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Published in: BMC Musculoskeletal Disorders 1/2018

Open Access 01-12-2018 | Study protocol

Overuse injuries in Swedish elite athletics– a study protocol for a prospective multifactorial cohort study

Authors: Andreas Lundberg Zachrisson, Pia Desai, Jon Karlsson, Elias Johanesson, Stefan Grau

Published in: BMC Musculoskeletal Disorders | Issue 1/2018

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Abstract

Background

Overuse injuries (OI) are common in elite athletics. Previous studies have had athletes self-report injuries rather than having a medical professional provide a clear diagnosis. This might be a major reason for the inconsistencies in reported incident proportions of OI in elite athletics, in addition to the varying definitions of OI in current literature.
Risk factors or combinations of risk factors (biomechanical, clinical, and training-related) have been shown to be important in the developmental process of OI. However, no studies have examined these relationships using a multifactorial and prospective approach in elite athletics.
The purpose of this study protocol is to describe OI incidence proportion, injury severity, location, and occurrence during a complete athletics season. Moreover, possible discipline specific and injury specific risk factors that might be associated with OI will be examined.

Methods

This study will be an explorative prospective cohort study including approximately 120 elite athletes. All athletes will be screened twice during one complete athletics season. The screening will consist of a body composition scan to measure muscle mass, fat free mass, lean mass, bone density, and bone mineral content. In addition, clinical examination will measure range of motion for the lower back, hip, knee, shoulder, and elbow and ankle joints. A running analysis will measure the 3D motions of the hip, knee, and ankle joints. Finally, maximal isometric strength tests of the main core and lower extremity muscles will be carried out.
To record injuries, each athlete will consult a physiotherapist or sports medicine doctor affiliated with the study to get a clear diagnosis. Injury data will be recorded according to the previously published athletics consensus statement.

