Consensus statement on the methodology of injury and illness surveillance in FINA (aquatic sports).

BACKGROUND: Injury and illness surveillance in the aquatic disciplines has been conducted during the FINA World Championships and Olympic Games. The development of an aquatic-specific injury and illness surveillance system will improve the quality of the data collected and the development of preventive measures. Our ultimate objective is to enhance aquatic athlete health and performance. OBJECTIVE: The objective was to refine the injury and illness surveillance protocols to develop aquatic-specific definitions of injury and illness; define aquatic-specific injury location and causation; better describe overuse injuries; regard pre-existing and recurrent injuries; more accurately define aquatic athlete exposures and develop a protocol to capture out-of-competition aquatic athlete health parameters. METHODS: FINA compiled an Injury and Illness Surveillance Expert Working Group comprised of international experts to review the scientific literature in the field. A consensus meeting was convened to provide an opportunity for debate, following which recommendations were collated. RESULTS: Aquatic-specific injury and illness surveillance protocols covering both the in-competition and out-of-competition time periods were developed. Definitions for all relevant variables were outlined, and documentation forms for athletes and for clinicians were proposed. Recommendations for the implementation of an injury and illness surveillance system for FINA are presented. CONCLUSION: The FINA consensus authors recommend ongoing in-competition and out-of-competition surveillance to determine injury and illness trends over time. The implementation of the definitions and methodology outlined in this paper will improve the accuracy and value of injury and illness surveillance, and provide important information for injury prevention.

Review of the Local Organizing Committee (LOC) medical services during the 12th FINA World Swimming Championships (25†m) in Doha, Qatar.

BACKGROUND: One of the primary roles of Fédération Internationale de Natation (FINA) is to promote athlete health. The planning and delivery of major international event medical services is carried out in collaboration with the Local Organizing Committee Medical Commission (LOCMC). Aspetar Orthopaedic and Sports Medicine Hospital provided the medical services to the 12th FINA World Swimming Championships (25 m) creating a unique opportunity for collaboration with FINA. AIM: The purpose of this paper is to review the planning and delivery of medical services and athlete health promotion projects during the 12th FINA World Swimming Championships (25 m) to facilitate the planning of future sporting events of this size and scope. METHODS: The 12th FINA World Swimming Championships (25 m) hosted 974 athletes from 166 countries. The LOC medical team recorded all medical encounters-newly incurred (or acute exacerbations of chronic) injuries and illnesses as well as follow-up consultations. RESULTS: More than 90% of teams did not travel with a team physician and relied on the LOCMC for diagnosis and treatment of injuries and illnesses in athletes and accredited team officials. The LOC medical team had a total of 554 medical encounters: 385 therapy, 34 athlete injury, 65 athlete illness and 70 non-athlete encounters. CONCLUSIONS: The LOCMC in collaboration with FINA delivered comprehensive medical services to athletes, officials and spectators attending the 12th FINA World Swimming Championships (25 m). This review paper provides information relevant to the planning and delivery of LOCMC medical services for future international swimming events contributing to the FINA objective of promoting athlete health.

Competing with injuries: injuries prior to and during the 15th FINA World Championships 2013 (aquatics).

BACKGROUND: Injury and illness surveillance is the foundation for the development of prevention strategies. OBJECTIVE: To examine injuries among the aquatic disciplines in the 4 weeks prior to and during the 2013 FINA World Championships. METHODS: The study was comprised of two components: (1) a retrospective athlete survey recording injuries in the 4 weeks prior to the Championships and (2) a prospective recording of injuries and illnesses by the medical teams of the participating countries and the local host medical team. RESULTS: One-third of the 1116 responding athletes reported an injury/physical complaint in the 4 weeks prior to the Championships. Significantly more women (36.7%) than men (28.6%) reported injuries. Divers reported the highest rate of injury/physical complaints (55.7%). At the start of the Championships, 70% of injured respondents (n=258) were still symptomatic; however, full participation was expected by 76%. During the Championships, 186 new injuries were reported (8.3/100 registered athletes) with the highest injury incidence rate in water polo (15.3/100 registered athletes). The most common injured body part was the shoulder (21%). A total of 199 illnesses were reported during the Championships (9.0/100 registered athletes) with the most common diagnosis of illness being gastrointestinal infection. Environmental exposure (allergy, otitis and jellyfish stings) was responsible for 27% of all illnesses in open water swimming. CONCLUSIONS: Injuries pose a significant health risk for elite aquatic athletes. A prospective study would improve understanding of out-of-competition injuries. Future injury and illness surveillance at FINA World Championships is required to direct and measure the impact of prevention strategies.

