Risk factors associated with a history of iliotibial band syndrome (hITBS) in distance runners: a cross-sectional study in 76 654 race entrants - a SAFER XXXIII study.

BACKGROUND: Despite the numerous health benefits of distance running, it is also associated with the development of 'gradual onset running-related injuries' (GORRIs) one of which is Iliotibial Band Syndrome (ITBS). Novel risk factors associated with a history of ITBS (hITBS) have not been described in a large cohort of distance runners. OBJECTIVE: To identify risk factors associated with hITBS in distance runners. DESIGN: Descriptive cross-sectional study. SETTING: 21.1 km and 56 km Two Oceans Marathon races (2012-2015). PARTICIPANTS: 106 743 race entrants completed the online pre-race medical screening questionnaire. A total of 1 314 runners confirmed an accurate hITBS diagnosis. METHODS: Selected risk factors associated with hITBS explored included: demographics (race distance, sex, age groups), training/running variables, history of existing chronic diseases (including a composite chronic disease score) and history of any allergy. Prevalence (%) and prevalence ratios (PR; 95% CI) are reported (uni- & multiple regression analyzes). RESULTS: 1.63% entrants reported hITBS in a 12-month period. There was a higher (p < 0.0001) prevalence of hITBS in the longer race distance entrants (56 km), females, younger entrants, fewer years of recreational running (PR = 1.07; p = 0.0009) and faster average running speed (PR = 1.02; p = 0.0066). When adjusted for race distance, sex, age groups, a higher chronic disease composite score (PR = 2.38 times increased risk for every two additional chronic diseases; p < 0.0001) and a history of allergies (PR = 1.9; p < 0.0001) were independent risk factors associated with hITBS. CONCLUSION: Apart from female sex, younger age, fewer years of running and slower running speed, two novel independent risk factors associated with hITBS in distance runners are an increased number of chronic diseases and a history of allergies. Identifying athletes at higher risk for ITBS can guide healthcare professionals in their prevention and rehabilitation efforts.

Patellofemoral Pain Syndrome Is Associated With Chronic Disease and Allergies in 60 997 Distance Runner Race Entrants: SAFER XXX Study.

OBJECTIVE: Patellofemoral pain syndrome (PFPS) is a common running-related injury. Independent risk factors associated with PFPS have not been described in a large cohort of distance runners. DESIGN: Descriptive, cross-sectional study. SETTING: 21.1 and 56 km Two Oceans Marathon races (2012-2015). PARTICIPANTS: 60 997 race entrants. ASSESSMENT OF RISK FACTORS: Participants completed a compulsory prerace medical screening questionnaire (history of PFPS in the past 12 months, n = 362; no injury history, n = 60 635). Selected risk factors associated with a history of PFPS were explored using univariate & multivariate analyses: demographics, training/running variables, history of chronic diseases (composite chronic disease score), and any allergy. MAIN OUTCOME MEASURES: Prevalence ratios (PRs, 95% confidence intervals). RESULTS: Risk factors associated with PFPS (univariate analysis) were increased years of recreational running (PR = 1.09; P = 0.0107), older age (>50 years), and chronic diseases (PR > 2): gastrointestinal disease (PR = 5.06; P < 0.0001), cardiovascular disease (CVD) (PR = 3.28; P < 0.0001), nervous system/psychiatric disease (PR = 3.04; P < 0.0001), cancer (PR = 2.83; P = 0.0005), risk factors for CVD (PR = 2.42; P < 0.0001), symptoms of CVD (PR = 2.38; P = 0.0397), and respiratory disease (PR = 2.00; P < 0.0001). Independent risk factors (multivariate analysis) associated with PFPS (adjusted for age, sex, and race distance) were a higher chronic disease composite score (PR = 2.68 increased risk for every 2 additional chronic diseases; P < 0.0001) and a history of allergies (PR = 2.33; P < 0.0001). CONCLUSIONS: Novel independent risk factors associated with PFPS in distance runners are a history of multiple chronic diseases and a history of allergies. Identification of chronic diseases and allergies should be considered as part of the clinical assessment of a runner presenting with a history of PFPS.

Risk factors associated with gradual onset running-related injuries in 5770 ultramarathon race entrants - SAFER XXXII.

