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Mitigating risk of injury in alpine skiing in the Pyeongchang 2018 Paralympic Winter Games: The time is now!
... The high injury incidence rate in Para Alpine at the Sochi 2014 Paralympic Games prompted medical and sport-technical experts to create an action plan to reduce the risk of injury for the following Pyeongchang 2018 Games [23]. It was hypothesized that modifiable factors (i.e., course design, number of training runs, the command and control structure between the technical and medical staff, etc.) and environmental factors (i.e., temperature and altitude of the skiing venues in Sochi and their effects on snow conditions) were the likely contributors to the high injury rate observed in Sochi 2014 [51]. In light of this information, the IPC Medical Committee engaged in discussions with the World Para Alpine Skiing management team to ensure injury risk and prevention were top priorities for Pyeongchang [51]. ...
... It was hypothesized that modifiable factors (i.e., course design, number of training runs, the command and control structure between the technical and medical staff, etc.) and environmental factors (i.e., temperature and altitude of the skiing venues in Sochi and their effects on snow conditions) were the likely contributors to the high injury rate observed in Sochi 2014 [51]. In light of this information, the IPC Medical Committee engaged in discussions with the World Para Alpine Skiing management team to ensure injury risk and prevention were top priorities for Pyeongchang [51]. Measures for Pyeongchang included: more training runs; earlier start times; a more optimal start location on the course; the widening of the course; official pre-Games technical and medical briefings; and the appointment of an independent race director who would facilitate the investigation into safety issues and have the final call to amend, postpone, or cancel an event if the conditions were deemed to be too hazardous [51]. ...
... In light of this information, the IPC Medical Committee engaged in discussions with the World Para Alpine Skiing management team to ensure injury risk and prevention were top priorities for Pyeongchang [51]. Measures for Pyeongchang included: more training runs; earlier start times; a more optimal start location on the course; the widening of the course; official pre-Games technical and medical briefings; and the appointment of an independent race director who would facilitate the investigation into safety issues and have the final call to amend, postpone, or cancel an event if the conditions were deemed to be too hazardous [51]. The outcomes of these measures appear to have been successful in lowering the total number of injuries (i.e., 39 injuries in Pyeongchang compared to 98 in Sochi), decreasing the number of acute injuries (i.e., 17 acute injuries in Pyeongchang compared to 48 acute injuries in Sochi), and decreasing the number of injuries in downhill skiing from 21 in Sochi to only 5 in Pyeongchang [52]. ...
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.
... The finding of a high injury incidence in alpine skiing over multiple Paralympic Winter Games has led to mitigation strategies being employed, including an increase in provision of training runs, avoidance of steep gradients and widened course designs. 19 The high incidence of injury in alpine skiing shows that continuous evaluation, with subsequent education and implementation of risk mitigation strategies in this sport are important in this sport. High speeds, steep and narrow courses with tight turns as well as warm temperatures have previously been identified as risk factors for injury in alpine skiing. ...
... High speeds, steep and narrow courses with tight turns as well as warm temperatures have previously been identified as risk factors for injury in alpine skiing. 19 Similar to the Sochi Games, warm temperatures were measured during the Beijing Games (Yanqing alpine skiing centre: 9-19°C; Zhangjiakou snowboarding: 7-19°C). 20 These warm temperatures have been shown to be detrimental for snow conditions, which particularly impacts alpine ski races and could contribute to higher risks for injury. ...
Objective
To describe the epidemiology of injuries and illnesses sustained during the Beijing 2022 Paralympic Winter Games, organised in a closed-loop environment to adhere with COVID-19 restrictions.
Methods
Injuries and illnesses from all teams were recorded on a daily basis by team medical staff on a web-based form and by local organising committee medical (polyclinic) facilities and venue medical support. Duplicates recorded on both systems were removed. Incidence of injuries and illnesses are reported per 1000 athlete days (95% CI).
