Symptom burden and follow-up of patients with neck and back complaints in specialized outpatient care: a national register study.

Back and neck pain are common in the population, especially among immigrants. In Norway's specialist care system, treating these patients typically involves a multidisciplinary approach based on the biopsychosocial model. However, language and cultural differences may create barriers to participation. Immigrants are often underrepresented in clinical studies, but a register-based approach can enhance their participation in research. This study aimed to compare both the symptom burden, and treatment, among Norwegians, non-Norwegians, and patients requiring translator service for back and neck pain within the Norwegian specialist care system. The Norwegian neck and back registry is a National Quality Register, established in 2012 and fully digitized in late 2020. The baseline data includes demographics and patient recorded outcome measures including Oswestry Disability Index, Fear-Avoidance Beliefs, pain rating on a numeric rating scale, Hopkins Symptom Checklist and EuroQol five-dimensional questionnaire on health related quality of life. During the two-year study period, a total of 14,124 patients were invited, and 10,060 (71%) participated. Norwegian patients reported less pain, better function assessed by Oswestry Disability Index, lower fear avoidance beliefs, less emotional distress, and higher health related quality of life compared to non-Norwegians. We found that patients with female gender, who were younger, more educated and exhibited fear-avoidance behavior were significantly more likely to receive multidisciplinary treatment. We found no difference in the proportion of Norwegian and non-Norwegian patients receiving multidisciplinary treatment [odds ratio (OR) 1.02 (95% confidence interval (CI) 0.90-1.16)]. However, patients needing a translator were less likely to receive multidisciplinary treatment compared to those who didn't require translation [OR 0.41 (95% CI (0.25-0.66)]. We found that non-Norwegian patients experience a higher symptom burden compared to Norwegian. We found that both non-Norwegians and patient in need of translator were to a greater extent recommended treatment in primary health care. The proportion of non-Norwegians patients receiving multidisciplinary treatment was similar to Norwegians, but those needing a translator were less likely to receive such treatment.

The Oslo Sports Trauma Research Center questionnaire on health problems: a new approach to prospective monitoring of illness and injury in elite athletes.

BACKGROUND: Little information exists on the illness and injury patterns of athletes preparing for the Olympic and Paralympic Games. Among the possible explanations for the current lack of knowledge are the methodological challenges faced in conducting prospective studies of large, heterogeneous groups of athletes, particularly when overuse injuries and illnesses are of concern. OBJECTIVE: To describe a new surveillance method that is capable of recording all types of health problems and to use it to study the illness and injury patterns of Norwegian athletes preparing for the 2012 Olympic and Paralympic Games. METHODS: A total of 142 athletes were monitored over a 40-week period using a weekly online questionnaire on health problems. Team medical personnel were used to classify and diagnose all reported complaints. RESULTS: A total of 617 health problems were registered during the project, including 329 illnesses and 288 injuries. At any given time, 36% of athletes had health problems (95% CI 34% to 38%) and 15% of athletes (95% CI 14% to 16%) had substantial problems, defined as those leading to moderate or severe reductions in sports performance or participation, or time loss. Overuse injuries represented 49% of the total burden of health problems, measured as the cumulative severity score, compared to illness (36%) and acute injuries (13%). CONCLUSIONS: The new method was sensitive and valid in documenting the pattern of acute injuries, overuse injuries and illnesses in a large, heterogeneous group of athletes preparing for the Olympic and Paralympic Games.

Sex differences in the risk of injury in World Cup alpine skiers: a 6-year cohort study.

BACKGROUND: In competitive alpine skiing, there is a controversy regarding the sex-related risk of injury. OBJECTIVE: To compare the risk of injury in female versus male World Cup (WC) alpine skiers. METHODS: Injuries were recorded through the International Ski Federation Injury Surveillance System for six consecutive winter seasons (2006-2012), based on retrospective interviews with athletes from 10 teams at the end of each season. All acute training and competition injuries which required medical attention were recorded. Race exposure was calculated based on the exact number of runs started in the WC for each of the interviewed athletes each season. RESULTS: Men had a higher overall rate of injury (relative risk (RR) 1.24, 95% CI 1.05 to 1.47), as well as a higher rate of time-loss injury (RR 1.23, 95% CI 1.03 to 1.48) than women in training and competitions, expressed as injuries/100 athletes/season. These sex differences were even more pronounced during WC races (RR 1.58, 95% CI 1.22 to 2.04 and RR 1.72, 95% CI 1.29 to 2.31, for overall and time-loss injuries, respectively). There was no sex difference in the risk of knee/anterior cruciate ligament (ACL) injuries. CONCLUSIONS: No previous studies from competitive skiing have reported a significantly higher risk of injuries in men than women. In contrast to recreational skiing and team sports, there was no sex difference in the risk of knee/ACL injuries and prevention efforts should be directed as much towards male as female competitive skiers.

Events leading to anterior cruciate ligament injury in World Cup Alpine Skiing: a systematic video analysis of 20 cases.

BACKGROUND: The authors have recently identified three main mechanisms for anterior cruciate ligament (ACL) injuries among World Cup (WC) alpine skiers, termed as "the slip-catch", "the landing back-weighted" and "the dynamic snowplow". However, for a more complete understanding of how these injuries occur, a description of the events leading to the injury situations is also needed. OBJECTIVE: To describe the skiing situation leading to ACL injuries in WC alpine skiing. METHODS: Twenty cases of ACL injuries reported through the International Ski Federation Injury Surveillance System (FIS ISS)for three consecutive WC seasons (2006-2009) were obtained on video. Ten experts (9 WC coaches, 1 former WC athlete) performed visual analyses of each case to describe in their own words, factors they thought may have contributed to the injury situation related to different predefined categories: (1) skier technique, (2) skier strategy, (3) equipment, (4) speed and course setting, (5) visibility, snow and piste conditions and (6) any other factors. RESULTS: Factors related to the three categories, namely skier technique, skier strategy, and visibility, snow and piste conditions, were assumed to be the main contributors to the injury situations. Skier errors, technical mistakes and inappropriate tactical choices, were the dominant factors. In addition, bumpy conditions, aggressive snow, reduced visibility and course difficulties were assumed to contribute. CONCLUSION: Based on this systematic video analysis of 20 injury situations, factors related to skier technique, skier strategy and specific race conditions were identified as the main contributors leading to injury situations.

