INJURIES IN ATHLETICS

Dr Juan Manuel Alonso MD PhD

Outline

• Background

• Methods

• Injury Rates

• Injury descriptors

• Risk Factors

• Limitations

• Future research directions

• Prevention Implications

• There have been recent studies on Athletics injury epidemiology.

• Osaka 2007 World IAAF Outdoors Championships FIRST INJURY SURVEILLANCE

• IAAF injury reporting system 2007-2013: 15 international championships

• There is a lack of prospective studies

– Bennell published Athletics prospective study in 1996

– Jacobsson published in 2012/13 another research

Background

Watson MD. Am J Sports Med 1987. Ahuja Br J Sports Med 1985. Bennell K. Aust J Sci Med Sport 1996. Jacobsson J. Br J Sports Med 2013. Alonso JM. Clin J Sports Med 2009. Feddermann-Demont N. Br J Sports Med 2014.

MethodsDifferences in

• Design: prospective Vs retrospective

• Population selection

• Observation period

• Injury Definition

• Data recording

• Reporting: incidences / exposure

All Season:

Incidence: 1.7-3 injuries/athlete/season

3.7-3.9 injuries/1000 h

Prevalence: 46-78% athletes injured/season

Recurrence: 8-33%

Subsequent Inj: 54%

42-47 % athletes sustain > 1 injury/season

Up to 10% athletes drop out during the season

Injury Rates

Watson MD. Am J Sports Med 1987. Ahuja Br J Sports Med 1985. Bennell K. Aust J Sci Med Sport 1996. Jacobsson J. Am J Sports Med 2012. Jacobsson J. Br J Sports Med 2013.

Competition:

• Incidence: 81.1 injuries/1000 registrations (time-loss 36.7)

– Highest in Combined events

(169 x 1000 registrations)

– Marathon (113) and

– Long (77.6) and middle distance (71.5).

• Lowest incidence was

– Throwing events (19.7)

– Jumps and short distances (43)

Injury Rates

Feddermann-Demont N. J. Br J Sports Med 2014.

Chime out dataDuring the season:

• Half to 2/3 of the squad will get injured

• Average: 2-3 injuries per athlete

Competition:

• 10% of your team could get injured

• More injured athletes at combined events, middle and long distance

Injury Descriptors

Onset

All Season

• 70-96 % Overuse

– 55% Gradual onset

– 41% Sudden onset

• 4-20% Traumatic

Competitions

• 60 % Overuse

– 37% Sudden

– 23% Gradual

• 30 % Traumatic

Sprint/Hurdles/Jumps/Combined events HIGHER % of Acute Injuries. However, Overuse >50%

Bennell K, Aust J Sci Med Sport 1996. Jacobsson J. Br J Sports Med 2013. Alonso JM, Med Sci Sports Exerc 2009. Alonso JM. Clin J Sports Med 2009. Alonso JM, Br J Sports Med 2012.

When?All Season

50

30

73

20

TRAINING COMPETITION

When?

Bennell Jacobsson

Bennell K, Aust J Sci Med Sport 1996. Jacobsson J. Br J Sports Med 2013.

.

• Lower extremity 75-89%

– Thigh All Season 21,5 %/ Competition 34.5 %

– Lower leg 15 %

– Foot 10 %

– Knee 10 %

• Injury location affected most frequently

– the thigh in Jumps, Sprints/Hurdles, Middle distance, Race walk and Combined events

– the foot in Marathon

– the leg in Long distance

– the upper extremity in Throws

Injury Site

Bennell K, Aust J Sci Med Sport 1996. Feddermann-Demont NJ, Br J Sports Med 2014.

Thigh 19-24%

Upper extremity 8-12%

Trunk 12-13%

Head & Neck 1-3%

Knee 13-15%

Lower leg 13-23%

Ankle 5-10%

Foot 6-8%

Hip & Groin 3-4%

Achilles tendon 4%

Alonso JM, Clin J Sports Med 2009.

Alonso JM, Br J Sports Med 2012.

.

Thigh 27-33%

Upper extremity 5-8%

Trunk 14%

Head & Neck 1%

Knee 7-10%Lower leg 11-20%

Ankle 6-8%

Foot 5-9%

Hip & Groin 6-8%

Achilles tendon 4-5%

Alonso JM, Clin J Sports Med 2009.

Alonso JM, Br J Sports Med 2012.

.

Hamstring Injuries Incidence

in Track and Field

0

10

20

30

40

50

60

70

80

90

THIGH INJURIES

Injuries/1000 competing athletes

Athletics Athletics Olympics Athletics FootballAll Injuries 2012 OG 2012 OG 2012

Inju

rie

s/1

00

0 c

om

pet

ing

ath

lete

s

Feddermann-Demont N. Br J Sports Med 2014. Engebretsen L. Br J Sports Med 2013.