BACKGROUND: There is limited evidence available on contributing factors for gradual onset running-related injuries (GORRIs) in ultramarathon runners. The aim was to determine if selected risk factors were associated with a history of GORRIs in 90-km ultramarathon race entrants. METHODS: Descriptive cross-sectional study. GORRI and medical data using an online pre-race medical screening tool was collected from 5770 consenting race entrants from the 2018 90-km Comrades Marathon. Selected risk factors associated with 12-months history of GORRIs (age, sex, training, chronic diseases and allergies) were analyzed using a multiple model (Poisson regression). Prevalence and prevalence ratios (PR, 95% CIs) are reported. RESULTS: The overall 12-month prevalence of GORRIs was 11.6% (95% CI: 10.8-12.5) and this was higher in females versus males (PR=1.6; 1.4-1.9) (P<0.0001). Novel independent risk factors associated with a history of GORRIs were: history of chronic disease (PR=1.3; P=0.0063); history of allergies (PR=1.7 increased risk for every disease; P<0.0001); fewer training sessions/week (PR=0.8 decreased risk for every two additional training sessions per week; P=0.0005); and increased number of years as a recreational runner (PR=1.1 increased risk per 5 years of running; P=0.0158). CONCLUSIONS: There is a complex interaction between the internal and external risk factors associated with GORRIs in 90-km distance runners. These data can inform injury prevention programs targeted at subgroups of ultradistance runners.

The illness burden of gastrointestinal illness is two times higher if it is associated with systemic symptoms and signs: a cross-sectional study of the super rugby tournament over 5 seasons (102,738 player-days).

BACKGROUND: Gastrointestinal tract illness (GITill) in rugby players is underreported. The incidence, severity (% time loss illness, days lost per illness) and burden of GITill with/without systemic symptoms and signs in professional South African male rugby players during the Super Rugby tournament (2013-2017) are reported. METHODS: Team physicians completed daily illness logs of players (N.=537; 1141 player-seasons, 102738 player-days). The incidence (illnesses/1000 player-days, 95% CI), severity (% ≥1-day time-loss; days until return-to-play [DRTP]/single illness [mean: 95% CI]) and illness burden (IB: days lost to illness/1000 player-days) for the subcategories of GITill with/without systemic symptoms and signs (GITill+ss; GITill-ss), and gastroenteritis with/without systemic symptoms and signs (GE+ss; GE-ss) are reported. RESULTS: The incidence of all GITill was 1.0 (0.8-1.2). Incidence was similar for GITill+ss 0.6 (0.4-0.8) and GITill-ss 0.4 (0.3-0.5; P=0.0603). Incidence of GE+ss 0.6 (0.4-0.7) was higher than GE-ss 0.3 (0.2-0.4; P=0.0045). GITill caused ≥1-day time-loss in 62% of cases (GE+ss 66.7%; GE-ss 53.6%). GITill caused an average of 1.1 DRTP/single GITill, which was similar for subcategories. IB of GITill+ss was higher than GITill-ss (IB Ratio: 2.1 [1.1-3.9; P=0.0253]). IB for GITill+ss is 2 times higher than GITill-ss (IB Ratio: 2.1 [1.1-3.9]; P=0.0253); and GE+ss >3 times higher than GE-ss (IB Ratio: 3.0 [1.6-5.8]; P=0.0007). CONCLUSIONS: GITill accounted for 21.9% of all illnesses during the Super Rugby tournament, with >60% of GITill resulting in time-loss. The average DRTP/single illness was 1.1. GITill+ss and GE+ss resulted in higher IB. Targeted interventions to reduce the incidence and severity of GITill+ss and GE+ss should be developed.

Chronic diseases and allergies are risk factors predictive of a history of Medial Tibial Stress Syndrome (MTSS) in distance runners: SAFER study XXIV.