Injury incidence in qualification runs versus final runs in FIS World Cup snowboard cross and ski cross.

BACKGROUND: In the International Ski Federation (FIS), World Cup (WC) snowboard cross (SBX) and ski cross (SX), the injury incidence in individual qualification runs versus final runs in heats of four athletes is unknown. Objective To investigate the injury incidence in individual qualification runs versus final runs of SBX and SX. METHODS: Injuries were recorded by the FIS injury surveillance system (FIS ISS) through retrospective athlete interviews at the end of each season during four WC seasons (2006-2010). A total of 713 athletes (345 SBX and 368 SX) were interviewed. Time-loss injuries occurring during SBX and SX competitions were included. Injury incidence was expressed as the relative injury rate (per 1000 runs). RESULTS: For SBX, the injury incidence per 1000 runs in finals was 12.1 vs. 6.1 in qualifications (RR 1.9, 95% CI 1.1-3.5). The injury incidence was 12.9 in finals and 4.4 in qualifications (RR 2.9, 95% CI 1.4-6.2) for SBX males and 10.5 vs. 9.3 (RR 1.1, 95% CI 0.5-2.8) for females. For SX, the injury incidence in finals was 12.4 and 9.2 in qualifications (RR 1.4, 95% CI 0.8-2.3). The injury incidence for SX males was 13.6 in finals vs. 8.8 in qualifications (RR 1.5, 95% CI 0.8-3.1) and10.8 vs. 9.8 (RR 1.1, 95% CI 0.5-2.6) for females. CONCLUSION: The injury incidence was significantly higher in final runs compared with qualification runs in SBX for males. For SBX females and in SX, no significant differences were found.

Mechanisms of anterior cruciate ligament injury in World Cup alpine skiing: a systematic video analysis of 20 cases.

BACKGROUND: There is limited insight into the mechanisms of anterior cruciate ligament injuries in alpine skiing, particularly among professional ski racers. PURPOSE: This study was undertaken to qualitatively describe the mechanisms of anterior cruciate ligament injury in World Cup alpine skiing. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Twenty cases of anterior cruciate ligament injuries reported through the International Ski Federation Injury Surveillance System for 3 consecutive World Cup seasons (2006-2009) were obtained on video. Seven international experts in the field of skiing biomechanics and sports medicine related to alpine skiing performed visual analyses of each case to describe the injury mechanisms in detail (skiing situation, skier behavior, biomechanical characteristics). RESULTS: Three main categories of injury mechanisms were identified: slip-catch, landing back-weighted, and dynamic snowplow. The slip-catch mechanism accounted for half of the cases (n = 10), and all these injuries occurred during turning, without or before falling. The skier lost pressure on the outer ski, and while extending the outer knee to regain grip, the inside edge of the outer ski caught abruptly in the snow, forcing the knee into internal rotation and valgus. The same loading pattern was observed for the dynamic snowplow (n = 3). The landing back-weighted category included cases (n = 4) where the skier was out of balance backward in flight after a jump and landed on the ski tails with nearly extended knees. The suggested loading mechanism was a combination of tibiofemoral compression, boot-induced anterior drawer, and quadriceps anterior drawer. CONCLUSION: Based on this video analysis of 20 injury situations, the main mechanism of anterior cruciate ligament injury in World Cup alpine skiing appeared to be a slip-catch situation where the outer ski catches the inside edge, forcing the outer knee into internal rotation and valgus. A similar loading pattern was observed for the dynamic snowplow. Injury prevention efforts should focus on the slip-catch mechanism and the dynamic snowplow.

Injuries among World Cup freestyle skiers.

BACKGROUND: Limited knowledge exists on injuries among professional freestyle skiers. OBJECTIVE: To describe the risk of injury and injury patterns among competitive World Cup (WC) freestyle skiers during the competitive season. METHODS: Retrospective interviews were conducted with WC freestyle skiers from 20 nations in a cohort study at the end of the 2006-2007, 2007-2008 and 2008-2009 winter seasons, and all acute injuries occurring during the 4.5 month competitive season were recorded. If an athlete was not present, we interviewed his or her coach or medical personnel. RESULTS: A total of 291 acute injuries were recorded among 662 WC freestyle skiers. Ninety-three injuries (32%) were severe in nature, defined as >28 days absence from training/competition. This corresponds to 14 (95% CI 11.2 to 16.9) injuries per 100 athletes per season. The most frequently injured body part was the knee with 77 injuries (27%) and 37 of these were severe. The head was the next most commonly injured body part with 39 (13%) injuries. As many as 106 injuries (36%) occurred during WC/World Ski Championship competitions, corresponding to an injury rate of 15.6 injuries per 1000 runs (95% CI 12.7 to 18.6). There were no significant differences between men and women in either the injury rate or the rate seen for knee injuries. CONCLUSIONS: The injury rate among WC athletes in freestyle skiing is high, especially for severe injuries. The knee is the most commonly injured body part, also dominated by severe injuries. We found no significant difference in the injury rate related to sex.