Results
564 athletes (426 male and 138 female) representing 46 countries were monitored for the 13-day period of the Beijing 2022 Paralympic Winter Games (7332 athlete days). The overall incidences were 13.0 injuries (10.6–15.8) and 6.1 illnesses (4.5–8.4) per 1000 athlete days. The incidence of injury in alpine skiing (19.9; 15.2–26.1) was significantly higher compared with Nordic skiing, ice hockey and wheelchair curling (p<0.05), while the incidence of respiratory illness was significantly higher in Nordic skiing (1.6; 0.9–2.9) compared with alpine skiing, ice hockey and snowboarding (p<0.05).
Conclusion
The incidence of both injury and illness at the Beijing 2022 Games were the lowest yet reported in the Paralympic Winter Games. The incidence of injury was highest in alpine skiing. These findings underscore the importance of ongoing vigilance and continued injury risk mitigation strategies to safeguard the well-being of athletes in these high-risk competitions. Respiratory illnesses were most commonly reported in Nordic skiing, which included the three cases of COVID-19 recorded at the games.
... The finding of a high injury incidence in alpine skiing over multiple Paralympic Winter Games has led to mitigation strategies being employed, including an increase in provision of training runs, avoidance of steep gradients and widened course designs. 19 The high incidence of injury in alpine skiing shows that continuous evaluation, with subsequent education and implementation of risk mitigation strategies in this sport are important in this sport. High speeds, steep and narrow courses with tight turns as well as warm temperatures have previously been identified as risk factors for injury in alpine skiing. ...
... High speeds, steep and narrow courses with tight turns as well as warm temperatures have previously been identified as risk factors for injury in alpine skiing. 19 Similar to the Sochi Games, warm temperatures were measured during the Beijing Games (Yanqing alpine skiing centre: 9-19°C; Zhangjiakou snowboarding: 7-19°C). 20 These warm temperatures have been shown to be detrimental for snow conditions, which particularly impacts alpine ski races and could contribute to higher risks for injury. ...
... Paralympic skiing is an emerging discipline not only in the Paralympic competitions but also in recreational skiing, with growing scientific attention mainly from physiological 1 and injury prevention points of view. [2][3][4][5] The dissemination of Paralympic skiing is a mission for several institutions and researchers 6,7 : the level of safety that Paralympic alpine skiing can ensure is crucial for the diffusion of the sport, its acceptance among the potential users, their coaches and the clinical staff. Statistics show that Paralympic alpine skiing can still be associated with upper limb trauma, mainly in combination with adverse ambient and snow conditions. ...
... Statistics show that Paralympic alpine skiing can still be associated with upper limb trauma, mainly in combination with adverse ambient and snow conditions. 4,5 Monoskis are complex mechanical systems for which the design and tuning of the suspension system, the ergonomics of the seat and the personalized setup of the mass distribution influence the performance and safety of the skier. 8 Although few technical standards exist to ensure the safety and adaptability of such sport equipment, 9 very limited data are available regarding the loads acting on the suspension of the monoski during recreational or competitive skiing. ...
Objectives
Aim was to study the effect of monoski foot adjustment on kinematic and kinetic skiing parameters expressing sit skier’s technique.
Design
Independent variable was skier position with respect to bindings, acting on position of monoski foot sole clamp. Front (F), Mid (M) and Rear (R) settings changed with intervals of 20 mm. Course time, skiing speed, Ground Reaction Forces (GRFs) magnitude and point of application and damper stroke were dependent variables.
Method
A Paralympic monoski was equipped with a dynamometric binding plate measuring GRFs, roll and pitch moments. A Paralympic gold medalist (LW10-1) was involved. Skier trajectory and gates location were measured by a differential global navigation satellite system (GNSS) in steep and medium steep slope portions. The athlete performed two giant slalom runs for each foot setting the same day.
Results
GRFs, center of pressure (COP) and variations with foot settings were measured. Peaks values up to 3.36 times the total weight and damper speed of 675 mm/s in compression were found. Fastest runs, highest peak loads and best subjective ratings were recorded with F setting. COP mean values were influenced by foot adjustments. GRFs in left turns were 54% larger than in the right turns with F setting on steep slope.
Conclusions
The monoski foot adjustment influenced kinematic and kinetic skiing, with F setting showing best results. A skier asymmetric behavior between right and left turning was discovered. Findings can support the design of monoskis for a wider dissemination of Paralympic alpine sit skiing.
