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

The epidemiology of injuries in professional sitting volleyball athletes

OBJECTIVES

This study investigated the epidemiology of injury among players at the Iran Sitting Volleyball Super League 2023-2024.

METHODS

A total of 56 athletes from 6 teams, representing 47% of all athletes in the Super League, took part in this study. Injury data were obtained retrospectively through one-by-one interview sessions and a questionnaire.

RESULTS

A total of 80 injuries were reported in 30 athletes at the Iran Sitting Volleyball (SV) Professional League. The injury proportion (IP) (%) of all athletes who sustained an injury during the League was 53.6%, with an overall incidence of 16.2 injuries per 1000 athlete days (95% CI 12.7 to 19.8). There was a significantly higher incidence of injury during the competition period (33.5 (95% CI 16.5 to 50.4)) compared with the pre-competition period (14.5 (95% CI 11.0 to 18.0); IR:2.31 (95% CI 1.3 to 4.0); p < 0.01). There were no significant differences between post and age groups concerning injury rate in the overall period. The injuries incurred are mostly re-injuries, and the anatomical areas of the fingers, wrist, and shoulder are at the most risk for injury.

CONCLUSION

This study provides important baseline data for medical staff and coaches, aiding in better preparation for long-term competitions and improving injury prevention programs for this sport.

Assessing musculoskeletal complaints in para-athletes: A systematic review and critical appraisal of available Patient-Reported Outcome Measures

OBJECTIVE

To identify the available Patient-reported Outcome Measures (PROMs) for assessing musculoskeletal complaints in para-athletes and to evaluate their psychometric properties, ultimately providing recommendations for their use.

METHODS

PubMed, Embase, Scopus, Cochrane Library, Web of Science, ProQuest, and COSMIN Database were searched until October 2024. Full report studies evaluating psychometric properties of PROMs in para-sport participants with musculoskeletal pain were included. The methodology followed the Consensus-based Standards for selection of Health Measurement Instruments (COSMIN) and PRISMA-COSMIN for OMIs 2024 Guidelines.

RESULTS

Six articles reported information on Wheelchair User's Shoulder Pain Index (WUSPI); Shoulder Pain Scale for Wheelchair Basketball (SPS-WB); and, Shoulder Pain Index for Wheelchair Basketball (SPI-WB). Content validity was inconsistent for WUSPI and SPS-WB. Structural validity was indeterminate for SPS-WB. Internal consistency was sufficient for SPS-WB but indeterminate for WUSPI and SPI-WB. Reliability was sufficient for WUSPI and SPI-WB. Convergent validity was sufficient for WUSPI but indeterminate for SPS-WB and SPI-WB. Discriminative validity was insufficient for WUSPI and SPI-WB and indeterminate for SPS-WB.

CONCLUSIONS

Evidence on PROMs for musculoskeletal complaints in para-sports focuses on shoulder pain in wheelchair basketball, showing low to very low-quality evidence. The WUSPI and SPS-WB can be used considering their limitations.

Case Report: Monitoring neuromuscular fatigue through jump performance over two seasons in a cerebral palsy sprinter

Introduction

World Para Athletics classifies athletes with brain injury, cerebral palsy, and motor coordination impairments into Group Class 31 to 38. Para athletes who can run and jump but are affected by impairments such as athetosis, ataxia, and dystonia, which impact all four limbs and the trunk, are categorized as Class T36. Monitoring training load and performance is essential for guiding training programs and preventing injuries in this population. Vertical jumps are commonly used to assess neuromuscular parameters in athletes with cerebral palsy. In this study, we tracked performance changes and monitored vertical jump height and power over two competitive seasons in a sprinter with cerebral palsy.

Case presentation/methods

The sprinter has had cerebral palsy since birth and is classified in the T36 class. Over two competitive seasons, his neuromuscular performance was monitored weekly using vertical jump tests, particularly Countermovement and Squat Jumps. His running performance was assessed through competition results. The parameters measured included Jump height and Peak power (WPEAK), which was calculated as the highest value from the curve obtained by multiplying the ground reaction force by the velocity during the concentric phase of the jump, normalized by body mass. Additionally, his official race times for the 100 m, 200 m, and 400 m events were recorded from January 2017 to October 2018.

Results

The absolute and relative sprint performance values improved significantly between the first and the best official results: 100 m (from 15.05 s to 13.97 s = -7.1%), 200 m (from 31.30 s to 29.05 s = -7.1%); and 400 m (from 71.60 s to 66.24 s = -7.4%). The correlation between vertical jump parameters and sprint performance results was large to very large for the 100 m and 200 m events (r = 0.55-0.87).

Discussion

The Para athlete demonstrated improved performance over two seasons and didn't sustain any injuries. These findings suggest that monitoring jump performance is a valuable and practical method for tracking training loads and predicting sprint performance. Further, longitudinal studies are needed to investigate the applicability of vertical jumps as a tool for coaches to monitor training load and performance across athletes with CP from various track classifications and event types.

Season changes in performance of upper limbs and trunk in para swimmers

OBJECTIVES

To evaluate upper limb performance, trunk extensor endurance, and serratus anterior strength in para swimmers over a sports season.

DESIGN

A cohort study conducted over eleven months.

SETTINGS

Three assessments were performed at pre-season, mid-season, and post-season, evaluating the CKCUEST, Sorensen Test, and isometric strength of the serratus anterior.

PARTICIPANTS

Twelve para swimmers from a sports center.

MAIN OUTCOME MEASURES

Generalized Mixed Models were used to assess seasonal changes and the influence of sex, age, type of impairment, and season phase. Coefficients of variation for each variable were calculated along with 95% confidence intervals (CIs), with a 5% significance level.

RESULTS

Sorensen Test values decreased during the season (C: 22.0; CI: 33.9 to -10.4; p < 0.01). A serratus anterior isometric strength difference was observed post-season between para athletes with motor impairments and those with visual/intellectual impairments on the dominant side (C: 3.3; CI: 6.2 to -0.5; p = 0.02).

CONCLUSION

Sorensen Test values declined in mid-season, and para athletes with motor impairments showed lower serratus anterior strength in post-season. CKCUEST values remained stable throughout the season.

Comparative Analysis of Injury and Illness Rates Among Team USA Athletes at the Tokyo 2020 Summer Olympic and Paralympic Games

Background

Previous research has reported higher rates of both injury and illness among Paralympic athletes compared with Olympic athletes during the Winter Olympic and Paralympic Games, but no studies have directly compared injury and illness incidence between Olympic and Paralympic athletes competing in a Summer Games.

Purpose

To compare injury and illness rates between Olympic and Paralympic Team USA athletes competing in the Tokyo 2020 Olympic and Paralympic Games.

Study Design

Descriptive epidemiology study.

Methods

All injuries and illnesses that occurred among the Team USA athletes competing in the Tokyo 2020 Summer Olympic or Paralympic Games were documented. A total of 701 Team USA athletes (53.6% female) competed in the Tokyo 2020 Summer Olympic Games, across 34 different sports. For the Tokyo 2020 Summer Paralympic Games, a total of 245 athletes (51.6% female) competed across 20 sports. Incidence rates (IRs) per 1000 athlete-days were calculated according to sex, sport, anatomic location, and illness type. IR ratios (IRRs) were calculated to compare IRs between male and female athletes and between Olympic and Paralympic athletes.

Results

Overall, there were no differences in injury incidence (IRR, 1.18; 95% CI, 0.84-1.68) or illness incidence (IRR, 0.68; 95% CI, 0.41-1.15) between Olympic and Paralympic athletes. Male Paralympic athletes were less likely to sustain an illness compared with female Paralympic athletes (IRR, 0.35; 95% CI, 0.11-0.90).

