Comprehensive periodic health evaluations of 454 Norwegian Paralympic and Olympic athletes over 8 years: what did we learn?

OBJECTIVE: A periodic health evaluation (PHE) is a comprehensive and multidisciplinary investigation of athlete health widely used in elite sport, but its contents and benefits can be questioned. This study aimed to determine the prevalence of conditions identified by a PHE among Paralympic and Olympic athletes over four consecutive Games cycles from Rio de Janeiro 2016 to Beijing 2022 and to assess the benefits and potential pitfalls of a comprehensive PHE programme in detecting existing injuries, illnesses and other health issues. METHODS: We collected extensive health history and clinical examination data on elite athletes: medical history, ECG, blood pressure, blood samples, spirometry, musculoskeletal health, cognitive function, mental health and compliance with public health programmes. RESULTS: The final cohort included 87 Paralympic and 367 Olympic athletes, representing 565 PHE cycles. Musculoskeletal problems and unspecified pain, infections and allergies were the most frequent health issues. High blood pressure was the most prevalent cardiovascular finding, and vitamin D deficiency the most common laboratory abnormality. Most athletes complied with the public childhood vaccination programmes, but fewer with recommended cancer screening. Follow-up of health issues was variable. CONCLUSION: Our PHE programme identified musculoskeletal problems, infections, allergies, elevated blood pressure and vitamin D deficiency as common health conditions. Longitudinal follow-up of health conditions identified during screening and improved compliance with public health and cancer screening programmes is needed to determine the true benefits of athlete care prompted by the PHE.

Injury and illness among Norwegian Olympic athletes during preparation for five consecutive Summer and Winter Games.

OBJECTIVE: To describe the patterns of health problems among Norwegian Olympic candidates during their preparations for five consecutive Olympic Games (London 2012, Sochi 2014, Rio de Janeiro 2016, PyeongChang 2018 and Tokyo 2020). METHODS: This was a descriptive epidemiological study using the Oslo Sports Trauma Research Center Questionnaire on Health Problems to collect data on all self-reported health problems from Norwegian Olympic candidate athletes for 12-18 months prior to each Olympic Games. Team physicians and physiotherapists followed up the athlete reports, providing clinical care and classifying reported problems according to the International Olympic Committee 2020 consensus statement on methods for recording and reporting of epidemiological data on injury and illness in sport. RESULTS: Between 2011 and 2020, 533 athletes were included in the Norwegian Olympic team monitoring programme, with a 78% response to the weekly questionnaire. During this time, athletes reported 2922 health problems, including 1409 illnesses (48%), 886 overuse injuries (repetitive mechanism, 30%) and 627 acute injuries (traumatic mechanism, 21%). Diagnostic codes were recorded for 2829 (97%) of health problems. Athletes reported, on average, 5.9 new health problems per year (95% CI: 5.6 to 6.1), including 1.3 acute injuries (CI: 1.2 to 1.4), 1.7 overuse injuries (CI: 1.6 to 1.9) and 2.9 illnesses (CI: 2.7 to 3.0). Each year, female and male athletes lost an average of 40 and 26 days of training and competition due to health problems, respectively. The diagnoses with the highest health burden were anterior cruciate ligament rupture, respiratory infection, lumbar pain and patellar tendinopathy. CONCLUSION: The injury burden was particularly high among female athletes and in team sports, whereas endurance sports had the greatest burden of illness. Our data provide a compelling argument for prioritising medical care and investing in prevention programmes not just during the Olympic Games, but also the preparation period.

High prevalence of low bone mineral density but normal trabecular bone score in Norwegian elite Para athletes.