... In a comparison of the 2010 WOG in Vancouver and the 2014 games in Sochi, Guisado (2017) found a 9% increase in competitor injury and a 5% decrease in the finish rate in the Alpine skiing, freestyle skiing, and snowboarding events. A similar comparison of the injury rate of Alpine skiers between the Vancouver and Sochi Paralympics found a six-fold increase in injury rates (approximately one-third of competitors sustained injury) and a higher rate of failure to complete (Derman et al., 2018). While there is inherent risk in such high-speed elite sporting competitions, the high ambient temperatures at the skiing venues at Sochi (reported as high as 10-15°C at lower elevations) caused slow, wet, and heavy snow that is difficult to manoeuvre in or gauge speed for jumps. ...
... rutting) of competition surfaces, leading to unfair and even unsafe events (e.g. soft and slow ski surfaces) (see Guisado, 2017;Derman et al., 2018). A more detailed risk assessment approach, informed by key climatic thresholds specified by sporting federations and competition surface experts, should be utilized to properly inform the IOC. ...
The Olympic Winter Games (OWG) and the Paralympic Winter Games (PWG) are showcases for winter sports. With their high dependence on weather conditions, accelerating climate change poses a challenge to these mega-events. Two indicators are used to assess the climate reliability of locations to host the Games (OWG in February, PWG in March) in the future under a low (RCP 2.6) and high (RCP 8.5) greenhouse gas emission scenario. Climate change will alter the geography of the Games over the twenty-first century. In a low-emission scenario, only 13 of 21 locations remain climate reliable for the OWG in the 2050s and 12 in the 2080s, whereas only 10 are reliable for the PWG (both in the 2050s and 2080s). The impact of a business-as-usual high-emission scenario is far greater, reducing the number of locations reliable for the OWG to 10 in the 2050s and 8 in the 2080s, with even fewer reliable for PWG (8 in the 2050s and only 4 in the 2080s). Adaptive responses are considered, including strengthening the climatological assessment requirements in forthcoming bid processes, the unification of the OWG and PWG (in the month of February), and considering dual host countries/regions.
... [8][9][10] These studies inform injury prevention interventions, which have been shown to reduce injury incidence, especially in sports that have been identified as high risk. 11 Ongoing Games-time injury surveillance is crucial for continued protection of the health of athletes in environments with multiple sports and teams. Unlike previous iterations of the Paralympic Games, the Tokyo 2020 Paralympic Games were held under unprecedented circumstances. ...
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.
... Compared with 2010 Vancouver Winter Paralympic Games, about one-third of athletes were injured, and the unfinished rates were also higher in 2014 Sochi Winter Paralympic Games. After analyzing the meteorological factors between these events, heavy snow and high humidity of ski resorts in Sochi are regarded as two major reasons [13]. On the other hand, if the snowfall is insufficient, alpine skiing events may have a large possibility to be cancelled. ...
Alpine skiing, as an outdoor winter sport, is particularly vulnerable to the variation of meteorological conditions. Scattered and multi-source big data cannot be fully utilized to conduct effective decision analyses by conventional data analysis methods. Presently, knowledge graphs are the most advanced organization form of knowledge base, which can make explicit the complex relationships among different objects. Thus, introducing knowledge graph to the event management of alpine skiing is significant to improve the ability of risk prediction and decision-making. In this research, we analyze the components and dynamic characteristics of alpine skiing, and construct an “Object-Characteristic-Relation” representation model to express multi-level knowledge. Moreover, we propose a “Characteristic-value- Relationship” representation method based on the multi-source data, to construct the knowledge graph of alpine skiing. With the proposed method, comprehensive relationships between meteorological conditions and alpine skiing can be represented clearly, and support further knowledge reasoning for the event management under meteorological conditions. We have tested the utility of the proposed method in a case study of 2018 Winter Olympics in PyeongChang. The case study realizes an semi-automatic construction of knowledge graph for alpine skiing, provides decision supports for event risk managements, according to different meteorological conditions, and grounds a foundation for future knowledge graph construction of other large-scale sport events.
