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Abstract
Background The prevention of injury and illness remains an important issue among young elite athletes. Systematic surveillance of injuries and illnesses during multi-sport events might provide a valuable basis to develop preventive measures, focusing especially on adequate information for youth athletes.
Aim To analyse the frequencies and characteristics of injuries and illnesses during the 2015 Winter European Youth Olympic Festival (W-EYOF).
Methods All National Olympic Committees were asked to report daily the occurrence or non-occurrence of newly sustained injuries and illnesses on a standardised reporting form.
Results Among the 899 registered athletes (37% female) with a mean age of 17.1±0.8 years, a total of 38 injuries and 34 illnesses during the 5 competition days of the W-EYOF were reported, resulting in an incidence of 42.3 injuries and 37.8 illnesses per 1000 athletes, respectively. Injury frequency was highest in snowboard cross (11%), Nordic combined (9%), alpine skiing (6%), and ice hockey (6%), taking into account the respective number of registered athletes. In snowboard cross, females showed a significant higher injury frequency compared to males (22% vs 4%, p=0.033). The lower back (16%), the pelvis (13%), the knee (11%), and the face (11%) were the most common injury locations. About 58% of injuries occurred in competition and about 42% in training. In total, 42% of injuries resulted in an absence of training or competition. The prevalence of illness was highest in figure skating (10%) and Nordic combined (9%), and the respiratory system was affected most often (53%).
Conclusions Four per cent of the athletes suffered from an injury and 4% from illnesses during the 2015 W-EYOF, which is about twofold lower compared to the first Winter Youth Olympic Games in 2012.
- Adolescent
- Epidemiology
- Illness
- Injuries
- Olympics
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Introduction
To protect the health of its athletes, the International Olympics Committee (IOC) initiated and developed, in cooperation with the International Olympic Sports Federations and the National Olympic Committees (NOCs), the injury and illness surveillance system for the Olympic Games in 2008.1 ,2 Since then, studies have reported the occurrence of injury and illness during the Winter Olympic Games in Vancouver 20103 and in Sochi 20144 as well as during the Summer Olympic Games in Beijing 20082 and in London 2012.5 The systematic monitoring of injury and illness trends over long periods of time should provide epidemiological data as a basis for evidence-based preventive measures for future multi-sport events.4
The protection of young athletes’ health by preventing injuries is also an important goal of the IOC6 as injuries can counter the beneficial effects of sports participation at a young age if a child or adolescent is unable to continue to participate because of long-term damage.7 However, the current knowledge on injury as well as illness risk for young elite athletes is scare, especially among winter sport athletes.7 As injury risk and patterns of young elite athletes may vary from their older professional counterparts,7 studies using the IOC injury and illness surveillance approach1 were conducted during the first Winter Youth Olympic Games (W-YOG) 20128 and during the Summer European Youth Olympic Festival 2013.9 Although there are recent data concerning injuries and illnesses from the traditional Winter Olympic Games in Vancouver 20103 and in Sochi 2014,4 only one study up to now has evaluated injury risk and illness occurrence in young elite athletes competing in a winter multi-sport event.8 In 2012, the first W-YOG were held in Innsbruck, Austria where more than 1000 athletes from 69 NOCs took part in 15 winter sports with 63 different sport disciplines.8 In total, 11% and 9% of athletes suffered from an injury or an illness during the first W-YOG, respectively.8 The frequencies of injuries and illnesses varied substantially between the different winter sport disciplines, with the highest frequency of injury in halfpipe skiing and the highest frequency of illness in ice hockey and cross-country skiing.8
However, to our knowledge, up until now no other data on injury and illness occurrence of young elite athletes competing in a winter multi-sport event exist. Therefore, the aim of this study was to evaluate the incidence and frequencies of injuries and illnesses occurring during the 12th Winter European Youth Olympic Festival (W-EYOF).