Background: Low bone mineral density (BMD) increases the risk of bone stress injuries (BSI) and is one of several clinical concerns in Para athlete sports medicine. However, whether bone microarchitecture is altered in Para athletes is not known. Objective: We aimed to investigate BMD, bone microarchitecture and incidence of bone stress injuries in Norwegian elite Para athletes. Design: In this cross-sectional study in Para athletes, Dual energy x-ray absorptiometry (iDXA, Lunar, GE Health Care) derived areal BMD, trabecular bone score (TBS), a surrogate marker for bone microarchitecture, and body composition (body weight (BW), lean body mass (LBM), fat mass (FM), fat percentage) were investigated and compared between ambulant and non-ambulant athletes. Also, the association between BMD, TBS and body composition variables was investigated. Incidence of BSI was assessed with a questionnaire and confirmed by a sports physician in a clinical interview. BMD Z-score <-1 was defined as low and ≤-2 as osteoporotic. TBS ≥ 1.31 was normal, 1.23-1.31 intermediate and <1.23 low. Results: Among 38 athletes (26 ± 6 yrs, 14 females), BMD Z-score was low in 19 athletes, and osteoporotic in 11 athletes' lumbar spine (LS) or femoral neck (FN). BMD was lower in non-ambulant vs. ambulant athletes both in LS (1.13 ± 0.19 vs. 1.25 ± 0.14 g/cm2, p = 0.030) and FN (0.90 ± 0.15 vs. 1.07 ± 0.16 g/cm2, p = 0.003). TBS was normal for all athletes. BMD Z-score in LS was positively associated with TBS (r = 0.408, p = 0.013), body weight (r = 0.326, p = 0.046) and lean body mass (r = 0.414, p = 0.010), but not with fat mass or fat percentage. None of the athletes reported any BSI. Conclusions: Half of the Norwegian elite Para athletes had low BMD, and 29% had BMD Z-score <-2 suggesting osteoporosis. Non-ambulant athletes were more prone to low BMD than ambulant athletes. However, despite high prevalence of low BMD, TBS was normal in all athletes, and BSI was absent in this young population.

Utilization of Imaging for Severe Injuries at the Beijing 2022 Winter Olympic Games.

Purpose: In order to better understand the imaging of severe trauma in sport, this study describes the imaging modalities utilized to image athletes who experienced severe traumatic injuries at the Beijing Winter Olympic Games 2022, the distribution of these modalities in relation to the sporting facilities, and the types of injuries imaged in each sport. Methods: This is a retrospective analysis with descriptive tables and figures, performed on a single population (athletes of the Beijing Winter Olympic Games 2022). Results: Of the 2871 athletes in the Beijing Winter Olympic Games, there were 40 athletes with severe injuries who underwent medical imaging. MRI was used more often than Radiography or CT. Athletes at venues without MRI on site had to be transferred to adjacent hospitals for care. Alpine and Freestyle skiing athletes experienced the majority of severe traumatic injuries at this Olympic Games, and the majority of injuries were to the lower limb. Conclusions: Access to medical imaging for severely injured athletes is a critical consideration in the organization of any sporting event. MRI in particular is highly utilized in this population.

Olympic Games during nationwide lockdown: sports injuries and illnesses, including COVID-19, at the Beijing 2022 Winter Olympics.

OBJECTIVE: The objective of this study is to describe the incidence of injuries and illnesses sustained during the Beijing Winter Olympic Games from 4 February 2022 to 20 February 2022. METHODS: We recorded the daily number of athlete injuries and illnesses (1) through the reporting of all National Olympic Committee (NOC) medical teams and (2) in the polyclinic and medical venues by the Beijing 2022 medical staff. RESULTS: In total, 2848 athletes (1276 women, 45%; 1572 men, 55%) from 91 NOCs were followed prospectively for the occurrence of injury and illness. NOC and Beijing 2022 medical staff reported 289 injuries and 109 illnesses, equalling 10.1 injuries and 3.8 illnesses per 100 athletes over the 17-day period. The injury incidence was highest in ski halfpipe (30%), ski big air (28%), snowboard slopestyle (23%) and ski slopestyle (22%), and lowest (1%-2%) in curling, alpine mixed team parallel slalom, Nordic combined and alpine super-G. The illness incidence was highest in ski aerials (10%), skeleton (8%), cross-country skiing (8%) and Nordic combined (7%). In the study period, COVID-19 affected 32 athletes, accounting for 29% of all illnesses affecting 1.1% of all athletes. CONCLUSION: Overall, 10% of the athletes incurred an injury and 4% an illness during the Beijing Winter Olympic Games. The incidence of illnesses overall, which was the lowest yet recorded in the Winter Olympic Games, and COVID-19 was mitigated through comprehensive countermeasures.

