modalidades esportivas, nas implementações tecnológicas para o desempenho dos atletas e da estrutura competitiva (de Luigi & Cooper, 2014;van der Slikke et al., 2017;Rum et al., 2021;Silva & Mello, 2021;Winckler & Mello, 2012), além disso, de investimentos financeiros para organização dos JPV (Webborn & Van de Vliet, 2012;Webborn et al., 2016). ...
O objetivo do presente estudo foi de caracterizar a trajetória evolutiva do Brasil durante a participação dos Jogos Paralímpicos de Verão entre 1976-2020 e comparar com os países mais bem ranqueados nos Jogos Paralímpicos Rio 2016, buscando relacionar com o contexto histórico-político nacional e o plano estratégico do Comitê Paralímpico Brasileiro nos diferentes ciclos Paralímpicos. Até os Jogos Paralímpicos realizados em 2020, a delegação brasileira foi representada por um total de 774 atletas, sendo 251 medalhistas (70,9% homens; 29,1% mulheres) em 17 diferentes modalidades, quatro coletivas e treze individuais. Com relação ao tipo de deficiência, 64,9% dos atletas medalhistas apresentam deficiência física, 32,3% correspondem à deficiência visual e 2,8%, deficiência intelectual. Durante o período analisado, o Brasil conquistou 373 medalhas em participações, sendo 109 de ouro (29,2%), 132 de prata (35,4%) e 132 de bronze (35,4%). A modo conclusão, é possível destacar o avanço nas políticas públicas, plano estratégico e investimentos que favoreceram que nos últimos quatro ciclos paralímpicos, o Brasil pudesse se consolidar entre as 10 maiores potências mundiais paralímpicas, conquistando o maior número de medalhas em 2016 e o terceiro lugar no crescimento acumulado (3,2%) nos Jogos Paralímpicos de Verão entre 1988-2020, sendo superado apenas por China e Ucrânia.
... Football 5-a-side is one of the most popular sports for visually impaired people; the team is composed of totally blind participants, except for the goalkeeper who may have normal vision 3 . In particular, visually impaired athletes participating in this sport are also among those with a higher incidence of sports-related injury 4 mainly in the lower limb 5,6 . In highly dynamic situations commonly observed in sports such as football -which provide rapid changes of direction, vertical and horizontal jumps -, the ability to align the center of pressure (CoP) concerning the support base is important for physical performance 7,8 . ...
... It was demonstrated that postural control performance during single-leg stance is not only used to discriminate between those with injured lower limbs and those without any lesions 38 but also has a positive association with ankle sprain incidence 39 . Given the degree of injury observed in blind athletes, mainly in the lower limb 5,6 , it could be suggested that functional tests such as single-leg stance must be included in preparticipation exam routines in this population. However, outcomes of such an exam should be interpreted with caution once balance performance in a single-leg position does not reflect only the lower limb function 38 , but also possible changes in postural control related to visual impairment. ...
... More so, the long-term effects of sports injuries among Paralympic athletes have been the subject of little research. One may speculate that a shoulder injury in a wheelchair athlete might have different effects than the same injury in a non-disabled competitor [30]. ...
... La literatura científica indica que las lesiones más frecuentes son en miembros inferiores, y se localizan en: muslo-tobillo, ingle-cadera, cuádricepsisquiotibiales, ligamento medial, cruzado y lateral (Mendoza-Lobo et al., 2022b), siendo este tema de la epidemiología lesional objeto de estudio desde hace años (Heredia, Paredes & Fernández-Seguín, 2023). La mayoría de las investigaciones se han realizado en el fútbol profesional (Arnason et al., 2004;Webborn et al., 2016). ...
Football is considered a highly physically demanding sport and due to the increase of the load and intensity in the training processes, there is an increase in the number of injuries to players. High-intensity ball striking and running activities may be the main causes of injuries to the muscles and groin. In contrast, duels for the ball may be the most common inciting activities for ankle injuries, being the lower limbs the ones with the highest number of injuries. The main purpose of the present study was to determine the influence of category and position of play on sports injuries. The dependent variables analysed were category and playing position. The independent variables were body part injured, tissue affected, side affected, and occurrence of injury. The results show an increase in the number of injuries as the category of the players increases. On the other hand, no significant differences were found according to the dependent variables analysed. Due to the influence of injuries on individual and overall team performance, individualized training programmes should be carried out to carry out injury prevention work.
... However, the authors did not examine specific injury types. In another study examining injuries during the 2012 Paralympic Games, Webborn et al. 38 found that the incidence ratio for football 7-a-side athletes (which comprises those with central neurologic injury including cerebral palsy and traumatic brain injury) was lower than that for able-bodied football athletes, although when injuries occurred, over half were acute knee and ankle injuries. ...
:
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.
... From the result of this study the researchers can understand that the highest prevalence of injury was observed in the middle age of the players. In line with the current finding there was a trend toward a higher injury rate in the 26 to 34 year-old age group (Webborn, et al., 2016). While, the finding other studies showed that the older players are more prone to injury (Ostenberg & Roos, 2000;Arnason, et al., 2004;Hagglund, et al., 2013). ...
... 29 However, there is further evidence that suggests underreporting or misreporting of CIPS is a significant problem, including a study in wheelchair basketball where 44% of respondents did not report their concussion. 2 28 29 The concept of the '3 E's of Injury Prevention': education, enforcement and engineering (or environment) are equally applicable to CIPS. ...