Discussion

Results from this study protocol will contribute more insight and detailed knowledge regarding the extent of OI occurrence among elite athletes during a complete athletics season. It will also provide further insights into which risk factors are associated with the development of OI in elite athletics.
Appendix
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Literature
1.
go back to reference Jacobsson J, Timpka T, Kowalski J, Nilsson S, Ekberg J, Dahlström Ö, Renström PA. Injury patterns in Swedish elite athletics: annual incidence, injury types and risk factors. Br J Sports Med. 2013;47(15):941–52.CrossRef Jacobsson J, Timpka T, Kowalski J, Nilsson S, Ekberg J, Dahlström Ö, Renström PA. Injury patterns in Swedish elite athletics: annual incidence, injury types and risk factors. Br J Sports Med. 2013;47(15):941–52.CrossRef
2.
go back to reference Opar D, Drezner J, Shield A, Williams M, Webner D, Sennett B, Kapur R, Cohen M, Ulager J, Cafengiu A. Acute injuries in track and field athletes: a 3-year observational study at the Penn relays carnival with epidemiology and medical coverage implications. Am J Sports Med. 2015;43(4):816–22.CrossRef Opar D, Drezner J, Shield A, Williams M, Webner D, Sennett B, Kapur R, Cohen M, Ulager J, Cafengiu A. Acute injuries in track and field athletes: a 3-year observational study at the Penn relays carnival with epidemiology and medical coverage implications. Am J Sports Med. 2015;43(4):816–22.CrossRef
3.
go back to reference Edouard P, Alonso J-M. Epidemiology of track and field injuries. New Stud Athletics. 2013;28(1/2):85–92. Edouard P, Alonso J-M. Epidemiology of track and field injuries. New Stud Athletics. 2013;28(1/2):85–92.
4.
go back to reference Bennell KL, Crossley K. Musculoskeletal injuries in track and field: incidence, distribution and risk factors. Aust J Sci Med Sport. 1996;28(3):69–75.PubMed Bennell KL, Crossley K. Musculoskeletal injuries in track and field: incidence, distribution and risk factors. Aust J Sci Med Sport. 1996;28(3):69–75.PubMed
5.
go back to reference D'souza D. Track and field athletics injuries--a one-year survey. Br J Sports Med. 1994;28(3):197–202.CrossRef D'souza D. Track and field athletics injuries--a one-year survey. Br J Sports Med. 1994;28(3):197–202.CrossRef
6.
go back to reference Zemper ED. Track and field injuries. In: Epidemiology of Pediatric Sports Injuries. Volume 48, edn. Basel: Karger Publishers; 2005:138–151.CrossRef Zemper ED. Track and field injuries. In: Epidemiology of Pediatric Sports Injuries. Volume 48, edn. Basel: Karger Publishers; 2005:138–151.CrossRef
7.
go back to reference Rebella GS, Edwards JO, Greene JJ, Husen MT, Brousseau DC. A prospective study of injury patterns in high school pole vaulters. Am J Sports Med. 2008;36(5):913–20.CrossRef Rebella GS, Edwards JO, Greene JJ, Husen MT, Brousseau DC. A prospective study of injury patterns in high school pole vaulters. Am J Sports Med. 2008;36(5):913–20.CrossRef
8.
go back to reference Edouard P, Depiesse F, Serra J-M. Throwing arm injuries in high-level athletics throwers. Sci Sports. 2010;25(6):318–22.CrossRef Edouard P, Depiesse F, Serra J-M. Throwing arm injuries in high-level athletics throwers. Sci Sports. 2010;25(6):318–22.CrossRef
9.
go back to reference Lysholm J, Wiklander J. Injuries in runners. Am J Sports Med. 1987;15(2):168–71.CrossRef Lysholm J, Wiklander J. Injuries in runners. Am J Sports Med. 1987;15(2):168–71.CrossRef
10.
go back to reference Jacobsson J, Timpka T, Kowalski J, Nilsson S, Ekberg J, Renström P. Prevalence of musculoskeletal injuries in Swedish elite track and field athletes. Am J Sports Med. 2012;40(1):163–9.CrossRef Jacobsson J, Timpka T, Kowalski J, Nilsson S, Ekberg J, Renström P. Prevalence of musculoskeletal injuries in Swedish elite track and field athletes. Am J Sports Med. 2012;40(1):163–9.CrossRef
11.
go back to reference Fuller CW, Ekstrand J, Junge A, Andersen TE, Bahr R, Dvorak J, Hägglund M, McCrory P, Meeuwisse WH. Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Scand J Med Sci Sports. 2006;16(2):83–92.CrossRef Fuller CW, Ekstrand J, Junge A, Andersen TE, Bahr R, Dvorak J, Hägglund M, McCrory P, Meeuwisse WH. Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Scand J Med Sci Sports. 2006;16(2):83–92.CrossRef