Conclusion

There were no differences in injury or illness rates between Olympic and Paralympic Team USA athletes competing at the Tokyo 2020 Summer Games, contrary to previous comparisons among winter sport athletes. These results challenge the prevailing notion that Summer Paralympic athletes are at greater injury and illness risk, suggesting that factors beyond Olympic or Paralympic Games participation influence health concerns.

Sport-related concussion research agenda beyond medical science: culture, ethics, science, policy

The Concussion in Sport Group guidelines have successfully brought the attention of brain injuries to the global medical and sport research communities, and has significantly impacted brain injury-related practices and rules of international sport. Despite being the global repository of state-of-the-art science, diagnostic tools and guides to clinical practice, the ensuing consensus statements remain the object of ethical and sociocultural criticism. The purpose of this paper is to bring to bear a broad range of multidisciplinary challenges to the processes and products of sport-related concussion movement. We identify lacunae in scientific research and clinical guidance in relation to age, disability, gender and race. We also identify, through multidisciplinary and interdisciplinary analysis, a range of ethical problems resulting from conflicts of interest, processes of attributing expertise in sport-related concussion, unjustifiably narrow methodological control and insufficient athlete engagement in research and policy development. We argue that the sport and exercise medicine community need to augment the existing research and practice foci to understand these problems more holistically and, in turn, provide guidance and recommendations that help sport clinicians better care for brain-injured athletes.

Exploring Research on Competitive Para-cyclists and Its Related Factors: A Scoping Review

This scoping review aimed to explore the characteristics and performance factors of competitive para-cyclists. A systematic search for studies on competitive para-cycling on WOS, PubMed, SPORTDiscus, and Scopus was performed until December 2023. The following five methodological phases were followed: (i) identifying the research question, (ii) identifying relevant studies, (iii) study selection, (iv) charting the data, and (v) collating, summarizing, and reporting the results. A systematic search across multiple databases was performed until March 2024. Five methodological phases were employed: identifying the research question, relevant studies, study selection, charting data, and summarizing results. A total of 36 relevant studies were selected. Three main research themes emerged: sport performance ( n = 15), biomechanics ( n = 12), and physical and mental health ( n = 9). Despite progress, gaps were identified, particularly in physiological response to exercise, fitness, and training. Biomechanics studies focused on prosthetic use and aerodynamics, mostly involving lower-limb amputees and simulated tandem competition. Injury risk in para-cycling appeared comparable to able-bodied cycling, but comprehensive studies considering confounding variables are needed. Overall, while research on para-cycling is growing, more studies with larger and diverse samples across all sport classes are essential to advance scientific understanding in this field.

Adaptive Sports and Recreation in Persons with Limb Loss/Limb Deficiency

Adaptive sports are a vital component in the continuum of rehabilitation for people with limb loss/limb deficiency (LL/LD), across the lifespan. Identifying the barriers and understanding health care disparities inform ways to help people with LL/LD stay active and reach their health and wellness goals. Building knowledge in adaptive sports helps facilitate having a person go beyond activities of daily living and basic locomotion. Considering the participant, requirements of the sport, and the activity-specific prosthesis/equipment required leads to successful participation in adaptive sports.

Sports Injury Surveillance Systems: A Scoping Review of Practice and Methodologies

Background: Injury prevention/reduction strategies are driven by data collected through injury surveillance systems. The aim of this review was to describe injury surveillance systems that are used for ongoing surveillance in either a professional or amateur sporting environment. This was an update to a review done in 2015 to determine the gaps in injury surveillance. Methods: A systematic search process of five databases (MEDLINE, CINAHL, EMBASE, SCOPUS and ProQuest) was used to discover published research that presented methodological data about the injury surveillance systems implemented by clubs and organisations for ongoing surveillance. Inclusion criteria centred on the population under surveillance and the ongoing nature of that activity. Data extracted and summarised included the level of athlete under surveillance, the data collection mechanism and the personnel involved, the injury definitions applied and the date and country of origin to provide a comprehensive picture of the systems. Results: A total of 21 systems were documented as being used in ongoing injury surveillance, with 57% of these exclusively in the professional/elite landscapes and 33% at the amateur level. Surveillance systems cater for one sport per athlete entry so there is a gap in research for multi-sport athletes at the amateur level, especially where there is no early specialisation in a multi-sport participation environment. Conclusions: Research in this area will lead to a better understanding of subsequent injury risk for multi-sport athletes who have a higher athlete exposure than single-sport athletes.

High rates of respiratory illnesses upon arrival: lessons from Team USA at the Santiago 2023 Pan American and Parapan American Games

OBJECTIVE

To describe the incidence and characteristics of injuries and illnesses among Team USA athletes competing at the Santiago 2023 Pan American Games (PAG) and Parapan American Games (PPAG), with a particular focus on the incidence of respiratory illnesses and on injuries for sports new to the Olympic and Paralympic programmes.

METHODS

Illnesses and injuries occurring among the 870 Team USA athletes competing in the Santiago 2023 PAG or PPAG were documented within Team USA's Injury and Illness Surveillance system. Illness and injury incidence per 1000 athlete-days (ADs) and incidence ratios (IR) were calculated, both with 95% CIs.

RESULTS

Illness (IR 2.5, 95% CI 1.6, 3.9) and injury (IR 1.8, 95% CI 1.3, 2.5) rates were greater during PPAG compared with PAG. Illness rates were higher in the pre-opening ceremony period compared with the competition period for both PAG (IR 2.7, 95% CI 1.1, 5.9) and PPAG (IR 1.9, 95% CI 0.9, 3.8). Respiratory illness was the most common illness with 3.2% and 8.9% of all Team USA athletes reporting a respiratory illness during the PAG and PPAG, respectively. Sports that are relatively new to the Olympic/Paralympic programmes exhibited the highest injury rates during the Games: breaking (250.0 (91.7, 544.2) per 1000 ADs), Para taekwondo (93.8 (19.3, 274.0) per 1000 ADs) and surfing (88.9 (24.2, 227.6) per 1000 ADs).

CONCLUSION

Respiratory illness rates were the most common type of illness during both PAG and PPAG and were more likely to occur prior to competition starting. Our data have identified high injury risk populations (breaking, surfing, Para taekwondo) and timing (pre-opening ceremony period) for further risk factor analysis.

Injury incidence according to athlete impairment type during the 2012 and 2016 Summer Paralympic Games: a combined analysis of 101 108 athlete days

OBJECTIVES

The relationship between sport-related injuries and Para athlete impairment type has not yet been comprehensively studied. This study aimed to describe injury incidence according to athlete impairment type during the London 2012 and Rio 2016 Summer Paralympic Games, by sex, age, Games period, chronicity and anatomical area.

METHODS

A combined analysis of 7222 athletes was conducted comprising 101 108 athlete days, using pooled data. Internet sources were used to identify impairments of registered athletes. Impairment types: brain disorders (BD), limb deficiency, neuromuscular disorders (NMD), spinal cord-related disorders, visual impairment (VI) and 'all others' (OTH: impaired passive range of movement, intellectual impairment, leg length difference, short stature and unknown impairments). Results by impairment type are reported as univariate unadjusted incidences (injuries/1000 athlete days; 95% CIs). Statistical significance between impairment types was determined when 95% CIs did not overlap.

RESULTS

The overall crude unadjusted incidence of injury was 11.1 (95% CI 10.4 to 11.9), significantly higher in VI (13.7 (95% CI 11.0 to 15.7)) and NMD (13.3 (95% CI 11.1 to 16.1)) compared with BD (9.1 (95% CI 7.7 to 10.8)). Acute (sudden onset) (8.6 (95% CI 7.3 to 10.1)) and lower limb (6.6 (95% CI 5.4 to 8.1)) injuries were higher among athletes with VI, while athletes with NMD had a higher incidence of repetitive (gradual onset) (5.9 (95% CI 4.3 to 8.0)) and upper limb (6.9 (95% CI 5.2 to 9.0)) injuries compared with other impairments.