BACKGROUND: Medial Tibial Stress Syndrome (MTSS) is one of the most common causes of exercise-associated lower leg pain in distance runners. AIM: To identify risk factors predictive of a history of MTSS in distance runners entering the Two Oceans Marathon races (21.1 km and 56 km). DESIGN: Cross-sectional study. SETTING: 2012 to 2015 Two Oceans Marathon races (21.1 km and 56 km). PARTICIPANTS: Consenting race entrants. METHODS: 106,743 race entrants completed an online pre-race medical screening questionnaire. 76,654 consenting runners (71.8%) were studied. 558 verified MTSS injuries were reported in the previous 12 months. Risk factors predictive of a history of MTSS were explored using uni - & multivariate analyses: demographics (race distance, sex, and age groups), training/racing history, history of chronic diseases, allergies, and medication use. RESULTS: Independent risk factors predictive of a history of MTSS (adjusted for sex, age group, and race distance) were a higher chronic disease composite score (PR = 3.1 times increase risk for every two additional chronic diseases; p < 0.0001) and a history of allergies (PR = 1.9; p < 0.0001). Chronic diseases (PR > 2) predictive of a history of MTSS were: symptoms of CVD (PR = 4.2; p < 0.0001); GIT disease (PR = 3.3; p < 0.0001); kidney/bladder disease (PR = 3.3; p < 0.0001); nervous system/psychiatric disease (PR = 3.2; p < 0.0001); respiratory disease (PR = 2.9; p < 0.0001) a history of CVD (PR = 2.9; p < 0.0001); and risk factors of CVD (PR = 2.4; p < 0.0001) (univariate analysis). Average running speed was associated with higher risk of MTSS. CONCLUSION: Novel independent risk factors predictive of a history of MTSS in distance runners (56 km, 21.1 km) were multiple chronic diseases and a history of allergies. Identifying athletes at higher risk for MTSS can guide healthcare professionals in their prevention and rehabilitation efforts.

Longer distance races and slower running pace are associated with Exercise associated collapse: SAFER XXV study in 153,208 distance runners.

BACKGROUND: Exercise associated collapse (EAC) is a common medical encounter at distance running events. Risk factors associated with EAC are not well documented. The objective is to determine the overall incidence of EAC and identify risk factors associated with EAC in 21.1-km and 56-km runners. METHODS: A cross-sectional analysis of 153,208 race starters from the Two Oceans Marathon races (2008-2015). All EACs on race day were documented by medical staff. Risk factors associated with EAC investigated included demographics, race distance (21.1 km vs. 56-km), running speed, race experience and race day environmental data (wet-bulb globe temperature [WBGT], humidity, wind speed). Incidence (per 1000 starters; 95% CIs) and incidence ratios (95%CIs) were calculated. RESULTS: The overall incidence of EAC was 1.50 (95% CI: 1.31-1.71). Longer race distance (IR: 2.1; 1.6-2.7; P<0.0001) and slower running speed (IR: 1.3; 1.1-1.5; P=0.0017) were significant risk factors associated with EAC. The incidence of EAC was higher in female vs. male 21.1-km race starters (IR=2.25; 1.47-3.46; P=0.0229). Age and environmental conditions were not associated with EAC (P>0.05) in a cool and temperate environment. CONCLUSIONS: About 1 in 667 race starters (21.1 km and 56-km) develop EAC. Longer race distance, slower running speed and female sex (in 21.1-km starters) are significant risk factors associated with EAC. Race medical directors can identify race entrants that may be at risk of developing EAC, develop prevention strategies and better prepare medical care at these events.

Risk factors for not finishing an ultramarathon: 4-year study in 23,996 race starters, SAFER XXI.

BACKGROUND: Limited data support prerace medical screening to identify risk factors for not finishing an endurance running race. The aim of the study was to determine risk factors associated with not finishing an ultramarathon. METHODS: A prospective, cross-sectional study of Two Oceans ultramarathon (56 km) race starters who completed a prerace medical screening questionnaire. Race day environmental conditions were recorded on race day. Univariate analyses of risk factors associated with the did-not-finish (DNF) included race day factors and prerace medical screening history. RESULTS: Risk factors for DNF amongst 23,996 starters during the 56 km race included older age and females (P<0.0001). After adjusting for age and sex, the following were significant univariate risk factors: fewer years of running (P<0.0001), less previous race experience (P<0.0001), less training/racing per week (P=0.0002), lower average weekly training distance (P=0.0016), slower race vs. training speed (P<0.0001), lack of allergies (P=0.0100) and average wet-bulb globe temperature (P<0.0001). CONCLUSIONS: Females, older age, training-related factors (less training/racing, average weekly training distance, race vs. training speed) and average wet-bulb temperature, were risk factors for not finishing an ultramarathon. The results may not only assist runners and coaches in race preparation, but also have clinical implications for the medical planning prior to races.