12.
go back to reference Renström P, Johnson RJ. Overuse injuries in sports. Sports Med. 1985;2(5):316–33.CrossRef Renström P, Johnson RJ. Overuse injuries in sports. Sports Med. 1985;2(5):316–33.CrossRef
13.
go back to reference Stanish WD. Overuse injuries in athletes: a perspective. Med Sci Sports Exerc. 1984;16(1):1–7.CrossRef Stanish WD. Overuse injuries in athletes: a perspective. Med Sci Sports Exerc. 1984;16(1):1–7.CrossRef
15.
go back to reference Timpka T, Alonso J-M, Jacobsson J, Junge A, Branco P, Clarsen B, Kowalski J, Mountjoy M, Nilsson S, Pluim B. Injury and illness definitions and data collection procedures for use in epidemiological studies in athletics (track and field): consensus statement. Br J Sports Med. 2014;48(7):483–90.CrossRef Timpka T, Alonso J-M, Jacobsson J, Junge A, Branco P, Clarsen B, Kowalski J, Mountjoy M, Nilsson S, Pluim B. Injury and illness definitions and data collection procedures for use in epidemiological studies in athletics (track and field): consensus statement. Br J Sports Med. 2014;48(7):483–90.CrossRef
16.
go back to reference Raysmith BP, Drew MK. Performance success or failure is influenced by weeks lost to injury and illness in elite Australian track and field athletes: a 5-year prospective study. J Sci Med Sport. 2016;19(10):778–83.CrossRef Raysmith BP, Drew MK. Performance success or failure is influenced by weeks lost to injury and illness in elite Australian track and field athletes: a 5-year prospective study. J Sci Med Sport. 2016;19(10):778–83.CrossRef
17.
go back to reference Hammond LE, Lilley JM, Ribbans WJ. Defining recovery: an overlooked criterion in sports injury surveillance. In: LWW. 2013. Hammond LE, Lilley JM, Ribbans WJ. Defining recovery: an overlooked criterion in sports injury surveillance. In: LWW. 2013.
18.
go back to reference Knapik JJ, Bauman CL, Jones BH, Harris JM, Vaughan L. Preseason strength and flexibility imbalances associated with athletic injuries in female collegiate athletes. Am J Sports Med. 1991;19(1):76–81.CrossRef Knapik JJ, Bauman CL, Jones BH, Harris JM, Vaughan L. Preseason strength and flexibility imbalances associated with athletic injuries in female collegiate athletes. Am J Sports Med. 1991;19(1):76–81.CrossRef
19.
go back to reference Nielsen RO, Nohr EA, Rasmussen S, Sørensen H. Classifying running-related injuries based upon etiology, with emphasis on volume and pace. Int J Sports Phys Ther. 2013;8(2):172.PubMedPubMedCentral Nielsen RO, Nohr EA, Rasmussen S, Sørensen H. Classifying running-related injuries based upon etiology, with emphasis on volume and pace. Int J Sports Phys Ther. 2013;8(2):172.PubMedPubMedCentral
20.
go back to reference Bertelsen M, Hulme A, Petersen J, Brund RK, Sørensen H, Finch C, Parner ET, Nielsen R. A framework for the etiology of running-related injuries. Scand J Med Sci Sports. 2017;27(11):1170–80.CrossRef Bertelsen M, Hulme A, Petersen J, Brund RK, Sørensen H, Finch C, Parner ET, Nielsen R. A framework for the etiology of running-related injuries. Scand J Med Sci Sports. 2017;27(11):1170–80.CrossRef
21.
go back to reference Van der Worp MP, Ten Haaf DS, van Cingel R, de Wijer A, Nijhuis-van der Sanden MW, Staal JB: Injuries in runners; a systematic review on risk factors and sex differences. PLoS One 2015, 10(2):e0114937.CrossRef Van der Worp MP, Ten Haaf DS, van Cingel R, de Wijer A, Nijhuis-van der Sanden MW, Staal JB: Injuries in runners; a systematic review on risk factors and sex differences. PLoS One 2015, 10(2):e0114937.CrossRef
22.
go back to reference Louw M, Deary C. The biomechanical variables involved in the aetiology of iliotibial band syndrome in distance runners–a systematic review of the literature. Phys Ther Sport. 2014;15(1):64–75.CrossRef Louw M, Deary C. The biomechanical variables involved in the aetiology of iliotibial band syndrome in distance runners–a systematic review of the literature. Phys Ther Sport. 2014;15(1):64–75.CrossRef
23.
go back to reference Prins MR, Van Der Wurff P. Females with patellofemoral pain syndrome have weak hip muscles: a systematic review. Aust J Physiother. 2009;55(1):9–15.CrossRef Prins MR, Van Der Wurff P. Females with patellofemoral pain syndrome have weak hip muscles: a systematic review. Aust J Physiother. 2009;55(1):9–15.CrossRef