International Olympic Committee (IOC) consensus paper on sports-related ophthalmology issues in elite sports.

Vision plays an important role in an athletes' success. In sports, nearly 80% of perceptual input is visual, and eye health and sports medicine are closely intertwined fields of utmost importance to athletes. The physical nature of sports activities renders individuals more prone to various eye injuries than the general population. Ocular trauma can lead to lifelong sequelae, and impaired vision requires careful follow-up and management. Apart from injuries, athletes may also experience vision problems that can hamper their performance, including blurred vision, double vision, and light sensitivity. The interdisciplinary nature of sports medicine necessitates collaboration between sports medicine professionals and ophthalmologists. Through such collaborations, athletes can receive appropriate eye care, education on proper eye protection and guidance on adopting good eye health practices. If any inconspicuous symptoms are not detected and treated promptly, athletes may acquire systemic injuries because of defective vision, preventing them from achieving high level athletic performance in competitions. The protection of the elite athlete is the responsibility of all of us in sports medicine. To advance a more unified, evidence-informed approach to ophthalmic health assessment and management in athletes and as relevant for sports medicine physicians, the International Olympic Committee Consensus Group aims for a critical evaluation of the current state of the science and practice of ophthalmologic issues and illness in high-level sports, and present recommendations for a unified approach to this important issue.

Effects of physical, psychosocial and dual-career loads on injuries and illnesses among elite handball players: protocol of prospective cohort study.

INTRODUCTION: Health problems in sport cause a major burden on several pillars: sport clubs, health and insurance system and mostly the individual athlete. There is limited knowledge in supporting dual-career athletes firmed on evidence-based research in injury/illness prevention, load and stress management. The main goal of this research approach is to determine how specific physical, psychosocial and dual-career loads affect the occurrence of injuries and illnesses in elite handball players and how much of a variation in the athlete's load leads to an occurrence of an injury/illness. A secondary aim is to determine the association between objective and subjective measures of stress as well as examine the benefits of certain biomarkers to monitor stress, load and injury/illness occurrence in athletes. METHODS AND ANALYSIS: This prospective cohort study, as part of a PhD project, will be carried out on 200 elite handball players of first men's handball league in Slovenia during an entire handball season, lasting from July 2022 to June 2023. Primary outcomes, including health problems, loads and stress, will be assessed weekly on a player level. Other player-related outcomes will include anthropometry, life event survey and blood biomarkers (cortisol, free testosterone and Ig-A), which will be taken three to five times across the observation period according to the players' training cycle. ETHICS AND DISSEMINATION: The project was approved by the National Medical Ethics Committee of Slovenia (number: 0120-109/2022/3) and will be conducted in compliance with the most recent version of Helsinki Declaration. The study results will be published as peer-reviewed articles, congress presentations and as a Doctoral thesis. The results will not only be of importance for the medical and sports community for development of new injury prevention and rehabilitation strategies but also for structuring the correct policy recommendations for athletes' general health. TRIAL REGISTRATION NUMBER: NCT0547129.

Injury History and Perceived Knee Function as Risk Factors for Knee Injury in Youth Team-Sports Athletes.