CONCLUSIONS

Incidence and type of injuries differed between athlete impairment types. Athletes with VI or NMD sustained the highest incidence of injury, and athletes with BD had the lowest. Findings of this study can inform the management of competition-related injuries in Para athletes.

Sports-Related Health Problems in Para-Sports: A Systematic Review With Quality Assessment

CONTEXT

Participation in sports is associated with a risk of sports-related health problems. For athletes with an impairment, sports-related health problems further burden an already restricted lifestyle, underlining the importance of prevention strategies in para-sports.

OBJECTIVE

To provide a comprehensive overview with quality assessment of the literature on sports-related health problems, their etiology, and available preventive measures in para-sports following the steps of the Sequence of Prevention.

DATA SOURCES

A literature search (in PubMed, Embase, SPORTDiscus, CINAHL and the Cochrane Library) was performed up to December 8, 2021, in collaboration with a medical information specialist.

STUDY SELECTION

The search yielded 3006 articles, of which 64 met all inclusion criteria.

STUDY DESIGN

Systematic review with quality assessment.

LEVEL OF EVIDENCE

Level 3.

DATA EXTRACTION

Two independent researchers carried out the screening process and quality assessment. One researcher extracted data, and the Sequence of Prevention categorized evidence.

RESULTS

A total of 64 studies were included, of which 61 reported on the magnitude and risk factors of sports-related health problems, while only 3 reported on the effectiveness of preventive measures. Of these, 30 studies were of high quality. Most studies (84%) included elite-level athletes. The reported injury incidence varied widely between sports (0-91 per 1000 athlete days) and impairment categories (1-50 per 1000 athlete days). The same applies to illness incidence with regard to different sports (3-49 per 1000 athlete days) and impairment categories (6-14 per 1000 athlete days).

CONCLUSION

This review shows the current vast range of reported sport-related health problems in para-sports. There is limited evidence concerning the severity of these sports-related health problems and inconclusive evidence on the risk factors. Lastly, the evidence regarding the development and effectiveness of preventive measures for para-athletes is sparse.

Development and implementation of an injury and illness surveillance system for team USA

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.

Epidemiology of adverse events related to sports among community people: a scoping review

OBJECTIVES

Numerous reports have described injuries and illnesses in competitive athletes, but studies on leisure-time physical activity and associated adverse events in the general population have not been adequately reviewed. This study aimed to summarise the previous findings on this topic.

DESIGN

Scoping review.

DATA SOURCES

PubMed and Ichushi-Web for articles in English and Japanese, respectively (13 April 2023).

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Articles on adverse events related to sports performed by 'individuals and groups active in the community' were included, whereas those on elite athletes, exercise therapy and rehabilitation, and school sports were excluded. Terms related to physical activity, exercise, sports and adverse events were used for the search strategies.

RESULTS

The literature search yielded 67 eligible articles. Most articles were from the USA, Japan and Australia. Running, scuba diving, rugby and soccer were the most commonly reported sports. Adults were the most common age category in the samples. The most commonly reported adverse events were injuries; only 10 articles reported diseases. 13 longitudinal studies reported the frequency of adverse events based on the number of events/participants×exposure.

CONCLUSION

Adverse events such as sports trauma, disability and certain diseases occur sometimes during sporting activities by residents; however, the articles identified in this review showed biases related to the countries and regions where they were published and the sports disciplines and types of adverse events reported, and articles reporting the frequency of adverse events were also limited. This highlights the need for more high-quality observational studies on diverse populations in the future.

Incidence of staff injury and illness at the Tokyo 2020 and Beijing 2022 Olympic and Paralympic Games

Objective

To report epidemiological data regarding injury and illness among the Team USA staff during the Tokyo 2020 Summer Olympic and Paralympic Games and Beijing 2022 Winter Olympic and Paralympic Games.

Methods

A retrospective review of all Team USA staff (total staff, N=1703 (62.5% female); total staff days (SD)=34 489) medical encounters during the Tokyo 2020 Games and Beijing 2022 Games was conducted. Details related to injury and illness were evaluated. Incidence with 95% CI per 1000 staff days were calculated.

Results

A total of 32 illnesses (incidence [95% CI] 0.9 [0.6, 1.2]) and 23 injuries (incidence 0.7 [0.4, 0.9]) were sustained by the Team USA delegation staff members during the Tokyo 2020 Games and Beijing 2022 Games. Female staff reported more illnesses (illnesses proportion (IP) 2.9%; incidence 1.4 [0.8, 2.0]), while male staff incurred more injuries (IP 1.8%; incidence 0.9 [0.5, 1.3]). When stratified by physiological system, dermatological and infectious were the most common systems involved with illness (IP 0.5%; incidence 0.2 [0.1, 0.4]). Injuries to the upper limb were most common (IP 0.3%; incidence 0.3 [0.1, 0.5]).

Conclusion

Injury and illness rates among the Team USA staff during the Tokyo 2020 Games and Beijing 2022 Games were low, but notable. Knowledge of injury and illness risks contributes to staffing decisions and prevention strategies for staff supporting athletes during competition.

Head impact differences in blind football between Rio 2016 and Tokyo 2020 Paralympic Games: video-based observational study

OBJECTIVE

In Tokyo 2020 Paralympic Games, there were the rule and goal size changes at the blind football competition. This study aimed to compare the scoring and head impact characteristics during blind football competition between the Rio 2016 and Tokyo 2020 Paralympic Games using the official videos.

DESIGN

Video-based observational study.

PARTICIPANTS

In total, 36 blind football (men's football 5-a-side) game videos were obtained from the official International Paralympic Committee.

PRIMARY AND SECONDARY OUTCOME MEASURES

Head impact was defined as the sudden contact of any object with the head. Videos were analysed to assess the number of scores and head impacts along with their corresponding details (ie, round, playing phase, scoring situation, impact situation, occurrence area, impact object, head impact site, fall and foul).

RESULTS

The total number of goals scored at the Tokyo 2020 Paralympic Games was nearly double that at the Rio 2016 Paralympic Games. Regarding head impacts, a total of 2036 cases (Rio 2016, n=1105; Tokyo 2020, n=931) were evaluated. Significant differences were observed in head impact characteristics between the Rio 2016 and Tokyo 2020 Paralympic Games among seven outcomes (round, scoring situation, impact situation, occurrence area, impact object, site of head impact and fall).

CONCLUSIONS

Compared with the Rio 2016 Paralympic Games, the Tokyo 2020 Paralympic Games showed an increase in the number of points scored and different head impact characteristics.

Year-round injury and illness surveillance in UK summer paralympic sport athletes: 2016-2019

OBJECTIVE

To identify the priority injuries and illnesses across UK summer Paralympic World Class Programmes (WCP).

METHODS

Four years (2016-2019) of electronic medical records from 360 athletes across 17 Paralympic WCP sports were analysed. Methods were based on the 2021 International Paralympic Committee translation of the original 2020 International Olympic Committee consensus statement for epidemiological recording and reporting. This included reporting incidence (count of injury per athlete year) and burden (time loss days per athlete year) of injuries by impairment category.