... The second success of the "sport injury prevention model" [26]. In the transition between Games, the IPC Medical Committee worked closely with the World Para Alpine Skiing technical staff establishing preventive measures with respect to course design (less aggressive GPS controlled course design with "waves" instead of jumps; widening of tight turns), procedures of competition (increased number of training runs; adjustment of the start times to snow conditions), and communication (pre-Games technical and educational briefings; direct communication between IPC Medical and race officials) [25,26]. Table 2 provides an overview of the injury incidence proportion (IP) and injury incidence rate (IR) for the Winter Games since the induction of the Injury Surveillance System by Dr. Nick Webborn [4]. ...
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.
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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.
... As previous literature has suggested, certain injuries sustained by disabled athletes can be controlled and avoided by the implementation of several prevention strategies [5,7,8,[11][12][13][15][16][17][18]. ...
Purpose: This review aimed to analyze and summarize current literature related to the characteristics, incidence of injuries of different winter Paralympic sports events and to discuss the key aspects that can be used to develop possible prevention strategies for future Winter Paralympic Games. Methods: An electronic search was performed in Google Scholar, PubMed, and Web of Science databases using the following key words: “Paralympic” AND “winter sports” AND “injury” OR “prevention strategy.” Inclusion and exclusion criteria were used to screening all the identified studies. Of 446 identified studies, 11 studies were included. Results: Most studies reported the injuries of disabled athletes in alpine skiing/snowboarding and ice sledge hockey, few studies reported injuries in cross-country skiing/biathlon and wheelchair curling. For these Winter Paralympic athletes, acute, traumatic injuries seem to be more common than overuse or chronic injuries, and alpine skiing and ice sledge hockey have always been the most dangerous winter sports events. However, the rates and injury locations appear to be disability and sport dependent. Results of this review demonstrated that there are 2 key areas in which specific prevention strategies would influence sports injuries and performance in Paralympic winter sports, namely, equipment in winter sports and physical condition of disabled athletes. Conclusion: According to the results, it is apparent that the overall injury rates sustained by disabled athletes are high and can be comparable with injury rates in able-bodied counterparts. While with few studies reported the pattern of injuries and possible prevention strategies, it is difficult to further understand the injury mechanisms and determine effective prevention strategies. Further longitudinal and disability specific studies are much needed.
... Illness Surveillance Study noted an unusually high injury incidence rate (IR) in the sport of Para alpine skiing at the 2014 Sochi Paralympic Games (IR 48.3, a sixfold increase in acute injuries in comparison to the Vancouver 2010 Paralympic Games). [1][2][3] There were likely several associated factors. Some were clearly modifiable such as the course design, number of training runs permitted on the course and the command and control structure between the technical and medical staff. ...
... Education opportunities were also made available to all NPC medical and technical staff to increase the awareness and management of para alpine injuries in this setting. 23 The incidence of injuries sustained during the Games' decreased from an IR of 43.8 (95% CI 35.0 to 54.9) injuries per 1000 athlete days in Sochi 2014 to 23.1 (95% CI 16.5 to 32.1) injuries per 1000 athlete days in Pyeongchang 2018. ...
Objective
To describe the epidemiology of sports injury at the Pyeongchang 2018 Paralympic Winter Games.
Methods
567 athletes from 49 countries were monitored daily for 12 days over the Pyeongchang 2018 Paralympic Winter Games (6804 athlete days). Injury data were obtained daily from teams with their own medical support (41 teams and 557 athletes) and teams without their own medical support (8 teams and 10 athletes) through two electronic data capturing systems.
Results
112 of 567 athletes (19.8%) reported a total of 142 injuries, with an injury incidence rate (IR) of 20.9 per 1000 athlete days (95% CI 17.4 to 25.0). The highest IR was reported for para snowboard (IR of 40.5 per 1000 athlete days [95% CI 28.5 to 57.5]; p<0.02), particularly in the lower limb and head/face/neck anatomical areas. Across all sports at the Games, acute traumatic injuries (IR of 16.2 per 1000 athlete days [95% CI 13.2 to 19.8]) and injuries to the shoulder/arm/elbow complex (IR of 5.7 per 1000 athlete days [95% CI 4.2 to 7.8]) were most common. However, most injuries (78.9%) did not require time loss.