Medical Care of the Aquatics Athlete.

Competitive swimmers are affected by several musculoskeletal and medical complaints that are unique to the sport. 'Swimmer's shoulder,' the most common overuse injury, is usually caused by some combination of impingement, rotator cuff tendinopathy, scapular dyskinesis, and instability. The condition may be treated with training modifications, stroke error correction, and strengthening exercises targeting the rotator cuff, scapular stabilizers, and core. Implementation of prevention programs to reduce the prevalence of shoulder pathology is crucial. Knee pain usually results from the breaststroke kick in swimmers, and the 'egg beater' kick in water polo players and synchronized swimmers. Lumbar back pain also is common in aquatics athletes. Among the medical conditions of particular importance in swimmers are exercise-induced bronchoconstriction, respiratory illnesses, and ear problems. Participants in other aquatics sports (water polo, diving, synchronized swimming, and open water swimming) may experience medical ailments specific to the sport.

High prevalence of overuse injury among iron-distance triathletes.

BACKGROUND: Triathlon is an increasingly popular sport at both the elite and the recreational level. However, there have been few high-quality studies of injuries and illnesses among triathletes. OBJECTIVE: To register overuse problems and acute injuries among iron-distance triathletes throughout a training season leading up to a major event. METHODS: A 26-week prospective cohort study was conducted including 174 participants of the 2011 Norseman Xtreme Triathlon. Data on overuse injuries located in the shoulder, lower back, thigh, knee and lower leg were collected every second week using the Oslo Sports Trauma Research Center Overuse Injury Questionnaire. Illnesses, acute injuries and overuse problems affecting other anatomical areas were also recorded using standard injury surveillance methods. RESULTS: The average prevalence of overuse problems was 56% (95% CI 51 to 61) (490 cases). The average prevalence of substantial overuse problems was 20% (95% CI 18 to 21) (165 cases). The most prevalent sites of overuse problems were the knee (25%), lower leg (23%) and lower back (23%). The acute injury incidence was 0.97 injuries per 1000 h of training (36 cases) and 1.02 injuries per 1000 h of competition (5 cases). A majority of moderate and severe acute injuries were located at the knee, shoulder/clavicle and sternum/ribs. The predominant types of acute injuries were contusions, fractures and sprains. The incidence of illness was 5.3/1000 athlete-days (156 cases). CONCLUSIONS: Overuse problems constitute the majority of injury cases among iron-distance triathletes, and are far more common than acute injuries and illnesses. The most prevalent sites of injury in the present study were the knee, lower leg, lower back and shoulder. Future injury prevention studies in iron-distance triathletes should focus on these areas.

Dental injuries in water polo, a survey of players in Switzerland.

Water polo is a sporting activity which has a medium risk of causing dental trauma. Owing to the high speed, close body contact, and the combination of throwing and swimming that is inherent to the sport, the general injury potential is high. Using a standardized questionnaire for a total of 415 water polo players from Switzerland, this study examines the frequency of dental and facial injuries in water polo, athletes' habits regarding the wearing of mouthguards, and the general level of knowledge about emergency procedures following dental trauma. The participating players came from 6 divisions: Swiss national leagues A and B, first and second leagues, as well as the women's, and junior's league. The data were evaluated according to division and gender. Of the 415 interviewees, 185 (44.6%) had witnessed a dental injury in water polo. Eighty-seven (21.0%) players reported having suffered a tooth injury when playing water polo. Tooth fracture was the most stated dental injury [86 (16.4%)]. A similar number of tooth injuries were experienced by both male [355 (21.1%)] and female [60 (20.0%)] players. The interviewees over the age of 50 showed a higher incidence of tooth injuries than younger players (>50 years = 41.7%). Slightly more than half of the interviewed players [228 (54.9%)] were aware of the possibility of replanting avulsed teeth. As few as 43 (10.4%) players were familiar with tooth rescue boxes. Only 32 (7.7%) water polo players wore a mouthguard; the most common reason for not wearing a mouthguard was that it was seen to be unnecessary [169 (40.7%)]. This survey highlights the potential for improvement in the level of knowledge about dental injury prevention in water polo. In addition to information and guidelines from the relevant sports' associations, and coaches, dentists could also play a role in the provision of this education.