Chronic Disease, Allergies, and Increased Years of Running Are Risk Factors Predicting Gradual Onset Running-Related Injuries in Ultramarathon Runners-SAFER XIX Study in 29 585 Race Entrants.

OBJECTIVES: To identify risk factors that predict gradual onset running-related injuries (GORRIs) in ultramarathon runners entering a mass community-based event. DESIGN: Descriptive cross-sectional study. SETTING: Two Oceans 56 km ultramarathon 2012 to 2015. PARTICIPANTS: Race entrants (n = 42 003) completed a compulsory pre-race medical history questionnaire; 29 585 (70.4%) of entrants consented. DEPENDENT/OUTCOME VARIABLE: A history of GORRIs in the past 12 months among race entrants. MAIN OUTCOME MEASURES: In a multi-variate model, runner demographics, training variables (years of recreational running, weekly running distance, training running speed), history of chronic disease (composite score), and history of allergies were included as factors predicting GORRIs. Prevalence (%) and prevalence ratios (PR, 95% CIs) are reported. RESULTS: The lifetime prevalence of GORRIs in ultramarathon runners was 24.4%. Independent factors predicting GORRIs were: higher chronic disease composite score (PR = 2.05 times increase risk for every 2 additional chronic diseases; P < 0.0001), history of allergies (PR = 1.66; P < 0.0001), increased years of recreational running (PR = 1.07 times increased risk for every 5 year increase in running; P < 0.0001), lower average weekly running distance (PR = 0.98 times decreased risk for every 15 km increase weekly running distance; P < 0.0001), and slower average training running speed (PR = 0.96 times decreased risk for every km/h increase in training running speed; P < 0.0001). CONCLUSIONS: Novel risk factors predicting GORRIs are increased number of chronic diseases and a history of allergies. These factors, together with training variables (years of recreational running, weekly running distance, and training running speed) can be targeted to develop and implement injury prevention, treatment, and rehabilitation interventions in ultramarathon runners.

An Evidence-Based Review of the Pathophysiology, Treatment, and Prevention of Exercise-Associated Muscle Cramps.

Exercise-associated muscle cramps (EAMCs) are common and frustrating for athletes and the physically active. We critically appraised the EAMC literature to provide evidence-based treatment and prevention recommendations. Although the pathophysiology of EAMCs appears controversial, recent evidence suggests that EAMCs are due to a confluence of unique intrinsic and extrinsic factors rather than a singular cause. The treatment of acute EAMCs continues to include self-applied or clinician-guided gentle static stretching until symptoms abate. Once the painful EAMCs are alleviated, the clinician can continue treatment on the sidelines by focusing on patient-specific risk factors that may have contributed to the onset of EAMCs. For EAMC prevention, clinicians should obtain a thorough medical history and then identify any unique risk factors. Individualizing EAMC prevention strategies will likely be more effective than generalized advice (eg, drink more fluids).

The epidemiology of injury and illness at the Vitality Netball World Cup 2019: an observational study.

BACKGROUND: Netball is a physical game with sudden direction changes, decelerations, jumping and landing, stop/start maneuvers and restrictive footwork rules exposing players to injury. Close contact play and shared facilities during tournaments, increase illness risk.Objective: To describe incidence, period prevalence, types and severity of injuries and illnesses during the 10-day Vitality Netball World Cup 2019 (NWC).Methods: All players from 16 teams consented (n = 192). Medical staff recorded injuries (840 exposure hours), illnesses (1440 player-days) and time-loss. Main outcome measures included incidence (I) calculated as injury/1000 player-hours and illness/1000 player-days, period prevalence (PP) and severity (time-loss) of all match injuries and illnesses. RESULTS: 39 players sustained 46 match injuries (I = 54.76; PP = 20.31%). Lower limb injuries (I = 29.76), specifically the ankle (I = 13.10) were most common with lateral ankle ligament sprains the highest (I = 17.39). Contact injuries (I = 40.48) significantly exceeded non-contact injuries (I = 14.29; p = 0.0124). Center players sustained most injuries (n = 12; 26%; I = 14.29), followed by goalkeepers (n = 10; 22%; I = 11.90) and goal defenders (n = 8; 17%; I = 9.52). Injuries occurred in almost 50% of matches, and 67% did not result in time-loss. Time-loss injuries (n = 14; 33%) were most frequent in the lower limb (n = 10; 71%) specifically involved lateral ankle ligaments (n = 4; 29%), attributable to contact (n = 11; 79%) and mostly implicated center players and goal defenders (n = 4 each; 29% each). 11 players contracted 11 illnesses (I = 7.64; PP = 5.72%) with respiratory tract illness contributing 36%. Most illnesses did not result in time-loss (91%). CONCLUSION: This is the first study reporting injury and illness during an NWC. Contact was the main mechanism of injury, and 2/3 of injuries did not result in time-loss. The ankle is most commonly injured and center players sustain most injuries. Non-respiratory system disease was most frequent, but upper respiratory tract infection remains the most common diagnosis. Targeted surveillance studies using similar methodology are required to develop injury and illness preventative strategies in elite netball.