BACKGROUND: The identification of risk factors for sports injuries is essential before injury prevention strategies can be planned. HYPOTHESIS: Previous acute knee injury and lower perceived knee function measured by Knee injury and Osteoarthritis Outcome Score (KOOS) will increase the risk of acute knee injury in youth team-sports athletes. STUDY DESIGN: Prospective cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: At baseline, youth (≤21 years old) male and female basketball and floorball athletes completed a questionnaire on previous acute knee injuries and perceived knee function (KOOS). A total of 211 male and 183 female athletes were followed for an acute knee injury up to 3 years. Unadjusted and adjusted Cox regression models were used in risk factor analyses. RESULTS: In male athletes, previous acute knee injury and lower KOOS Pain, Activities of Daily Living, Sport and Recreation, and knee-related Quality of Life subscale scores increased the risk of acute knee injury in the unadjusted analyses. Adjusted analyses for male injuries were not performed because of low number of acute knee injuries (n = 18). In female athletes, previous acute knee injury increased the risk of acute knee injury when adjusted for athletes' age and body mass index (hazard ratio, 2.6 [95% CI, 1.3-5.2]). In female athletes, none of the KOOS subscale scores were associated with the increased risk of acute knee injury in the adjusted analyses. CONCLUSION: Previous acute knee injury was associated with the risk of new acute knee injury in youth male and female athletes. In youth male athletes, additionally, lower perceived knee function in 4 out of 5 KOOS subscale scores were associated with the increased risk of new acute knee injury. CLINICAL RELEVANCE: The treatment and rehabilitation of the present acute knee injury and secondary prevention of reinjury should be emphasized in youth team-sports athletes.

Prevalence of and factors associated with osteoarthritis and pain in retired Olympians compared with the general population: part 2 - the spine and upper limb.

OBJECTIVES: (1) To determine the prevalence of spine and upper limb osteoarthritis (OA) and pain in retired Olympians; (2) identify risk factors associated with their occurrence and (3) compare with a sample of the general population. METHODS: 3357 retired Olympians (44.7 years) and 1735 general population controls (40.5 years) completed a cross-sectional survey. The survey captured demographics, general health, self-reported physician-diagnosed OA, current joint/region pain and significant injury (lasting ≥1 month). Adjusted ORs (aORs) compared retired Olympians and the general population. RESULTS: Overall, 40% of retired Olympians reported experiencing current joint pain. The prevalence of lumbar spine pain was 19.3% and shoulder pain 7.4%, with lumbar spine and shoulder OA 5.7% and 2.4%, respectively. Injury was associated with increased odds (aOR, 95% CI) of OA and pain at the lumbar spine (OA=5.59, 4.01 to 7.78; pain=4.90, 3.97 to 6.05), cervical spine (OA=17.83, 1.02 to 31.14; pain=9.41, 6.32 to 14.01) and shoulder (OA=4.91, 3.03 to 7.96; pain=6.04, 4.55 to 8.03) in retired Olympians. While the odds of OA did not differ between Olympians and the general population, the odds of lumbar spine pain (1.44, 1.20 to 1.73), the odds of shoulder OA after prior shoulder injury (2.64, 1.01 to 6.90) and the odds of cervical spine OA in female Olympians (2.02, 1.06 to 3.87) were all higher for Olympians compared with controls. CONCLUSIONS: One in five retired Olympians reported experiencing current lumbar spine pain. Injury was associated with lumbar spine, cervical spine and shoulder OA and pain for Olympians. Although overall OA odds did not differ, after adjustment for recognised risk factors, Olympians were more likely to have lumbar spine pain and shoulder OA after shoulder injury, than the general population.

New sports, COVID-19 and the heat: sports injuries and illnesses in the Tokyo 2020 Summer Olympics.

OBJECTIVE: To describe the incidence of injuries and illnesses sustained during the Tokyo Summer Olympic Games from 23 July to 8 August 2021. METHODS: We recorded the daily number of athlete injuries and illnesses (1) through the reporting of all National Olympic Committee (NOC) medical teams and (2) in the polyclinic and medical venues by the Tokyo 2020 medical staff. RESULTS: In total, 11 315 athletes (5423 women, 48%; 5892 men, 52%) from 206 NOCs were followed up prospectively for the occurrence of injury and illness. NOC and Tokyo 2020 medical staff reported 1035 injuries and 438 illnesses, equalling 9.1 injuries and 3.9 illnesses per 100 athletes over the 17-day period. Altogether, 9% of the athletes incurred at least one injury and 4% at least one illness. The incidence of injury was highest in boxing (27%), BMX racing (27%), BMX freestyle (22%), skateboarding (21%), karate (19%) and handball (18%), of which both BMX freestyle and skateboarding were new events, and lowest in diving, road cycling, rowing, marathon swimming and shooting (1-2%). Marathon and artistic swimming presented the highest illness incidences (both 8%), followed by skateboarding and karate (both 7%). In the study period, COVID-19 affected 18 athletes, accounting for 4% of all illnesses and 0.16% of all athletes. Exertional heat illness affected 78 athletes (18% of all illnesses, 0.7% of all athletes), the majority (88%) resulting in no time lost from sport. CONCLUSION: Overall, 9% of the athletes incurred an injury and 4% an illness during the Games. Comprehensive countermeasures helped mitigate both COVID-19 and exertional heat illnesses.