Conclusion
The new Paralympic Winter Games sport of Para snowboard requires attention to implement actions that will reduce injury risk. The shoulder was the most injured single joint—a consistent finding in elite para sport.
Objective
The objective of the present study was to describe eye illness among athletes with disability.
Design
Prospective cohort study.
Setting
Sochi 2014 and Pyeongchang 2018 Paralympic Winter Games.
Participants
Five hundred forty-seven athletes over 12 days (6564 athlete days) at Sochi 2014 and 567 athletes over 12 days (6804 athlete days) at Pyeongchang 2018 Paralympic Winter Games.
Interventions
All athletes with eye illnesses presented themselves to the team physicians via the WEB-IISS and/or polyclinic staff via the local polyclinic services (ATOS system).
Main Outcome Measures
Incidence of eye illnesses per 1000 athlete days. Descriptive statistics, including the number and proportion of illnesses, broken down by sport, age, sex, type of impairment, medical diagnosis, medical decision, and anticipated time loss (in days).
Results
Seventy five percent of eye illnesses were reported in male Para athletes. Athletes participating in Ice hockey (61%) accounted for two-thirds of all eye illnesses across all sports reported during the 2 Winter Games. Most eye illnesses were reported in athletes with limb deficiency (66%), visual impairment (21%), and spinal cord injury (10%). Environmental eye illnesses (24%), allergic conjunctivitis (21%), corneal erosion (7%), and infective conjunctivitis (7%) were the most frequently reported diagnoses.
Conclusion
Eye illnesses are prevalent in the Paralympic Winter Games across athletes of various ages and genders, with a higher incidence observed among male Para athletes. Ice hockey was highlighted as the sport with the highest reported cases of eye illnesses, with conditions affecting various anatomical areas of the eye.
Background
The purpose of this report is to provide insight and details regarding the development and implementation of an injury and illness surveillance (IIS) system for the United States Olympic and Paralympic Committee (USOPC).
Methods
The development and deployment of the IIS employed a multiphase approach. First, researchers determined variables to include in the IIS using the recommendations from the 2020 IOC consensus statement for reporting sport epidemiological data. Second, the hosting and deployment platforms were comprehensively evaluated for their suitability, ease of use, flexibility, and backend data structure (for both capture and aggregation). Third, focus groups consisting of the Sports Medicine department leadership and clinicians piloted the IIS system and revisions were made based on their feedback. Pilot testing of the IIS and follow-up focus groups were then conducted among all departmental clinicians to solicit additional feedback and drive further revisions. Finally, the IIS system was piloted among providers working during the 2023 Pan American and Parapan American Games to refine the system for future Games. After reviewing all potential software platform options (electronic medical record [EMR] system, athlete management systems, secure data collection platforms), Qualtrics (Qualtrics, Provo, UT, USA) was selected to host the IIS system. This choice was made due to the inability of the EMR and athlete-management systems to make frequent updates, modify existing questions, and provide the necessary form logic for the variety of scenarios in which the IIS system would be deployed. Feedback from the department’s leadership and clinicians resulted in a number of changes, most notably being the ability to enter multiple diagnoses for a single injury event. Additionally, clinician feedback resulted in the creation of additional diagnostic codes not currently present in the OSIICS v14.0 diagnostic coding system, adding “non-sport” as an additional variable for injury setting, and developing a system for reporting return-to-sport date for time-loss injuries.
Discussion
A multi-stage process of extensive planning, stakeholder feedback, and ongoing updates is required in order to successfully develop and implement an IIS system within a National Olympic and Paralynpic Committee. This process can be used to inform the development and implementation of IIS systems in other sporting organizations.
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.
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.
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.