RESULTS

836 injuries and 453 illnesses were recorded during the surveillance period, accounting for 34 638 and 10 032 time-loss days, respectively. 216 (60%) athletes reported at least one injury, while 171 (47.5%) reported at least one illness. There were 0.9 injuries per athlete year, resulting in a mean injury burden of 38.1 days per athlete year. The lumbar/pelvis, shoulder and thoracic/ribs body region had the greatest incidence whereas the shoulder, lumbar/pelvis and wrist had the greatest injury burden. All impairment categories had shoulder or lumbar/pelvis as the body region with the greatest incidence, however the burden of body areas did not always reflect the incidence. Athletes reported 0.5 illnesses per athlete year, resulting in an average illness burden of 11.3 days per athlete year. The respiratory, gastrointestinal, dermatological and genitourinary organ systems had the greatest illness incidence.

CONCLUSIONS

To optimise health and performance in Paralympic sport athletes, system-wide mitigation initiatives should target priority injury problems occurring in the lumbar/pelvis, shoulder, thoracic spine/ribs and wrist. Illness types causing the greatest burden vary with impairment group, and illness mitigation initiatives should consider athlete impairment types in their design, while continuing to note the high incidence of respiratory and gastrointestinal illness across all impairments. Further research should examine associated risk factors and the influence of impairment categorisation.

Musculoskeletal Pain, Mood, and Sports Injury in Wheelchair Power Soccer Players

CONTEXT

Wheelchair Power Soccer (WPS) is the only team sport that allows the participation of people with severe physical disabilities who require the daily use of motorized wheelchairs. These individuals may live with chronic pain due to the characteristics of the disabilities and treatments, interfering with their health and limiting their participation in sports.

OBJECTIVES

To investigate the prevalence of musculoskeletal pain and its relationship with mood in WPS players and to analyze the incidence of traumatic injuries during a championship.

METHODS

A prospective, longitudinal study was carried out on 30 WPS athletes (93.33% male) with a mean (SD) (range) age of 22.37 (9.79) (47) years. Data collection was performed during a South American WPS Championship lasting 3 days, with: investigation of the presence of musculoskeletal pain and mood through a questionnaire; investigation of the occurrence of traumatic injuries through match observation; and confirmation of the occurrence of traumatic injuries through access to medical department records.

RESULTS

About 30% (n = 9/30) of the sample presented some pain on the day of evaluation, with an intensity of 5.67 (3.35) (10) points on the visual analog scale. The most common regions of pain were the lower back (13.3%, n = 4/30), thoracic (10%; n = 3/30), and cervical (10%; n = 3/30) areas of the spine. A total of 46.7% (n = 14/30) reported pain in the month before data collection but of less intensity (2.56 [4] [10] points), the most common regions being the lower limbs (20%; n = 6/30) and cervical spine (20%; n = 6/30). Among the between-group comparisons (ie, participants with pain vs without pain), no relationship was observed between mood state and pain. No traumatic injuries were identified during the competition.

CONCLUSION

The presence of musculoskeletal pain was common in WPS players, but it was not related to mood. As no traumatic injuries were observed during the championship, this modality seems to be safe for people with physical disabilities in general.

Occurrence of injuries and illnesses in athletes with a physical impairment; a forty-week prospective cohort study

OBJECTIVES

Currently, the knowledge about the epidemiology of sport-related health problems of athletes with a physical impairment is limited. Therefore, this study aims to describe the prevalence, incidence and severity of sport-related health problems of athletes with a physical impairment in the Netherlands over a one sport season.

DESIGN

Prospective cohort study.

METHODS

Athletes (n = 99) with a physical impairment participated in this study. After completing a baseline questionnaire, athletes started a 40-week health monitoring period, during which they completed the Dutch translation of the OSTRC Questionnaire on Health Problems every week. Based on the reported information, injury and illness prevalence, incidence, weekly cumulative severity score, weekly time loss from sport and the total burden were calculated.

RESULTS

A total of 368 health problems were reported by 95 athletes. These health problems consisted of 258 injuries and 110 illnesses. The average weekly prevalence of health problems was 48.0 %; for injuries 34.6 %, and illnesses 13.4 %. Differences were found when considering injury severity, with the highest severity scores for athletes with a limb deficiency. Furthermore, recreational athletes reported the highest injury severity scores, followed by athletes who competed nationally and athletes who competed internationally.

CONCLUSIONS

Data from this study show a high average weekly prevalence of health problems, and differences amongst various impairment categories and sport levels when considering the severity of injuries. These results add to the knowledge regarding sport-related health problem epidemiology in this population, indicating that impairment category and sport level should be taken into account when developing injury prevention strategies.

An Urgent Call for Concussion Incidence Measures in Para Sport for Athletes with Vision Impairment: A Narrative Review

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 usefulness of balance test in preseason evaluation of injuries in amputee football players: a pilot prospective observational study

Background

Low balance ability is generally associated with an increased risk of ligament injuries. It seems that assessing the level of stability in amputee football players can help evaluate the accompanying risk of sports injuries. Thus, the study aimed to examine the usefulness of the balance test in preseason evaluation by calculating between-group differences in stability parameters between injured and non-injured amputee players.

Methods

The study was designed as a pilot prospective observational study. Twenty-five elite amputee football players representing the Polish National Team and the highest division in Polish League completed one-leg preseason balance tests on the Biodex Balance System before the start of the football season. All players in this study were male, with an average age of 29 years (SD = 7.9), a stature of 174.2 cm (SD 5.2) and a body mass of 80.1 kg (SD = 13.1). Then, players were prospectively observed over one football season, and lower leg injury data were prospectively collected through the nine months. The between-group differences were tested using the non-parametric Mann-Whitney U test for players who sustained an injury (yes) and those who did not within the analysed season (no). Overall (OSI), medial-lateral (MLSI), and anterior-posterior stability index (APSI) were analysed as primary outcomes.

Results

The preseason values of the balance tests were not predictive (p > 0.05) regarding sustaining an injury during the season. No between-group differences were noted for any analysed outcomes (p values ranged from 0.093 to 0.453).

Conclusions

Although static balance tasks offer a chance to make a preliminary assessment of injury prediction in amputee footballers, in overall, the balance test results cannot be regarded as the sole predictive injury risk factor in amputee football.

Overhead and Wheelchair Sport-Related Injuries in Para Athletes: Interplay Between Disability and Sport-Specific Factors

ABSTRACT

With the increasing opportunities for people with disabilities to engage in competitive Para sports, it becomes imperative to understand the injury consequences that may impact both sports participation and daily life activities. This narrative review aims to examine the intrinsic and extrinsic risk factors inherent in overhead and wheelchair summer Para sports, while also exploring prospective avenues for implementing prevention strategies. By understanding the injury epidemiology in this cohort of Para athletes, this review aims to explore the intricate interplay between the athletes' underlying disability with sport-specific factors, such as how wheelchair use might amplify injury susceptibility. Specifically, we highlight the impact of impairment, daily activity, and workload or discipline-induced overuse on injury occurrence, as well as how surveillance methods can be tailored to this population. In this regard, we propose practical injury surveillance methods that encompass a sensitive injury definition, severity assessment, incidence rate calculation, and the recording of adaptive equipment (e.g., type of wheelchair) and workload monitoring. It is worth noting that studies of prospective injury surveillance systems coupled with workload monitoring within a dedicated Para sport web-based platform are scarce. To establish a comprehensive understanding of Para athlete health, the monitoring framework should incorporate regular athlete follow-ups and facilitate knowledge transfer.

Prevalence and incidence of health problems and their characteristics in Brazilian para athletes: A one-season single-center prospective pilot study

BACKGROUND

Para athletes experience high prevalence and incidence of health problems related to sport. Despite this, there are few longitudinal studies.

OBJECTIVE

To describe the characteristics, prevalence, incidence, and severity of health problems in para athletes from one of the Brazilian Paralympic Reference Centers during a sports season and to compare the prevalence of health problems between para athletics, para powerlifting, and para swimming.