Longer race distance predicts gastrointestinal illness-related medical encounters in 153,208 endurance runner race starters - SAFER XVI.

BACKGROUND: Gastrointestinal illness-related (GITill) medical encounters during distance running range from mild to debilitating. The objective of this study was to identify factors that may predict GITill among 21.1 km and 56 km race starters. METHODS: This is a cross-sectional analysis of data collected prospectively over 8 years at the Two Oceans 56 km and 21.1 km races with 153,208 race starters. GITill encounters requiring medical attention on race day were recorded by medical staff. Risk factors associated with GITill explored in univariate models included: race distance (21.1 km; 56 km), sex, age group, running experience, running speed, and environmental factors (wet-bulb temperature, wind speed and humidity). Incidence (per 100,000 race starters; 95% CI) and incidence ratios (IR) (with 95% CI) are reported. RESULTS: The incidence of GITill encounters was 60 (95%CI: 50-80) (1/1667 race starters). A longer race distance (56 km vs. 21.1 km) was the strongest predictor of GITill (IR=4.3; 95% CI: 2.7-6.7) (P<0.0001). Among the 56 km race starters, slower running speed (km/h) was a predictor of GITill (IR=1.63; 95%CI:1.2-2.3) (P=0.0024). Neither age group, nor running experience or any environmental factors (wet-bulb temperature, wind speed, humidity) were associated with a higher risk of GITill. CONCLUSIONS: Medical teams, responsible for care at longer race distances, can expect a higher incidence of GITill that require medical attention compared with shorter race distances. Slower runners competing in ultramarathons are a subgroup at higher risk of GITill. These data can assist medical teams at events to improve and plan medical care, target runner education and establish prevention strategies to reduce GITill in runners.

Independent Risk Factors Predicting Gradual Onset Injury in 2824 Trail Running Race Entrants: SAFER XVIII Study.

INTRODUCTION: Trail running is characterized by elevation changes, with uneven and varying running surfaces. Risk factors that may predict gradual-onset running-related injuries (GORRIs) in short-distance trail running have not been explored. The objective was to determine risk factors that predict GORRIs in trail running race entrants who entered mass community-based trail running events. METHODS: In this descriptive cross-sectional study, data were collected prospectively from a prerace medical screening questionnaire over 4 trail run events held annually. Using a Poisson regression model, runner demographics, race distance, running training/racing variables, history of chronic diseases (number of chronic diseases reported as a cumulative "chronic disease composite score"), and allergies were investigated to determine factors predicting self-reported GORRI history in the previous 12 mo. RESULTS: This study included 2824 race entrants (80% of entrants). The retrospective annual incidence for GORRIs was 13%. Independent risk factors predicting GORRIs were longer race distance (P<0.0001), increasing chronic disease composite score (P=0.0012), and a history of allergies (P=0.0056). The lower limb (94%) was the main anatomic region of GORRIs, and soft tissue injuries accounted for most (83%) GORRIs. Common specific GORRIs were iliotibial band syndrome (22%), Achilles tendon injury (10%), and hamstring injury (9%). CONCLUSIONS: Independent risk factors predicting GORRIs among trail running entrants included longer race distance, a higher chronic disease composite score, and a history of allergies. This study has highlighted trail running race entrants at risk for sustaining GORRIs who could be targeted for future injury prevention interventions.

Days until return-to-play differ for sub-categories of acute respiratory tract illness in Super Rugby players: A cross-sectional study over 5 seasons (102,738 player-days).