24.
go back to reference Lankhorst NE, Bierma-Zeinstra SM, van Middelkoop M. Factors associated with patellofemoral pain syndrome: a systematic review. Br J Sports Med. 2013;47(4):193–206.CrossRef Lankhorst NE, Bierma-Zeinstra SM, van Middelkoop M. Factors associated with patellofemoral pain syndrome: a systematic review. Br J Sports Med. 2013;47(4):193–206.CrossRef
26.
go back to reference Hein T, Janssen P, Wagner-Fritz U, Haupt G, Grau S. Prospective analysis of intrinsic and extrinsic risk factors on the development of Achilles tendon pain in runners. Scand J Med Sci Sports. 2014;24(3).CrossRef Hein T, Janssen P, Wagner-Fritz U, Haupt G, Grau S. Prospective analysis of intrinsic and extrinsic risk factors on the development of Achilles tendon pain in runners. Scand J Med Sci Sports. 2014;24(3).CrossRef
28.
go back to reference Hreljac A, Marshall RN, Hume PA. Evaluation of lower extremity overuse injury potential in runners. Med Sci Sports Exerc. 2000;32(9):1635–41.CrossRef Hreljac A, Marshall RN, Hume PA. Evaluation of lower extremity overuse injury potential in runners. Med Sci Sports Exerc. 2000;32(9):1635–41.CrossRef
29.
go back to reference Kluitenberg B, van Middelkoop M, Verhagen E, Hartgens F, Huisstede B, Diercks R, van der Worp H. The impact of injury definition on injury surveillance in novice runners. J Sci Med Sport. 2016;19(6):470–5.CrossRef Kluitenberg B, van Middelkoop M, Verhagen E, Hartgens F, Huisstede B, Diercks R, van der Worp H. The impact of injury definition on injury surveillance in novice runners. J Sci Med Sport. 2016;19(6):470–5.CrossRef
31.
go back to reference Gabbe BJ, Finch CF, Bennell KL, Wajswelner H. How valid is a self reported 12 month sports injury history? Br J Sports Med. 2003;37(6):545–7.CrossRef Gabbe BJ, Finch CF, Bennell KL, Wajswelner H. How valid is a self reported 12 month sports injury history? Br J Sports Med. 2003;37(6):545–7.CrossRef
32.
go back to reference Valuri G, Stevenson M, Finch C, Hamer P, Elliott B. The validity of a four week self-recall of sports injuries. Inj Prev. 2005;11(3):135–7.CrossRef Valuri G, Stevenson M, Finch C, Hamer P, Elliott B. The validity of a four week self-recall of sports injuries. Inj Prev. 2005;11(3):135–7.CrossRef
33.
go back to reference Buist I, Bredeweg SW, Lemmink KA, Van Mechelen W, Diercks RL. Predictors of running-related injuries in novice runners enrolled in a systematic training program. Am J Sports Med. 2010;38(2):273–80.CrossRef Buist I, Bredeweg SW, Lemmink KA, Van Mechelen W, Diercks RL. Predictors of running-related injuries in novice runners enrolled in a systematic training program. Am J Sports Med. 2010;38(2):273–80.CrossRef
34.
go back to reference Malisoux L, Ramesh J, Mann R, Seil R, Urhausen A, Theisen D. Can parallel use of different running shoes decrease running-related injury risk? Scand J Med Sci Sports. 2015;25(1):110–5.CrossRef Malisoux L, Ramesh J, Mann R, Seil R, Urhausen A, Theisen D. Can parallel use of different running shoes decrease running-related injury risk? Scand J Med Sci Sports. 2015;25(1):110–5.CrossRef
35.
go back to reference Malisoux L, Nielsen RO, Urhausen A, Theisen D. A step towards understanding the mechanisms of running-related injuries. J Sci Med Sport. 2015;18(5):523–8.CrossRef Malisoux L, Nielsen RO, Urhausen A, Theisen D. A step towards understanding the mechanisms of running-related injuries. J Sci Med Sport. 2015;18(5):523–8.CrossRef
36.
go back to reference Roe M, Malone S, Blake C, Collins K, Gissane C, Büttner F, Murphy JC, Delahunt E. A six stage operational framework for individualising injury risk management in sport. Inj Epidemiol. 2017;4(1):26.CrossRef Roe M, Malone S, Blake C, Collins K, Gissane C, Büttner F, Murphy JC, Delahunt E. A six stage operational framework for individualising injury risk management in sport. Inj Epidemiol. 2017;4(1):26.CrossRef
37.
go back to reference Nielsen RO, Bertelsen ML, Møller M, Hulme A, Windt J, Verhagen E, Mansournia MA, Casals M, Parner ET. Training load and structure-specific load: applications for sport injury causality and data analyses. In: BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine; 2017. Nielsen RO, Bertelsen ML, Møller M, Hulme A, Windt J, Verhagen E, Mansournia MA, Casals M, Parner ET. Training load and structure-specific load: applications for sport injury causality and data analyses. In: BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine; 2017.