As the participation rate and popularity of winter adaptive sports increases, understanding injury patterns and equipment is crucial for athletes, coaches, athletic trainers, sports physicians, prosthetists/orthotists, and all the staff involved. While the inaugural Winter Paralympics in 1976 had 17 participating countries, the most recent paralympic games in Pyeongchang, South Korea had >500 athletes from 49 different countries competing in 6 disciplines: Alpine skiing, nordic skiing, sledge hockey, wheelchair curling, biathlon, and snowboarding. In this paper, we review participation rates, injury trends and equipment, with a focus on the 3 most popular events: Alpine skiing, nordic skiing, and sledge hockey. Despite injury risk within this athletic community, there are documented advantages to physical movement, and for each individual the risks of injury have to be weighted with the benefits of competing. Overall, there is a need for educational efforts regarding the development, access, and participation to injury prevention programs with an integrated and multidisciplinary approach.
Objective To describe the epidemiology of injuries at the Sochi 2014 Winter Paralympic Games.
Methods A total of 547 athletes from 45 countries were monitored daily for 12 days during the Sochi 2014 Winter Paralympic Games (6564 athlete days). Daily injury data were obtained from teams with their own medical support (32 teams, 510 athletes) and teams without their own medical support (13 teams, 37 athletes) through electronic data capturing systems.
Results There were 174 total injuries reported, with an injury incidence rate (IR) of 26.5 per 1000 athlete days (95% CI 22.7% to 30.8%). There was a significantly higher IR recorded in alpine skiing/snowboarding (IR of 41.1 (95% CI 33.7% to 49.6%) p=0.0001) compared to cross-country skiing/biathlon, ice sledge hockey or wheelchair curling. Injuries in the shoulder region were the highest single-joint IR (IR of 6.4 (95% CI 4.6% to 8.6%)), although total upper and lower body IR were similar (IR 8.5 vs 8.4 (95% CI 6.4% to 11.1%)). Furthermore, the IR of acute injuries was significantly higher than other types of injury onset (IR of 17.8 (95% CI 14.7% to 21.4%)).
Conclusions In a Winter Paralympic Games setting, athletes report higher injury incidence than do Olympic athletes or athletes in a Summer Paralympic Games setting. The highest incidence of injury was reported in the alpine skiing/snowboarding sporting category. There was a similar incidence of injury in the upper and lower limbs. The joint with the greatest rate of injury reported was the shoulder joint. Our data can inform injury prevention programmes and policy considerations regarding athlete safety in future Winter Paralympic Games.
Different results have been reported for skiing and snowboarding injuries worldwide. Few studies consider the injury severity score (ISS) for the evaluation of differences among injured skiers-snowboarders. The aim of this study is to identify possible risk factors that affect the severity of skiing and snowboarding injuries in three winter seasons (2002-2005) in South Tyrol. For every injured skier or snowboarder referred to our emergency department in three consecutive seasons, the following data were collected: date of birth, gender, self-declared technical skills level, place of residence (local/non-local), as well as the date, time, and place of the accident. Type of injury and ISS were retrospectively assigned. Data concerning the snowfall in the last 24 h, average snow level, and outdoor air temperature values were obtained from four weather stations that were located inside the ski resorts. A multiple linear regression model was used to evaluate the association between ISS and potential determinants. In the analyzed seasons, 2,511 injured skiers and 843 injured snowboarders were evaluated at our emergency department. There was a significant change in the ISS value for subjects with different self-reported skills levels (P < 0.001). Men and non-local residents experienced more severe injuries than women and local residents, respectively (P < 0.013, P < 0.001). The ISS was higher for people aged over 60 (P < 0.001). Snowfalls brought about a decrease in accident severity (P = 0.009). The severity of the injuries increases with age. Prevention and information programs should be targeted to people who are at high risk of severe injury. A 24-h fresh snowfall seems to reduce the severity of injuries. Very little is known about snow conditions and winter sports injury. Further studies are needed to explore this field.
Limited knowledge exists on injuries among professional alpine skiers.
To describe the risk of injury and the injury pattern among competitive World Cup alpine skiers during the competitive season.
Retrospective interviews were performed with all World Cup athletes from 10 nations at the end of the 2006-7 and 2007-8 winter seasons, and all acute injuries occurring during the 4.5-month competitive season were recorded. If the athlete was not present, their coaches or medical personnel were interviewed.