METHODS

This prospective pilot study was conducted from October 2019 to March 2020. The Oslo Sports Trauma Research Center Questionnaire on Health Problems was used to record injuries and illnesses every week for 24 weeks. The characteristics, prevalence, incidence, and severity of health problems were described for each modality. The prevalence of health problems was compared among the three sport modalities.

RESULTS

Thirty-five para athletes participated. Most of the injuries occurred in the shoulder, and most illnesses caused respiratory and gastrointestinal symptoms. The average weekly prevalence and the incidence rate of health problems were 40.6% (95% CI 17.0-64.4) and 12.7 (95% CI 9.6-15.9) per 1000 athlete hours, respectively. Para powerlifting had the highest prevalence of all and substantial health problems; para swimming had the lowest prevalence of injuries; and para athletics had the lowest prevalence of illnesses.

CONCLUSIONS

This group of Brazilian para athletes showed a high prevalence and incidence of health problems throughout the season. Para athletics, para powerlifting, and para swimming each had a different prevalence of injuries and illnesses.

Acute and Chronic Injury Patterns in Competitive Paraclimbing Sports

OBJECTIVE

This is the first study to evaluate sport-related injuries in competitive Paraclimbing athletes with the aim of creating a medical database for future research on injury prevention.

DESIGN

This was a descriptive epidemiology study. Data collection took place in two parts. In the first part, an online survey ( n = 81) was conducted. The second part was undertaken during three competitions ( n = 273) of the 2021 International Federation of Sport Climbing Paraclimbing competitions. Injury severity grading was determined using the Climbing Injury Score of the International Federation of Sport Climbing.

RESULTS

In the online survey, 76 injuries were reported: 62% acute and 38% chronic injuries. Injury severity was as follows: 21 scored 1, 34 scored 2a, 19 scored 2b, and 2 scored 3. The most injured body regions were the upper extremity (66%) with shoulder injuries (29%) most common; 53% reported regular pain/discomfort during training/competition and 16% used nonsteroidal anti-inflammatory drugs regularly to prevent pain/discomfort when training. In the 2021 International Federation of Sport Climbing Paraclimbing competitions, eight injuries were recorded. Injury severity was as follows: seven scored 1 and one scored 2a. The most injured body region was the upper extremity (47%). Overall, the calculated climbing time was 975 hrs, and injury incidence risk was 8.21 per 1000 hrs.

CONCLUSION

Compared with nondisabled climbers, the injury pattern seems to be sport dependent but influenced by the unique impairments of the athletes. In Paraclimbing competitions, the injury severity is mostly mild, with an overall low injury incidence. A concern is the number of athletes with pain/discomfort during training/competition with regular nonsteroidal anti-inflammatory drug intake.

Team USA injury and illness incidence at the 2022 Beijing Winter Olympic and Paralympic Games

OBJECTIVE

The purpose of this study was to determine the injury and illness incidence from Team USA athletes from the 2022 Beijing Winter Olympic and Paralympic Games and assess any sex-based differences or differences between Olympic and Paralympic athletes.

METHODS

Team USA Olympic (n=231, 48.5% female) and Team USA Paralympic (n=63, 22.2% female) athletes had medical encounters documented during the Games. Injuries and illnesses were defined according to the 2020 International Olympic Committee Consensus Statement and reviewed for accuracy by a physician. Incidence rates were calculated per 1000 athlete-days and further analysed by sex, sport, anatomical location, type of illness, injury event and injury mechanism, with incident rate ratios (IRRs) used for group comparisons.

RESULTS

There were no differences in illness (Olympic illness, IRR=0.99 (95% CI 0.48 to 2.07), p=0.998; Paralympic illness, IRR=1.43 (95% CI 0.41 to 4.97), p=0.572) or injury rates (Olympic injury, IRR=0.63 (95% CI 0.39 to 1.03), p=0.062; Paralympic injury, IRR=1.01 (95% CI 0.43 to 2.35), p=0.988) between male and female (reference group) athletes. However, Olympic athletes had significantly lower illness (IRR=0.41 (95% CI 0.22 to 0.76), p=0.003) and injury (IRR=0.56 (95% CI 0.37 to 0.87), p=0.009) risks compared with Paralympic athletes.

CONCLUSION

No significant sex-related differences in injury or illness were detected in Team USA Olympic or Paralympic participating in the 2022 Beijing Winter Games. However, Paralympic athletes exhibited higher rates of injury and illness compared with their Olympic counterparts. This study highlights delegation-specific epidemiological data which may facilitate more focused approaches for injury and illness prevention.

Head Impact in Blind Football During the Tokyo Paralympics: Video-Based Observational Study

ABSTRACT

Head impacts during blind football are common and have high injury rates; however, their characteristics and impact are still underreported. We compared head impact characteristics in blind football players with and without falls on all 18 official blind football match videos from the Tokyo 2020 Paralympic games. The rate of head impacts with falls was significantly higher in the preliminary phase, offense phase, and during dribbling. Significant differences in the region of the head impacted were also observed among the impact subjects/objects. The findings in this study would contribute to the development of injury prevention measures to minimize head injuries from head impact in blind football.

Shoulder pain in wheelchair basketball athletes: A scoping review

CONTEXT

Wheelchair basketball athletes have increased upper limb stress, which frequently leads to shoulder pain.

OBJECTIVE

The purpose of this scoping review was to summarize the existing literature on shoulder pain in wheelchair basketball athletes.

METHODS

We searched PubMed, Cochrane Library, Scopus, and PEDro databases for studies performed between January 1990 and February 2021. Two independent reviewers screened the studies according to the inclusion and exclusion criteria. Participants' characteristics and results were extracted from the study.

RESULTS

The initial database search yielded 2455 articles, 11 of which met the inclusion criteria. This review included seven studies in its final analysis; among them, seven determined the prevalence and incidence of shoulder pain, five investigated the factors and mechanisms contributing to shoulder pain, and two reported the treatment and preventive measures. The prevalence of shoulder pain in wheelchair basketball players ranged from 38%-75%, and the incidence of shoulder pain was 14%. Factors/mechanisms included overuse, decreased trunk control, and driving posture. Treatment/preventive measures consisted of shoulder and scapular muscle strengthening and stretching exercises. However, the literature on treatment/prevention was scarce, and its effectiveness was unclear.

CONCLUSION

This scoping review confirmed the high prevalence of shoulder pain in wheelchair basketball players; despite this, studies regarding treatment or preventive measures remain lacking. Further studies investigating the mechanism of onset of shoulder pain and the effectiveness of therapeutic and preventive measures are needed in the future.

The Underlying Mechanisms of Sports Injuries in Paralympic Goalball: A Mixed-Method Study

OBJECTIVE

Data from the Paralympic Games indicate a fluctuating injury incidence in the Paralympic sport goalball, but the mechanisms behind have not been explored. The aims of this study are to (1) quantitatively analyze goalball injuries reported in the London 2012 and Rio 2016 Paralympic Games, (2) qualitatively explain the differences between both games, and (3) qualitatively assess general injury mechanisms and prevention opportunities of injuries in Goalball.

DESIGN

This is a mixed-method study. Injury incidence rates were analyzed from data collected during the 2012 and 2016 Paralympic Games. Then, semistructured interviews of games participants qualitatively explored injury mechanisms and prevention opportunities.

RESULTS

A reduction of injuries occurred from 2012 (incidence rate, 19.5; 95% confidence interval, 12.5-26.5) to 2016 (incidence rate: 5.6; 95% confidence interval, 1.7-9.5). In both games, acute traumatic injuries were most common. Female athletes reported higher rate of injuries compared with males ( P = 0.05). Qualitative data revealed that causes of injuries were collisions, overuse, and poor physical conditioning. The differences between the two games were explained by equipment, environment, and preparations.

