Oslo Sports Trauma Research Center Research Articles

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

ObjectiveTo 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...

Italian Cross-Cultural Adaptation and Validation of the Improved Report of Oslo Sports Trauma Research Centre Questionnaires on Overuse Injuries and Health Problems

Italian Cross-Cultural Adaptation and Validation of the Improved Report of Oslo Sports Trauma Research Centre Questionnaires on Overuse Injuries and Health Problems

#ReadyToPlay: health problems in women’s football–a two-season prospective cohort study in the Norwegian premier league

ObjectivesTo describe the prevalence, incidence and burden of all health problems in the Norwegian women’s premier league.MethodsDuring the 2020 and 2021 seasons, players in the Norwegian women’s premier league reported...

Does injury risk increase when youth athletes start to study at a sports high school?

Background/aimThe injury risk is high in adolescent elite athletes. However, little is known about how the injury risk changes when young talented athletes start studying at a sports high school....

PREVALENCE OF MUSCULOSKELETAL OVERUSE INJURIES AMONG MALAYSIAN ELITE ATHLETES DURING THE PREPARATION PHASE FOR INTERNATIONAL SPORT COMPETITION

Intensive training with a high volume of training in preparation for the tournament may predispose athletes to overuse injuries. Therefore, this study aims to determine the prevalence of musculoskeletal overuse injuries among Malaysian athletes during the pre-competition phase. A 13-week prospective cohort study was conducted, including 100 elite athletes representing Malaysia at Commonwealth Games, Asian Games and World Championships. Data on overuse injuries were collected every second week using the Oslo Sports Trauma Research Center Overuse Injury Questionnaire. The average weekly prevalence of overuse injuries was calculated using the questionnaire results. A total of 119 cases of substantial overuse condition were reported, which were in the back (35 cases), knee (31 cases), ankle (28 cases), and shoulder (25 cases), affecting 100 athletes (100% of the cohort). About 42.5 % of the participants classified themselves as having substantial overuse problems, leading to a moderate (71%) or severe (29%) reduction in sports participation or performance or inability to participate in high-performance activities. The average weekly severity score for the back was 16, 12 cases for the shoulder, and the same score of 14 cases for the knee and ankle. Overuse injuries occurred among elite Malaysian athletes during the preparation and training phase for international competition due to the rapid intensity of the training. This study suggests that a guideline is needed for injury prevention strategies for the benefit of Malaysian athletes to prevent injuries.

Health problems occurring in national-level female soccer players are different between leagues and throughout the season: a 6-month prospective cohort study

ObjectivesThis study investigated the prevalence and severity of health problems in national-level female soccer players with respect to league and seasonality.MethodsIn a prospective cohort study, 46 female soccer players aged...

Higher age and present injury at the start of the season are risk factors for in-season injury in amateur male and female football players—a prospective cohort study

PurposeTo describe the injury prevalence, injury pattern, and potential baseline risk factors for injuries in male and female adolescent and adult amateur football players.MethodsThis prospective study followed adolescent and adult amateur football players over one season March–October 2020. The study was completed by 462 players (130 men, age 20.0 ± 5.7, 14–46 years) who answered a baseline survey and a weekly web survey during the season. A total of 1456 weekly surveys were registered from males and 5041 from females. Injuries were recorded with the Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC-O2). Potential baseline risk factors (age, performance of strength/conditioning training, participation in other sports, perceived importance of sporting success, self-rated training and match load, perceived balance between training/match load and recovery, previous/present injury at start of season, and injury beliefs) and their association with injury were analysed with Poisson regressions within each sex.ResultsMales reported 95 injuries (262 injury weeks, weekly prevalence 18.0% (95% CI 16.1–20.1)) and females 350 injuries (1206 injury weeks, weekly prevalence 23.9% (95% CI 22.8–25.1)). Gradual-onset injuries accounted for 57% of the injuries in males and 66% in females. For males, substantial injuries were most common in the hip/groin (weekly prevalence 3.8%), ankle (2.1%), posterior thigh (2.0%), and knee (2.0%); and for females, in the knee (4.3%), ankle (2.5%), and lower leg/Achilles tendon (2.0%). Significant risk factors for injury were higher age (rate ratio males 1.05 per year increase (95% CI 1.02–1.08), females 1.03 (95% CI 1.01–1.05)), and present injury at baseline (males 1.92 (95% CI 1.27–2.89), females 1.58 (95% CI 1.19–2.09)).ConclusionAt any given week, almost one in five male and one in four female amateur football players reported new or ongoing injuries. Hip/groin injuries were more frequent in males, while female players had a higher prevalence of knee injuries. Older players and those with an existing injury at the start of the season were more prone to new injury during the season. Rehabilitation of pre-season injury and complaints are key to reduce the injury burden in amateur football.Level of evidenceLevel II.Trial registration number NCT04272047, Clinical trials

Epidemiology of Acute and Overuse Injuries in Underwater Rugby.