Illness and injury among Norwegian Para athletes over five consecutive Paralympic Summer and Winter Games cycles: prevailing high illness burden on the road from 2012 to 2020.

OBJECTIVE: To describe the illness and injury pattern of Norwegian Para athletes over five consecutive Paralympic Summer and Winter Games cycles and to identify which health problems should be targeted in risk management plans with respect to impairment types. METHODS: We monitored athletes from 12 to 18 months prior to each Game using a weekly online questionnaire (Oslo Sports Trauma Research Center-H2 (OSTRC-H2)). We asked them to report all health problems they had experienced in the preceding 7 days, irrespective of their consequences on their sports participation or performance and whether they had sought medical attention. RESULTS: Between 2011 and 2020, 94 candidate athletes were included in this monitoring programme and prepared to represent Norway; of these, 66 (71%) were finally selected for multiple Paralympic Games. The overall response rate to the weekly questionnaires was 87%. At any given time during the five observation cycles, 37% of the athletes (95% CI 36% to 38%) reported having at least one health problem. Athletes with neurological impairments (n=51) lost 10 days per year due to respiratory problems (95% CI 9 to 11) compared with 9 days (8-10) among those with musculoskeletal impairments (n=37). Gastrointestinal problems caused a time loss of on average 4 days per year in athletes with neurological impairments versus 1 day in athletes with musculoskeletal impairments (mean difference 2.7 days, 2.1-3.3). Musculoskeletal injuries generated a high burden for both athlete groups, in particular, to the elbow, shoulder and lumbosacral regions. CONCLUSION: At any given time, nearly two out of five elite Norwegian Para athletes reported at least one health problem. Respiratory tract and other infections; gastrointestinal problems, injuries to the shoulder, elbow and lumbosacral regions represented the greatest health burden. Our findings can help guide the allocation of clinical resources, which should include a broad network of medical specialists, together with dieticians and physiotherapists, to meet the health challenges in Para athletes.

Adherence to an Injury Prevention Warm-Up Program in Children's Soccer-A Secondary Analysis of a Randomized Controlled Trial.

This study examined the impact of high adherence to a neuromuscular training (NMT) warm-up on the risk of lower extremity (LE) injuries in children's soccer. Twenty U11-U14 youth clubs (n = 92 teams, 1409 players) were randomized into intervention (n = 44 teams) and control (n = 48 teams) groups. The intervention group was advised to perform an NMT warm-up 2 to 3 times a week for 20 weeks. Team adherence, injuries, and exposure were registered throughout the follow-up. Primary outcomes were the incidence of soccer-related acute LE injuries and the prevalence of overuse LE injuries. Intervention teams conducted mean 1.7 (SD 1.0) NMT warm-ups weekly through follow-up. The seasonal trend for adherence declined significantly by -1.9% (95% CI -0.8% to -3.1%) a week. There was no difference in the incidence of acute injuries nor the prevalence of overuse LE injuries in high team adherence group (n = 17 teams) compared to controls. However, the risk for acute noncontact LE injuries was 31% lower in the high team adherence group compared to controls (IRR 0.69, 95% CI 0.49 to 0.97). In an efficacy analysis (n = 7 teams), there was a significant reduction of 47% in the rate of noncontact LE injuries (IRR 0.53, 95% CI 0.29 to 0.97). In conclusion, teams conducted NMT warm-up sessions regularly, but with a declining trend. A greater protective effect was seen in teams with the highest adherence to the NMT warm-up.