CONCLUSIONS

The result from this study indicates that injuries in goalball are multifactorial. Ultimately, the mixed-method data from this study can help the sports context develop prevention measures.

Epidemiology of injuries and illnesses in elite wheelchair basketball players over a whole season - a prospective cohort study

BACKGROUND

Wheelchair basketball is an adaptation of pedestrian basketball and one of the most popular Paralympic sports worldwide. The epidemiology of health problems in wheelchair basketball has been prospectively studied only during the Paralympic Games, the 2018 World Championships, the 2021 South America Wheelchair Basketball Championship, and one season of two American intercollegiate wheelchair basketball teams. The objective of the study was to prospectively monitor and analyze the prevalence, incidence, burden, and characteristics of injuries and illnesses in a wheelchair basketball league during an entire season for the first time.

METHODS

All players of the highest German wheelchair basketball league (Bundesliga) were invited to participate in the study. Included players completed the Oslo Sports Trauma Research Center Questionnaire once a week during the entire season 2020/21 to report health problems. Exposure was captured by self-reported training time and officially-recorded competition time.

RESULTS

Sixty of 117 players (51%, 47 male, 13 female) of the national league participated with an average response of 93%. Seventy health problems (5.5/1000 exposure hours [95% CI: 4.9-6.1]) were reported, including 54 injuries and 16 illnesses. Prevalence of health problems was 60% (95% CI: 48-72). Most injuries affected the shoulder (32% of all injuries), cervical spine/neck (17%), and hand (13%). More overuse injuries (2.9/1000 exposure hours [95% CI: 2.5-3.3]) than acute injuries (1.3/1000 exposure hours [95% CI: 1.0-1.6]) occurred. Of all health problems, 53% were associated with time-loss. The incidences of all health problems, illnesses, injuries, and overuse injuries were higher in women than in men.

CONCLUSIONS

Characteristics and frequency of injuries and illnesses during wheelchair basketball season differed from those during major wheelchair basketball tournaments. The high proportion of overuse injuries and the higher injury rates in women should be regarded in the development of individualized prevention measures. Since results from previous studies during major tournaments are only partially comparable to wheelchair basketball league play, further studies should follow.

Injuries and Illnesses During the 53rd FIS Nordic World Ski Championships 2021 in Oberstdorf: A Prospective Cohort Study

OBJECTIVE

For the 3 Nordic ski disciplines of cross-country skiing, Nordic combined, and ski jumping, data on injuries and illnesses during major sporting events only exist from the Winter Olympics of 2010 to 2018. So far, an investigation has not been conducted during the Nordic World Ski Championships.

DESIGN

Prospective cohort study.

SETTING

Fédération Internationale de Ski (FIS) Nordic World Ski Championships 2021 in Oberstdorf, Germany.

PARTICIPANTS

Overall, 663 athletes from 65 nations participated in the FIS Nordic World Ski Championships 2021. The study population included 344 athletes from 32 nations.

INTERVENTIONS

National medical teams were invited to report daily all newly incurred or exacerbated injuries and illnesses.

MAIN OUTCOME MEASURES

All reported injuries and illnesses that occurred during the championships from February 23 until March 7, 2021, were analyzed. Injury and illness rates were calculated with 95% confidence intervals (95% CIs).

RESULTS

The 32 reporting nations returned 88.4% of the daily report forms. The incidence of injuries was 4.7 (95% CI, 2.4-6.9) per 100 athletes in the 3 Nordic ski disciplines. The incidence of illness was also 4.7 (95% CI, 2.4-6.9) per 100 athletes with a relative proportion of infection-related illnesses of 31.3%.

CONCLUSIONS

Although the incidence of injuries of the Nordic disciplines was comparable with those of the 2010 to 2018 Winter Olympics, the incidence of illnesses was lower than during the previous 3 Winter Olympic Games with a lower rate of infection-related illnesses. This might be caused by the high hygiene measures due to the coronavirus disease 2019 pandemic.

Concussion through my eyes: a qualitative study exploring concussion experiences and perceptions of male English blind footballers

OBJECTIVES

Athletes with impairments play sports with a risk of sustaining head injuries and concussions. However, the scientific knowledge needed to improve care is lacking. This qualitative study explores English blind 5-a-side footballers' perceptions of concussion, concussion risks and prevention to improve para concussion care.

METHODS

Nine semi-structured interviews were conducted with male English blind footballers (six current and three retired). Data were analysed by thematic analysis using a six-stage approach.

RESULTS

Blind footballers were not sure about the number of concussions they had sustained. They lacked an understanding of what to experience when concussed, and they perceived the diagnosis and experience of a concussion to be different for a person without vision. Perceived concussion severity and previous concussion experiences were key concepts affecting their concussion reporting behaviours. Participants mentioned spatial orientation and sleep are important to function in daily life and were affected by concussions. However, these factors are not adequately included in current assessment tools or clinical guidance for sports-related concussions.

CONCLUSION

Blind footballers suggested the quality and accuracy of reported concussions were impacted by lack of concussion experience, knowledge and concomitant impairment. A better understanding of concussion symptoms and injury mechanisms will improve concussion reporting for athletes with visual impairments. These athlete insights should guide future studies and para sports governing body initiatives to improve concussion reporting, diagnosis and management in para athletes.

Incidence and burden of injury at the Tokyo 2020 Paralympic Games held during the COVID-19 pandemic: a prospective cohort study of 66 045 athlete days

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.

Analysis of wheelchair falls in team sports at the Paralympic Games: video-based descriptive comparison between the Rio 2016 and Tokyo 2020 games

OBJECTIVES

To identify the fall characteristics of athletes in wheelchair rugby and wheelchair basketball during the Tokyo 2020 Paralympic Games and descriptively compare these with those of the Rio 2016 Paralympic Games.

DESIGN

Cross-sectional analysis.

PRIMARY AND SECONDARY OUTCOME MEASURES

We obtained video footage from the International Paralympic Committee of the Tokyo 2020 Paralympic Games that included 8 teams from each of the 18 wheelchair rugby and 10 wheelchair basketball games (men and women). The data were analysed to evaluate the number of falls, class difference (low or high pointer), time of play during the fall, phase of play, contact with other athletes, fall direction, fall location and the body part that first contacted the floor during the fall. These data from the Rio 2016 and Tokyo 2020 games were compared.

RESULTS

Overall, 430 falls (rugby, 104; men's basketball, 230 and women's basketball, 96) occurred (average per game ±SD: 5.8±3.1, 23.0±5.4 and 9.6±5.0, respectively). Significant differences in class, direction, fall location and body part point of contact between the three sports were observed. In wheelchair rugby, falls occurred mainly in high pointers and tended to be more lateral due to contact. In wheelchair basketball, falls occurred more in female high-pointers and in male low pointers, with more forward falls due to forward contact. Unlike in the Rio 2016 games, no difference between the events based on the presence or absence of contact was observed in the Tokyo 2020 games.

CONCLUSIONS

The number of falls increased in Tokyo 2020 compared with Rio 2016, with no significant difference in the characteristics of falls between the Rio 2016 and Tokyo 2020 games. Only in men's wheelchair basketball, the number of falls in low pointers significantly increased in the Tokyo 2020 games when compared with that in the Rio 2016 games.

