Pedro Branco

Injury and illness definitions and data collection procedures for use in epidemiological studies in Athletics (track and field): Consensus statement

Background Movement towards sport safety in Athletics through the introduction of preventive strategies requires consensus on definitions and methods for reporting epidemiological data in the various populations of athletes. Objective To define health-related incidents (injuries and illnesses) that should be recorded in epidemiological studies in Athletics, and the criteria for recording their nature, cause and severity, as well as standards for data collection and analysis procedures. Methods A 1-day meeting of 14 experts from eight countries representing a range of Athletics stakeholders and sport science researchers was facilitated. Definitions of injuries and illnesses, study design and data collection for epidemiological studies in Athletics were discussed during the meeting. Two members of the group produced a draft statement after this meeting, and distributed to the group members for their input. A revision was prepared, and the procedure was repeated to finalise the consensus statement. Results Definitions of injuries and illnesses and categories for recording of their nature, cause and severity were provided. Essential baseline information was listed. Guidelines on the recording of exposure data during competition and training and the calculation of prevalence and incidences were given. Finally, methodological guidance for consistent recording and reporting on injury and illness in athletics was described. Conclusions This consensus statement provides definitions and methodological guidance for epidemiological studies in Athletics. Consistent use of the definitions and methodological guidance would lead to more reliable and comparable evidence.

Injuries in 13 international Athletics championships between 2007–2012

Background The International Association of Athletics Federation has systematically surveyed all Athletics injuries in their competitions since 2007 in order to develop strategies for health protection of their athletes. Aims Analysis of frequency and characteristics of injuries during 13 international Athletics championships from 2007 to 2012 regarding different types of championships and discipline categories. Methods The team physicians and the Local Organizing Committee reported daily all injuries on a standardised injury report form during each championship. Results A total of 1470 injuries were reported, equivalent to 81.1±4.2 injuries per 1000 registrations of which 36.7±2.9 were expected to result in absence from sports. The incidence of time-loss injuries was significantly higher in competition (29.0±2.6) than in training (5.8±1.9), and in outdoor (46.4±4.0) than in indoor (23.7±6.2) or youth/junior championships (13.2±4.0). While most in-competition time-loss injuries were reported during short distance events (32.5%), combined events had the highest incidence of in-competition time-loss injuries (106±26.5). The most frequent diagnosis was thigh strain (28.2%), followed by lower leg strain and ankle sprain. Injury location varied between different discipline categories: in long distances the lower leg, in Marathon the foot and in throws the upper extremity were mainly affected. Conclusions The incidence of injuries varied substantially between different types of Athletics championships and between discipline categories. Special attention should be paid to combined events, running disciplines and (thigh) strain to better understand the injury mechanisms and risk factors and develop related preventive measures.

Injuries and illnesses during the 2011 Paris European Athletics Indoor Championships.

This study aimed to record and analyse incidence and characteristics of injuries and illnesses incurred during the Indoor Athletics Championships. During the 2011 European Indoor Athletics Championships in Paris, incidence and characteristics of new injuries and illnesses were recorded prospectively by physicians and physiotherapists from national teams and local organizing committee in 631 registered athletes. Around 70% of athletes were covered by the medical teams (response rate: 84%). Thirty injuries, including eight time‐loss injuries, were reported, representing an incidence of 47.5 injuries and 29.4 time‐loss injuries per 1000 registered athletes. Injury and time‐loss injury risk were highest in heptathlon and hurdles. Three‐quarters of injuries affected the lower extremity. Thigh strain was the most common diagnosis (n = 7; 23%). Noncontact trauma (n = 9; 30%) was the predominant cause. A total of 18 illnesses were reported. Incidence of illnesses was 28.5 per 1000 registered athletes, with 17% resulting in time lost from sport. Upper respiratory tract infection was the most common diagnosis (n = 8; 44%) followed by upper respiratory tract allergy (n = 3; 17%) and gastroenteritis (n = 3; 17%). Injury and illness incidence and severity were lower during the 2011 European Indoor Athletics Championships than during outdoor championships, probably due to the shorter duration, the fewer number of events, and shorter sprint distances.