Methods
The EYOF, organised on behalf of the European Olympic Committee (EOC) and held under the patronage of the IOC, is a multi-sport event for young European athletes aged 14–18 years. Young athletes compete in different Olympic disciplines which makes the EYOF an ideal warm-up for qualified youngsters in reaching the ‘real’ Olympics.9 According to the traditional Olympic Games, both a winter and a summer edition take place in a 2-year cycle, in odd years. In 2015, the 12th W-EYOF was held in the countries of Austria and Liechtenstein. A total of 899 young athletes from 45 European countries competed in the eight winter sports: alpine skiing, biathlon, cross-country skiing, figure skating, ice hockey, Nordic combined, snowboard cross (SBX), and ski jumping.
In the present study, the same methods of the IOC injury and illness surveillance used during previous Olympic Games1 ,3–5 ,8 ,9 were implemented. About 3 weeks before the 2015 W-EYOF (25–30 January), the NOCs were informed about the study and were invited to participate in the 2015 W-EYOF injury and illness surveillance study. The medical representatives and the chefs de mission of all NOCs received a booklet with detailed information about the study, including the injury and illness forms to be filled out. In addition, in the morning of the first competition day, the medical representatives of the NOCs (physicians, physiotherapists) were invited to a meeting covering the details of this study. The NOCs were asked to report daily the occurrence (or non-occurrence) of newly sustained injuries and illnesses on a standardised report form. In cases where an NOC had no physician or physiotherapist, the chef de mission of the NOC was asked to conduct the reporting. Data collected by NOC members (mostly physicians or physiotherapists) were the primary dataset. The chief medical officer of the W-EYOF checked and completed these data if necessary for those collected by the medical centres. To prevent double registrations, the athlete's accreditation number was manually checked in all data sources and information from the NOC physician was preferred over the clinic physician's report.
According to the methods of the IOC injury and illness surveillance, an athlete was defined as injured or ill if he/she received medical attention regardless of the consequences with respect to absence from competition or training.1 ,3–5 ,8 ,9
An injury should be reported if it fulfilled the following criteria1 ,3–5 ,8 ,9: (1) musculoskeletal complaint or concussion; (2) newly incurred injury or re-injury; (3) incurred in training or competition; and (4) incurred during the 2015 W-EYOF. An illness was defined as any physical complaint (not related to injury) newly incurred during the W-EYOF that received medical attention. Chronic pre-existing illnesses were not included unless there was an exacerbation requiring medical attention.
In cases where multiple body parts were injured during the same incident, multiple types of injuries occurred in the same body part, or different body parts were affected by illnesses, only the most severe injury/illness was registered, however, with several diagnoses.1 ,3–5 ,8 ,9
The report form was identical to the one used in previous Olympic Games,1 ,3–5 ,8 ,9 requiring the following information: athlete's accreditation number, sport discipline/event, date, time, competition/training, injured body part, injury type, cause, and estimated time loss. The illness part was located on the same page directly below the injury part and included the athlete's accreditation number, sport discipline/event, date of occurrence, diagnosis, affected system, main symptom(s) and cause of illness, as well as an estimate of time loss. Detailed instructions on how to fill out the form correctly were given in the booklet with examples for injuries and illnesses. Injury and illness report forms were distributed to all NOCs in the following languages of choice: English, French, German, Russian and Spanish.
All information was treated strictly confidentially. The accreditation numbers were only used to avoid duplicate reporting from NOC physicians and the medical centres and to provide information on age, gender, sport and national federation of participating athletes. Ethical approval for methods used was obtained from the institutional review board and from the ethics committee of the University of Innsbruck, Austria.
Data analysis
All data were statistically analysed using SPSS for Windows, V.21.0 (SPSS, Chicago, Illinois, USA). Descriptive data were generally presented for variables as frequencies and proportions as well as mean values with SDs. The incidence of injuries and illnesses was calculated as the number of injuries/illnesses per 1000 registered athletes, referring to an exposure of the 5 days of the 2015 W-EYOF. Frequencies of injuries/illnesses in different sports were calculated in relation to the number of registered athletes of the different winter sport disciplines. χ2 tests were used to compare gender differences between frequencies of injuries and illnesses, and a rate ratio (RR) was calculated. All p values were two-tailed and values of p≤0.05 were considered to indicate statistical significance.
