Sport specialization of female figure skaters: cumulative effects on low back injuries

Development and validation of the Wisconsin Sport Specialization Questionnaire (WISSQ) for older adolescent athletes

OBJECTIVE

The proliferation of youth sport specialisation may be concerning for the overall health of adolescent athletes, but no validated tool to measure specialisation exists. We aimed to assess the measurement properties and validate the Wisconsin Sport Specialization Questionnaire (WISSQ) in older adolescent athletes.

METHODS

Using previously developed sport specialisation items with established content validity, questionnaires were administered to 14-18-year-old athletes residing in both regional and national settings, who were participating in organised sport. Confirmatory factor analyses and Rasch partial credit modelling independently assessed structural and concurrent validity and reliability in both datasets. The best-fitting national model was then fit onto the regional data to further assess the stability of the measurement properties.

RESULTS

The regional and national data included 474 (77% female, 86% non-Hispanic White) and 564 (38% female, 63% non-Hispanic White) athletes, respectively. Twelve of 25 items were retained in three domains (n=4 social, n=5 motivation, n=3 physical). One item cross-loaded on both the motivation and physical domains. The adapted regional (comparative fit index (CFI), 0.97; Tucker-Lewis index (TLI), 0.97; root mean square error of approximation (RMSEA), 0.04) and national (CFI, 0.99; TLI, 0.99; RMSEA, 0.05) datasets achieved good model fit. Internal consistency among the three subdomains ranged from Ω=0.78-0.88 (national) to Ω=0.73-0.83 (regional). All items contributed appropriately to measuring the construct of sport specialisation in the regional (infit/outfit: 0.77-1.16) and national (infit/outfit: 0.74-1.16) datasets.

CONCLUSIONS

We present the first validated tool to measure youth sport specialisation while considering physical, motivational and social characteristics of sport participation. The WISSQ is a valid, reliable assessment of sport specialisation in older adolescent athletes.

Epidemiology and associated injury risk factors in figure skating: A systematic review

OBJECTIVES

To identify and critically appraise the available evidence on injury epidemiology and risk factors in figure skating.

DESIGN

Systematic review.

METHODS

Eight electronic databases were searched from inception to 01 November 2023. Studies were included if they reported injury epidemiology and/or injury risk factors in figure skating. Non-English publications were excluded. Risk of Bias of included studies was assessed using the QUIPS tool (quality in prognostic factor studies).

RESULTS

This systematic review identified twenty-nine studies (n = 4202 figure skaters), with an injury prevalence of 2.1 %-34 %. An injury incidence of 1.37 injuries/1000 total training hours was reported in one study (n = 8). Three significant intrinsic risk factors (older age, previous history of stress fracture and a higher body mass) and eight significant extrinsic risk factors (training more than 12 sessions per week, skipping meals, RED-s indicators, hamstring and quadriceps immobility, training rather than competing, increased time on-ice time and boot-foot length difference) were identified from individual studies. Age, as the most studied risk factor, requires careful interpretation due to study design limitations.

LIMITATIONS

Existing data lacks quality of evidence and current reported injury risk factors in figure skating should be interpreted with caution.

CONCLUSIONS

High-quality research of injuries and injury risk factors in figure skating is scarce. The inconsistent reporting of injury data across the currently available literature due to variations in injury definition and data collection methods makes it difficult to compare and draw conclusions. A critical need exists for standardized research approaches to accurately determine the true burden of injury in this sport.

Figure Skating Musculoskeletal Injury: Evidence across Disciplines, Mechanisms, and Future Directions

ABSTRACT

This review provides a synopsis of current injury patterns, potential mechanisms, and off-ice exercise prevention considerations as the sport of figure skating evolves. The lifetime prevalence of injury for all skaters is estimated to be 79.5%, with the most common sites being spine and lower extremity. Singles skaters more often develop chronic injuries compared to acute (68.9% vs 31.1%), whereas non-singles skaters more often experience acute injuries. Lower limb stress fracture prevalence ranges from 10% to 21.4% across disciplines. Emerging contributors include training volume, technical difficulty and repetition of complex elements (multirotational jumps, lifts, holds), extreme ranges of movement about the spine and hip, age and experience level, and functional capacity (dynamic strength, flexibility, balance, and neuromotor control). Prevention programs in competitive figure skaters may include monitoring of training volumes, emphasis on technique, appropriate boot fit, and strength and conditioning content to prepare for increasing neuromotor, balance, and power demands of the sport.

