Multiple factors explain injury risk in adolescent elite athletes: Applying a biopsychosocial perspective.

Many risk factors for injury are presented in the literature, few of those are however consistent and the majority is associated with adult and not adolescent elite athletes. The aim was to identify risk factors for injury in adolescent elite athletes, by applying a biopsychosocial approach. A total of 496 adolescent elite athletes (age range 15-19), participating in 16 different sports, were monitored repeatedly over 52 weeks using a valid questionnaire about injuries, training exposure, sleep, stress, nutrition, and competence-based self-esteem. Univariate and multiple Cox regression analyses were used to calculate hazard ratios (HR) for risk factors for first reported injury. The main finding was that an increase in training load, training intensity, and at the same time decreasing the sleep volume resulted in a higher risk for injury compared to no change in these variables (HR 2.25, 95% CI, 1.46-3.45, P<.01), which was the strongest risk factor identified. In addition, an increase by one score of competence-based self-esteem increased the hazard for injury with 1.02 (HR 95% CI, 1.00-1.04, P=.01). Based on the multiple Cox regression analysis, an athlete having the identified risk factors (Risk Index, competence-based self-esteem), with an average competence-based self-esteem score, had more than a threefold increased risk for injury (HR 3.35), compared to an athlete with a low competence-based self-esteem and no change in sleep or training volume. Our findings confirm injury occurrence as a result of multiple risk factors interacting in complex ways.

Too little sleep and an unhealthy diet could increase the risk of sustaining a new injury in adolescent elite athletes.

Little is known about health variables and if these variables could increase the risk of injuries among adolescent elite athletes. The primary aim was to present overall data on self-perceived stress, nutrition intake, self-esteem, and sleep, as well as gender and age differences, on two occasions among adolescent elite athletes. A secondary aim was to study these health variables as potential risk factors on injury incidence. A questionnaire was e-mailed to 340 adolescent elite athletes on two occasions during a single school year: autumn semester and spring semester. The results show that during autumn semester, the recommended intake of fruits, vegetables, and fish was not met for 20%, 39%, and 43% of the adolescent elite athletes, respectively. The recommended amount of sleep during weekdays was not obtained by 19%. Multiple logistic regression showed that athletes sleeping more than 8 h of sleep during weekdays reduced the odds of injury with 61% (OR, 0.39; 95% CI, 0.16-0.99) and athletes reaching the recommended nutrition intake reduced the odds with 64% (OR, 0.36; 95% CI, 0.14-0.91). Our findings suggest that nutrition intake and sleep volume are of importance in understanding injury incidence.

Swedish translation and validation of a web-based questionnaire for registration of overuse problems.

The main aim of this study was to translate the Oslo Sport Trauma Research Center (OSTRC) Overuse Injury Questionnaire into Swedish. The validity and applicability of the questionnaire for studying overuse injuries among Swedish handball, volleyball, tennis, and orienteering top athletes were also examined. The back-translation method was used for translation. An expert committee further developed it for use in a study of injuries in handball, orienteering, tennis, and volleyball. A 10-week pretest was then conducted on 43 athletes, average age 21 (18-31) from these sports, during which time the athletes completed the modified OSTRC questionnaire on a weekly basis. In the 10th week, four additional questions were added in order to examine the questionnaire's content validity. No major disagreement was found in the translation. The athletes perceived the web-based questionnaire to be smooth and easy to complete, accurately capturing overuse injuries. However, suggestions were made to add questions relating to the hip for orienteerers and to the hand/fingers for handball players. The average prevalence of overuse injuries for all athletes, in any anatomical area was 22% (95% confidence interval 20-25). Construct validity appeared to be high, and we therefore suggest that the questionnaire may be used when studying overuse injuries in different sports.

A nine-test screening battery for athletes: a reliability study.

Studies have shown that reduced neuromuscular control or strength increases the risk of acute injuries. It is hypothesized that a non-functional movement pattern can predispose for injuries. In the present paper a detailed description of a test battery consisting of nine different tests to screen athletic movement pattern is provided. The aim was to evaluate the inter- and intra-rater reliability of the test battery on a group of male elite soccer players. Twenty-six healthy elite soccer players (17-28 years) were screened. Eighteen participated at a second occasion 7 days later. No significant difference (P=0.31) was found between test occasion 1 (LS means 18.3, 95% confidence interval 14.9-21.7) and test occasion 2 (18.0, 14.4-21.7) in the mean total score of the test battery. No significant difference in the inter-rater reliability was found between the eight physiotherapists at the two test occasions. The intra-class correlation coefficient was 0.80 and 0.81, respectively. The test battery showed good inter- and intra-rater reliability. The screening battery is easy to use for familiarized professionals and requires minimal equipment. However, further studies are needed to confirm the validity of the test battery in injury prevention, rehabilitation and performance enhancement.

Characteristics of functional movement screening testing in elite handball players: Indicative data from the 9.

OBJECTIVES: To test 9 + screening batterie's intra-rater reliability, to provide indicative data of elite handball players, and to analyze difference between age, playing positions and level of play. DESIGN: Descriptive study. SETTING: Icelandic elite male handball players. PARTICIPANTS: 182 elite male handball players. MAIN OUTCOME MEASURES: Nine + screening battery. RESULTS: Reliability test: Intra-class correlation for the total score was 0.95. The correlation of each of the test factors varied from 0.63 to 0.91. The mean total score was 22.3 ±â€¯2.9 (95%CI 16.7-28.1), with no difference in total score comparing players age or level of play. Goalkeepers displayed a higher total score than other players (F3,151 = 5.75, p = 0.001). Junior players had a lower score than senior players in tests measuring abdominal strength and core stability; Test 5; │2(3, 182) = 41.5, p < 0.0001, Test 6; │2(3, 182) = 55.7, p < 0.0001, Test 7; │2(3, 182) = 11.8, p < 0.005, but higher scores in tests measuring trunk and shoulder mobility Test 8; │2(3, 182) = 18.2, p < 0.0001, Test 9; │2(3, 182) = 22.2, p = 0.006. CONCLUSIONS: The 9+ intra-rater reliability was acceptable for the total score and individual tests. Age-related differences were provided in many individual tests.

Patellar tendon load in different types of eccentric squats.

BACKGROUND: Differences in mechanical loading of the patellar tendon have been suggested as a reason for varying effects in rehabilitation of patellar tendinopathy using different eccentric squat exercises and devices. The aim was to characterize the magnitude and pattern of mechanical load at the knee and on the patellar tendon during four types of eccentric squat. METHODS: Subjects performed squats with a submaximal free weight and with maximal effort in a device for eccentric overloading (Bromsman), on a decline board and horizontal surface. Kinematics was recorded with a motion-capture system, reaction forces with force plates, and electromyography from three leg muscles with surface electrodes. Inverse dynamics was used to calculate knee joint kinetics. FINDINGS: Eccentric work, mean and peak patellar tendon force, and angle at peak force were greater (25-30%) for squats on decline board compared to horizontal surface with free weight, but not in Bromsman. Higher knee load forces (60-80%), but not work, were observed with Bromsman than free weight. Angular excursions at the knee and ankle were larger with decline board, particularly with free weight, and smaller in Bromsman than with free weight. Mean electromyography was greater on a decline board for gastrocnemius (13%) and vastus medialis (6%) with free weight, but in Bromsman only for gastrocnemius (7%). INTERPRETATION: The results demonstrated clear differences in the biomechanical loading on the knee during different squat exercises. Quantification of such differences provides information that could be used to explain differences in rehabilitation effects as well as in designing more optimal rehabilitation exercises for patellar tendinopathy.