Results
A total of 25 physicians from 19 nations were accredited to the W-EYOF. Compliance of the injury and illness surveillance was below 50% after the 5 competition days, but due to intense contact via email and telephone with the NOCs compliance reached 100% within 4–6 weeks after the W-EYOF.
Among the 899 registered athletes (37% females) with a mean age of 17.1±0.8 years, a total of 38 injuries and 34 illnesses during the 5 competition days of W-EYOF were reported, resulting in an incidence of 42.3 injuries and 37.8 illnesses per 1000 registered athletes, respectively (table 1). Injury risk among females was 5.1% and among males 3.6%, respectively, with no significant difference between gender (p=0.285). In SBX, females showed a significant higher injury frequency compared to males (22% vs 4%, p=0.033) with an RR of 5.5.
Number (n), proportions (%) and frequencies of injuries and illnesses in different sports
In total, 3.2% of females and 3.3% of males suffered from an illness (p=0.942). In alpine skiing, differences within illness frequency between females and males (5.7% vs 0.9%) did not reach statistical significance (p=0.054).
Injury characteristics
In relation to the number of registered athletes, the prevalence of injury was highest in SBX (11%), Nordic combined (9%), alpine skiing (6%), and ice hockey (6%) (table 1). In four athletes two body parts were injured during the same incident.
About 58% of injuries occurred during competition (table 2). In total, 16 (42%) injuries were expected to result in time loss. Of those, four injuries resulted in an estimated absence of training or competition of between 1 and 2 weeks, and two injuries caused an estimated absence of up to 4 weeks (table 2).
Number and proportions of severity and circumstances of injuries in different sports
The most affected injured body part was the lower back (16%), the pelvis (13%), the knee (11%), and the face (11%) (table 3). Contusion (41%) was the most common reported injury type, while all other injury types were below 10% except for the category ‘other injury’ with 11% (table 3). The most common reported injury cause was contact with a stationary object (24%), followed by a non-contact trauma (21%) (table 3).
Number (n) and proportions (%) of injuries, locations, types and causes separated for sport disciplines during W-EYOF
Illness characteristics
In relation to the number of registered athletes, the prevalence of illness was highest in figure skating (10%) and Nordic combined (9%) (table 4). About 62% (21/34) of illnesses were expected to result in absence from further training or competition. Of those, three illnesses were expected to result in an estimated time loss of 1 week. In total, the respiratory system was affected by 18 (53%) illnesses, mostly observed in alpine skiing (n=5), cross-country skiing (n=3), and Nordic combined (n=3) (table 4). Accordingly, the illness cause was most often classified as an infection (n=26, 77%).
Number (n) and proportions (%) of illnesses, affected systems, symptoms and causes separated for sport disciplines during W-EYOF
Discussion
The principal findings were that 4% of the athletes suffered from an injury and 4% from illnesses during the 5 competition days of W-EYOF. The frequencies of injuries and illnesses varied between different sports.
Comparison of data with similar events
This study is the first surveillance of injuries and illnesses involving young athletes participating in the 2015 W-EYOF, held in Liechtenstein and Austria. Therefore, data from this study can, on the one hand, be age-specific when compared with the injury and illness data from the 2013 Summer EYOF (S-EYOF) in Utrecht in the Netherlands,9 and, on the other hand, be age- and also sport-specific when compared with the injury and illness data from the 2012 first W-YOG in Innsbruck, Austria.8 In addition, for a better comparison, data are also provided from traditional Olympic Games.