A total of 191 acute injuries were recorded among 521 World Cup alpine skiers. As many as 86 injuries (45%) occurred during World Cup/World Ski Championship competitions, corresponding to an injury rate of 9.8 injuries per 1000 runs (95% CI 7.8 to 11.9). The injury rate was found to increase with increasing speed (slalom 4.9 injuries per 1000 runs, 95% CI 2.5 to 7.4--giant slalom 9.2, 5.1 to 13.3--super-G 11.0, 5.2 to 16.8--downhill 17.2, 11.6 to 22.7). The most frequently injured body part was the knee, with 68 injuries (36%), and 37 of these were severe. The overall injury rate was higher in males than in females, but not for knee injuries.
The risk of injury among World Cup athletes in alpine skiing is even higher than previously reported. The knee is the most commonly injured body part and with many severe injuries. Injury rate increased with a higher speed and was higher among males than in females.
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.
Current research examining the impact of mechanism of injury and daily snowfall amounts on injury severity among skiers and snowboarders is limited. The purpose of this study was to define correlations between injury mechanism and daily snowfall on injury patterns and severity among skiers and snowboarders.
This observational study analyzed daily snowfall measurements coupled with trauma admissions during the 2011 and 2012 ski seasons from a Level III trauma center servicing a large North American ski resort. Post hoc adjusted analyses and multivariate modeling was used to determine independent predictors of increased injury severity.
Six hundred forty-four trauma admissions were analyzed, with primary research considerations detailing the variances in injury severity resulting from collisions with other skiers or snowboarders and daily total snowfall. Findings demonstrated that collisions were independently associated with increased (1) injury severity (Injury Severity Score [ISS ≥ 16]) (odds ratio [OR], 3.9; 95% confidence interval [CI], 2.0-7.6; p < 0.001), (2) thoracic injury severity (Abbreviated Injury Scale [AIS] score ≥ 3) (OR, 7.5; 95% CI, 3.7-15.0; p < 0.001), and (3) renal injuries (OR, 3.2; 95% CI, 1.2-8.1; p = 0.017) as well as and axial skeleton fractures (OR, 4.5; 95% CI, 2.6-7.7; p < 0.001). In addition, mean ISS was significantly higher in the setting of a collision when compared with a fall (8.6 vs. 5.8; p < 0.001). Findings regarding total snowfall demonstrate a negative correlation between snowfall and injury severity (r = -0.08, p = 0.05); the majority (65.5%) of injuries were sustained when there was 1 inch or less of recent snowfall, and a snowfall total of 2 inches or less was independently associated with increased injury severity (ISS ≥ 16) (OR, 3.1; 95% CI, 1.1-9.1; p = 0.036).
Collisions between snowsport enthusiasts and total trace snowfall predict an increase in injury severity among alpine skiers and snowboarders. Findings from this project may lead to an increased understanding of predictive factors contributing to injury, alter the diagnostic evaluation of patients, provide educational opportunities for alpine enthusiasts, and enhance resort safety initiatives tailored to ambient conditions.
Epidemiologic study, level III.
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.
In alpine skiing, the knee represents the dominant injury location with marked gender differences. Snow, slope and weather conditions as well as altitude and low temperatures are thought to influence the prevalence of knee injuries. Therefore, ski patrol injury reports were used to compare gender-specific prevalence of knee injuries with regard to several environmental factors including the actual air temperatures. A total of 1039 non-contact knee injuries were reported with a corresponding prevalence of knee injuries of 44.4% (males: 30.1%; females: 57.4%). Temperature quartiles of all recorded injuries were calculated to compare gender-specific prevalence of knee injury with regard to temperatures. Comparing the first quartile (mean temperature -11°C) with the fourth quartile (mean temperature +3°C), the prevalence of knee injury in female skiers was higher at low ambient temperatures (61% vs 50%, odds ratio: 1.60, 95% confidence interval: 1.16-2.22; P=0.005) while no such association was found for male skiers. Additionally, knee-injured females showed a twofold prevalence when skiing during snowfall compared with females with other injuries (15.4% vs 8.6%; P=0.001). No other environmental factor showed a significant association with the gender-specific prevalence of knee injury. In conclusion, low ambient temperature and snowfall are important environmental risk factors for knee injuries in female skiers.