Muscle injury is the principal injury type and hamstring muscle injury is the first injury diagnosis during top-level international athletics championships between 2007 and 2015

Background During top-level international athletics championships, muscle injuries are frequent. Objective To analyse the incidence and characteristics of muscle injuries and hamstring muscle injuries (hamstring injuries) occurring during top-level international athletics championships. Methods During 16 international championships held between 2007 and 2015, national medical team and local organising committee physicians reported daily all injuries on a standardised injury report form. Only muscle injuries (muscle tears and muscle cramps) and hamstring injuries have been analysed. Results 40.9% of all recorded injuries (n=720) were muscle injuries, with 57.5% of them resulting in time loss. The overall incidence of muscle injuries was higher in male athletes than female athletes (51.9±6.0 vs 30.3±5.0 injuries per 1000 registered athletes, respectively; RR=1.71; 95% CI 1.45 to 2.01). Muscle injuries mainly affected the thigh (52.9%) and lower leg (20.1%), and were mostly caused by overuse with sudden onset (38.2%) and non-contact trauma (24.6%). Muscle injury risk varied according to the event groups. Hamstring injuries represented 17.1% of all injuries, with a higher risk in male compared to female athletes (22.4±3.4 vs 11.5±2.6 injuries per 1000 registered athletes, respectively; RR=1.94; 95% CI 1.42 to 2.66). Conclusions During international athletics championships, muscle injury is the principal type of injury, and among those, the hamstring is the most commonly affected, with a two times higher risk in male than female athletes. Athletes in explosive power events, male athletes and older male athletes, in specific were more at risk of muscle injuries and hamstring injuries. Injury prevention strategies should be sex-specific.

Analyses of Helsinki 2012 European Athletics Championships injury and illness surveillance to discuss elite athletes risk factors.

Objective:To further analyze newly incurred injuries and illnesses (I&Is) during Athletics International Championships to discuss risk factors. Design:Prospective recording of newly occurred injuries and illnesses. Setting:The 2012 European Athletics (EA) Championships in Helsinki, Finland. Participants:National team and local organizing committee physicians and physiotherapists and 1342 registered athletes. Main Outcome Measures:Incidence and characteristics of new injuries and illnesses. Results:Ninety-three percent of athletes were covered by medical teams, with a response rate of 91%. One hundred thirty-three injuries were reported (incidence of 98.4 injuries per 1000 registered athletes). Sixty-two injuries (47%) resulted in time loss from sport. The most common diagnosis was hamstring strain (11.4% of injuries and 21% of time-loss injuries). Injury risk was higher in males and increased with age. The highest incidences of injuries were found in combined events and middle- and long-distance events. Twenty-seven illnesses were reported (4.0 illnesses per 1000 athlete days). The most common diagnoses were upper respiratory tract infection (33.3%) and gastroenteritis/diarrhea (25.9%). Conclusions:During outdoor EA Championships, injury and illness incidences were slightly lower and injury characteristics were comparable with those during outdoor World Athletics Championships. During elite athletics Championships, gender (male), age (older than 30 years), finals, and some events (combined events and middle- and long-distance races) seem to be injury risk factors. Illness risk factors remain unclear. As in previous recommendations, preventive interventions should focus on overuse injuries, hamstring strains, and adequate rehabilitation of previous injuries, decreasing risk of infectious diseases transmission, appropriate event scheduling, sports clothes, and heat acclimatization.

Meta-narrative analysis of sports injury reporting practices based on the Injury Definitions Concept Framework (IDCF): A review of consensus statements and epidemiological studies in athletics (track and field)

OBJECTIVES Consistency in routines for reporting injury has been a focus of development efforts in sports epidemiology for a long time. To gain an improved understanding of current reporting practices, we applied the Injury Definitions Concept Framework (IDCF) in a review of injury reporting in a subset of the field. DESIGN Meta-narrative review. METHODS An analysis of injury definitions reported in consensus statements for different sports and studies of injury epidemiology in athletics (track and field) published in PubMed between 1980 and 2013 was performed. Separate narratives for each of the three reporting contexts in the IDCF were constructed from the data. RESULTS Six consensus statements and 14 studies reporting on athletics injury epidemiology fulfilled the selection criteria. The narratives on sports performance, clinical examination, and athlete self-report contexts were evenly represented in the eligible studies. The sports performance and athlete self-report narratives covered both professional and community athletes as well as training and competition settings. In the clinical examination narrative, data collection by health service professionals was linked to studies of professional athletes at international championships. CONCLUSIONS From an application of the IDCF in a review of injury reporting in sports epidemiology we observed a parallel usage of reporting contexts in this field of research. The co-existence of reporting methodologies does not necessarily reflect a problematic situation, but only provided that firm precautions are taken when comparing studies performed in the different contexts.