Concussion is a frequent injury in many sports and is also common in para athletes. However, there is a paucity of concussion research related to para sport, and prior International Concussion in Sport (CIS) consensus papers have not substantively addressed this population. To remedy this and to improve concussion care provided to para athletes, the concussion in para sport (CIPS) multidisciplinary expert group was created. This group analysed and discussed in-depth para athlete-specific issues within the established key clinical domains of the current (2017) consensus statement on CIS. Due to the onset of the COVID-19 pandemic, the group held all meetings by video conferencing. The existing Sport Concussion Assessment Tool 5 (SCAT5) for the immediate on-field and office-based off-field assessment of concussion was evaluated as part of this process, to identify any para athlete-specific concerns. Regular preparticipation and periodic health examinations are essential to determine a baseline reference point for concussion symptoms but pose additional challenges for the interpreting clinician. Further considerations for concussion management for the para athlete are required within the remove, rest, reconsider and refer consensus statement framework. Considering return to sport (RTS), the 2017 CIS consensus statement has limitations when considering the RTS of the para athlete. Case-by-case decision making related to RTS following concussion is imperative for para athletes. Additional challenges exist for the evaluation and management of concussion in para athletes. There is a need for greater understanding of existing knowledge gaps and attitudes
towards concussion among athlete medical staff, coaches and para athletes. Future research should investigate the use and performance of common assessment tools in the para athlete population to better guide their clinical application and inform potential modifications. Concussion prevention strategies and sport-specific rule changes, such as in Para Alpine Skiing and Cerebral Palsy Football, also should be carefully considered to reduce
the occurrence of concussion in para athletes.
... From the result of this study the researchers can understand that the highest prevalence of injury was observed in the middle age of the players. In line with the current finding there was a trend toward a higher injury rate in the 26 to 34 year-old age group (Webborn, et al., 2016). While, the finding other studies showed that the older players are more prone to injury (Ostenberg & Roos, 2000;Arnason, et al., 2004;Hagglund, et al., 2013). ...
Objective
In Tokyo 2020 Paralympic Games, there were the rule and goal size changes at the blind football competition. This study aimed to compare the scoring and head impact characteristics during blind football competition between the Rio 2016 and Tokyo 2020 Paralympic Games using the official videos.
Design
Video-based observational study.
Participants
In total, 36 blind football (men’s football 5-a-side) game videos were obtained from the official International Paralympic Committee.
Primary and secondary outcome measures
Head impact was defined as the sudden contact of any object with the head. Videos were analysed to assess the number of scores and head impacts along with their corresponding details (ie, round, playing phase, scoring situation, impact situation, occurrence area, impact object, head impact site, fall and foul).
Results
The total number of goals scored at the Tokyo 2020 Paralympic Games was nearly double that at the Rio 2016 Paralympic Games. Regarding head impacts, a total of 2036 cases (Rio 2016, n=1105; Tokyo 2020, n=931) were evaluated. Significant differences were observed in head impact characteristics between the Rio 2016 and Tokyo 2020 Paralympic Games among seven outcomes (round, scoring situation, impact situation, occurrence area, impact object, site of head impact and fall).
Conclusions
Compared with the Rio 2016 Paralympic Games, the Tokyo 2020 Paralympic Games showed an increase in the number of points scored and different head impact characteristics.
Sport-related concussion (SRC) in the adaptive athlete is simultaneously the same and different as in the able-bodied athlete. An adaptive athlete’s underlying medical diagnosis or disability could impact the diagnosis of sport-related concussion as well as its management and return to play considerations. They may have symptoms at baseline that overlap with concussion symptoms and have difficulty performing standardized able-bodied testing and completion of return to play progression. This chapter highlights the signs and symptoms, assessment and return to play from a concussion, and addresses some of the unique challenges in the adaptive athlete.
Modifications to the game of ice hockey allow individuals to play and participate at multiple competitive levels with different impairments and disabilities. Adaptations to the rink, the hockey puck, special prostheses, and sleds make it possible for individuals with hearing loss, visual impairment, amputations, and lower body impairments to play ice hockey and compete at multiple levels including the Deaflympics and Paralympics. Special Hockey emphasizes teamwork, social interaction, and enjoyment for individuals with intellectual, developmental, and physical disabilities. Each of these disciplines is unique and the individuals participating bring unique considerations for the sports medicine provider.
Soccer or football is arguably the most beloved and widely played sport in the world. Since the late twentieth century, significant progress has been made for the sport to evolve and become more inclusive through rule and game play modifications and incorporation of specialty equipment. While the progenitor has well-established injury surveillance systems, all forms of adaptive soccer are still in their infancy with regards to tracking injury profiles and monitoring outcomes. The need to address this ongoing deficiency as well as the barriers affecting participation is recognized and must addressed as a collective. Legislative policy and organizational change have positively impacted this movement, but there remains a significant opportunity to meet the sporting and medical needs of the athletes who currently or aspire to participate in adaptive soccer.
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.
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.
Objectives
Athletes with impairments play sports with a risk of sustaining head injuries and concussions. However, the scientific knowledge needed to improve care is lacking. This qualitative study explores English blind 5-a-side footballers’ perceptions of concussion, concussion risks and prevention to improve para concussion care.
Methods
Nine semi-structured interviews were conducted with male English blind footballers (six current and three retired). Data were analysed by thematic analysis using a six-stage approach.
Results
Blind footballers were not sure about the number of concussions they had sustained. They lacked an understanding of what to experience when concussed, and they perceived the diagnosis and experience of a concussion to be different for a person without vision. Perceived concussion severity and previous concussion experiences were key concepts affecting their concussion reporting behaviours. Participants mentioned spatial orientation and sleep are important to function in daily life and were affected by concussions. However, these factors are not adequately included in current assessment tools or clinical guidance for sports-related concussions.
Conclusion
Blind footballers suggested the quality and accuracy of reported concussions were impacted by lack of concussion experience, knowledge and concomitant impairment. A better understanding of concussion symptoms and injury mechanisms will improve concussion reporting for athletes with visual impairments. These athlete insights should guide future studies and para sports governing body initiatives to improve concussion reporting, diagnosis and management in para athletes.
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.
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.