Analysis of Injuries and Wellness in Blind Athletes during an International Football Competition

Five-a-side football for blind people is the only adapted football modality present at the Paralympic games. Fa5 is a collaborative-opposition sport in which its participants play with no vision, which causes numerous impacts. At the London 2012 Paralympic Games, it was the sport with the highest incidence of sports injuries. The main objective of this work is to analyse the association between pain perception; spatio-temporal, mechanical, and metabolic workload with injuries; and wellness in players during an international Fa5 competition. The following variables, monitored during an International Fa5 Tournament, were analysed: general well-being, perception of pain and injuries, and the spatio-temporal and metabolic workload. The results show that the incidence of injuries increases as the tournament progresses, where injured players reported greater muscle pain and stress before the matches started. Besides, the players’ internal and external load did not explain the incidence of injury. Still, the values obtained in the wellness questionnaire, the perception of pain, and stress suggested they contributed to the incidence of injury.

Injuries in Judo Athletes With Disabilities: Prevalence, Magnitude, and Sport-Related Mechanisms

CONTEXT

The participation of judo athletes with disabilities in competitions has increased over the years as well as the burden of sports-related injuries and illnesses in this population. However, there is limited knowledge about sports-related injuries in judo athletes with different disabilities.

OBJECTIVE

To investigate the prevalence of injuries in judo athletes with disabilities, considering the different impairment groups, magnitude of injury (ie, mechanism, nature, and severity of injury), and specific body parts.

DESIGN

Cross-sectional study (level of evidence, 3).

SETTING

Brazilian Judo athletes with disabilities.

PATIENTS

Fifty-one judo athletes with disabilities (15 men and 36 women) participated in this study.

MAIN OUTCOME MEASURES

Data were obtained from an adapted injury report form. The prevalence of injuries was assessed, considering type of impairment, body parts, mechanisms, and severity as well as differences between male and female athletes, with the significance level set at P < .05.

RESULTS

The results demonstrated a high prevalence of injuries in female athletes with visual impairment (n = 11, 73.3%) and male athletes with amputations (n = 14, 38.8%). A high prevalence was found in the national group, especially for male athletes (n = 29, 80.5%). Among athletes who had injuries, 69.4% (n = 12) of male and 80.0% (n = 25) of female athletes' injuries occurred due to direct contact with other athletes, and 72.2% (n = 26) of male and 86.6% (n = 13) of female athletes' injuries were in the training environment. The magnitude of injuries ranged from moderate to severe for male and female athletes. The knee (n = 25, 49.0%) and shoulder (n = 12, 23.5%) were the body parts most affected by injuries in both male and female athletes.

CONCLUSION

A large percentage of judo athletes with disabilities reported experiencing an injury during the previous 2 years; percentages were greater in athletes with visual and physical impairment. Moreover, most injuries occurred in the knee or shoulder, during training, and in direct contact with other athletes and were of severe magnitude.

Electromyography, Wavelet Analysis and Muscle Co-Activation as Comprehensive Tools of Movement Pattern Assessment for Injury Prevention in Wheelchair Fencing

The aim of the study was to determine the correct movement patterns of fencing techniques in wheelchair fencers. Through a comprehensive analysis, the key muscles in the kinematic chain exposed to potential injuries were identified. The study participants were 16 wheelchair fencers, divided into two groups representing two categories of disability: Group A (N = 7) comprising fencers with mild paraplegia, having freedom of movement of the trunk and arms; and Group B (N = 9) comprising fencers with a spinal cord injury and partial paresis of the arms. EMG and an accelerometer were used as the main research tools. The EMG electrodes were placed on the muscles of the sword arm as well as on the left and right sides of the abdomen and torso. The EMG signal was transformed using wavelet analysis, and the muscle activation time and co-activation index (CI) were determined. In Group A fencers, first the back and abdominal muscles were activated, while in Group B, it was the deltoid muscle. The wavelet coherence analysis revealed intermuscular synchronization at 8–20 Hz for Group A fencers and at 5–15 Hz for Group B fencers. In Group A fencers, the co-activation index was 50.94 for the right-side back and abdominal muscles, 50.75 for the ECR-FCR, and 47.99 for the TRI-BC pairs of upper limb muscles. In contrast, Group B fencers demonstrated higher CI values (50.54) only for the postural left-side muscle pairs. Many overload injuries of the shoulder girdle, elbow, postural muscles, spine, and neck have been found to be preventable through modification of current training programs dominated by specialist exercises. Modern wheelchair fencing training should involve neuromuscular coordination and psychomotor exercises. This will facilitate the individualization of training depending on the fencer’s degree of disability and training experience.

Sports Injuries Among Players of the Polish National Team in Amputee Football in the Annual Training Cycle

The aim of the study was to determine the frequency, type and origin of the occurrence of injuries in amputee football. The studied group comprised all members of the Polish national amputee football team (n = 25). During the 9-month observation period, 13 players incurred 22 injuries. The incidence proportion was 48.0 per 100 athletes (95% Cl, 28.4-67.6) and the incidence rate was 5.73 per 1000 athlete-days (95% Cl, 3.33-8.12). The study showed that 32.8% of the injuries were to the thigh, 13.6% to the ankle, and 9.1% to the knee. The obtained results indicate that amputee football players rather frequently incur play-related injuries, but a single athlete incurs relatively few of them, with the lower limb being most commonly injured.

Injury and Injury Prevention in United States Para Swimming: A Mixed-Methods Approach

BACKGROUND

Para swimming has experienced increased participation in recent years. Injury and injury prevention research on Para swimmers is lacking compared to swimmers without impairment.

PURPOSE

This study aimed to gather data in Para swimmers on typical injuries, injury prevention programs, and attitudes toward injury and injury prevention in this population.

STUDY DESIGN

Cross-sectional, mixed-methods design evaluating injuries, injury management, and injury prevention in elite Para swimmers in United States (U.S.).

METHODS

Para swimmers on the U.S. Paralympics Swimming National teams at multiple competition levels were invited to complete an online survey. Qualitative interviews with six U.S. Paralympics National team Para swimmers were conducted to provide detail on athlete experiences with injury and prevention.

RESULTS

Twenty-one of 56 surveys were returned: 11 of 21 participants (52.4%) reported experiencing an injury that altered their weekly training. All (21/21) reported participating in strength training and 19 of 21 (90.5%) reported incorporating stretching into their training regimen, although strengthening/stretching regimens included routines that may not have been specifically targeted toward injury prevention. Six of 21 (28.6%) reported participation in an injury prevention program. Qualitative interview themes included the impact of swimmers' compensated body mechanics on injury risk, the value of individualized injury prevention programs, and the importance of knowledgeable coaching and rehabilitation staff.

CONCLUSIONS

Injury prevention programs are important components in Para swimming training although they are underutilized based on responses in this study. These programs should be individualized to address swimming biomechanics and athlete-specific impairments. Increasing coaching knowledge and access to individualized programs may reduce injury prevalence among this at-risk population.

LEVEL OF EVIDENCE

3.

Adaptive Cycling: Injuries and Health Concerns

Para-cycling has high rates of acute injuries. The underlying medical conditions of para-athletes predispose these cyclists to injury patterns and sequelae different from those of their able-bodied counterparts. Such injuries include an increased incidence of upper-extremity and soft tissue injuries, along with predisposition for respiratory, skin, genitourinary, and heat-related illnesses. There are no validated sideline assessment tools or return-to-play protocols for sports-related concussion in wheelchair user para-athletes or those with balance deficits. Para-cyclists may be at increased risk for relative energy deficiency in sport due to competitive pressure to maintain certain weights and increased incidence of low bone mineral density.

