common injuries in athletes with impairment: do we need ...€¦ · 2016. injury rate by sport...
TRANSCRIPT
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Common injuries in athletes with impairment: do we need different prevention strategies in
Paralympic athletes to Olympic athletes?
Nick WebbornClinical Professor (Sport & Exercise Medicine)
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Common injuries in athletes with impairment:
do we need different prevention strategies in
Paralympic athletes to Olympic athletes?
Nick WebbornClinical Professor (Sport & Exercise Medicine)
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Sports Injury Prevention
1. Establishing the extent of the problem:
Incidence
Severity
2. Establishing the aetiology and mechanism
of sports injury
3. Introducing a preventive measure
4. Assess effectiveness of intervention by repeating
1.
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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), 811–815
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IPC Winter Injury Surveys
Salt Lake 2002
Torino 2006
Vancouver 2010
Sochi 2014
Pyeongchang 2018Under Review BJSM
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IPC Summer Injury Surveys
London 2012
Rio 2016
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Injury rate by sport – London 2012
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General Risk Factors
Paralympians
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
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Areas of Discussion
Upper Limb Injuries
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“Biomechanics is
everything” Yves Vanlandewijck
Injury related to the
Mechanics of Sport
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For optimum injury prevention it is essential
to understand
The Sport
The Impairment type
The Impairment level
And the biomechanical
differences
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Different Sports – Different Uses
– Different Chairs
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Impairment Level
Full Trunk & ArmsLimited Trunk
& Full Arms
No Trunk
& Limited Arms
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WHEELCHAIR STROKE
PATTERN
PROPULSION:
Catch
Drive
Release
RECOVERY
Lift & stretch
Acceleration
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Injuries/1000 athlete days by
sport – London 2012
Wheelchair Sports
Mixed Sports
Non-Wheelchair Sports
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INJURY RATE BY BODY PART
Willick SE, Webborn N, Emery C, et al. Br J Sports Med Published Online First
doi:10.1136/bjsports-2013- 092374
1. Shoulder 17.7%
3. Elbow 8.8%
2. Wrist/Hand 11.4%
4. Knee 7.9%
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Injury Location is Impairment/Event
Specific
Ambulant Athletes Wheelchair/Seated Athletes
1. Thigh 1. Shoulder/clavicle
2. Knee 2. Elbow
3. Lumbar spine 3. Knee
4. Lower leg 4. Upper arm
5. Foot 5. Wrist
Lower extremity involvement Upper extremity involvement
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Incidence Rate Injuries by
Impairment – Track Athletics
No.
of
Ath
lete
s
Inju
ries
Incid
ence
Rate
/1000
Ath
lete
D
ays
Incid
ence
rate
95%
confi
dence
Inte
rvals
Ambulant VI 160 37 23.1 (16.6 - 29.7)
Ambulant Amputee
121 36 29.8 (21.6 - 37.9)
Ambulant CP 98 10 10.2 (4.2 - 16.2)
Wheelchair racing 95 7 7.4 (2.1 - 12.6)
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Injuries/1000 athlete days - Sport v
Athletics Track Wheelchair
Wheelchair Sports
Mixed Sports
Non-Wheelchair Sports
Wheelchair Track
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Injuries Wheelchair Athletics
by Event Type
Sprints Long distances Throws
Athletes participating 110 32 177
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)
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Wheelchair Sports
Mixed Sports
Non-Wheelchair Sports
Wheelchair Field
Injuries/1000 athlete days - Sport v
Athletics Field Wheelchair
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Region Track FieldNo. of injuries
% of all injuries
Incidence rate
Shoulder
/clavicle2 9 11 19.3% 3.4
Elbow 1 8 9 15.8% 2.8
Knee 1 5 6 10.5% 1.9
Upper
arm2 3 5 8.8% 1.6
Wrist 1 3 4 7.0% 1.3
Top 5 Injuries by Anatomical
Region in Wheelchair Athletes
Problem of the throwing athlete
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Sport specific -
Impingement
Swimming
Tennis
Athletics -throwing events
Volleyball
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Aggravating Factors
▪ Existing spinal
disease / injury
▪ Scoliosis +/-
spasm
▪ Seating posture
▪ Protracted
shoulders from
push position
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Incidence Rate Injuries by
Impairment – Track Athletics
No. ofAthletes
Injuries Incidence Rate/1000 Athlete
Days
Incidence rate 95% confidence
Intervals
Ambulant
Amputee121 36 29.8 (21.6 - 37.9)
Ambulant VI 160 37 23.1 (16.6 - 29.7)
Ambulant CP 98 10 10.2 (4.2 - 16.2)
Wheelchair
racing95 7 7.4 (2.1 - 12.6)
May be non-sport factors?
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Additional 5472 steps / day
when at a Paralympic Games
(83% increase over normal day)
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Injury rate by sport – London 2012
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Injuries in competition IR =10.2 (95% CI; 4.42-
20.0) 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%
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Injury Mechanism FB5
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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.
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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
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CollectingConcussionData
Real-time Data
Assist Clinical Decision Making Collate info on Impacts and Risk
NPC Team Physician IPC Research Team
Wearable Technology Implanted in head protection
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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.
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Carlo Rovelli“Science is an acute
awareness of the
extent of our
ignorance”
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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
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Thanks for your attention
Please get
off my
arm…