Distribution and risk factors for stress fractures in competitive figure skaters and association with acute fractures

INTRODUCTION

Figure skating combines esthetic components with high impact, technically demanding elements requiring high volume repetitive training. The evidence base for the sport is limited, particularly regarding stress fracture injuries. This study aims to describe the prevalence and anatomical distribution of stress fracture injuries and assess for risk factors, as well as associations with acute fractures.

METHODS

An online anonymous retrospective survey of competitive figure skaters was distributed through social media networks and e-mail for completion by skaters from all three disciplines of figure skating.

RESULTS

In a sample of 164 skaters from novice to Olympic level, career prevalence of stress fractures was 24.4%, most commonly affecting tibia and ankle. There was statistically significant increased risk of stress fracture in those training ≥12 times/week (33.3% vs. 17.8%; P = 0.028) but no increased risk associated with level or gender of skater. There was a higher prevalence of acute fracture in those with a history of stress fracture (45.0% vs. 21.8%; P = 0.007).

CONCLUSIONS

Figure skaters are at a high risk of stress fractures, independent of the level performed at. There is a higher risk in those training more frequently and an association with additional acute fractures. Results advocate education on fracture features and bone health measures to skaters, coaches, and physicians, at all levels of the sport to facilitate early diagnosis and management.

The Lumbopelvic-Hip Complex Contribution During Lower Extremity Screening Tests in Elite Figure Skaters

CONTEXT

Figure skating requires power and stability for takeoff and landing from multirotational jumps and various on-ice skills. Repetitive forces may cause overuse injuries distally, making lumbopelvic-hip endurance, strength, and neuromuscular control imperative.

OBJECTIVE

To compare lumbopelvic-hip endurance and neuromuscular control in elite figure skaters between sexes and landing and nonlanding limbs using common screening tests.

DESIGN

Cross-sectional study.

SETTING

US Olympic and Paralympic Training Center.

PATIENTS OR OTHER PARTICIPANTS

Forty elite figure skaters (20 women, 20 men; age = 23.2 ± 4.3 years) performed the Y-balance test, single-legged squat (SLS), single-legged squat jump (SLSJ), and unilateral hip-bridge endurance test (40 right [R] landing limbs, length = 169.1 ± 12.2 cm).

MAIN OUTCOME MEASURE(S)

Normalized reach difference (% of leg length) and composite scores [(anterior + posteromedial + posterolateral)/(limb length × 3) × 100] were calculated for the Y-balance test. Skaters held the unilateral hip bridge until failure with a maximum allotted time of 120 seconds. They performed 5 SLSs and 5 SLSJs while barefoot with the contralateral limb held behind them to mimic a landing position. Both tests were scored by the number of times the patella moved medially to the first ray (medial knee displacement [MKD]). Multivariate analyses of variance with post hoc independent t tests were conducted between sexes and groups. Paired t tests were used to analyze limb differences.

RESULTS

Women had a larger composite Y-balance score (R = 10.8% of leg length, P = .002; left = 10.5%, P = .001) and hip-bridge hold time (R = 26.4 seconds, P = .004; left = 28.2 seconds, P = .002) for both limbs compared with men. Men held the hip-bridge longer on their landing limb. Six skaters performed worse on their nonlanding limb during the SLS, and 11 skaters had no MKD with either the SLS or SLSJ.

CONCLUSIONS

Women performed better on the Y-balance and unilateral hip bridge tests. Increased MKD for some skaters during the SLS and SLSJ may have indicated hip-abductor weakness. Understanding the proximal lumbopelvic-hip variables during takeoff and landing may elucidate contributing factors to distal overuse injuries.

