Common injuries in athletes with impairment: do we need different prevention strategies in Paralympic athletes to Olympic athletes?
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1 Common injuries in athletes with impairment: do we need different prevention strategies in Paralympic athletes to Olympic athletes? Nick Webborn Clinical Professor (Sport & Exercise Medicine) Centre for Sport and Exercise Science and Medicine (SESAME) University of Brighton, UK
2 Common injuries in athletes with impairment: do we need different prevention strategies in Paralympic athletes to Olympic athletes? Nick Webborn Clinical Professor (Sport & Exercise Medicine) Centre for Sport and Exercise Science and Medicine (SESAME) University of Brighton, UK
3 Sports Injury Prevention 1. Establishing the extent of the problem: Incidence Severity 2. Establishing the aetiology and mechanism of sports injury 4. Assess effectiveness of intervention by repeating Introducing a preventive measure
4 Sports Injury Prevention Example Webborn, N., Willick, S. & Reeser, J.C. (2006) Injuries among disabled athletes during the 2002 Winter ParalympicGames. Medicine and Science in Sports and Exercise 38(5),
5 IPC Winter Injury Surveys Salt Lake 2002 Torino 2006 Vancouver 2010 Sochi 2014
6 IPC Summer Injury Surveys London 2012 Rio 2016
7 Injury rate by sport London 2012
8 General Risk Factors Tend to be older than Olympians Mean age 30 (Range12-67) Co-morbidities from medical conditions Manual wheelchair use independent risk factor for upper limb injury Impact on later life Paralympians
9 Areas of Discussion Upper Limb Injuries
10 Biomechanics is everything Yves Vanlandewijck Injury related to the Mechanics of Sport
11 For optimum injury prevention it is essential to understand The Sport The Impairment type The Impairment level And the biomechanical differences
12 Different Sports Different Uses Different Chairs Different Design = Different Pushing Techniques & Different Sport Demands = Different Mechanical Loads
13 Impairment Level Different Push Techniques According to Level of Disability In the same Event Full Trunk & Arms Limited Trunk & Full Arms No Trunk & Limited Arms
14 WHEELCHAIR STROKE PATTERN PROPULSION: Catch Drive Release RECOVERY Lift & stretch Acceleration
15 Injuries/1000 athlete days by sport London 2012 Wheelchair Sports Mixed Sports Non-Wheelchair Sports
16 INJURY RATE BY BODY PART 1. Shoulder 17.7% 2. Wrist/Hand 11.4% 3. Elbow 8.8% 4. Knee 7.9% Willick SE, Webborn N, Emery C, et al. Br J Sports Med Published Online First doi: /bjsports
17 No. of Athletes Injuries Incidence Rate/1000 Athlete Days Incidence rate 95% confidence Intervals Incidence Rate Injuries by Impairment Track Athletics Ambulant VI ( ) Ambulant Amputee ( ) Ambulant CP ( ) Wheelchair racing ( )
18 Injuries/1000 athlete days - Sport v Athletics Track Wheelchair Wheelchair Sports Mixed Sports Non-Wheelchair Sports Wheelchair Track
19 Injuries Wheelchair Athletics by Event Type Sprints Long distances Throws Athletes participating Acute Traumatic (IR) 6 (5.5) 4 (12.5) 18 (6.8) Acute on Chronic (IR) 2 (1.8) 0 (0) 10 (4.5) Overuse injury (IR) 3 (2.7) 0 (0) 14 (7.9) Total 11(10) 4 (12.5) 42 (23.7) 0-1 days missed (IR) 9 (8.2) 3 (9.4) 32 (14.7) > 1 day missed (IR) 2 (1.8) 1 (3.1) 10 (4.5)
20 Injuries/1000 athlete days - Sport v Athletics Field Wheelchair Wheelchair Sports Mixed Sports Non-Wheelchair Sports Wheelchair Field
21 Top 5 Injuries by Anatomical Region in Wheelchair Athletes Region Track Field Shoulder /clavicle No. of injuries % of all injuries Incidence rate % 3.4 Elbow % 2.8 Knee % 1.9 Upper arm Problem of the throwing athlete % 1.6 Wrist % 1.3
22 Sport specific - Impingement Swimming Tennis Athletics - throwing events Volleyball
23 Aggravating Factors Existing spinal disease / injury Scoliosis +/- spasm Seating posture Protracted shoulders from push position
24 Incidence Rate Injuries by Impairment Track Athletics No. of Athletes Injuries Incidence Rate/100 0 Athlete Days Incidence rate 95% confidence Intervals Ambulant Amputee ( ) Ambulant VI ( ) Ambulant CP ( ) Wheelchair racing May be non-sport factors? ( )
25 Additional 5472 steps / day when at a Paralympic Games (83% increase over normal day)
26
27 Injury rate by sport London 2012
28 Injuries in competition IR =10.2 (95% CI; ) acute injuries per 1000 days. 33 matches involving 8 outfield VI players per match = 264 player games Risk of any player getting an acute injury in a match is 1 in 33 or 3.03%
29 Injury Mechanism FB5
30 Mechanism of Acute Injury in Competition 7/8 injuries - contact with other athletes 1 contact with ball leading to injury 5 out of 8 (62.5%) were reported as relating to foul play and contact with other athlete.
31 Head Injury Issues Head and neck injuries account for 25% of acute injuries during competition No mandatory head protection only eyeshades Concussive blows witnessed but not reported athletes 44% in basketball study - Physicians - education
32 Collecting Concussion Data Wearable Technology Implanted in head protection Real-time Data NPC Team Physician IPC Research Team Assist Clinical Decision Making Collate info on Impacts and Risk
33
34
35 Integration of Innovative Materials and Sport Specific Design D30 - rate-sensitive, soft, flexible materials with high shock absorbing properties Based on non-newtonian principles, molecules flow freely, but on impact, lock together to dissipate impact energy and reduce transmitted force.
36 Carlo Rovelli Science is an acute awareness of the extent of our ignorance
37
38
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40 Common injuries in athletes with impairment: do we need different prevention strategies in Paralympic athletes to Olympic athletes? Nick Webborn Clinical Professor (Sport & Exercise Medicine) Centre for Sport and Exercise Science and Medicine (SESAME) University of Brighton, UK
41 Thanks for your attention Please get off my arm
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