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.

Year-round longitudinal health surveillance in UK Olympic Summer Sport Athletes 2016-2019.

OBJECTIVES: To identify the priority injury and illness types across UK summer Olympic World Class Programme sports to inform development, implementation and evaluation of associated injury risk mitigation and management initiatives. METHODS: Four years (2016-2019) of electronic medical records of 1247 athletes from 22 sports were analysed and reported using methods based on the 2020 International Olympic Committee consensus statement for epidemiological recording and reporting. RESULTS: 3562 injuries and 1218 illness were recorded, accounting for 146 156 and 27 442 time-loss days. Overall, 814 (65%) athletes reported at least one injury, while 517 (41%) reported at least one illness. There were 1.3 injuries per athlete year resulting in a mean burden of 54.1 days per athlete year. The lumbar/pelvis, knee, ankle and shoulder body regions had the highest incidence and burden. Athletes reported 0.5 illnesses per athlete year, resulting in a mean burden of 10.4 days per athlete year, with most composed of respiratory illness and gastroenteritis. Injuries within sport groups were representative of the injury risk profile for those sports (eg, knee, hand and head injuries had the highest incidence in combat sports), but respiratory illnesses were consistently the greatest problem for each sport group. CONCLUSIONS: To optimise availability for training and performance, systematic risk mitigation and management initiatives should target priority injury problems occurring in the lumbar/pelvis, knee, ankle and shoulder, and respiratory illness. Follow-up analysis should include identification of sport-specific priority health problems and associated risk factors.

Lumbar bone stress injuries and risk factors in adolescent cricket fast bowlers.

Cricket fast bowling is associated with a high prevalence of lumbar bone stress injuries (LBSI), especially in adolescent bowlers. This has not been sufficiently explained by risk factors identified in adult players. This study aimed to examine the incidence of LBSI in adolescent fast bowlers over a prospective study and potential risk factors. Forty asymptomatic male fast bowlers (aged 14-17 years) received baseline and annual lumbar dual-energy X-ray absorptiometry (DXA) and magnetic resonance imaging (MRI) scans, and musculoskeletal and bowling workload assessment; 22 were followed up after one year. LBSI prevalence at baseline and annual incidence were calculated. Potential risk factors were compared between the injured and uninjured groups using T-tests with Hedges' g effect sizes. At baseline, 20.5% of participants had at least one LBSI. Subsequent LBSI incidence was 27.3 ± 18.6 injuries per 100 players per year (mean ± 95% CI). Injured bowlers were older on average at the beginning of the season preceding injury (16.8 versus 15.6 years, g = 1.396, P = 0.047). LBSI risk may coincide with increases in bowling workload and intensity as bowlers step up playing levels to more senior teams during late adolescence whilst the lumbar spine is immature and less robust.

Data Collection Procedures and Injury Definitions in Badminton: A Consensus Statement According to the Delphi Approach.

ABSTRACT: Previous studies involving injury surveillance in badminton players have used nonstandardized injury definitions and data collection methodologies. The purpose of this study was to apply a Delphi method to (1) reach a consensus on an injury definition in badminton and (2) develop a standardized badminton injury report form. An Injury Consensus Group was established under the auspices of the Badminton World Federation, and initial injury definitions and injury report form were developed. An internal panel was formed from the Injury Consensus Group, and an external panel was selected based on a combination of profession, experience in the field, sport-specific knowledge/expertise, and geographical location to obtain a widely representative sample. Through 2 rounds of voting by the external panel, consensus was reached on both the definition of an injury in badminton and a standardized injury report form. The agreed injury definition was "Any physical injury sustained by a player during a match or training regardless if further diagnostic tests were done or if playing time was lost" and the injury report form contained the following 7 sections: Injury record, Diagnosis, Injury mechanism, Regarding pain, Pain and return to play/training after injury, Grade of severity, and Recurrence. We recommend the use of the definitions and methods presented in this consensus statement for the reporting of injury in all international and domestic badminton players. This should make future injury surveillance reports directly comparable and hence more informative in recognizing trends over time and differences between countries.

Training and injuries among world elite junior badminton players - Identifying the problems.

