Injuries to athletes with disabilities: identifying injury patterns

Participation in sport activities for people with disabilities continues to gain in popularity. With participation in sports, there is an inherent risk of injury. A review of current sport epidemiological studies was used and we concluded that injury patterns for this population are similar to those for athletes without disabilities. Injury data from Paralympic competitions dating back to 1976 indicate that most elite athletes with disabilities seek medical care for illness and musculo-skeletal injuries. However, there are very limited injury data regarding Winter Paralympic events or skiing injuries. For those athletes who participate in Summer Paralympic events, abrasions, strains, sprains and contusions are more common than fractures and dislocations. However, location of injuries appears to be disability and sport dependent. Lower extremity injuries are more common in ambulatory athletes (visually impaired, amputee, cerebral palsy) and upper extremity injuries are more frequent in athletes who use a wheelchair. While it appears that the majority of the injuries occurring in this population are minor in nature, inconsistencies in the definition of injury in the literature make this conclusion tenuous. When injuries are expressed as time lost in participation, 52% of injuries resulted in 7 days lost or less, 29% in 8 to 21 days lost and 19% in greater than 22 days lost. The only prospective study addressing injury rates of athletes with disabilities in a manner consistent with other sport epidemiological studies found an injury rate of 9.3 injuries per 1000 athlete-exposures (AE). This injury rate is less than American football (10.1 to 15/1000 AE) and soccer (9.8/1000 AE), and greater than basketball (7.0/1000 AE). It is unclear whether comparative statistics such as these take into consideration the number of illness and injury episodes that resulted from the disability. Further complicating epidemiological studies for athletes with disabilities is the definition of the population and samples of convenience which are frequently used. These samples are often not representative of the multiplicity of disability conditions, levels of competition and range of sport activities available. Prospective studies comparing athletes to sedentary control individuals to measure differences in injury rates, type and frequency between and within disability groups, sports and levels of competition are desperately needed to further the knowledge of injury trends and develop and establish accurate injury prevention programmes.     

Injuries among disabled athletes during the 2002 Winter Paralympic Games

PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.     

Prevention of non-contact anterior cruciate ligament injuries in sports. Part II: systematic review of the effectiveness of prevention programmes in male athletes

Purpose

To synthesize the results of systematic literature review focused on the effectiveness of anterior cruciate ligament (ACL) injury prevention programmes in male athletes.

Methods

All abstracts and articles of potential interest identified through the systematic literature search were reviewed in detail to determine on inclusion status. Information regarding prevention programmes to reduce ACL injuries or to modify risk factors for ACL injuries in male athletes was systematically extracted and included intervention and study design, characteristics of participants, sport and level of competition, characteristics of prevention programmes, results, and conclusions. All studies were evaluated for methodological quality to assess the risk of bias.

Results

The principal findings of this systematic review are as follows: (1) most of the studies applied prevention programmes that utilized risk factors as outcomes of interest as opposed to ACL injury incidence (5 and 2 studies, respectively); (2) the effectiveness of prevention programmes to reduce ACL injuries in male athletes is equivocal (1 in favour, 1 against) and only refers to soccer players; (3) the effectiveness of prevention programmes to modify risk factors for ACL injuries in male athletes is controversial (2 in favour, 3 against) and outcome data are limited to cutting manoeuvres.

Conclusion

Data regarding the effectiveness of prevention programmes to reduce ACL injuries or to modify risk factors for ACL injuries in male athletes are scarce and not conclusive. Future research to better determine the most effective approaches to optimize the effectiveness of prevention programmes targeted to reduce ACL injuries in male athletes is warranted.

Level of evidence

Systematic review on level I–II evidence studies, Level II.     