Introduction: 5-a-side soccer is a sports modality exclusively for athletes with vision impairment (VI) classified as blind - B1 (Blind 1) by the visual classification process. Type of impairment and high-performance training are factors that contribute to the development of sports injuries. Objective: The purpose of this study was to characterize the prevalence of sports-related injuries in visually disabled athletes of the Brazilian 5-a-side soccer team. Methods: The method was defined as a descriptive, longitudinal, epidemiological study. The sample was composed of ten male athletes, members of the Brazilian 5-a-side soccer team, including two athletes without VI and eight athletes with the B1 visual classification, who participated in competitions in 2014. The questionnaire for the data collection was based on the Sport Injuries Protocol for Paralympic Sports (PLEEP), expressing quantitative data analyzed by descriptive statistics. Results: The results showed that, in 2014, five athletes with VI had seven sports injuries, with a prevalence of 62.5%, clinical incidence of 0.87 injuries per athlete per year, and 1.4 injuries per injured athlete. The main sports injuries were muscle strain (28.6%), groin pull (athletic pubalgia) (28.6%), and shin splints (periostitis) (28.6%). All sports injuries occurred in the lower limbs, affecting legs (71.4%) and hips (28.6%). Overload was the most frequent mechanism (57%), reported after the technical kick movement and linked to the muscle imbalance between dominant and supporting lower limbs, in addition to the postural misalignment typical of people with visual impairments. Conclusions: In summary, the Brazilian 5-a-side soccer athletes presented a pattern of overload injuries resulting from the repetition of the technical kick movement, occurring predominantly in sports competitions. Epidemiological data can contribute to the development of strategies to prevent injuries in this sport. Level of evidence II, Progressive prognostic study.
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.
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.
This article explores relevant issues in dance medicine for dancers with disabilities, blindness/low vision, and/or deafness/hard of hearing (DWDBD). Within dance medicine and science, there has been minimal focus on DWDBD. Little is known about injury patterns, injury prevention, or wellness strategies for DWDBD. However, there are increasing numbers of dance programs and companies involving DWDBD at preprofessional and professional levels. This article reviews the history and experience of DWDBD and offers best guidance regarding dance medicine considerations for DWDBD based on the limited research and evidence that exists, extrapolation from para/adaptive sports medicine literature, and expert opinion.
Fleeton, JRM, Sanders, RH, and Fornusek, C. Strength training to improve performance in athletes with cerebral palsy: A systematic review of current evidence. J Strength Cond Res XX(X): 000-000, 2019-Persons with cerebral palsy (CP) can partake in many different forms of organized sport including elite competition at state and international levels. There is limited evidence on how CP athletes should train to enhance performance. The purposes of this article were to conduct a systematic review of the current evidence on ambulatory individuals with CP for (a) strength and functional improvement through strength training; (b) potential sports performance improvement through strength training; (c) the identification of risk and special considerations associated with strength and conditioning for this population, and; (d) the identification of future research foci to educate strength and conditioning coaches on specific program design for elite CP athletes. Seven electronic databases were searched for studies investigating resistance training interventions. The databases were also searched for training interventions or investigations into sports performance in athletes with CP competing at regional level or above. Thirty articles were included in the systematic review of strength training, and 23 articles included in the narrative review of training for sports performance. High-quality evidence indicates that resistance training can improve muscular strength in individuals with CP, with some preliminary evidence of structural and neurological adaptations. However, there is limited evidence for functional improvements. Limited research has examined the performance capacity of athletes with CP, and no training interventions have been conducted. Coaches should employ existing guidelines when designing programs while considering specific athlete limitations. Initially, the focus should be increasing athlete muscular strength before considering specific sport demands.
Objective
To describe the incidence of injuries and illnesses sustained during the XXIII Olympic Winter Games, hosted by PyeongChang on 9–25 February 2018.
Methods
We recorded the daily number of athlete injuries and illnesses (1) through the reporting of all National Olympic Committee (NOC) medical teams and (2) in the polyclinic and medical venues by the PyeongChang 2018 medical staff.
Results
In total, 2914 athletes (1210 women, 42%; 1704 men, 58%) from 92 NOCs were observed for occurrence of injury and illness. NOC and PyeongChang 2018 medical staff reported 376 injuries and 279 illnesses, equalling 12.6 injuries and 9.4 illnesses per 100 athletes over the 17-day period. Altogether, 12% of the athletes incurred at least one injury and 9% at least one illness. The injury incidence was highest in ski halfpipe (28%), snowboard cross (26%), ski cross (25%), snowboard slopestyle (21%) and aerials (20%), and lowest in Nordic combined, biathlon, snowboard slalom, moguls and cross-country skiing (2%–6%). Of the 376 injuries recorded, 33% and 13% were estimated to lead to ≥1 day and >7 days of absence from sport, respectively. The highest incidences of illness were recorded in biathlon (15%), curling (14%), bobsleigh (14%) and snowboard slalom (13%). Thirty per cent of the illnesses were expected to result in time loss, and 70% affected the respiratory system. Women suffered 61% more illnesses than men.
Conclusion
Overall, 12% of the athletes incurred at least one injury during the Games and 9% an illness, incidences that are similar to the Olympic Winter Games of 2010 and 2014.
As adaptive sports grow in popularity, it is increasingly important to understand the injuries for which their athletes are at risk. This population is challenging to study given its small size and diversity of its participants; accordingly, research is mostly low quality because of limited sample sizes and study durations. Summer adaptive sports account for 22 of 28 Paralympic sports, with the most frequently studied being wheelchair basketball, rugby, tennis, athletics, swimming, and soccer. Injuries vary by sport because of differences in contact level, limbs utilized, and athlete impairments. Equipment changes and technological advances, especially within wheelchair and amputee sports, have increased the level of competition and reduced injury rates. Fortunately, the majority of injuries across adaptive sports are minor and do not result in significant time off from sport. Still, even minor injuries can negatively impact these athletes' mobility and activities of daily living compared to the nondisabled population.
Although Para athletes (the International Paralympic Committee term for sportspeople with a disability) are exposed to a risk of concussion just like their able-bodied counterparts, there has been little research into the incidence of concussion in para sport. Existing assessment and management guidelines and tools have been developed for the general sport population but may not be appropriate for use in some para-athletes. This review examines what is currently known about concussion in para sport and identifies challenges and opportunities in moving knowledge on this topic forward.