BACKGROUND: The game of badminton has evolved since the early injury epidemiology studies. Since there is no published literature on injuries in elite junior badminton players from an international cohort, this study provides an updated reference of injuries in this population to inform future injury prevention strategies. The objective of this study was to report injury prevalence and training hours in elite junior badminton players participating at the World Junior Championships in 2018. METHODS: A questionnaire was used to collect data and was available in English, French, Spanish, Korean, Japanese or Chinese. It was designed to collect information including basic demographics, hours of training and competition, number of tournaments per year, current and previous injuries characterized by anatomical region, diagnosis, treatment and injury duration. The questions were focused on previous significant injuries lasting a minimum of 30 days and current musculoskeletal symptoms. RESULTS: One hundred and sixty-four of 436 players with a mean age of 17.1 years (SD ± 0.8) filled in the questionnaire. Participants represented North and South America, Europe, Asia, Africa and The Pacific's including the top 10 performing nations, providing a good overall representation of tournament participants. A total of 104 significant injuries (median duration of 90 days) with disruption of full training or competition capacity were reported. Seventy-eight (48%) players reported one or more significant injury. The most common location of significant injury was in the knee, ankle and lower back. Eleven injuries were reported as stress fractures. In 35 cases a player felt lasting limitation from a significant injury and in 37 cases a player felt lasting pain. CONCLUSION: Previously in their career almost 50% of the players had sustained a significant injury with a median duration of 90 days. The lower extremities and the lower back were the predominant injured regions. In one third of the injuries a player had lasting limitations or pain. Stress fractures may be a serious underestimated problem in badminton.

Injuries in England and Wales elite men's domestic cricket: A nine season review from 2010 to 2018.

OBJECTIVES: This study primarily aimed to explore injury incidence rates in the three main domestic competition formats in England and Wales (First-Class, One-Day and Twenty20 [T20]). For the first time, the study also describes the epidemiology of elite men's domestic cricket injuries across nine seasons (2010-2018 inclusive). DESIGN: Prospective cohort analysis. METHODS: Injury incidence and prevalence from all injuries calculated according to the updated international consensus statement on injury surveillance in cricket, with statistical process control charts (SPC) used to detect trends in the data. RESULTS: The average match injury incidence was 102 injuries/1000 days of play, with highest incidence in One-Day (254 injuries/1000 days of play), followed by T20 (136 injuries/1000 days of play) and First-Class Cricket (68 injuries/1000 days of play). Most match injuries were sustained during bowling (41.6 injuries/1000 days of play), followed by fielding (26.8 injuries/1000 days of play) and batting (22.3 injuries/1000 days of play). The thigh was the body area most commonly injured (7.4 injuries/100 players per season), with lumbar spine injuries the most prevalent (1.3% of players unavailable on any given day during the season). On average, 7.5% of players were unavailable on any given day during the domestic season when all injuries were considered (match and training). The SPC charts showed relatively consistent match injury incidence for all competitions, reproduced across all nine seasons. CONCLUSION: These findings provide a robust empirical base for the extent of the injury problem in domestic cricket played in England and Wales, with similar injury profiles across the three formats.

Bowling loads and injury risk in male first class county cricket: Is 'differential load' an alternative to the acute-to-chronic workload ratio?

OBJECTIVES: Methodological concerns relating to acute-to-chronic workload ratios (ACWR) have been raised. This study aimed to assess the relationship between an alternative predictor variable named 'differential load', representing the smoothed week-to-week rate change in load, and injury risk in first class county cricket (FCCC) fast bowlers. DESIGN: Prospective cohort study. METHODS: Bowling loads and injuries were recorded for 49 professional male fast bowlers from six FCCC teams. A range of differential loads and ACWRs were calculated and subjected to a variable selection procedure. RESULTS: Exponentially-weighted 7-day differential load, 9:21-day ACWR, 42-day chronic load, and 9-day acute load were the best-fitting predictor variables in their respective categories. From these, a generalized linear mixed-effects model combining 7-day differential load, 42-day chronic load, and 9-day acute load provided the best model fit. A two-standard deviation (2SD) increase in 7-day differential load (22 overs) was associated with a substantial increase in injury risk (risk ratio [RR]=2.47, 90% CI: 1.27-4.80, most likely harmful), and a 2SD increase in 42-day chronic load (17.5 overs/week) was associated with a most likely harmful increase in injury risk (RR=6.77, 90% CI: 2.15-21.33). For 9-day acute load, very low values (≤1 over/week) were associated with a most likely higher risk of injury versus moderate (17.5 overs/week; RR: 15.50, 90% CI: 6.19-38.79) and very high 9-day acute loads (45.5 overs/week; RR: 133.33, 90% CI: 25.26-703.81). CONCLUSIONS: Differential loads may be used to identify potentially harmful spikes in load, whilst mitigating methodological issues associated with ACWRs.

Passive range of motion of the hips and shoulders and their relationship with ball spin rate in elite finger spin bowlers.