A review of epidemiology of paediatric elbow injuries in sports

The elbow is a common site of orthopaedic injury in the paediatric population. The number of these injuries continues to rise following increased levels of participation in paediatric recreational and competitive sport. Injuries to the paediatric elbow can be classified as either overuse or acute. Delineating injury patterns to the elbow in children can be challenging, given the cartilaginous composition of the distal humerus and the multiple secondary ossification centres that appear and unite with the epiphysis at defined ages. Pitching in baseball, serving in tennis, spiking in volleyball, passing in American football and launching in javelin-throwing can all produce elbow pathology by forceful valgus stress, with medial stretching, lateral compression and posterior impingement. In children and adolescents, the epiphyseal plate is weaker than the surrounding ligaments, predisposing them to epiphyseal plate injuries. On the other hand, post-pubescent or skeletally mature athletes are more prone to tendinous or ligamentous injury. Injuries may cause significant impact on the athlete, parents and healthcare system. With the exception of baseball, there are few prospective cohort studies on the epidemiological trends of childhood elbow injuries in other sports. This paper aims to describe the epidemiological trends in paediatric elbow injuries related to sports, suggests prevention strategies and discusses the scope for further research. A web-based search of existing articles pertaining to paediatric elbow injuries in sports was performed. The implications of acute and overuse injuries and the possibility of permanent damage should be understood by parents, coaches and the athletes. Proper understanding of the intrinsic and extrinsic risk factors that could lead to elbow injuries is thus required. Measures to prevent elbow injuries should include proper coaching, warm-up, officiation, legislation, medical expertise and protective gear. There are still many opportunities for prospective studies and other research projects among young athletes in various sports. Current studies will serve as a baseline for future research to assess the success of specific interventions in reducing the incidence of elbow injury in the paediatric athlete. Further epidemiological studies in various sports will help expand our knowledge and prevent potential disability and deformity in the paediatric elbow.     

Prevention of anterior cruciate ligament injuries in sports—Part I: Systematic review of risk factors in male athletes

Purpose

The purpose of this study was to report a comprehensive literature review on the risk factors for anterior cruciate ligament (ACL) injuries in male athletes.

Methods

All abstracts were read and articles of potential interest were reviewed in detail to determine on inclusion status for systematic review. Information regarding risk factors for ACL injuries in male athletes was extracted from all included studies in systematic fashion and classified as environmental, anatomical, hormonal, neuromuscular, or biomechanical. Data extraction involved general characteristics of the included studies (type of study, characteristics of the sample, type of sport), methodological aspects (for quality assessment), and the principal results for each type of risk factor.

Results

The principal findings of this systematic review related to the risk factors for ACL injury in male athletes are: (1) most of the evidence is related to environmental and anatomical risk factors; (2) dry weather conditions may increase the risk of non-contact ACL injuries in male athletes; (3) artificial turf may increase the risk of non-contact ACL injuries in male athletes; (4) higher posterior tibial slope of the lateral tibial plateau may increase the risk of non-contact ACL injuries in male athletes.

Conclusion

Anterior cruciate ligament injury in male athletes likely has a multi-factorial aetiology. There is a lack of evidence regarding neuromuscular and biomechanical risk factors for ACL injury in male athletes. Future research in male populations is warranted to provide adequate prevention strategies aimed to decrease the risk of this serious injury in these populations.

Level of evidence

Systematic review on level I–IV studies, Level IV.     

Epidemiology and risk factors of sports injuries--multivariate analyses using German national data

Representative data on the incidence of sports injuries and the risk groups involved is extremely rare. The data generated by the "First National Health Survey for the Federal Republic of Germany", conducted between October 1997 and March 1999, included information on the incidence of sports injuries requiring medical care and the associated sick leave, fitness indicators, and potential risk factors. The data was collected on the basis of a standardised cross-sectional questionnaire. The net sample comprised 6687 subjects aged 18 to 79. 3.1 % of adult Germans sustained a sports-related injury within the foregoing year. The annual incidence of injury among those actively engaging in sports is 5.6 %. 62 % of all sports injuries result in sick leave. The period off work was longer than 30 days in only one out of five cases. Three out of four injured recreational athletes are male. The incidence declines significantly in the more senior population. These differences apply even if the specific sporting profile is factored in. Analysis of incidence rates on their own is misleading for some population groups. For instance, although individuals of normal weight and a good fitness display more than twice the average incidence of sports injuries, our study shows that these figures do not reflect the actual risk of injury, as bivariate calculation of incidence does not take account of the specific extent of sporting activity. When specific participation rates and the intensity of training are taken into account, no significant differences in the risk of injury are apparent. Our representative data also shows that future injury prevention strategies should focus on the highest risk group of young male recreational athletes.     

Medical aspects of sports: epidemiology of injuries, preparticipation physical examination, and drugs in sports

The epidemiology of sports injuries helps identify the necessity for medical event coverage, injury risk factors, and potential prevention strategies. The preparticipation examination provides an opportunity for the team physician to identify athletes at risk of injury, to teach injury prevention, and to address athlete wellness.Knowledge of performance-enhancing drugs, nutritional supplements,and banned and legal medications is critical in caring for athletes.     