During the S-EYOF 9% and 2% of young athletes suffered from an injury and an illness, respectively.9 The higher prevalence of injury during the S-EYOF might be due to the nearly tripled number of athletes participating in nine disciplines that included more sports with direct (judo, basketball, handball) or indirect (volleyball, tennis, cycling, steeple chase events, etc) contact with opponents compared to the W-EYOF where only ice hockey and SBX had direct contact with opponents. In contrast, comparing the traditional summer Olympic Games in London 20125 and winter Olympic Games in Sochi 2014,4 no differences within injury frequency (11% vs 12%) or within illness frequency (7% vs 8%) are apparent. Compared to the S-EYOF, the higher prevalence of illnesses among W-EYOF athletes might be due to competing mainly outdoors in a cold environment where the inhalation of large volumes of cold air during training and competition can diminish the defence of the respiratory system and thus enhance susceptibility to respiratory infections.10 Thus, among winter sport athletes, the most important prophylactic intervention may be prevention of exposure which should be carefully considered by athletes and coaches.11 In general, changes in the prevalence and incidence of injuries and illnesses between multisport events can be the result of differences or changes in the number and types of sport disciplines, in environmental factors (weather, snow or ice conditions, venue or track design), competition rules, in equipment or other factors.4
Injuries during the W-EYOF
Compared to the 2012 W-YOG where 11% of athletes suffered from an injury,8 and to the 2014 Sochi Olympic Games with 12% of injuries,4 only 4% of athletes were injured during the W-EYOF. This lower injury frequency might be partly due to the fact that during the W-EYOF young athletes competed in only eight sport disciplines compared to 17 during the W-YOG.8 More disciplines per winter sport might also increase injury risk for young athletes; for example, in alpine skiing where athletes often compete in more than one discipline, six races were held during W-YOG8 whereas only three races were held during W-EYOF. Accordingly, injury risk for alpine skiing was more than double in W-YOG compared to W-EYOF (14% vs 6%).8
For comparison, injury frequency during W-YOG was highest in skiing in the halfpipe (44%) and snowboarding (halfpipe and slope style: 35%), followed by ski cross (17%).8 Three of the most dangerous sport disciplines of the W-YOG, including high jumps and many aerial manoeuvres, were not in the W-EYOF, a fact that may be partly responsible for the low injury rate during the W-EYOF. However, similar to the 2010 Vancouver Olympic Games,3 SBX had the highest injury rate during W-EYOF. While at the 2010 Olympic Games in Vancouver 35% of SBX athletes suffered from an injury,3 only 11% of young SBX athletes had an injury during W-EYOF. This difference might be partly due to a lower bodyweight and therefore lower mean speed of young athletes compared to their more skilled professional older counterparts in SBX. In general, SBX is the discipline with the highest injury risk and the highest risk of severe injuries during competition among elite World Cup snowboarders.12 In contrast to the study by Major et al12 which reported no gender difference within SBX injury risk, females showed a fivefold higher injury rate in SBX during W-EYOF. This observed gender difference in SBX might be caused by the fact that the SBX track was the same for both sexes and that this track might be more challenging for young female SBX athletes compared to young males.