OBJECTIVES: Investigate rotational passive range of motion of the hips and shoulders for elite finger spin bowlers and their relationship with spin rate. DESIGN: Correlational. METHODS: Spin rates and twelve rotational range of motion measurements for the hips and shoulders were collected for sixteen elite male finger spin bowlers. Side to side differences in the rotational range of motion measurements were assessed using paired t-tests. Stepwise linear regression and Pearson product moment correlations were used to identify which range of motion measurements were linked to spin rate. RESULTS: Side to side differences were found with more external rotation (p = 0.039) and less internal rotation (p = 0.089) in the bowling shoulder, and more internal rotation in the front hip (p = 0.041). Total arc of rotation of the front hip was found to be the best predictor of spin rate (r = 0.552, p = 0.027), explaining 26% of the observed variance. Internal rotation of the rear hip (r = 0.466, p = 0.059) and the bowling shoulder (r = 0.476, p = 0.063) were also associated with spin rate. CONCLUSIONS: The technique and performance of elite finger spin bowlers may be limited by the passive range of motion of their hips and shoulders. The observed side to side differences may indicate that due to the repetitive nature of finger spin bowling adaptive changes in the rotational range of motion of the hip and shoulder occur.

Association of Daily Workload, Wellness, and Injury and Illness During Tours in International Cricketers.

PURPOSE: To examine the relationship between player internal workloads, daily wellness monitoring, and injury and illness in a group of elite adolescent cricketers during overseas competitions. METHODS: A total of 39 male international adolescent cricketers (17.5 [0.8] y) took part in the study. Data were collected over 5 tours across a 3-y period (2014-2016). Measures of wellness were recorded and daily training loads were calculated using session rating of perceived exertion. The injury and illness status of each member of the squad was recorded daily. Acute and chronic workloads were calculated using 3-d and 14-d moving averages. Acute workloads, chronic workloads, and acute chronic workload ratios were independently modeled as fixed effects predictor variables. RESULTS: In the subsequent week, a high 3-d workload was significantly associated with an increased risk of injury (relative risk = 2.51; CI = 1.70-3.70). Similarly, a high 14-d workload was also associated with an increased risk of injury (relative risk = 1.48; CI = 1.01-2.70). Individual differences in the load-injury relationship were also found. No clear relationship between the acute chronic workload ratios and injury risk was found, but high chronic workloads combined with high or low acute chronic workload ratios showed an increased probability of injury compared with moderate chronic workloads. There were also trends for sleep quality and cold symptoms worsening the week before an injury occurred. CONCLUSION: Although there is significant individual variation, short-term high workloads and change in wellness status appear to be associated with injury risk.

The effect of a cricket fielding session on glenohumeral range of motion and active joint position sense.

OBJECTIVE: To assess the effects of a cricket fielding session, at an identified throwing injury risk workload, on shoulder joint position sense (JPS) and active range of motion (AROM) in cricketers. DESIGN: Repeated measures observational study. SETTING: Indoor cricket centre. PARTICIPANTS: Nineteen, asymptomatic University cricketers. MAIN OUTCOME: AROM was assessed supine at 90° abduction and from this 10% off end range IR and ER was used as the position matching angle to assess JPS. JPS error scores as well as AROM were assessed pre and post a cricket fielding session consisting of 40 throws. RESULTS: Following the cricket fielding session, no alteration in JPS in ER (p = 0.91) or IR (p = 0.27) was observed. There was however a significant decrease in IR (-3.9°) following the fielding drill (p = 0.007) while no significant change was observed in ER or total motion. CONCLUSION: Active IR ROM is significantly decreased immediately following a cricket fielding drill, while no alterations in JPS were observed. High levels of eccentric stress have been reported in the external rotators after throwing which may contribute to the acute musculotendinous adaptations observed. Changes in IR may be a contributing factor to workload-acquired shoulder throwing injuries.

A biomechanical evaluation of the combined elevation test.

OBJECTIVES: To evaluate biomechanically the relationships between the outcome of the Combined Elevation Test, its component joint motions, and thoracic spine angles. DESIGN: Cross-sectional study. SETTING: Laboratory. PARTICIPANTS: 18 elite swimmers and triathletes (11 males and 7 females). MAIN OUTCOME MEASURES: Combined Elevation Test outcome in forehead and chin positions. Individual joint contributions to test outcome. RESULTS: No sex differences were found in test components, or between head positions. Test outcome was greater in the forehead position than the chin position (34.3 cm vs 30.2 cm; p < 0.001). The variables most strongly associated with test outcome were glenohumeral joint flexion (r = 0.86-0.97; p < 0.001), and shoulder retraction (r = 0.75-0.82; p < 0.001). Total thoracic spine angle related strongly to test outcome in females (r = -0.77 to -0.88; p < 0.05), but not in males (r = -0.17 to -0.24; p > 0.05). CONCLUSIONS: The Combined Elevation Test is an effective screening tool, measuring upper limb mobility into shoulder flexion and scapula retraction in both sexes, and thoracic extension in women. It is recommended that the test be performed in the forehead position. If a subject performs poorly on the test, follow up assessments are required to identify the impairment location.