Effect of an Unsupervised Exercises-Based Athletics Injury Prevention Programme on Injury Complaints Leading to Participation Restriction in Athletics: A Cluster-Randomised Controlled Trial.

OBJECTIVE: To test the efficacy of the Athletics Injury Prevention Programme (AIPP) to reduce the percentage of athletes presenting at least one injury complaint leading to participation restriction (ICPR) over an athletics season. METHODS: During the 2017-2018 athletics season, we included in this cluster randomised controlled trial (ClinicalTrials.gov Identifier: NCT03307434) 840 athletes randomly assigned (randomisation unit: athletic clubs) to a control group (regular training) or to an intervention group (regular training plus the AIPP 2/week). Using a weekly online questionnaire, athletes reported the ICPR, training and competition exposures, and, for the intervention group, the compliance with the AIPP. The primary outcome was the percentage of athletes presenting at least one ICPR over the study follow-up. RESULTS: A total of 449 and 391 athletes were included in the intervention and control groups, respectively. From them, 68 (15.1%) and 100 (25.6%) athletes, respectively, provided 100% of the requested information during the follow-up (39 weeks). A total of 6 (8.8%) performed the AIPP 2/week or more. The proportion of athletes who had at least one ICPR over the follow-up period was similar in the intervention (64.7%) and control groups (65.0%), with adjusted odds ratios: 0.81 (95% CI 0.36 to 1.85). There were no between-group differences when comparing separately the subgroups corresponding with the different compliance levels. CONCLUSION: This cluster randomised controlled trial reported no efficacy of the AIPP. However, the overall response proportion and the compliance with the AIPP in the intervention group were low. In individual sports especially, efforts should be first made to improve the implementation and adoption of interventions.

Methods, challenges and benefits of a health monitoring programme for Norwegian Olympic and Paralympic athletes: the road from London 2012 to Tokyo 2020.

OBJECTIVE: To describe the implementation of a health monitoring programme for Norwegian Paralympic and Olympic candidates over five consecutive Olympic and Paralympic Games cycles (London 2012, Sochi 2014, Rio de Janeiro 2016, PyeongChang 2018 and Tokyo 2020). METHODS: Athletes were monitored for 12-18 months preparing for the games using a weekly online questionnaire (OSTRC-H2) with follow-up by physicians and physiotherapists, who provided clinical care and classified reported problems. RESULTS: Between 2011 and 2020, 533 Olympic and 95 Paralympic athletes were included in the monitoring programme, with an overall response of 79% to the weekly questionnaire and a total observation period of 30 826 athlete weeks. During this time, 3770 health problems were reported, with a diagnosis rate of 97%. The average prevalence of health problems at any given time was 32% among Olympic athletes and 37% among Paralympic athletes. Acute traumatic injuries represented the greatest burden for Olympic team sport athletes, and illnesses represented the greatest burden for Olympic endurance and Paralympic athletes. On average, Olympic athletes lost 27 days and Paralympic athletes lost 33 days of training per year due to health problems. CONCLUSION: Conducting long-term health monitoring of Olympic and Paralympic athletes is challenging, particularly because athletes travel frequently and often relate to many medical providers. This programme has been implemented and improved within Team Norway for five Olympic and Paralympic cycles and during this time we believe it has helped protect our athletes' health.

Para sport translation of the IOC consensus on recording and reporting of data for injury and illness in sport.