KEY POINTS
(1) Seated Para athletes sustain upper extremity injuries more commonly, whereas ambulant Para athletes frequently sustain lower extremity injuries.
(2) The upper extremity is the most commonly injured area in all Para athletes, unlike ablebodied athletes for whom lower extremity injuries predominate.
(3) Minor soft tissue injuries are the most common injuries among Para athletes, similar to injury patterns observed among able-bodied athletes
(4) Football 5-a-side, powerlifting, Goalball, Wheelchair fencing, and Wheelchair rugby are the highest risk summer sports; ice hockey, alpine skiing, and snowboarding are the highest-risk winter Paralympic sports
(5) Compared with elite Para athletes, recreational and youth Para athletes remain understudied in the literature.
Objectives
To describe the incidence of injury in the precompetition and competition periods of the Rio 2016 Summer Paralympic Games.
Methods
A total of 3657 athletes from 78 countries, representing 83.4% of all athletes at the Games, were monitored on the web-based injury and illness surveillance system over 51 198 athlete days during the Rio 2016 Summer Paralympic Games. Injury data were obtained daily from teams with their own medical support.
Results
A total of 510 injuries were reported during the 14-day Games period, with an injury incidence rate (IR) of 10.0 injuries per 1000 athlete days (12.1% of all athletes surveyed). The highest IRs were reported for football 5-a-side (22.5), judo (15.5) and football 7-a-side (15.3) compared with other sports (p<0.05). Precompetition injuries were significantly higher than in the competition period (risk ratio: 1.40, p<0.05), and acute traumatic injuries were the most common injuries at the Games (IR of 5.5). The shoulder was the most common anatomical area affected by injury (IR of 1.8).
Conclusion
The data from this study indicate that (1) IRs were lower than those reported for the London 2012 Summer Paralympic Games, (2) the sports of football 5-a-side, judo and football 7-a-side were independent risk factors for injury, (3) precompetition injuries had a higher IR than competition period injuries, (4) injuries to the shoulder were the most common. These results would allow for comparative data to be collected at future editions of the Games and can be used to inform injury prevention programmes.
Concussion management in sport is a serious medical issue. Frequent high-profile incidents coupled with ongoing debate and research surrounding the definition, diagnosis and management of concussion mean that it is likely to remain a hot topic.1 Internationally, concussion has become a key focus for many sporting governing bodies, with a range of educational campaigns aimed at improving recognition and management.2
Football is the world's most popular global sport, and appropriately many disability football leagues have been developed to provide competitive opportunities for those individuals with disability wishing to compete outside ‘mainstream’ football. Adapted versions of football for athletes with major disabilities including learning disability; visual impairment; cerebral palsy/acquired brain injury; hearing impairment and amputation are all in existence. There has been a suggestion of an increased risk of musculoskeletal injury and head injury from participation, including concussion.3
However, at present the rates of and best-practice assessment and management for concussion …
Background:
Musculoskeletal complaints are frequently diagnosed in Paralympic athletes. Despite the increased professionalism in Paralympic Sports, the documentation of injuries and other health complaints during high-level competition is sparse. With respect to the upcoming Paralympic Summer Games in Rio de Janeiro, the aim of this study was the analysis of all musculoskeletal complaints within the German Paralympic Athletes during the London 2012 Paralympic Games.
Methods:
All musculoskeletal complaints (MSC) of the 150 German athletes seeking medical attention, hereby defined as "injury", were recorded during the in-competition period of the London Paralympics Games (22 days), regardless of their severity and consequences. Standardised documentation included the onset of symptoms, the medical diagnoses, the therapeutic measures taken as well as consecutive restrictions in training and competition. Incidence rates and localisations were analysed by sports discipline.
Results:
A total of 201 musculoskeletal complaints were recorded for 140 athletes (93.3%), corresponding to 1.4 musculoskeletal complaints per "injured" athlete. The incidence of musculoskeletal complaints in German athletes was 62.9 ± 15.4 /1000 athlete-days. High incidence rates (IR) were observed in wheelchair basketball (IR 72/1000 athlete-days, 1.6 injuries per athlete) and equestrian events (IR 72.7, 1.6). Musculoskeletal complaints were mainly located in the upper extremities (37.6%) and the spine (37.6%). The most frequent diagnoses were myalgia (n=105, 52%).
Conclusions:
We noted a high rate of musculoskeletal complaints among German Paralympic athletes across sports and body parts, highlighting the need for prevention programs that focus on the upper extremities and spine.
Background and purpose:
Evidence suggests that para-athletes are injured more often than able-bodied athletes. The benefits of massage therapy for these disabled athletes are yet to be explored. This paper documents the process followed for creating a massage program for elite paracycling athletes with the goal to assess effects on recovery, rest, performance, and quality of life both on and off the bike.
Setting:
Massage therapists' private practices throughout the United States.
Participants:
A United States Paracycling team consisting of 9 elite athletes: 2 spinal cord injury, 2 lower limb amputation, 1 upper limb amputation, 1 transverse myelitis, 1 stroke, 1 traumatic brain injury, and 1 visually impaired.
Design:
The process used to develop a massage therapy program for para-cyclists included meetings with athletes, coaching staff, team exercise physiologist, and sports massage therapists; peer-reviewed literature was also consulted to address specific health conditions of para-athletes.
Results:
Team leadership and athletes identified needs for quicker recovery, better rest, and improved performance in elite paracyclists. This information was used to generate a conceptual model for massage protocols, and led to creation of the intake and exit questionnaires to assess patient health status and recovery. Forms also were created for a general health intake, therapist information, and a therapist's SOAAP notes.
Discussion:
The conceptual model and questionnaires developed herein will help to operationalize an exploratory study investigating the feasibility of implementing a standardized massage therapy program for a decentralized elite paracycling team.
