Martin Peter Schwellnus

How much is too much? (Part 2) International Olympic Committee consensus statement on load in sport and risk of illness

Athletes participating in elite sports are exposed to high training loads and increasingly saturated competition calendars. Emerging evidence indicates that poor load management is a major risk factor for injury. The International Olympic Committee convened an expert group to review the scientific evidence for the relationship of load (defined broadly to include rapid changes in training and competition load, competition calendar congestion, psychological load and travel) and health outcomes in sport. We summarise the results linking load to risk of injury in athletes, and provide athletes, coaches and support staff with practical guidelines to manage load in sport. This consensus statement includes guidelines for (1) prescription of training and competition load, as well as for (2) monitoring of training, competition and psychological load, athlete well-being and injury. In the process, we identified research priorities.

The incidence and patterns of illness at the Sochi 2014 Winter Paralympic Games: a prospective cohort study of 6564 athlete days

Objective To describe the epidemiology of illness at the Sochi 2014 Winter Paralympic Games. Methods A total of 547 athletes from 45 countries were monitored daily for 12u2005days over the Sochi 2014 Winter Paralympic Games (6564 athlete days). Illness data were obtained daily from teams without their own medical support (13 teams, 37 athletes) and teams with their own medical support (32 teams, 510 athletes) through electronic data capturing systems. Results The total number of illnesses reported was 123, with an illness incidence rate (IR) of 18.7 per 1000 athlete days (95% CI 15.1% to 23.2%). The highest IR was reported for wheelchair curling (IR of 20.0 (95% CI 10.1% to 39.6%)). Illnesses in the respiratory system (IR of 5.6 (95% CI 3.8% to 8.0%)), eye and adnexa (IR of 2.7 (95% CI 1.7% to 4.4%)) and digestive system (IR of 2.4 (95% CI 1.4% to 4.2%)) were the most common. Older athletes (35–63u2005years) had a significantly higher IR than younger athletes (14–25u2005years, p=0.049). Conclusions The results of this study indicate that Paralympic athletes report higher illness incidence rates compared to Olympic athletes at similar competitions. The highest rates of illness were reported for the respiratory and digestive systems, eye and adnexa, respectively. Thus, the results of this study form a basis for the identification of physiological systems at higher risk of illness, which can in turn inform illness prevention and management programmes with eventual policy change to promote athlete safety in future editions of the Winter Paralympic Games.

High incidence of injury at the Sochi 2014 Winter Paralympic Games: a prospective cohort study of 6564 athlete days

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 12u2005days 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.

The Epidemiology of Injuries in Football at the London 2012 Paralympic Games

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.

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

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

Genetics and soft-tissue injuries in sport: clinical commentary.

Introduction The prevention, diagnosis, and management (including rehabilitation) of injuries related to participation in physical activity are key components of the scope of clinical practice of the sport and exercise medicine physician. These components of the scope of clinical practice are not only confined to dealing with injuries in elite athletes, but are as important for 1) the recreational athlete of any age or gender who participates in school, college, or club sports, or 2) patients who are given an exercise prescription as part of a lifestyle intervention program for the primary and secondary prevention of chronic disease. It is well established that the majority of injuries related to participation in physical activity occur in the ‘‘soft tissues.’’ The term ‘‘soft-tissue injuries’’ is not well defined, but usually refers to injuries to muscle, tendon, and ligamentous tissue. However, ‘‘soft tissue’’ injuries also can include injuries to vascular tissue, nervous tissue, and other tissues. For the purposes of this commentary, I will use the loose definition of ‘‘soft-tissue injuries’’ to refer mainly to muscle, tendon, and ligamentous injuries. As clinicians, we spend considerable time with our patients to prevent these soft-tissue injuries, diagnose them correctly, and then prescribe the correct treatment and rehabilitation before making the correct decision in allowing an individual to return to full activity. In recent years, there has been growing interest in these injuries, and this has resulted in a rapid growth in our knowledge regarding all aspects of softtissue injury prevention, diagnosis, and management.