OBJECTIVES: To document incidence rate and severity of specific sub-categories of respiratory tract illness (RTill) in rugby players during the Super Rugby tournament. DESIGN: Cross-sectional study. METHODS: Team physicians completed daily illness logs in 537 professional male rugby players from South African teams participating in the Super Rugby Union tournaments (2013-2017) (1141 player-seasons, 102,738 player-days). The incidence rate (IR: illness episodes/1000 player-days) and severity [%RTill resulting in time-loss, illness burden (IB: days lost to illness/1000 player-days) and days until return-to-play (DRTP)/single illness (mean: 95% Confidence Intervals)] are reported for the following specific sub-categories of RTill: non-infective respiratory tract illness (RTnon-inf), respiratory tract infections (RTinf), influenza-like illness, infective sinusitis, upper respiratory tract infections (URTinf), lower respiratory tract infections (LRTinf). RESULTS: The overall IR of RTill was 2.9 (2.6-3.3). IR was higher for RTinf (2.5; 2.2-2.9) vs. RTnon-inf (0.4; 0.3-0.6) (p < 0.001). For sub-categories the highest IR was in URTinf (1.9; 1.7-2.2), while the % illness causing time-loss was influenza-like illness (100%), LRTinf (91.7%), infective sinusitis (55.6%), and URTinf (49.0%). IB was highest for URTinf (2.0; 1.6-2.5), and the DRTP/single illness was highest for LRTinf (3.2; 2.3-4.4), and influenza-like illness (2.1; 1.6-2.8). CONCLUSIONS: RTinf accounted for >57% of all illness during the Super Rugby tournament, and mostly URTinf. Influenza-like illness. LRTinf caused time-loss in >90% cases. URTinf, LRTinf and influenza-like illness resulted in the highest burden of illness and LRTinf caused the highest DRTP. Prevention strategies should focus on mitigating the risk of RTinf, specifically URTinf, LRTinf and influenza-like illness.

Diagnosis and management of nasal obstruction in the athlete. A narrative review by subgroup B of the IOC Consensus Group on "Acute Respiratory Illness in the Athlete".

Protection of the health of the athlete is required for high level sporting performance. Acute respiratory illness is the leading cause of illness and can compromise training and competition in athletes. To date the focus on respiratory health in athletes has largely been on acute upper respiratory infections and asthma/exercise induced bronchoconstriction (EIB), while nasal conditions have received less attention. The nose has several important physiological functions for the athlete. Nasal conditions causing obstruction to airflow can compromise respiratory health in the athlete, negatively affect quality of life and sleep, cause mouth breathing and ultimately leading to inadequate recovery and reduced exercise performance. Nasal obstruction can be broadly classified as structural (static or dynamic) or mucosal. Mucosal inflammation in the nose (rhinitis) is the most frequent cause of nasal obstruction and is reported to be higher in athletes (21-74%) than in the general population (20-25%). This narrative review provides the sport and exercise medicine physician with a clinical approach to the diagnosis and management of common nasal conditions that can cause nasal obstruction, ultimately leading to improved athlete health and better sports performance.

The Injury and Illness Profile of Male and Female Participants in a 94.7 km Cycle Race: A Cross-Sectional Study.

OBJECTIVE: To describe the incidence and patterns of injury and illness of male and female participants during a 94.7 km distance cycling event. DESIGN: Descriptive study. SETTING: Momentum 94.7 Cycle Challenge 2014. PARTICIPANTS: All 23 055 race starters (males = 17 520, females = 5236, not specified = 299). MAIN OUTCOME MEASURES: The incidence and type of all medical complaints and difference between sexes. RESULTS: Incidence (per 1000 race starters) of all medical complaints was 38.69 (males = 36.52, females = 38.39), adverse medical events 11.88 (males = 10.73, females = 16.42) and serious adverse events 1.3 (males = 0.86, females = 2.67). The incidence of nontraumatic medical complaints was 32.49 (males = 33.39, females = 31.32) and of traumatic injuries was 3.99 (males = 3.14, females = 7.07). Females compared to males had a higher risk of sustaining traumatic injuries (P < 0.001), central nervous system, (P = 0.0062) and eye complaints (P = 0.0107). Most complaints (80.6%) were reported for the musculoskeletal system. Males 10-15 years (P = 0.0013) and females 23-39 years (P = 0.0336), and older than 50 years (P = 0.0002) had a higher than expected risk for traumatic injuries. CONCLUSIONS: Medical complaints ratio reported was 1:26 (males = 1:28, females = 1:26) in all starters during the cycling event. Cyclists that did not finish the race (adverse events) were 1:84 (males = 1:93, females = 1:61). Serious adverse events that required hospitalization were 1:769 (males = 1:1163, females = 1:374). The majority of admissions were for traumatic injuries, followed by cardiovascular complaints. Results from this study indicated that a wide spectrum of medical complaints can be expected during such an event with a higher risk for females to sustain traumatic injuries and to encounter central nervous system and eye complaints. Information regarding the pattern and type of medical encounters can prove useful during planning and management of similar future events.