Analysis of Grip Amplitude on Velocity in Paralympic Powerlifting

(1) Background: Paralympic Powerlifting (PP) is a Paralympic modality that is predominantly about developing maximal force, as there are athletes who lift three times their body weight. Our objective was to evaluate the averages of the velocity for 30% and 50% of 1 Maximum Repetition (1 RM) on different amplitudes of the footprint in PP athletes; (2) Methods: The intervention happened over two weeks, with the first being devoted to the familiarization and testing of 1 RM, while in the second week, through the use of a linear Encoder, tests of velocity average (VA), velocity average propulsive (VAP), and velocity peak (VP) were carried out with loads of 30% and 50% of a maximum repetition 1 RM for 1× of the biacromial distance (BAD) 1.3 × BAD, 1.5 × BAD; (3) Results: There was a significant difference in the average velocity of 1 × BAD (1.16 ± 0.14 m/s, 1.07-1.26 IC; η2p 0.20) when compared to 1.3 × BAD (1.00 ± 0.17 m/s, 0.90-1.09 IC; η2p 0.20) over 30% of 1 RM. For the other velocity variables for 30% and 50% of 1 RM with different grip amplitudes, there were no significant differences; (4) Conclusions: In PP, the 1 × BAD footprint contributes significantly to VA at 30% of 1 RM when compared to the 1.3 × BAD and 1.5 × BAD footprints. For loading at 50% of 1 RM the VA, VAP and VP decreased when compared to 30% of 1 RM, to the extent that the VAP and VP generated with the 1.3 × BAD and 1.5 × BAD footprints were higher than those with 1 × BAD, other than for VA 50% of 1 RM, where the 1 × BAD footprint was superior to the others.

Illness and injury among Norwegian Para athletes over five consecutive Paralympic Summer and Winter Games cycles: prevailing high illness burden on the road from 2012 to 2020

OBJECTIVE

To describe the illness and injury pattern of Norwegian Para athletes over five consecutive Paralympic Summer and Winter Games cycles and to identify which health problems should be targeted in risk management plans with respect to impairment types.

METHODS

We monitored athletes from 12 to 18 months prior to each Game using a weekly online questionnaire (Oslo Sports Trauma Research Center-H2 (OSTRC-H2)). We asked them to report all health problems they had experienced in the preceding 7 days, irrespective of their consequences on their sports participation or performance and whether they had sought medical attention.

RESULTS

Between 2011 and 2020, 94 candidate athletes were included in this monitoring programme and prepared to represent Norway; of these, 66 (71%) were finally selected for multiple Paralympic Games. The overall response rate to the weekly questionnaires was 87%. At any given time during the five observation cycles, 37% of the athletes (95% CI 36% to 38%) reported having at least one health problem. Athletes with neurological impairments (n=51) lost 10 days per year due to respiratory problems (95% CI 9 to 11) compared with 9 days (8-10) among those with musculoskeletal impairments (n=37). Gastrointestinal problems caused a time loss of on average 4 days per year in athletes with neurological impairments versus 1 day in athletes with musculoskeletal impairments (mean difference 2.7 days, 2.1-3.3). Musculoskeletal injuries generated a high burden for both athlete groups, in particular, to the elbow, shoulder and lumbosacral regions.

CONCLUSION

At any given time, nearly two out of five elite Norwegian Para athletes reported at least one health problem. Respiratory tract and other infections; gastrointestinal problems, injuries to the shoulder, elbow and lumbosacral regions represented the greatest health burden. Our findings can help guide the allocation of clinical resources, which should include a broad network of medical specialists, together with dieticians and physiotherapists, to meet the health challenges in Para athletes.

Injuries and Illnesses Observed in Athletes from Beginner to Elite Levels at the 18th National Sports Festival for Persons with Disabilities in Japan

Objectives

: This study aimed to describe the injuries and illnesses that occurred at the 18th National Sports Festival for Persons with Disabilities in Japan, which was attended by more than 3000 athletes from beginner to elite levels.

Methods

: Records from medical stations set up at the venues for each sport were reviewed. The incidence rates (IRs) were calculated as the number of medical station visits per 1000 athlete-days. The backgrounds of injuries and illnesses were investigated.

Results

: In total, 3277 athletes attended the festival, and 134 eligible medical station visits were analyzed. Overall, 102 athletes complained of injuries. For the whole schedule of the festival, IRs were 15.5 for injuries and illnesses and 11.8 for injuries alone. For injuries and illnesses, high IRs were seen in soccer (39.8), basketball (25.6), and foot baseball (22.4); for injuries alone, high IRs were also seen in soccer (33.6), basketball (25.6), and foot baseball (16.8). The most frequent symptoms were internal symptoms (n=32), contusions (n=30), and wounds (n=24). Joint sprains occurred in various sports, whereas muscle strains happened mainly in disciplines demanding sprinting or high agility. Of the 55 cases that occurred during events or public rehearsals, 45 were traumatic, whereas the relation to sports activities was not described in 51 cases. Of participants with internal symptoms, 11 were suggested to have viral infections. We identified 21 injuries caused by falls.

Conclusions

: Minor trauma and viral infection were the most frequently observed symptoms among injuries and illnesses, respectively. Structured medical records and organized surveillance systems should be utilized to improve data collection and understand the onset of injury and illness.

Incidence of sports-related concussion in elite para athletes - a 52-week prospective study

Objective: To assess the 52-week incidence proportion and incidence rate of sports-related concussion (SRC) among elite Para athletes, and to analyze the injury mechanisms.Method: In total, 70 male and 37 female Swedish elite Para athletes (median age 29 years) with vision, physical and intellectual impairment, weekly self-reported sports-related injuries including concussion in an eHealth application adapted to Para athletes. Descriptive statistics were used to assess the incidence rate and incidence proportion. Chi-square statistics were used to analyze differences in the proportion of SRC.Results: A total of 13 SRC were reported: three athletes each sustained two SRC. The incidence proportion was 9.3% (95% CI 4.8-16.7), and the incidence rate 0.5 SRC/1000 hours (95% CI 0.3-0.9) of sports exposure. Athletes with vision impairment and female athletes reported a significantly higher proportion of SRC. A majority of the injuries (n = 9; 69%) occurred during sport-specific training. The injury mechanisms were collision with object (n = 7; 54%), collision with person (n = 4; 31%), and poor playing field conditions (n = 2; 16%).Conclusion: The incidence of concussion among elite Paralympic athletes is comparable to sports for able-bodied athletes. Athletes with vision impairment and female athletes reported a significantly higher incidence of SRC, and collisions were the most common injury mechanism. These results can form the basis for future preventive research studies.

Methods, challenges and benefits of a health monitoring programme for Norwegian Olympic and Paralympic athletes: the road from London 2012 to Tokyo 2020

OBJECTIVE

To describe the implementation of a health monitoring programme for Norwegian Paralympic and Olympic candidates over five consecutive Olympic and Paralympic Games cycles (London 2012, Sochi 2014, Rio de Janeiro 2016, PyeongChang 2018 and Tokyo 2020).

METHODS

Athletes were monitored for 12-18 months preparing for the games using a weekly online questionnaire (OSTRC-H2) with follow-up by physicians and physiotherapists, who provided clinical care and classified reported problems.

RESULTS

Between 2011 and 2020, 533 Olympic and 95 Paralympic athletes were included in the monitoring programme, with an overall response of 79% to the weekly questionnaire and a total observation period of 30 826 athlete weeks. During this time, 3770 health problems were reported, with a diagnosis rate of 97%. The average prevalence of health problems at any given time was 32% among Olympic athletes and 37% among Paralympic athletes. Acute traumatic injuries represented the greatest burden for Olympic team sport athletes, and illnesses represented the greatest burden for Olympic endurance and Paralympic athletes. On average, Olympic athletes lost 27 days and Paralympic athletes lost 33 days of training per year due to health problems.

CONCLUSION

Conducting long-term health monitoring of Olympic and Paralympic athletes is challenging, particularly because athletes travel frequently and often relate to many medical providers. This programme has been implemented and improved within Team Norway for five Olympic and Paralympic cycles and during this time we believe it has helped protect our athletes' health.