Extended reality in musculoskeletal rehabilitation and injury prevention - A systematic review

ObjectiveUnlike in neurological patient populations, the effects of Extended Reality within the context of sports medicine have rarely been studied. This systematic review was conducted to investigate the value of Extended Realty-assisted rehabilitation and injury prevention strategies on injury rehabilitation and prevention outcomes.MethodsPubMed and Web of Science databases were consulted. The search strategy consisted of the terms Virtual Reality (Intervention), rehabilitation and injury prevention (Outcome) and healthy athletes or athletes with a musculoskeletal sports injury (Population). After eligibility and Risk of Bias screening, ten articles were included. Risk of Bias analysis resulted in a level of evidence varying between C (three articles), B (six articles) and A2 (one article) scores.ResultsExtended Reality was found to provide an added value for both sports injury prevention and rehabilitation outcomes. It particularly provides clinicians with the opportunity to address the underlying biomechanical risk profile for common sports injuries, allowing the athletes to train protective movement patterns more effectively.ConclusionMore large-scale high-quality prospective research is needed in order to determine whether Extended Reality-assisted therapy is superior to conventional therapy in sports rehabilitation and injury prevention circles with strong conclusive evidence.     

The injury experience of the competitive athlete with a disability: prevention implications.

The purpose of this project was to describe the injury experiences of athletes with disabilities. A cross-disability instrument was developed to measure variables of interest. A retrospective survey was administered to 426 athletes who participated at the 1989 national competition of the National Wheelchair Athletic Association (NWAA), United States Association for Blind Athletes (USABA), and the United States Cerebral Palsy Athletic Association (USCPAA). The definition of injury was any trauma to the participant that occurred during any practice, training, or competition session that caused the athlete to stop, limit, or modify participation for 1 d or more. Thirty-two percent (N = 137) of the total respondents reported at least one time-loss injury. By organization, 26% of the total injuries were from the NWAA and 37% were from the USABA and USCPAA, respectively. The shoulder and arm/elbow accounted for 57% of the total NWAA injuries. Fifty-three percent of the injuries to the USABA athlete were to the lower extremity. Injuries to the USCPAA athlete were distributed among four body locations, knee (21%), shoulder (16%), forearm/wrist (16%), and leg/ankle (15%). The athlete with a disability demonstrated approximately the same percentage of injury as the athlete without a disability in similar sport activities. Biomechanical considerations of locomotion and specific sport skills should be analyzed by experts to reduce the percentage of injuries.     

Prévention des lésions de l’appareil locomoteur liées à la pratique de l’athlétisme sur piste. Revue des données épidémiologiques

Objectives

Sports injuries have an important impact on the sport and in daily life. Although athletics is known and performed on five continents, few is known about epidemiological data such as frequency, incidence, diagnosis or risk factors of injuries in athletics. In this context, consideration on strategies of sports injury prevention in athletics should be conducted.

Current knowledge

Sports injury surveillance by epidemiological studies is a preliminary step necessary in the clinical research on sports injury prevention. This is permitted by an agreed and validated methodolgy. Currently, the musculoskeletal lesions related to the track and field practice are common. The great diversity of these lesions reflects the diversity of disciplines, the constraints are different between the explosive disciplines (sprints, hurdles, jumps, throws) and endurance disciplines (middle and long distance). There was a predominance of lesions of thigh and hamstrings in the disciplines of sprint/hurdles, the Achilles tendon in jumps and sprints/hurdles, and chronic knee injuries and stress fractures in middle-distance.

Conclusion

Preventive measures which target the most frequent pathologies should be introduced. However, these data appear insufficient to fully understand the specific injury according to disciplines, and to understand the risk factors and injury mechanisms. Therefore, prospective epidemiological studies, and studies focused on specific populations or pathologies, are needed to improve strategies for the prevention of injuries in track and field.     

Practical management: common medical problems in disabled athletes.