Match injury incidence during the Super Rugby tournament is high: a prospective cohort study over five seasons involving 93 641 player-hours.

OBJECTIVES: To determine the incidence and nature of injuries in the Super Rugby tournament over a 5-year period. METHODS: 482 male professional rugby union players from six South African teams participating in the Super Rugby tournament were studied (1020 player-seasons). Medical staff of participating teams (2012-2016 tournaments) recorded all time loss injuries (total injuries and match injuries) and exposure hours (93 641 total playing hours; 8032 match hours). Injury incidence, injured player proportion, severity (time lost), anatomical location, tissue type and activity/phase during which injury occurred are reported. RESULTS: The overall incidence of match injuries (per 1000 player-hours; 95% CI) for each year was as follows: 2012 (83.3; 69.4-99.2); 2013 (115.1; 98.7-133.5); 2014 (95.9; 80.8-113.1), 2015 (112.3; 96.6-129.9) and 2016 (93.2; 79.9-107.9). The injured player proportion for each year was as follows: 2012 (54.6%); 2013 (49.4%); 2014 (52.0%); 2015 (50.0%); and 2016 (39.8%). The thigh, knee, head/face and shoulder/clavicle are the most frequently injured locations, and muscle/tendon and joint/ligament injuries account for the majority of injuries. Most injuries (79%) occur in contact situations, in particular during a tackle (54%). CONCLUSION: The incidence of match injuries and the injured player proportion in South African teams competing in the Super Rugby tournament is high. Match injury incidence is consistently higher than previously reported for senior male rugby players at elite/professional level. Targeted risk management strategies are therefore needed in the Super Rugby tournament to manage risk of injury.

Novel Factors Associated With Analgesic and Anti-inflammatory Medication Use in Distance Runners: Pre-race Screening Among 76 654 Race Entrants-SAFER Study VI.

OBJECTIVE: Analgesic/anti-inflammatory medication (AAIM) increases the risk of medical complications during endurance races. We determined how many runners use AAIM before or during races, AAIM types, and factors associated with AAIM use. DESIGN: Cross-sectional study. SETTING: 21.1-km and 56-km races. PARTICIPANTS: Seventy-six thousand six hundred fifty-four race entrants. METHODS: Participants completed pre-race medical screening questions on AAIM use, running injury or exercise-associated muscle cramping (EAMC) history, and general medical history. MAIN OUTCOME MEASURES: Analgesic/anti-inflammatory medication use, types of AAIM (% runners; 95% confidence interval), and factors associated with AAIM use (sex, age, race distance, history of running injury or EAMC, and history of chronic diseases) [prevalence ratio (PR)]. RESULTS: Overall, 12.2% (12.0-12.5) runners used AAIM 1 week before and/or during races (56 km = 18.6%; 18.0-19.1, 21.1 km = 8.3%; 8.1-8.6) (P < 0.0001). During races, nonsteroidal anti-inflammatory drugs (NSAIDs) (5.3%; 5.1-5.5) and paracetamol (2.6%; 2.4-2.7) were used mostly. Independent factors (adjusted PR for sex, age, and race distance; P < 0.0001) associated with AAIM use were running injury (2.7; 2.6-2.9), EAMC (2.0; 1.9-2.1), cardiovascular disease (CVD) symptoms (2.1; 1.8-2.4), known CVD (1.7; 1.5-1.9), CVD risk factors (1.6; 1.5-1.6), allergies (1.6; 1.5-1.7), cancer (1.3; 1.1-1.5), and respiratory (1.7; 1.6-1.8), gastrointestinal (2.0; 1.9-2.2), nervous system (1.9; 1.7-2.1), kidney/bladder (1.8; 1.6-2.0), endocrine (1.5; 1.4-1.7), and hematological/immune (1.5; 1.2-1.8) diseases. CONCLUSIONS: 12.2% runners use AAIM before and/or during races, mostly NSAIDs. Factors (independent of sex, age, and race distance) associated with AAIM use were history of injuries, EAMC, and numerous chronic diseases. We suggest a pre-race screening and educational program to reduce AAIM use in endurance athletes to promote safer races.