Hamstring injuries in Athletics

• No data of recurrence

• No data on time-loss impact

Diagnosis

0 5 10 15 20 25 30

Thigh (Hamstring) Strain

Stress Fractures

Ankle Sprain

Overuse Knee Injuries

Achilles / Foot Tendinosis

Medial Tibial Stress Syndrome

Lumbar Pain

Hip (adductor) strain

Lower Leg Strain

Plantar Fasciitis

Competition

All Season

Ahuja Br J Sports Med 1985. Bennell K, Aust J Sci Med Sport 1996. Jacobsson J. Br J Sports Med 2013. Solaja A, Med Pregl 2013. Feddermann-Demont NJ Br J Sports Med 2014.

• Competition

– 45 % absence 1 day

– 30% absence 1-7 days

– 3% absence higher than 4 weeks

• All season 50 % absence higher than 3 weeks

• Subsequent / Recurrent injuries more severe than first/index injuries

• Catastrophic

– Pole Vault

– Throwing

Injury Severity

Jacobsson J. Br J Sports Med 2013. Feddermann-Demont NJ Br J Sports Med 2014. Alonso JM, Br J Sports Med 2012

• Competition

– Athletes presenting with health problem

– Training more 12 h/week

– Combined events

• All season– Severe injury (3 weeks) previous season

– Higher training hours and hard workouts

– Highest ranked athletes

– Increased age

– Higher flexibility

– Menstrual disturbances

Risk Factors

Bennell K, Aus J Sci Med Sport 1996. Jacobsson J. Br J Sports Med 2013. Feddermann-Demont NJ Br J Sports Med 2014. Edouard P, Br j Sports Med 2014

Limitations

• Competitions mainly– World, Europe

– Lack of data from Africa, Asia, America, Oceania

– Newly incurred injuries

– Lack of information on overuse injuries

• Scarce prospective studies in athletics

• Prospective whole season surveillance

– Appropriate methods

– Overuse injuries

• Prevention interventions on:

– Hamstring Injuries

– Ankle injuries

– Stress Fractures

– Tendinopathies

Future Research Directions

Prospective Whole Season Cohort Studies

CHALLENGES:

• Athletics Training Structure– Clubs seldom professional

– Rarely employ any health staff

– Athletes live apart from the club

– Athletes train individually/groups not linked to clubs

– Some (few) athletes have their own medical team

• Specificities Athletics Culture– Tendency to medical nomadism

– Lack of concern by the medical follow-up

• Not well structured Medical organisation around athletes– National Federations providing medical care ONLY in training camps or

domestic/international competitionsEdouard P, Branco P Alonso JM. Br j Sports Med 2014

• Special attention should be paid to injuries in:

– Combined events

– Long distance including Marathon

– Short Distance

• Future prevention studies should focus on Thigh Strain

• Improve understanding of injury mechanisms and risk factors

• Analyse efficacy of adapted preventive measures

Prevention implications

Conclusions

• On average, 1 out of each 12 registered athletes (81.1 injuries per 1000 registrations) suffered one injury during 2007-2012 international Athletics competitions

• More injuries were incurred during competition that in training.

• The incidence of all and of time-loss was higher in outdoor than in indoor or youth/junior championships

Conclusions

• High injury incidence

• Overuse traumatic

• Training Competition

• 4/5 Lower limb, 3/10 thigh

• Hamstring strain, stress fractures, ankle sprain

• Disciplines different locations and diagnosis

• Half of injuries more thatn 3 weeks

• Risk factors to be elucidated

Take home messageIF YOU WORK OR WANT TO WORK IN ATHLETICS EXPECT

•Half to 2/3 of your team will get injured

•Many of your athletes will suffer from 2-3 injuries/season

•10% of your team could get injured in competition

•You have to be good clinician dealing with:

–Overuse Injuries

–Hamstring and Calf Strains,

–Achilles, Patellar, Knee, Foot, Hip Tendinopathies,

–Stress Fractures,

–Ankle Sprains

–Lumbar Spine

Acknowledgements Group• Prof. Dr Lars Engebretsen, IOC

• Kathrin Steffen PhD, IOC, OSTRC

• Prof. Dr Jiri Dvorak, FIFA,

• PD Dr Astrid Junge, F-MARC

• Prof. Dr Per Renström, IOC

• Dr Margo Mountjoy, FINA

• Dr Pascal Edouard, France

• Dr Marc Aubry, IIHF

• Jenny Jacobsson PT PhD, Sweden

• Dr Ola Ronsen, Norway

• Dr Pedro Branco, Portugal

• Prof Toomas Timpka, Sweden• Team physicians of participant countries and

medical staff of all Championships.