Participation in sporting activities carries an injury risk. Conversely, the increased awareness that physical inactivity is a major risk factor for disease has led government agencies and the medical community to encourage increased levels of physical activity. Many people will achieve this through participation in sport. Injury inevitably leads to a reduction in participation on a temporary or permanent basis, but the injury experience may also influence the lifelong physical activity behaviour. Few studies adequately examine the possible long-term consequences of sport participation after the competitive period has been completed, but by understanding the patterns of injuries in different sports one test can develop strategies to prevent and better manage the conditions that occur and promote lifelong physical activity. There is a need to develop models of understanding of injury risk at different life phases and levels of participation in a specific sport. The risk assessment of sport participation has to be relevant to a particular sport, the level of participation, skill, age and potential future health consequences. This article describes a sport-specific model which will improve guidance for coaches and healthcare professionals. It poses questions for sports physicians, healthcare providers, educators and for governing bodies of sports to address in a systematic fashion. Additionally the governing body, as an employer, will need to meet the requirements for risk assessment for professional sport and its ethical responsibility to the athlete.
Background International sports bodies should protect the health of their athletes, and injury surveillance is an important pre-requisite for injury prevention. The Fédération International de Football Association (FIFA) has systematically surveyed all football injuries in their tournaments since 1998.
Aims Analysis of the incidence, characteristics and changes of football injury during international top-level tournaments 1998–2012.
Methods All newly incurred football injuries during the FIFA tournaments and the Olympic Games were reported by the team physicians on a standardised injury report form after each match. The average response rate was 92%.
Results A total of 3944 injuries were reported from 1546 matches, equivalent to 2.6 injuries per match. The majority of injuries (80%) was caused by contact with another player, compared with 47% of contact injuries by foul play. The most frequently injured body parts were the ankle (19%), lower leg (16%) and head/neck (15%). Contusions (55%) were the most common type of injury, followed by sprains (17%) and strains (10%). On average, 1.1 injuries per match were expected to result in absence from a match or training. The incidence of time-loss injuries was highest in the FIFA World Cups and lowest in the FIFA U17 Women's World Cups. The injury rates in the various types of FIFA World Cups had different trends over the past 14 years.
Conclusions Changes in the incidence of injuries in top-level tournaments might be influenced by the playing style, refereeing, extent and intensity of match play. Strict application of the Laws of the Games is an important means of injury prevention.
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.
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.
Background:
The Olympic Movement Medical Code encourages all stakeholders to ensure that sport is practised without danger to the health of the athletes. Systematic surveillance of injuries and illnesses is the foundation for developing preventive measures in sport.
Aim:
To analyse the injuries and illnesses that occurred during the Games of the XXX Olympiad, held in London in 2012.
Methods:
We recorded the daily occurrence (or non-occurrence) of injuries and illnesses (1) through the reporting of all National Olympic Committee (NOC) medical teams and (2) in the polyclinic and medical venues by the London Organising Committee of the Olympic and Paralympic Games' (LOCOG) medical staff.
Results:
In total, 10 568 athletes (4676 women and 5892 men) from 204 NOCs participated in the study. NOC and LOCOG medical staff reported 1361 injuries and 758 illnesses, equalling incidences of 128.8 injuries and 71.7 illnesses per 1000 athletes. Altogether, 11% and 7% of the athletes incurred at least one injury or illness, respectively. The risk of an athlete being injured was the highest in taekwondo, football, BMX, handball, mountain bike, athletics, weightlifting, hockey and badminton, and the lowest in archery, canoe slalom and sprint, track cycling, rowing, shooting and equestrian. 35% of the injuries were expected to prevent the athlete from participating during competition or training. Women suffered 60% more illnesses than men (86.0 vs 53.3 illnesses per 1000 athletes). The rate of illness was the highest in athletics, beach volleyball, football, sailing, synchronised swimming and taekwondo. A total of 310 illnesses (41%) affected the respiratory system and the most common cause of illness was infection (n=347, 46%).
Conclusions:
At least 11% of the athletes incurred an injury during the games and 7% of the athletes' an illness. The incidence of injuries and illnesses varied substantially among sports. Future initiatives should include the development of preventive measures tailored for each specific sport and the continued focus among sport bodies to institute and further develop scientific injury and illness surveillance systems.
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).
Purpose:
The aims of this study were to determine the epidemiology, nature, and pattern of sports injuries in Brazilian Paralympic track and field athletes with visual impairment and to assess differences between visual classes and sex.
Methods:
Forty visually impaired elite Paralympic athletes participated in this study (28 males and 12 females). All athletes competed in International Paralympic competitions between 2004 and 2008. According to the visual classification, 14 athletes were T/F11, 15 were T/F12, and 11 were T/F13. A standardized report form was used to collect injury data during five competitions.
Results:
Thirty-one athletes reported 77 sports injuries, with a prevalence of 78%, a clinical incidence of 1.93 injuries per athlete, and an incidence rate of 0.39 injuries per athlete per competition. Overuse injuries accounted for 82% and traumatic injuries 18% (P < 0.05). Small variations in the prevalence and clinical incidence of injury between sexes and visual classes were observed, but these were not statistically different (P > 0.05). The highest distribution of injury was in the lower limbs (87%), followed by spine (12%) and upper limbs (1%). The body regions most affected were the thighs (33.8%), lower legs (16.9%), and knees (9.1%). The most frequent diagnoses were spasms (26%), tendinopathies (23.4%), and strains (13%).
Conclusions:
Elite visually impaired track and field Paralympic athletes present a pattern of overuse injuries predominantly affecting the lower limbs, particularly the thighs, lower legs, and knees. These injuries are associated with tendinopathies, muscle spasms, and strains. There were no apparent differences in injury characteristics between visual classes or sex.