Disabled athletes face many challenges during training and competition. As the number of disabled athletes grows, sports medicine professionals must become proficient in dealing with this population. A functional classification system is used to classify disabled athletes into 1 of 6 categories: wheelchair athletes, amputees, athletes with cerebral palsy, visual impairment, intellectual impairment, and les autres. Injury patterns have been identified for certain groups, with wheelchair athletes typically sustaining upper extremity injuries, blind athletes sustaining lower extremity injuries, and cerebral palsy athletes sustaining both. Common problems affecting wheelchair athletes include autonomic dysreflexia, difficulty with thermoregulation, pressure sores, neurogenic bladder, premature osteoporosis, peripheral nerve entrapment syndromes, and upper extremity injuries. Cerebral palsy athletes often have injuries involving the knee and foot due to problems with spasticity and foot deformities. Amputee athletes sustain injuries to the stump, spine, and intact limbs, while blind athletes suffer lower extremity injuries. Intellectually disabled athletes frequently have underlying ocular and visual defects, congenital cardiac anomalies, and atlantoaxial instability that predispose them to injuries. This article reviews key information pertinent to the care of these athletes.     

Gender differences in noncontact anterior cruciate ligament injuries

Female athletes have an increased incidence of ACL rupture. The cause of this increased injury rate is unclear, but it is most likely from a complex interplay between multiple variables. The relative risk of incurring an ACL injury is still low. The increased risk of ACL injury in women compared with men should not discourage female participation in sports. Instead, the focus should be on strategies to prevent injuries. Intrinsic factors are difficult or impossible to change; modifiable risk factors need to identified and prevention strategies should be employed.     

Pediatric and adolescent injury in mountain biking

ABSTRACT

Mountain-biking has become a popular competitive and recreational activity but also involves risk of injury. This article provides an overview of what is known about the scope of the injury problem affecting children and adolescent mountain bikers, the risk factors involved and injury prevention strategies. The proportion of injured child and adolescent mountain bikers ranges from 10.6% to 64.0%, but few studies provide separate analysis of youth injuries. Upper extremity injuries appear most common except among adolescents where the risk of head injury and traumatic brain injuries are greater. Concern is raised regarding the reported frequency of spine fractures and spinal cord injuries. Multi-faceted, longitudinal injury research focusing on youth mountain bikers is required to provide a reliable basis for testing risk factors and evaluating preventive measures. Reducing mountain biking-related injuries will require multiple strategies that integrate approaches from education, engineering, and evidence-based safety measures and their enforcement.     

Part I: epidemiology and risk factors for stress fractures in female athletes

ABSTRACT

Objectives: Stress fractures (SFx) are a common athletic injury, occurring in up to 40% of athletes at some point in their career. These injuries can cause pain, permanent disability, financial burden, and loss of playing time. This review presents updated epidemiology and comprehensive analysis of risk factors for stress fractures, especially as it pertains to female athletes.

Results: Stress fractures (SFx) account for up to 10% of all orthopedic injuries and up to 20% of injuries seen in sports medicine clinics, with an incidence among female athletes as high as 13%. Lower extremity SFx represent 80–95% of SFx, and the increased popularity of endurance running has contributed to the tibia (49% prevalence) replacing the metatarsals (9%) as the most common location for lower extremity SFx. Studies have demonstrated that 50% of peak bone mass is acquired during adolescence, a ‘peak time’ for eating disorder and female athlete triad development; furthermore, catch-up growth cannot be expected in athletes with diminished bone growth in this critical period. The female athlete triad (low energy availability with or without disordered eating, menstrual dysfunction, and low bone mineral density) are well-known risk factors for SFx; the risk of SFx for female athletes presenting with a single aspect of the triad is 15–20%, and this risk increases to 30–50% for female athletes presenting with multiple aspects of the triad.

Conclusion: This review provides a basis for how to identify populations at greatest risk for SFx. Prompt recognition of the intrinsic and extrinsic risk factors for SFx in female athletes is imperative to early diagnosis and to develop targeted strategies to prevent SFx occurrence or recurrence.     

Health professionals' perceptions of musculoskeletal injury and injury risk factors in Australian triathletes: A factor analysis

ObjectiveThis study investigated health professional perceptions of triathlon-related injury risk factors and injury prevention strategies, to inform prospective cohort studies investigating injury in triathletes.DesignExploratory factor analysis.MethodsA questionnaire was developed and distributed to Australian sports medicine health professionals (n = 504). Information was collected about their perceptions of factors contributing to injury and injury prevention strategies relating to Sprint/Olympic (S/O) and Ironman/Long Course (I/LC) athletes. Factor analysis was performed to identify the number and nature of the constructs (factors) underlying the responses to the questions, and to ascertain whether these factors were similar for S/O and I/LC athletes.ResultsThe response rate was 22.4% (n = 113). Five factors were extracted for injury risk accounting for 53% (S/O) and 56% (I/LC) of the variance. The factors were common across S/O and I/LC groups; biomechanics and technique, training factors, demographics, injury prevention and personal factors. Three common factors accounted for 54% (S/O) and 55% (I/LC) of the variance for injury prevention strategies; designated training regimes, health and medical monitoring and preparation of the triathlete.ConclusionsThese results indicate that future studies into triathlon injuries should include, at a minimum, detailed training load and demographic factors to test their impact as injury risk factors in triathlete populations.     