In 2020, the IOC proposed a universal methodology for the recording and reporting of data for injury and illness in sport. Para sport is played by individuals with impairment, and they have a unique set of considerations not captured by these recommendations. Therefore, the aim of this addendum to IOC consensus statement was to guide the Para sport researcher through the complexities and nuances that should be taken into consideration when collecting, registering, reporting and interpreting data regarding Para athlete health. To develop this translation, experts in the field of Para sports medicine and epidemiology conducted a formal consensus development process, which began in March 2020 with the formation of a consensus group that worked over eight phases, incorporating three virtual consensus meetings to finalise the translation. This translation is consistent with the IOC consensus statement, yet provides more detailed Para athlete specific definitions and recommendations on study population, specifically, diagnostic and eligible impairment categorisation and recording of adaptive equipment, and defining and classifying health problems in the context of Para sport. Additionally, recommendations and Para athlete specific examples are described with regards to injury mechanism, mode of onset, injury and illness classification, duration, capturing and reporting exposure and risk. Finally, methods and considerations are provided to cater to the varied needs of athletes with impairment with respect to data collection tools. This harmonisation will allow the science to develop and facilitate a more accurate understanding of injury and illness patterns for tailoring evidence-informed prevention programmes and enabling better planning of medical services for Para sport events.

Neuromuscular Training Warm-up Prevents Acute Noncontact Lower Extremity Injuries in Children's Soccer: A Cluster Randomized Controlled Trial.

BACKGROUND: Prevention of sports injuries is essential in youth, as injuries are associated with less future physical activity and thus greater all-cause morbidity. PURPOSE: To investigate whether a neuromuscular training warm-up operated by team coaches is effective in preventing acute lower extremity (LE) injuries in competitive U11-U14 soccer players. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: Twenty top-level U11 to U14 soccer clubs in Finland were randomized into intervention and control groups and assessed for 20 weeks. Participants included 1403 players (280 female, 1123 male; age range, 9-14 years): 673 players (44 teams) in the intervention group and 730 players (48 teams) in the control group. The intervention group team coaches were introduced to a neuromuscular training warm-up to replace the standard warm-up 2 to 3 times per week. The control teams were asked to perform their standard warm-up. Injury data collection was done via weekly text messages. The primary outcome measure was a soccer-related acute LE injury, and the secondary outcome measure was an acute noncontact LE injury. RESULTS: A total of 656 acute LE injuries occurred: 310 in the intervention group and 346 in the control group. The overall acute LE injury incidence was 4.4 per 1000 hours of exposure in the intervention group and 5.5 per 1000 hours of exposure in the control group, with no significant difference between groups (incidence rate ratio [IRR], 0.82 [95% CI, 0.64-1.04]). There were 302 acute noncontact LE injuries: 129 in the intervention group (incidence, 1.8 per 1000 hours) and 173 in the control group (2.7 per 1000 hours). A significant reduction in acute noncontact LE injuries of 32% (IRR, 0.68 [95% CI, 0.51-0.93]) was observed in the intervention group compared with the control group. Furthermore, significant reductions in injury incidence in favor of the intervention group were seen in the subanalyses of acute noncontact LE injuries, leading to ≤7 days of time loss and fewer ankle and joint/ligament injuries. CONCLUSION: A neuromuscular training warm-up operated by team coaches was found to be effective in preventing acute noncontact LE injuries in children's soccer, but this was not seen in all acute LE injuries. CLINICAL RELEVANCE: We encourage children's soccer coaches and health care professionals to implement neuromuscular training warm-up in youth sports. REGISTRATION: ISRCTN14046021 (ISRCTN registry).

Injury and Illness Surveillance in Elite Para Athletes: An Urgent Need for Suitable Illness Prevention Strategies.

BACKGROUND: Longitudinal monitoring data of Para athletes are sparse. OBJECTIVE: The aim of the study was to describe the weekly prevalence and incidence of injuries and illnesses among German athletes preparing for the 2016 Rio de Janeiro Paralympic Games. METHODS: Athletes were invited to weekly report on medical problems, their severity/burden and training load, using the Oslo Sports Trauma Research Center Questionnaire on Health Problems. In case of any health problem, athletes were contacted and medical support offered. Data were analyzed with regard to impairment type. The acceptance of the monitoring program was evaluated. RESULTS: Fifty-eight athletes were followed for 29 wks, 10.927 athlete-days. At any given time, 28% (95% confidence interval = 26% to 30%) of athletes reported health problems, and 12% (11% to 14%) substantial health problems. The prevalence of health and illness problems diminished over time by 20.9 ± 4.1% and 16.1 ± 2.9%, P < 0.001, respectively, based on the means of the first and final 5 wks. Paraplegic athletes reported a significantly higher prevalence of all health problems (33%, 29% to 37%) than nonparaplegic athletes (26%, 23% to 29%; P = 0.007). Illnesses were in general more severe and resulted in more time loss days. Athletes reported a high satisfaction with the program. CONCLUSIONS: At any given time, 28% of German Para athletes reported health problems, and 12% experienced substantial health problems. For a health team, illnesses seem to be more important to handle than injuries. The Oslo Sports Trauma Research Center Questionnaire on Health Problems is a suitable method for injury and illness surveillance in Para athletes.