A survey of Swiss swimming pool attendants' knowledge of first-aid treatment after lip and dental injuries.

SUMMARY: Although dental injuries are common occurrences at swimming pools, there are very few publications about them. The purpose of this study was to interview pool attendants at public swimming pools/bathing resorts in Switzerland on lip and dental injuries in 2007. The questions focussed on their knowledge of first aid, the frequency and accident site of lip and tooth trauma, as well as the storage medium for avulsed teeth. Questions were also asked about the presence of a "dental first-aid kit" and the poster on dental first aid. 606 public pools were contacted, and one pool attendant per pool was interviewed by telephone. 553 individuals participated; 53 declined to take part. The results show that in 2007, 40% of the interviewed pool attendants (n = 221) had witnessed at least one lip injury, and 36.9% (n = 204) at least one tooth trauma. At pools with slides, accidents were more frequent (p<0.001), and the waterslide was the most common accident site. The pool attendants provided satisfactory answers on their actions after lip and dental injuries. However, 68.7% could not adequately answer the questions on storage of avulsed teeth. Only 74 pool attendants had a dental first-aid kit. Of these, only 68 used the kits as the storage medium for avulsed teeth. 59 pool attendants were in possession of the poster on dental first aid. Overall, it was shown that pool attendants who had a dental first-aid kit and a dental first aid poster gave better answers on how to handle tooth trauma.

ACC claims for sports-related dental trauma from 1999 to 2008: a retrospective analysis.

OBJECTIVE: To describe trends in sports-related dental injuries reported to ACC in the past 10 years. DESIGN: Retrospective case series. METHODS: De-identified data on orofacial injuries were obtained from ACC for the financial years 1999-2008, and new claims were identified for each year (with recurring claims omitted from the analysis). Patterns in new-claim data were identified by age, sex, region and the sport involved. Trends in claims for the sport categories were also identified RESULTS: The annual number of claims ranged from 24,998 to 31,257; overall, 38.7% of claims were made by females and 61.3% by males, and these proportions remained largely unchanged during the observation period. For sports-related claims, those aged 11-20 years had the highest percentage of claims (with between 41.7% and 44.4%, depending on year) while those older than 60 had the smallest percentage of claims, with 0.5% to 1.1%. Sport was involved in 20.6% to 26.2% of new claims. The highest percentage of injuries was attributable to rugby (between 22.2% and 33.1%, depending on the year). Water sports contributed to between 14.2% and 20.8% of claims. Cycling increased from 1.5% in 1999 to 15.3% in 2006, and then decreased to 10.6% in 2008. Hockey, basketball, soccer, cricket and netball had 4.4%, 4.8%, 6.9%, 4.7% and 3.9% respectively. CONCLUSIONS: Although its share has decreased in recent years, rugby remained the greatest contributor to sport-related orofacial injuries, with water sports consistently second (cycling had the largest change, with a rapid increase in the past 3 years). There is a need to re-examine mouthguard (and other injury prevention) policies for particular sports.

Two case reports of complicated permanent crown fractures treated with partial pulpotomies.

The partial pulpotomy can offer a superb outcome for the treatment of traumatic complicated crown fractures. The procedure is often used for dental trauma in children when the major aim of treatment is to preserve tooth vitality while providing a favorable environment for continued root development. The purpose of this paper was to review scientific evidence supporting partial pulpotomy and its high success rate and illustrate the clinical technique by presenting 2 challenging cases of complicated crown fractures with long-term follow-up.