Wheelchair sports medicine

Wheelchair sports medicine involves the assessment of recreational and competitive sport capacities of physically disabled individuals, medical classification to allow fair competition among athletes with various types and degrees of disability, the prevention, diagnosis, and treatment of athletic injuries, and research into the biomechanics and physiology of wheelchair athletics. Involvement in wheelchair sports medicine activities increases professional awareness and provides a valuable referral source for organized sports activities.     

A qualitative study on overuse injuries: The beliefs of athletes and coaches

ObjectivesPreventive approaches for overuse injuries in sports will be more successful when synchronised with athletes’ and coaches’ beliefs. We interviewed athletes and coaches in order to better characterize their beliefs about the definition of an overuse injury, as well as the intrinsic and extrinsic risk factors that underlie overuse injuries.DesignQualitative study using in-depth interviews in athletes and coaches of different sports.MethodsAthletes who had experienced overuse injuries and coaches who trained athletes who had sustained overuse injuries from sports clubs were invited to participate through interview. We explored each participant's individual definition of an overuse injury and the beliefs concerning the intrinsic and extrinsic risk factors concerning overuse injuries were explored.ResultsAfter nine athletes and nine coaches, sample size saturation was confirmed. Athletes and coaches integrate somatic as well as psychological and sociological factors into the definition of and risk factors for overuse injuries. Intrinsic factors for an overuse injury were related to physical factors, technique, psychological factors and heredity. The extrinsic factors were related to situational, social and training factors, as well as the individual coach.ConclusionsAthletes and coaches have a holistic view on the definition of overuse injuries, and the intrinsic and extrinsic risk factors for overuse injuries. If preventive approaches for overuse injuries are developed and implemented, they should incorporate physical factors, as well as incorporate psychological and social factors. Based on the input of coaches and athletes, the latter are important risk factors for overuse injuries.     

Prevention of pediatric sports injuries

With over 30 million children participating in sports each year across the United States, a number of significant injuries are to be expected. Although mild injuries such as strains, sprains, and contusions predominate, catastrophic injuries do occur. Young athletes are at an increased risk for growth plate and apophyseal injuries, overuse injuries, and heat illness. Many of these sports injuries can be prevented. Prevention strategies include protective equipment, rule changes, preseason and season prevention interventions, safety measures, better coaching, education, and a societal awareness of injury and prevention. This article discusses current injury prevention for children participating in baseball, football, soccer, and ice hockey.     

Risk factors and risk statistics for sports injuries.

BACKGROUND: Risk factors for sports injuries include characteristics and behaviors of athletes and characteristics of sports and the environment that are associated with some measure of risk of injury. OBJECTIVE: To introduce risk statistics to clinicians evaluating studies of sports injuries. METHODS: Plain-language review of risk statistics and their practical application to sports injuries. RESULTS: The various measures of injury incidence are injury risk (proportion of athletes injured in a given period of training, playing, or other exposure time), injury rate (number of injuries per unit of exposure time), odds of injury (probability injury will happen divided by probability injury will not happen), injury hazard (instantaneous proportion injured per unit of time or mean injury count per unit of time), and mean time or mean number of playing exposures to injury. Effects of risk factors are estimated as values of effect statistics representing differences or ratios of one or more of these measures between groups defined by the risk factor. Values of some ratios and their sampling uncertainty (confidence limits) are estimated with specialized procedures: odds ratios with logistic regression, rate ratios with Poisson regression, and hazard ratios with proportional hazards (Cox) regression. Injury risks and mean time to injury in each group can also be estimated and can give a better sense of the effect of a risk factor. Risk factors identified in nonexperimental cohort and case-control studies are not always causes of injury; data from randomized controlled trials provide stronger evidence of causality. CONCLUSION: Expressing risk statistics as meaningful numbers should help clinicians make better use of sports injury studies.