Participation in sporting activities carries an injury risk. Conversely, the increased awareness that physical inactivity is a major risk factor for disease has led government agencies and the medical community to encourage increased levels of physical activity. Many people will achieve this through participation in sport. Injury inevitably leads to a reduction in participation on a temporary or permanent basis, but the injury experience may also influence the lifelong physical activity behaviour. Few studies adequately examine the possible long-term consequences of sport participation after the competitive period has been completed, but by understanding the patterns of injuries in different sports one test can develop strategies to prevent and better manage the conditions that occur and promote lifelong physical activity. There is a need to develop models of understanding of injury risk at different life phases and levels of participation in a specific sport. The risk assessment of sport participation has to be relevant to a particular sport, the level of participation, skill, age and potential future health consequences. This article describes a sport-specific model which will improve guidance for coaches and healthcare professionals. It poses questions for sports physicians, healthcare providers, educators and for governing bodies of sports to address in a systematic fashion. Additionally the governing body, as an employer, will need to meet the requirements for risk assessment for professional sport and its ethical responsibility to the athlete.
Sport and exercise have long-term health benefits, but there is also a risk that participants will sustain injuries and/or ill health from these activities. For this reason, international sports governing bodies have a responsibility to identify the risks that exist within their sport and to provide guidance to participants and other stakeholders on how these risks can be controlled within acceptable levels.
To demonstrate how Fédération Internationale de Football Association (FIFA), as football's governing body, uses a risk management framework to identify, quantify, mitigate and communicate the risks of injury and ill health in football for men, women and children in all environments.
All the research papers published by FIFA's Medical Assessment and Research Centre (F-MARC) during the period 1994 to 2011 were reviewed and categorised according to an established sport-related risk management framework.
F-MARC investigated and mitigated 17 areas of risk to footballers' health in a coherent and consistent approach through the process of risk management.
Athletes with disabilities are highly skilled. Sports-related injuries and disorders interfere with their efforts. Several aspects of these injuries have been studied in previous studies. The aim of this study was to correlate the types of injuries with the disability group in athletes with physical disabilities.
One hundred and thirty nine elite athletes with physical disabilities completed a questionnaire about sports-related injuries that resulted in at least one day off from training or competition.
All disability groups show soft tissue injuries in high percentages. Cerebral palsy (CP) athletes reported soft tissue injuries (P < 0.01) and lacerations (P < 0.001) in higher percentage than Other Disabled Athletes (ODA) and Spinal Cord Injured (SCI) athletes. Spinal cord injured athletes sustained fractures (P < 0.05) and blisters (P < 0.05) in higher percentages than the other groups. No differences were found between the studied groups for contusions, low back pain, ruptures, thermoregulation disorders, urinary tract infections, pressure sores and pneumonias.
CP athletes sustained soft tissue injuries and lacerations more than other disability groups did because moving and walking patterns of this population add risk factors for such injuries. Fractures and blisters occur more frequently to SCI athletes because they participate in higher percentage in wheelchair basketball which is high risky sport.
A problem with epidemiological studies of football injuries is the inconsistent manner in which injury is defined and data are collected. Projects have been initiated to study the incidence and causes of injury in football, but there is no uniformly accepted reporting system. In this report, some common pitfalls encountered in the recording of injury are addressed, and practical guidelines for epidemiological studies are provided. An injury reporting system developed for the UEFA Football Safety Project for studies on professional footballers is used as a starting point for a general discussion on injury registration and compared with other existing reporting systems. The recording definition of injury may vary between studies depending on its purpose. A time loss injury definition is practical for all playing levels, and, as a minimum, results on time loss injuries should therefore always be reported separately to allow direct comparisons between studies. There is a need to agree on a uniform sports injury classification system with corresponding diagnostic criteria, as well as standardised return to play criteria after injury.
No previous study on adult football involving several different countries has investigated the incidence and pattern of injuries at the highest club competitive level.
To investigate the risk exposure, risk of injury, and injury pattern of footballers involved in UEFA Champions League and international matches during a full football season.
Eleven top clubs (266 players) in five European countries were followed prospectively throughout the season of 2001-2002. Time-lost injuries and individual exposure times were recorded during all club and national team training sessions and matches.
A total of 658 injuries were recorded. The mean (SD) injury incidence was 9.4 (3.2) injuries per 1000 hours (30.5 (11.0) injuries per 1000 match hours and 5.8 (2.1) injuries per 1000 training hours). The risk of match injury was significantly higher in the English and Dutch teams than in the teams from France, Italy, and Spain (41.8 (3.3) v 24.0 (7.9) injuries per 1000 hours; p = 0.008). Major injuries (absence > 4 weeks) constituted 15% of all injuries, and the risk of major injury was also significantly higher among the English and Dutch teams (p = 0.04). National team players had a higher match exposure, with a tendency towards a lower training injury incidence than the rest of the players (p = 0.051). Thigh strain was the most common injury (16%), with posterior strains being significantly more common than anterior ones (67 v 36; p < 0.0001).
The risk of injury in European professional football is high. The most common injury is the thigh strain typically involving the hamstrings. The results suggest that regional differences may influence injury epidemiology and traumatology, but the factors involved are unclear. National team players have a higher match exposure, but no higher risk of injury than other top level players.
Several authors have analyzed the incidence of injuries in a given sport, but only a few have examined the exposure-related incidence of injuries in different types of sports using the same methodology.
Analysis of the incidence, circumstances, and characteristics of injuries in different team sports during the 2004 Olympic Games.
Cohort study; Level of evidence, 2.
During the 2004 Olympic Games, injuries in 14 team sport tournaments (men's and women's soccer, men's and women's handball, men's and women's basketball, men's and women's field hockey, baseball, softball, men's and women's water polo, and men's and women's volleyball) were analyzed. After each match, the physician of the participating teams or the official medical representative of the sport completed a standardized injury report form. The mean response rate was 93%.
A total of 377 injuries were reported from 456 matches, an incidence of 0.8 injuries per match (95% confidence interval, 0.75-0.91) or 54 injuries per 1000 player matches (95% confidence interval, 49-60). Half of all injuries affected the lower extremity; 24% involved the head or neck. The most prevalent diagnoses were head contusion and ankle sprain. On average, 78% of injuries were caused by contact with another player. However, a significantly higher percentage of noncontact (57%) versus contact injuries (37%) was expected to prevent the player from participating in his or her sport. Significantly more injuries in male players (46%) versus female players (35%) were expected to result in absence from match or training. The incidence, diagnosis, and causes of injuries differed substantially between the team sports.