Challenges in Athletics injury and illness prevention: implementing prospective studies by standardised surveillance

Athletes’ health protection through prevention research is an important goal of the International Olympic Committee (IOC)1 and is a task taken seriously by several major international sports federations including the International Association of Athletics Federations (IAAF)2–5 and the European Athletics (EAA).6 ,7 To this end, surveillance studies have been conducted at 13 international Athletics championships in recent years,2–7 using standardised methods developed by the IOC1 and IAAF.2 ,3 Thus, important data on injury and illness incidences and characteristics in elite athletes during international Athletics competition have been reported and, as demonstrated in the paper by Feddermann et al ,5 successfully monitored over time. However, the nature of Athletics requires that a vast majority of athletes’ time is spent preparing to compete rather than actually competing. Consequently, injury and illness risk is expected to be higher during training periods than during competition periods only. Our knowledge on their risk of injury and illness during out-of-competition periods …

Sex differences in injury during top-level international athletics championships: surveillance data from 14 championships between 2007 and 2014

Background Injury incidence has been reported for international athletics championships from 2007 to 2012. However, it is unclear whether male or female athletes differ in risk and/or characteristics of injuries. Objective To compare the incidences and characteristics of injuries that occurred during international athletics championships between female and male athletes. Methods The national medical team and the local organising committee physicians reported all injuries daily on a standardised injury report form during 14 international championships from 2007 to 2014. Relative risks (RR) of injury, 95% CI and magnitude thresholds were calculated. Results The rate of injuries per 1000 registered athletes was significantly higher in male (110.3±6.8) than in female (88.5±6.7) athletes (RR=1.25; 95% CI 1.13 to 1.37, small effect size). Male athletes incurred significantly more injuries in the thigh (RR=1.64; 95% CI 1.32 to 2.05, small), lower leg (RR=1.36; 95% CI 1.05 to 1.75, small) and hip/groin injuries (RR=2.26; 95% CI 1.31 to 3.88, moderate), more muscle strains (RR=1.64; 95% CI 1.33 to 2.04, small), cramps (RR=1.81; 95% CI 1.35 to 2.43, small), and especially more thigh strains (RR=1.66; 95% CI 1.25 to 2.19, small), but fewer stress fractures (RR=0.32; 95% CI 0.12 to 0.81, moderate) than female athletes. A higher injury risk of male than of female athletes was observed in sprints (RR=1.32; 95% CI 1.06 to 1.66, small), middle distance runs (RR=1.48; 95% CI 1.06 to 2.06, small), race walks (RR=2.55; 95% CI 1.27 to 5.10, moderate) and jumps (RR=2.13; 95% CI 1.53 to 2.97, moderate). No sex difference was found for cause and severity of injury. Conclusions Injury risk during international athletics championships differed between female and male athletes for location, type and event groups. Injury prevention strategies should be sex-specific, regarding the differences in injury location and type.

Electronic data capture on athletes' pre-participation health and in-competition injury and illness at major sports championships: an extended usability study in athletics

This study set out to identify factors critical for the usability of electronic data collection in association with championships in individual sports. A qualitative analysis of electronic data collection system usability for collection of data on pre-participation health from athletes and in-competition injury and illness from team physicians was performed during the 2013 European Athletics Indoor Championships. A total of 15 athletes and team physicians participated. Athletes were found to experience few problems interacting with the electronic data collection system, but reported concerns about having to reflect on injury and illness before competitions and the medical terminology used. Team physicians encountered problems when first navigating through the module for clinical reporting, but they were not subjected to motivational problems. We conclude that athletes’ motivation to self-report health data and the design of the human–computer interface for team physicians are key issues for the usability of electronic data collection systems in association with championships in individual sports.

Methodological quality of the injury surveillance system used in international athletics championships

OBJECTIVES Incidence and prevalence data obtained from injury surveillance studies could be biased by the response rate as well as by the completeness and quality of the reports. It therefore appears crucial to analyse the quality of the injury surveillance system itself and thereby validate the quality of the data. This study aimed to analyse the quality of and compliance with the injury surveillance system implemented during international athletics championships. DESIGN Prospective, epidemiological study. METHODS The national medical teams and the local organising committee physicians daily reported all injuries on a standardised injury report form during 14 international athletics championships from 2007 to 2015. The quality of the injury surveillance system was analysed following the guidelines laid down by the Centre for Disease Control and Prevention. RESULTS On average 41.7±17.4% (mean±standard deviation) of all registered countries participated in the injury surveillance project, accounting for a coverage of athletes of 79.5±10.2% of all registered athletes. Their medical staff returned 89.2±8.4% of the expected injury report forms (information is missing for one championship). The completeness of injury data provided by medical teams and local organising committee physicians averaged 95.8±6.5%. National medical teams reported 60.6±16.6% of all injuries, and local organising committee physicians 28.7±15.0% whereas 10.6±6.5% of injuries were reported by both. CONCLUSIONS The injury surveillance system used during international athletics championships provided good national medical team participation, coverage of athletes, response rate, and completeness of reports. These parameters should be systematically reported for injury surveillance studies to show the quality of the study.