38.
go back to reference Vandenbroucke JP, Von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, Poole C, Schlesselman JJ, Egger M, Initiative S. Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. PLoS Med. 2007;4(10):e297.CrossRef Vandenbroucke JP, Von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, Poole C, Schlesselman JJ, Egger M, Initiative S. Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. PLoS Med. 2007;4(10):e297.CrossRef
39.
go back to reference Ryf C, Weymann A. The neutral zero method—a principle of measuring joint function. Injury. 1995;26:1–11.CrossRef Ryf C, Weymann A. The neutral zero method—a principle of measuring joint function. Injury. 1995;26:1–11.CrossRef
40.
go back to reference Jungmalm J, Grau S, Desai P, Karlsson J, Nielsen RØ. Study protocol of a 52-week prospective running INjury study in Gothenburg (SPRING). BMJ Open Sport Exerc Med. 2018;4(1):e000394.CrossRef Jungmalm J, Grau S, Desai P, Karlsson J, Nielsen RØ. Study protocol of a 52-week prospective running INjury study in Gothenburg (SPRING). BMJ Open Sport Exerc Med. 2018;4(1):e000394.CrossRef
41.
go back to reference Wu G, Van der Helm FC, Veeger HD, Makhsous M, Van Roy P, Anglin C, Nagels J, Karduna AR, McQuade K, Wang X. ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion—part II: shoulder, elbow, wrist and hand. J Biomech. 2005;38(5):981–92.CrossRef Wu G, Van der Helm FC, Veeger HD, Makhsous M, Van Roy P, Anglin C, Nagels J, Karduna AR, McQuade K, Wang X. ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion—part II: shoulder, elbow, wrist and hand. J Biomech. 2005;38(5):981–92.CrossRef
42.
go back to reference Wu G, Siegler S, Allard P, Kirtley C, Leardini A, Rosenbaum D, Whittle M, D D’Lima D, Cristofolini L, Witte H. ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion—part I: ankle, hip, and spine. J Biomech. 2002;35(4):543–8.CrossRef Wu G, Siegler S, Allard P, Kirtley C, Leardini A, Rosenbaum D, Whittle M, D D’Lima D, Cristofolini L, Witte H. ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion—part I: ankle, hip, and spine. J Biomech. 2002;35(4):543–8.CrossRef
43.
go back to reference Frohm A, Heijne A, Kowalski J, Svensson P, Myklebust G. A nine-test screening battery for athletes: a reliability study. Scand J Med Sci Sports. 2012;22(3):306–15.CrossRef Frohm A, Heijne A, Kowalski J, Svensson P, Myklebust G. A nine-test screening battery for athletes: a reliability study. Scand J Med Sci Sports. 2012;22(3):306–15.CrossRef
44.
go back to reference Kerr A, Slater GJ, Byrne N, Nana A. Reliability of 2 different positioning protocols for dual-energy X-ray absorptiometry measurement of body composition in healthy adults. J Clin Densitom. 2016;19(3):282–9.CrossRef Kerr A, Slater GJ, Byrne N, Nana A. Reliability of 2 different positioning protocols for dual-energy X-ray absorptiometry measurement of body composition in healthy adults. J Clin Densitom. 2016;19(3):282–9.CrossRef
45.
go back to reference Nana A, Slater GJ, Hopkins WG, Halson SL, Martin DT, West NP, Burke LM. Importance of standardized DXA protocol for assessing physique changes in athletes. Int J Sport Nutr Exerc Metab. 2016;26(3):259–67.CrossRef Nana A, Slater GJ, Hopkins WG, Halson SL, Martin DT, West NP, Burke LM. Importance of standardized DXA protocol for assessing physique changes in athletes. Int J Sport Nutr Exerc Metab. 2016;26(3):259–67.CrossRef
46.
go back to reference Hougaard P. Analysis of multivariate survival data. Springer Science & Business Media; 2012. Hougaard P. Analysis of multivariate survival data. Springer Science & Business Media; 2012.
Metadata
Title
Overuse injuries in Swedish elite athletics– a study protocol for a prospective multifactorial cohort study
Authors
Andreas Lundberg Zachrisson
Pia Desai
Jon Karlsson
Elias Johanesson
Stefan Grau
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2018
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-018-2296-z

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