Retrospective case evaluation of gender differences in sports injuries in a Japanese sports medicine clinic.

BACKGROUND: Although both gender- and sports-specific injuries exist among athletes, gender differences in the types of injuries caused by sports activities, except for anterior cruciate ligament (ACL) injury and anterior knee pain, are not well established. OBJECTIVE: An observational study with a retrospective case-series design was conducted to investigate gender-specific differences in the types of injuries sustained while engaging in sports activities common to both males and females. METHODS: We analyzed injuries sustained during sports activities including basketball, volleyball, tennis, skiing, track and field, and swimming, using data on age, sex, sports activities, activity levels, and sports injuries that had been computerized at our sports medicine (orthopedics) clinic. Inclusion criteria were sports activities that had a record of >100 injuries in total and athletes aged <50 years who were engaging in only 1 sports activity. We determined the absolute number of patients in each category and their percentage (proportion) of our cohort. The proportions of common injuries caused by sports activities were investigated, and gender-specific differences in the types of common injuries caused by sports activities were clarified. The Fisher exact test was used to determine the significance (P < 0.01) of the gender-specific differences in the types of sports injuries. RESULTS: According to our database, during the 14-year period between October 1992 and December 2006, a total of 2,989 athletes (1,624 males and 1,365 females) aged <50 years who engaged in 1 of the 6 sports activities described consulted our sports medicine clinic. The most common sports injuries were ACL injury (14.3%) and knee pain (13.7%), followed by ankle sprain (9.4%), lumbar disc disease (7.0%), meniscus injury (5.1%), stress fracture (2.9%), low back pain (2.5%), patellar tendinitis (2.1%), injury of the medial collateral ligament of the knee (2.0%), lumbar spondylolysis (1.7%), and muscle strain (1.5%). Among these 11 types of sports injuries, a significantly higher proportion of females who engaged in basketball (24.4% vs 10.5%), volleyball (20.5% vs 4.5%), or skiing (41.4% vs 26.5%) presented with an ACL injury, compared with their male counterparts (all, P < 0.001). There was also a significantly higher proportion of females than of males among the track and field athletes who presented with stress fractures (18.7% vs 3.9%; P < 0.001). CONCLUSION: The findings of this retrospective study suggest that there are gender-specific differences in the types of injuries sustained during sports activities.

Shoulder injuries in competitive swimmers.

Sports medicine literature often refers to "swimmer's shoulder." Increasingly, however, it is evident that swimmer's shoulder is a spectrum of maladies whose underlying origins may be incidental to athletic activity. Those dealing with the treatment of swimmers should have a thorough understanding of the differential diagnosis of the shoulder, the age range of competitive swimmers, and the effects of the aging process, and age-related disease processes and should consider the possibilities of neoplasm, degenerative diseases, and acquired processes such as arthritis or metabolic diseases.

Health professionals' perceptions of musculoskeletal injury and injury risk factors in Australian triathletes: a factor analysis.

OBJECTIVE: This study investigated health professional perceptions of triathlon-related injury risk factors and injury prevention strategies, to inform prospective cohort studies investigating injury in triathletes. DESIGN: Exploratory factor analysis. METHODS: A questionnaire was developed and distributed to Australian sports medicine health professionals (n = 504). Information was collected about their perceptions of factors contributing to injury and injury prevention strategies relating to Sprint/Olympic (S/O) and Ironman/Long Course (I/LC) athletes. Factor analysis was performed to identify the number and nature of the constructs (factors) underlying the responses to the questions, and to ascertain whether these factors were similar for S/O and I/LC athletes. RESULTS: The response rate was 22.4% (n = 113). Five factors were extracted for injury risk accounting for 53% (S/O) and 56% (I/LC) of the variance. The factors were common across S/O and I/LC groups; biomechanics and technique, training factors, demographics, injury prevention and personal factors. Three common factors accounted for 54% (S/O) and 55% (I/LC) of the variance for injury prevention strategies; designated training regimes, health and medical monitoring and preparation of the triathlete. CONCLUSIONS: These results indicate that future studies into triathlon injuries should include, at a minimum, detailed training load and demographic factors to test their impact as injury risk factors in triathlete populations.