Most injuries among elite SBX athletes result on the one hand from jumping with a technical error at the takeoff, and on the other hand from an unintentional contact between riders at the bank turning.13 In this study, the most common cause of injury among SBX athletes was non-contact trauma and contact with a stationary object (33% each), while contact with another athlete was the primary injury cause in only one SBX athlete (11%). In general, to reduce injury risk among young winter sport athletes, preventive measures need to focus on creating safe sport arenas that take into consideration the athletes’ age, musculoskeletal development, and skill level.8
Illnesses during the W-EYOF
Compared to the W-EYOF, the higher prevalence of illnesses during the W-YOG (4% vs 9%) might be due to the higher number of competition days (5 vs 10 days) and sport disciplines (8 vs 17).8 In contrast to the W-YOG,8 the 2010 Vancouver3 and 2014 Sochi4 data, where the illness frequency for females was about twofold compared to males, no gender differences in illness frequencies were detected during W-EYOF. The prevalence of illness during W-EYOF was highest in figure skating (10%) and Nordic combined (9%), while during W-YOG ice hockey (14%) and cross-country skiing (14%) showed the highest illness frequencies.8 In both the W-EYOF and the W-YOG the respiratory system was most often affected (53% and 61%, respectively).8 The respiratory system may have been more affected during the W-YOG than the W-EYOF due to the different weather conditions prevailing during the two events. To mitigate illnesses, specific illness prevention strategies before and during Olympic Games are recommended.14 In addition, the higher risk of illness among athletes travelling intercontinentally should be considered in advance of Olympic Games.15
Data collection procedures
Regarding compliance of injury and illness surveillance, <50% of reports were returned after the 5 competition days of W-EYOF. This might be caused by the fact that, in contrast to the W-YOG 2012 in Innsbruck, no athlete village for the W-EYOF existed where all athletes and members of the NOCs stood together and were easily reachable if reports were lacking. Due to intense contact via email and telephone after the W-EYOF, our study nurse obtained all lacking information from all the NOCs within 4–6 weeks. Nevertheless, a recall bias cannot entirely be excluded and during this duration less serious injuries or illnesses might be overseen or simply forgotten. In addition, results may have been biased by the fact that smaller NOCs often did not have a team doctor or physiotherapist, and in this case the chef de mission, a non-medical person, should have reported the daily occurrence or non-occurrence of injuries or illnesses. Furthermore, results may also have been biased due to the small sample of registered athletes and consequently the small number of injuries and illnesses. To improve injury and illness surveillance compliance during future Olympic Games, and according to the recommendation by van Beijsterveldt et al,9 an online system to record injuries and illnesses (instead of paper forms) should be implemented by the IOC medical commission to facilitate data recording and accurate data collection more easily within all multisport-events under the patronage of the IOC.
Conclusion
This is the first study evaluating the risk of injury and illness among young elite athletes competing in several sports of the W-EYOF. Four per cent of athletes suffered from an injury and 4% from an illness during the 2015 W-EYOF. The frequencies of injuries and illnesses varied substantially between sports, with the highest injury risk in snowboard cross and the highest illness risk in figure skating and Nordic combined.
According to the injury results of this study and the comparisons with the injury rates of the S-EYOF9 and the W-YOG,8 we conclude that injury risk among young winter sport athletes is lower when fewer disciplines with direct or indirect opponent contact or without many aerial manoeuvres and high jumps are included in a multi-sport event for young athletes.
What are the findings?
During the 2015 Winter European Youth Olympic Festival, an incidence of 42.3 injuries and 37.8 illnesses per registered 1000 athletes was found, respectively.
The risk of sustaining an injury was highest in snowboard cross (11%), Nordic combined (9%), alpine skiing (6%), and ice hockey (6%). In total, 42% of injuries resulted in an absence of training or competition.
The prevalence of illness was highest in figure skating (10%) and Nordic combined (9%) and the respiratory system was affected most often (53%).
How might it impact on clinical practice in the future?
The presented epidemiological data are the basis for future research on injury mechanisms and associated risk factors as well as on causes for illnesses among young elite athletes competing in winter multi-sport events, with the aim to implement effective injury and illness prevention measures.
Acknowledgments
The research group highly appreciates the cooperation of all NOCs as well as the LOC medical staff. The authors also like to thank all participating athletes.
References
Footnotes
Contributors All listed authors have significantly contributed to this work to justify authorship. This study was conceived and designed by GR, MS, and WK. Literature search was done by GR, MS, and EP. Acquisition of data and statistical analysis were done by GR, RS, HP, EP, MK and MB, respectively. All listed authors (GR, MS, WK, RS, HP, MK, MB, EP) contributed to the interpretation and discussion of the findings and participated in editing or re-writing of the article lead by GR (the guarantor).
Competing interests None declared.
Ethics approval Institutional Review Board.
Provenance and peer review Not commissioned; externally peer reviewed.