The risk of injury in different team sports can be compared using standardized methodology. Even if the incidence and characteristics of injuries are not identical in all sports, prevention of injury and promotion of fair play are relevant topics for almost all team sports.
This prospective injury surveillance study was conducted to better understand the types of and risk factors of injuries sustained by athletes with disabilities competing in adapted winter sports at the elite level.
Detailed information was collected on all injuries evaluated by polyclinic or venue medical personnel during the operational 20-d period of the 2002 Winter Paralympics.
A total of 39 injuries involving 9% of the Paralympic athletes were recorded in the injury registry. Most of these injuries were of acute, traumatic onset and involved the disciplines of alpine skiing and sledge hockey. Sprains (32%), fractures (21%), and strains and lacerations (14% each) represented the most common diagnoses. Of the recorded injuries, eight (21%) resulted in time lost from training or competition.
The injury patterns observed among winter Paralympians in this study are not appreciably different from able-bodied athletes competing in similar disciplines, although in many instances the risk factors for sport-specific injury appear to be unique to disabled or adapted competition. Our preliminary observations suggest that several of the more severe injuries were potentially preventable. Ongoing data collection by the International Paralympic Committee should enable feasible injury prevention strategies to be designed and implemented.
To systematically summarise the evidence on the effectiveness of proprioceptive training in reducing the incidence and recurrence rates of ankle sprains in the sporting population.
A systematic review and meta-analysis of randomised controlled trials.
A computer-based literature search of MEDLINE, EMBASE, CINAHL, SPORTDiscus and PEDro (to October 2013) was conducted. Methodological quality of individual studies was assessed using the PEDro scale. Meta-analysis was performed on eligible studies to produce a pooled estimate of the effectiveness of the intervention.
Seven moderate-to-high quality randomised controlled trials involving 3726 participants were included. Results of the meta-analysis combining all participants, irrespective of ankle injury history status, revealed a significant reduction of ankle sprain incidence when proprioceptive training was performed compared to a range of control interventions (relative risk=0.65, 95% CI 0.55-0.77). Results favouring the intervention remained significant for participants with a history of ankle sprain (relative risk=0.64, 95% CI 0.51-0.81). Results looking exclusively at primary prevention in those without a history were also statistically significant (relative risk=0.57, 95% CI 0.34 to 0.97), although the pooled effect was obtained from two non-significant trials.
Proprioceptive training programmes are effective at reducing the rate of ankle sprains in sporting participants, particularly those with a history of ankle sprain. Current evidence remains inconclusive on the benefits for primary prevention of ankle sprains.
Objective:
The incidence of injury during elite-level football tournaments has been well documented, but the incidence of illness and medical conditions has not been well studied. The main objective was to analyze the incidence and nature of medical illnesses and injuries in football players.
Design:
Prospective cohort study.
Setting:
2009 Fédération Internationale de Football Association Confederations Cup soccer tournament.
Participants:
One hundred eighty-four soccer players (8 teams of 23 players).
Main outcome measures:
Incidence (per 1000 player days) of illnesses and injuries. Each team physician was requested to complete a daily report of injury (match and training) and medical illness of their players during the tournament (2070 player days). A total of 63 daily reports were obtained (70% response rate).
Results:
A total of 56 injuries and 35 illness incidents were recorded, resulting in an overall rate of 16.9 illnesses per 1000 player days and 27.0 injuries (match and training) per 1000 player days. The overall injury rate was 64.4 per 1000 match hours or 2.1 per match. About 0.88 days were lost per injury, and 0.46 days were lost per illness. Thirteen (37%) illnesses were because of conditions of the ear, nose, and throat, and 7 (20%) illnesses were because of other respiratory tract symptoms. The lower limb was the most commonly injured body part, with thigh (20%) being the most frequent location, and contusion (44%) the most frequent type of injury.
Conclusions:
Illnesses are as common but less severe compared with match and training injuries during an international football tournament. Illnesses comprise an important component in the day-to-day medical care of a traveling football team. Medical illness therefore needs to be considered by the team physicians when planning for and managing the medical needs of elite football teams.
The objective of this study was to examine incidence proportion and the characteristics of athlete injuries sustained during the 2010 Vancouver Paralympic Games.
Descriptive epidemiological study.
All medical venues at the 2010 Vancouver Paralympic Games, Canada.
A total of 505 athletes from 44 National Paralympic Committees participating in the 2010 Vancouver Winter Paralympic Games.
Baseline covariates included sport specificity (ie, ice sledge hockey, alpine skiing, Nordic skiing, wheelchair curling), gender, age, and disability classification.
All injuries that occurred during the 2010 Vancouver Paralympic Games. "Injury" was defined as any sport-related musculoskeletal complaint that caused the athlete to seek medical attention during the study period, regardless of the athlete's ability to continue with training or competition.
The Injury Surveillance System identified a total of 120 injuries among 505 athletes [incidence proportion = 23.8% (95% confidence interval, 20.11-27.7)] participating in the 2010 Winter Paralympic Games. There was a similar injury incidence proportion among male (22.8%) and female (26.6%) athletes [incidence rate ratio = 1.1 (95% confidence interval, 0.7-1.7)]. Medical encounters for musculoskeletal complaints were generated in 34% of all sledge hockey athletes, 22% of alpine ski racers, 19% of Nordic skiers, and 18% of wheelchair curling athletes.
The Injury Surveillance System identified sport injuries in 24% of all athletes participating in the 2010 Winter Paralympic Games. The injury risk was significantly higher than during the 2002 (9.4%) and 2006 (8.4%) Winter Paralympic Games. This may reflect improved data collection systems but also highlights the high risk of acute injury in alpine skiing and ice sledge hockey at Paralympic Games. These data will assist future Organizing Committees with the delivery of medical care to athletes with a disability and guide future injury prevention research.