[Aquatic injuries]. / Vandlandsskader.

The pattern of injury sustained in an aquascape is described. The most serious and the highest number of injuries were sustained in the water chute (head, face). 15 percent of the injuries were bone or dental fractures. Prophylactic advice is given.

[Incidence of orodental trauma in sports: soccer, water polo and cycling]. / Incidenza dei traumatismi oro-dentari nella pratica sportiva: calcio, pallanuoto, ciclismo.

The Authors analyze the incidence of the oral-dental traumas during the practise of three different sports: soccer, water polo and cycling, underlining the importance of the use of mouthguard as a specific oral protection.

[Vertical distraction osteogenesis of the alveolar process using a tooth-borne device]. / Vertikale Distraktion des bezahnten Alveolarfortsatzes mittels einer zahngetragenen Apparatur.

Since the communication of McCarthy et al. in 1992, applications for distraction osteogenesis in the maxillofacial complex have increased enormously. The advantages as compared to conventional reconstructive procedures are missing donor-site morbidity for bone graft harvesting, reduced blood loss and also a gradual gain in the soft tissue envelope. Meanwhile, even the vertical lengthening of the alveolar process has become a clinically reliable method. The case presented illustrates the treatment of a 16-year-old patient who suffered a sporting accident at the age of 7 years, leading to ankylosis of the upper middle incisors with subsequent underdevelopment of the frontal alveolar process. After fabrication of a custom-made distraction device, an osteotomy of the tooth-bearing segment in the upper front was performed and the segment was attached to the distraction device. Bone lengthening was started on the seventh postoperative day at a daily rate of 0.5 mm. The distraction was maintained until closure of the open bite was achieved. On the 22nd day, the segment was fixed using an orthodontic arch wire and the distraction device was removed. A retention period of 6 weeks was maintained until sufficient stability was detectable. Now, 1.5 years after the treatment, the situation is stable with a good consolidation of the bone fragments and a physiologically shaped gingivobuccal sulcus. Lengthening of the alveolar process by vertical distraction osteogenesis using a tooth-borne device may be indicated in certain cases. With this technique a second operation can be avoided and there is less risk of laceration of dental roots by fixation screws.

Analysis of injuries in long-distance triathletes.

Triathlon is an individual sport consisting of three disciplines - swimming, cycling and running. Triathlon has changed from a novel appearance to a very popular Olympic sport within the last fifteen years. Nevertheless, there is not sufficient data about injuries in triathlon. The aim of this retrospective survey was to investigate the incidence of injuries according to class of injuries, anatomical sites and disciplines. Relations to age, sex, performance level, training habits and medical care were analysed. Questionnaires were sent to all German speaking participants of the Ironman Europe 2000. With a response rate of 35 %, 656 questionnaires met the inclusion criteria. At least one injury was experienced by 74.8 % (95 %-CI: 71.3-78.1) of all respondents during their active time in triathlon. 51.1 % (95 %-CI: 47.2-55.0) suffered one or more contusion/skin-abrasions, 33.1 % (95 %-CI: 29.5-36.8) muscle-/tendon-injuries, 29.0 % (95 %-CI: 25.5-32.6) ligament-/capsule-injuries and 11.9 % (95 %-CI: 9.5-14.6) fractures. Most of the injuries happened during cycling (54.8 % [95 %-CI: 51.9-57.8]) within training sessions. 18.7 % (95 %-CI: 16.4-21.2) of all injuries occurred while the athletes were competing. Considering the low number of competition hours per year, the incidence of injuries during competition was higher than during training session. Significant relations were found considering the age, performance level and weekly training hours of the triathletes. Older athletes sustained more fractures (p = 0.024), high performance athletes suffered more contusions/abrasions (p = 0.003) and muscle-tendon-injuries (p = 0.001) and athletes with a large number of weekly training hours suffered more muscle-tendon-injuries (p = 0.014). To summarize, injuries in triathlon seem to be related to age, performance level and weekly training hours, but not to sex, presence of training coach and medical care.