Comparing High School Sport Specialization Trends Between Division I and Club Collegiate Athletes

BACKGROUND

Adolescent athletes report that sports specialization improves their ability to receive a collegiate athletics scholarship, though this is not well-understood. The purpose of this study was to examine self-reported trends in high school specialization and influences for sport participation between Division I (D-I) and college-aged club (club) athletes.

HYPOTHESIS

There would be no difference in high school sport specialization or sport participation influences between D-I and club athletes.

STUDY DESIGN

Retrospective cross-sectional study.

LEVEL OF EVIDENCE

Level 3.

METHODS

A survey included specialization classification (low, moderate, and high) for 9th to 12th grade, age that the athlete started organized sport and his or her collegiate sport, and several influential factors for participation in one's primary high school sport (1 = no influence to 5 = extremely influential). Chi-square analyses were used to compare specialization classifications between groups. Nonparametric tests were used to determine significant differences in age-related variables and influential factors between D-I and club athletes. All analysis were also conducted with boys and girls separately.

RESULTS

Participants included 266 D-I (girls, 155; 58%) and 180 club (girls, 122; 68%) athletes. Club athletes were more likely to be classified as low specialization at every grade in high school, and this difference was more pronounced between D-I and club female athletes than male athletes. The number of years an athlete was classified as highly specialized in high school was not different between D-I and club athletes. Club athletes were more influenced by playing with friends than D-I athletes and D-I athletes were more influenced by pursuing a collegiate scholarship than club athletes.

CONCLUSION

High levels of specialization in high school sport may not be necessary for playing at the collegiate level, though some level of specialization in high school might be necessary.

CLINICAL RELEVANCE

Clinicians should advocate for healthy long-term athlete development, which does not support high specialization in high school sports.

Determinants of Sports Injury in Young Female Swedish Competitive Figure Skaters

Introduction: Although figure skating attracts several hundred thousand participants worldwide, there is little knowledge about physical health and sports injuries among young skaters. The present study aimed to describe the health status of a geographically defined Swedish population of licensed competitive figure skaters and to examine injury determinants.

Methods: All licensed competitive skaters in the southeastern region of Sweden were in April 2019 invited to participate in a cross-sectional study using an online questionnaire. Multiple binary logistic regression was used for the examination of injury determinants. The primary outcome measure was the 1-year prevalence of a severe sports injury episode (time loss >21 days). The secondary outcome measure was the point prevalence of an ongoing injury. The determinants analyzed were age, skating level, relative energy deficiency indicators, and training habits.

Results: In total, 142 (36%) skaters participated, 137 (96%) girls [mean (SD) age: 12.9 (SD 3.0) years]. Participating boys (n = 5) were excluded from further analysis. The 1-year prevalence of a severe sports injury episode was 31%. The most common injury locations for these injuries were the knee (25%), ankle (20%), and hip/groin (15%). In the multiple model, having sustained a severe injury episode was associated with older age (OR 1.2, 95% CI 1.1–1.4; p = 0.002) and an increased number of skipped meals per week (OR 1.1, 95% CI 1.0–1.3; p = 0.014). The point prevalence of an ongoing injury episode was 19%. The most common locations were the knee (24%), ankle (24%), and foot (24%). Having an ongoing injury episode was associated with older age (OR 1.4, 95% CI 1.2–1.7; p < 0.001) and an increased number of skipped meals per week (OR 1.1, 95% CI 1.0–1.3; p = 0.049).

Conclusion: One-third of young female Swedish competitive figure skaters had sustained a severe injury episode during the past year, and a fifth reported an ongoing episode. Older age and an increased number of skipped meals per week were associated with a sports injury episode. Long-term monotonous physical loads with increasing intensity and insufficient energy intake appear to predispose for injury in young female figure skaters. Further examination of injury determinants among competitive figure skaters is highly warranted.