Underlying Chronic Disease, Medication Use, History of Running Injuries and Being a More Experienced Runner Are Independent Factors Associated With Exercise-Associated Muscle Cramping: A Cross-Sectional Study in 15778 Distance Runners.

BACKGROUND: Exercise-associated muscle cramping (EAMC) is a significant medical complication in distance runners, yet factors associated with EAMC are poorly documented. OBJECTIVE: To document risk factors associated with EAMC in runners. DESIGN: Cross-sectional study. SETTING: Two ocean races (21.1 km, and 56 km). PARTICIPANTS: Fifteen thousand seven hundred seventy-eight race entrants. METHODS: Participants completed a prerace medical history screening tool including: training, cardiovascular disease (CVD), risk factors for, and symptoms of CVD, history of diseases affecting major organ systems, cancer, allergies, medication use, and running injury. Runners were grouped as having a history of EAMC (hEAMC group = 2997) and a control group (Control = 12 781). RESULTS: Independent factors associated with a higher prevalence ratio (PR) of hEAMC were any risk factor for CVD (PR = 1.16; P = 0.0002), symptoms of CVD (PR = 2.38; P < 0.0001), respiratory disease (PR = 1.33; P < 0.0001), gastrointestinal disease (PR = 1.86; P < 0.0001), nervous system or psychiatric disease (PR = 1.51; P < 0.0001), kidney or bladder disease, (PR = 1.60; P < 0.0001), haematological or immune disease (PR = 1.54; P = 0.0048), cancer (PR = 1.34; P = 0.0031), allergies (PR = 1.37; P < 0.0001), regular medication use (PR = 1.80; P < 0.0001), statin use (PR = 1.26; P = 0.0127), medication use during racing (PR = 1.88; P < 0.0001), running injury (PR = 1.66; P < 0.0001), muscle injury (PR = 1.82; P < 0.0001), tendon injury (PR = 1.62; P < 0.0001), and runners in the experienced category (PR = 1.22; P < 0.0001). CONCLUSION: Novel risk factors associated with EAMC in distance runners were underlying chronic disease, medication use, a history of running injuries, and experienced runners. These factors must be identified as possible associations, and therefore be considered in the diagnosis and treatment of EAMC.

Sport, sex and age increase risk of illness at the Rio 2016 Summer Paralympic Games: a prospective cohort study of 51 198 athlete days.

OBJECTIVE: To describe the epidemiology of illness at the Rio 2016 Summer Paralympic Games. METHODS: A total of 3657 athletes from 78 countries, representing 83.5% of all athletes at the Games, were monitored on the web-based injury and illness surveillance system (WEB-IISS) over 51 198 athlete days during the Rio 2016 Summer Paralympic Games. Illness data were obtained daily from teams with their own medical support through the WEB-IISS electronic data capturing systems. RESULTS: The total number of illnesses was 511, with an illness incidence rate (IR) of 10.0 per 1000 athlete days (12.4%). The highest IRs were reported for wheelchair fencing (14.9), para swimming (12.6) and wheelchair basketball (12.5) (p<0.05). Female athletes and older athletes (35-75 years) were also at higher risk of illness (both p<0.01). Illnesses in the respiratory, skin and subcutaneous and digestive systems were the most common (IRs of 3.3, 1.8 and 1.3, respectively). CONCLUSION: (1) The rate of illness was lower than that reported for the London 2012 Summer Paralympic Games; (2) the sports with the highest risk were wheelchair fencing, para swimming and wheelchair basketball; (3) female and older athletes (35-75 years) were at increased risk of illness; and (4) the respiratory system, skin and subcutaneous system and digestive system were most affected by illness. These results allow for comparison at future Games.