The incidence of injuries in footballers is described. Nearly half of footballer's injuries involve the knee, with vertical tearing of the meniscus being common; surgical intervention may be required. Approximately one third of injuries involve the ankle, and will often require immobilisation. Other injuries include muscle damage, spondylosis of L4 or L5, concussion, and dislocations. The importance of prompt and correct treatment of injuries is emphasised.
To assess the risks to footballers' health and safety during competitive international matches, with identification of the most common causes of injury.
Videos of 44 of the 52 matches played during the 1994 World Cup finals staged in the USA were analysed. During each match, several relevant variables were recorded, including the number of fouls, injuries, treatments, times of incidents, identity of players treated or injured, and the injury mechanism. Additional information on players' injuries was obtained from the extensive media coverage of the event.
Only 29% of injuries resulted from foul play, whereas 71% of injuries to players occurred where no foul play was adjudged by the referee to have taken place (P < 0.01). Defenders were found to be proportionately subjected to a greater risk of injury than other players (P < 0.05). Fifteen per cent of all injuries were judged to be at least moderate, resulting in the player missing at least one match. Frequency of moderate injury was 1026 injuries per 100,000 hours played.
The major causes of injuries during international football matches were not found to be associated with foul play, as judged by the referees. However, in those cases where injuries occurred without a foul being committed, almost 50% involved player to player contact. This gives some cause for concern and is worth further investigation.
The need for health surveillance for professional footballers has been assessed against criteria specified in UK health and safety legislation. As footballers suffer from chronic injuries under normal playing conditions, professional football clubs have a requirement to implement health surveillance programmes to protect their players. A health surveillance programme, based on benchmarking a player's fitness and addressing the issues of pre-recruitment, pre-season, during-season, post-season, and rehabilitation assessment, is proposed.
To determine clinical effectiveness of strength training in children with spastic cerebral palsy.
Prospective before and after trial in which subjects participated in a 6-week strength training program. All received before and after isometric strength evaluation of eight muscle groups in both lower extremities with a hand-held dynamometer, 3-D gait analysis at free and fast speeds, administration of the Gross Motor Function Measure (GMFM), and assessment of energy expenditure during gait.
Pediatric rehabilitation center at a tertiary care hospital.
Eleven children met inclusion criteria for participation. Six had spastic diplegia, were limited community ambulators, and demonstrated less than 50% of normal muscle strength. Five had spastic hemiplegia and demonstrated a 20% strength asymmetry in at least two muscles across extremities.
Each group had significant strength gains in the muscles targeted. The entire cohort had higher gait velocity primarily as a result of increased cadence, with greater capacity to walk faster. GMFM Dimension 5 also improved, with no change in energy expenditure. Asymmetry in strength improved in hemiplegia, with no change in asymmetry in support times or joint motion across extremities.
This study reinforced the relationship of strength to motor function in cerebral palsy and further demonstrated the effectiveness of strengthening in this population.
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.
Standardized assessment of sports injuries provides not only important epidemiological information, but also directions for injury prevention, and the opportunity for monitoring long-term changes in the frequency and characteristics of injury.
Development and implementation of an easy to use injury-reporting system to analyze the incidence, circumstances and characteristics of injury during major international football tournaments.
Prospective survey.
A comprehensive injury report form was developed, and implemented during 12 international football tournaments. The physicians of all participating teams were asked to report all injuries after each match. The response rate was 84% on average.
A total of 901 injuries were reported from 334 matches, which is equivalent to an incidence of 2.7 injuries per match. Approximately one injury per match resulted in a player's absence from training or matches. On average 86% of the injuries arose as a result of contact with another player, and approximately half of all injuries were caused by foul play. The number of injuries per match differed substantially between the tournaments for players of different age, sex and skill-level.
An injury-reporting system has been implemented as matter of routine in FIFA tournaments. The consistent findings in the present study demonstrate the high quality of the data obtained.
Physical activity and fitness are well recognized as essential to the health of able-bodied people, both young and old. The exact role of athletics and fitness in the lives of people with cerebral palsy is less well defined. In this review we examine the benefits of physical activity and athletics for people of all ages with cerebral palsy. Precautions for safe exercise prescription are discussed. The primary care practitioner will be able to recommend appropriate activities or refer patients to appropriate sources for further evaluation.
Layman's guide to paralympic classification Available at http://www.paralympic.org/ sites/default/files
- International Paralympic Committee
International Paralympic Committee. Layman's guide to paralympic classification. Available at http://www.paralympic.org/
sites/default/files/document/120716152047682_classificationguide_2.
pdf. Accessed October 22, 2015.
Football for the Blind: Aplikovany´chAplikovany´ch Pohybovy´chbovy´ch Aktivit
- Oliveira Mayr De
- G Silva
Mayr de Oliveira Silva G. Football for the Blind: Aplikovany´chAplikovany´ch Pohybovy´chbovy´ch Aktivit. Olomouc, Czech Republic: Palacky University; 2008.
Medical Committee, International Paralympic Committee
- N W Disclosure
Disclosure
N.W. Medical Committee, International Paralympic Committee, Bonn, Germany;
- N Webborn
N. Webborn et al. / PM R XXX (2015) 1-8
Football injuries during FIFA tournaments and the Olympic Games
- A Junge
- J Dvorak
- T Graf-Baumann
- L Peterson
Junge A, Dvorak J, Graf-Baumann T, Peterson L. Football injuries
during FIFA tournaments and the Olympic Games, 1998-2001:
Development and implementation of an injury-reporting system.
Am J Sports Med 2004;32(1 suppl):80s-89s.
Layman's guide to paralympic classification
- International Paralympic Committee
International Paralympic Committee. Layman's guide to paralympic classification. Available at http://www.paralympic.org/
sites/default/files/document/120716152047682_classificationguide_2.
pdf. Accessed October 22, 2015.
Football for the Blind: Aplikovaných Pohybových Aktivit
- Oliveira Mayr De
- G Silva
Mayr de Oliveira Silva G. Football for the Blind: Aplikovaných Pohybových Aktivit. Olomouc, Czech Republic: Palacky University; 2008.