The epidemiology of injuries in powerlifting at the London 2012 Paralympic Games: An analysis of 1411 athlete-days.

Sport injury epidemiology has received increased recognition as a field of sport medicine research that can improve the health and safety of athletes. Injuries among Paralympic powerlifters have not previously been systematically studied. The purpose of this prospective cohort study was to characterize injuries among Paralympic powerlifters. Athletes competing in the sport of powerlifting were followed over the 7‐day competition period of the 2012 London Paralympic Games. The main outcome measurements were injury incidence rate (IR; number of injuries per 1000 athlete‐days) and injury incidence proportion (IP; injuries per 100 athletes). A total of 38 injuries among 163 powerlifters were documented. The overall IR was 33.3 injuries/1000 athlete‐days (95% CI 24.0–42.6) and the overall IP was 23.3 injuries per 100 athletes (95% CI 16.8–29.8). The majority of injuries were chronic overuse injuries (61%). The most commonly injured anatomical region was the shoulder/clavicle (32% of all injuries), followed by the chest (13%) and elbow (13%). The information obtained in this study opens the door for future study into the mechanisms and details of injuries into powerlifters with physical impairments.

High precompetition injury rate dominates the injury profile at the Rio 2016 Summer Paralympic Games: a prospective cohort study of 51 198 athlete days

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 51u2009198 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.

Sport, sex and age increase risk of illness at the Rio 2016 Summer Paralympic Games: a prospective cohort study of 51 198 athlete days

Objective To describe the epidemiology of illness at the Rio 2016 Summer Paralympic Games. Methods A total of 3657 athletes from 78 countries, representing 83.5% of all athletes at the Games, were monitored on the web-based injury and illness surveillance system (WEB-IISS) over 51 198 athlete days during the Rio 2016 Summer Paralympic Games. Illness data were obtained daily from teams with their own medical support through the WEB-IISS electronic data capturing systems. Results The total number of illnesses was 511, with an illness incidence rate (IR) of 10.0 per 1000 athlete days (12.4%). The highest IRs were reported for wheelchair fencing (14.9), para swimming (12.6) and wheelchair basketball (12.5) (p<0.05). Female athletes and older athletes (35–75 years) were also at higher risk of illness (both p<0.01). Illnesses in the respiratory, skin and subcutaneous and digestive systems were the most common (IRs of 3.3, 1.8 and 1.3, respectively). Conclusion (1) The rate of illness was lower than that reported for the London 2012 Summer Paralympic Games; (2) the sports with the highest risk were wheelchair fencing, para swimming and wheelchair basketball; (3) female and older athletes (35–75 years) were at increased risk of illness; and (4) the respiratory system, skin and subcutaneous system and digestive system were most affected by illness. These results allow for comparison at future Games.

Premarathon evaluations : is there a role for runner prerace medical screening and education to reduce the risk of medical complications?

There is irrefutable evidence that regular participation in physical activity has substantial health benefits, and as such participation in mass community-based sports events should be supported. However, with the promotion of physical activity comes the potential risk of medical complications during an acute exercise session, with this risk varying according to the risk factor profile of an individual and the nature of the event. The demographics of marathon race entrants changed over the past two to three decades, and currently about 50% of runners are older than 40 yr. A consolidated view of previously published research shows that in a marathon with a field of 50,000 runners for example, the medical staff will, on average, encounter a sudden death every 2 to 3 yr, a sudden cardiac arrest every year, 25 runners that present with a serious medical complication requiring specialized management or hospitalization, and 1000 runners that require medical attention. Runners may have several intrinsic risk factors that can predispose them to serious acute cardiovascular or other serious noncardiac medical complications on race day. This intrinsic risk can be exacerbated by several extrinsic risk factors as well. As health care professionals, we are obliged to give the best medical advice to individuals who wish to participate in moderate- and high-intensity endurance activities, and at the same time reduce their risk of a medical complication during exercise. Preliminary data indicate that an online prerace medical screening and targeted educational intervention program can be successfully implemented and is effective in reducing the risk of acute medical complications during a race.