The usage of multidisciplinary physical therapies at the Rio de Janeiro 2016 Olympic Summer Games: an observational study.

BACKGROUND: This observational research study analyses the uptake of physical therapies treatments in the Polyclinic during the Rio 2016 Olympic Games. OBJECTIVE: To describe the usage of physical therapies services - physical therapy, osteopath, chiropractic, and sports massage - by athletes and non-athletes and across different sports. METHODS: The multidisciplinary team of physical therapies recorded treatment modalities, information on provider discipline and reason for attendance, in an Electronic Medical Record system throughout the 32 days of operation of the Olympic Polyclinic. Cold-therapy total immersion ice baths (TIIB) were provided as part of the services, but were reported and analysed separately. RESULTS: There were 4993 encounters (4038 athletes, 955 non-athlete encounters). 1395 athletes (12.4% of all athletes) and 393 non-athletes sought treatment. For all four provider disciplines, in addition to TIIB, the primary reason for athlete attendance was for recovery (52% of all encounters), followed by injury treatment (30%), and maintenance (16%). Athletes reported "injury" as the main reason for physical therapy (92% of all encounters, 2.8 encounters per athlete), chiropractic (94%, 1.9) and osteopathy (91%, 1.8) visits. Almost all TIIB visits were used for recovery (98% of all TIIB encounters; 2.1 encounters per athlete). Athletes from handball (37% of all handball athletes), followed by judo (22%), and athletics (21%), presented the largest user groups. CONCLUSION: This Olympic Polyclinic study evaluates the physical therapies' activity, and athlete's reason for use of the multidisciplinary physical therapies team, including total immersion ice bath provision. These results emphasise the importance of a multidisciplinary approach.

Self-reported sports injuries and later-life health status in 3357 retired Olympians from 131 countries: a cross-sectional survey among those competing in the games between London 1948 and PyeongChang 2018.

OBJECTIVE: Describe the self-reported prevalence and nature of Olympic-career injury and general health and current residual symptoms in a self-selected sample of retired Olympians. METHODS: 3357 retired Olympians from 131 countries completed a cross-sectional online survey, distributed by direct email through World Olympians Association and National Olympian Associations databases. The survey captured Olympic sport exposure, significant training and competition injury history (lasting >1 month), general health (eg, depression) during the athlete's career, and current musculoskeletal pain and functional limitations. RESULTS: 55% were men (44% women, 1% unknown), representing 57 sports (42 Summer, 15 Winter), aged 44.7 years (range 16-97). A total of 3746 injuries were self-reported by 2116 Olympians. This equated, 63.0% (women 68.1%, men 59.2%) reporting at least one significant injury during their Olympic career. Injury prevalence was highest in handball (82.2%) and lowest in shooting (40.0%) for Summer Olympians; and highest in alpine skiing (82.4%) and lowest in biathlon (40.0%) for Winter Olympians. The knee was the most frequently injured anatomical region (20.6%, 120 median days severity), followed by the lumbar spine (13.1%, 100 days) and shoulder/clavicle (12.9%, 92 days). 6.6% of Olympians said they had experienced depression during their career. One-third of retired Olympians reported current pain (32.4%) and functional limitations (35.9%). CONCLUSIONS: Almost two-thirds of Olympians who completed the survey reported at least one Olympic-career significant injury. The knee, lumbar spine and shoulder/clavicle were the most commonly injured anatomical locations. One-third of this sample of Olympians attributed current pain and functional limitations to Olympic-career injury.