Underwater rugby (UWR) is a team sport. Athletes require a high degree of strength, endurance, speed, and coordination involving intense physical contact. Currently, a paucity of literature exists regarding injury occurrence in UWR. To examine the nature and prevalence of acute and overuse injuries in UWR. Descriptive epidemiology study. Between November 2020 and March 2021, a total of 720 German UWR athletes were invited to take an online survey developed by orthopaedic specialists with UWR athletes. Data were recorded regarding general and health-related information, training habits, acute injuries that necessitated an interruption in training and/or doctor consultation, as well as overuse injuries. Overuse injuries were evaluated using the Oslo Sports Trauma Research Centre Overuse Injury Questionnaire. Statistical analyses included t tests or rank sum tests depending on normality of distribution. A nonparametric Kruskal-Wallis 1-way analysis of variance on ranks was used for nonnormally distributed data among several groups. This study included 161 active athletes (mean ± SD, 36.1 ± 11.9 years old; 75.3% male) for analysis, of whom 90.1% were competing regularly. The performance-level distribution was as follows: first German national league (n = 73), second German national league (n = 46), state league (n = 17), district league (n = 1), and no league (n = 24). The mean ± SD sport-specific training workload was 5.6 ± 3.0 h/wk, including UWR training, additional swimming (n = 71; 44.1%), strength (n = 70; 43.5%), and/or endurance training (n = 102; 63.4%). Acute injuries were recorded in 78.9% of all athletes. The most typical locations for acute injuries were hand/finger (42.4%), head/face (concussion, ruptured eardrum; 18.1%), wrist (5.5%), or spine (5.0%). Overuse injuries were reported by 42.9% of the participants. The predominant locations for overuse injuries were hand/finger (18.8%), shoulder/clavicle (14.1%), spine and wrist (10.7% each), head/face (8.7%), and ankle joint and knee (6.7% each). In the current study, 3 of 4 athletes reported at least 1 acute injury, and 2 of 5 athletes reported at least 1 overuse injury. Leading injury regions were the hand/finger, head/ear, wrist, and spine.

Prevalence and incidence of health problems and their characteristics in Brazilian para athletes: A one-season single-center prospective pilot study

BackgroundPara athletes experience high prevalence and incidence of health problems related to sport. Despite this, there are few longitudinal studies. ObjectiveTo describe the characteristics, prevalence, incidence, and severity of health problems in para athletes from one of the Brazilian Paralympic Reference Centers during a sports season and to compare the prevalence of health problems between para athletics, para powerlifting, and para swimming. MethodsThis prospective pilot study was conducted from October 2019 to March 2020. The Oslo Sports Trauma Research Center Questionnaire on Health Problems was used to record injuries and illnesses every week for 24 weeks. The characteristics, prevalence, incidence, and severity of health problems were described for each modality. The prevalence of health problems was compared among the three sport modalities. ResultsThirty-five para athletes participated. Most of the injuries occurred in the shoulder, and most illnesses caused respiratory and gastrointestinal symptoms. The average weekly prevalence and the incidence rate of health problems were 40.6% (95% CI 17.0–64.4) and 12.7 (95% CI 9.6–15.9) per 1000 athlete hours, respectively. Para powerlifting had the highest prevalence of all and substantial health problems; para swimming had the lowest prevalence of injuries; and para athletics had the lowest prevalence of illnesses. ConclusionsThis group of Brazilian para athletes showed a high prevalence and incidence of health problems throughout the season. Para athletics, para powerlifting, and para swimming each had a different prevalence of injuries and illnesses.

Previous Injury and Lower Well-being Increase Injury Risk in Female Adolescent Athletes.

Several risk factors for injury have been suggested in female elite athletes. However, there is a lack of prospective studies in young female athletes where multiple risk factors have been studied. The aim of this study was to identify risk factors for injury in female adolescent elite athletes. Substantial injuries were monitored in 222 athletes using the validated Oslo Sports Trauma Research Centre Questionnaire over 20 weeks. Over 20 potential risk factors were explored. Based on a binomial generalized linear mixed model, two significant (p<0.05) risk factors for injury were identified; previous injury within the last 12 months (OR 2.55) and well-being (OR 0.97). An athlete with a previous injury had twice as high a risk of injury (13% vs. 6%) compared to an athlete with no previous injury. Higher perceived well-being was associated with a decreased risk of injury. Based on a prospective design with a large sample of female adolescent elite athletes, investigating over 20 potential risk factors for injury, our results suggest that a previous injury and well-being are risk factors for injury.

Epidemiology of injuries and illnesses in elite wheelchair basketball players over a whole season – a prospective cohort study

BackgroundWheelchair basketball is an adaptation of pedestrian basketball and one of the most popular Paralympic sports worldwide. The epidemiology of health problems in wheelchair basketball has been prospectively studied only during the Paralympic Games, the 2018 World Championships, the 2021 South America Wheelchair Basketball Championship, and one season of two American intercollegiate wheelchair basketball teams. The objective of the study was to prospectively monitor and analyze the prevalence, incidence, burden, and characteristics of injuries and illnesses in a wheelchair basketball league during an entire season for the first time.MethodsAll players of the highest German wheelchair basketball league (Bundesliga) were invited to participate in the study. Included players completed the Oslo Sports Trauma Research Center Questionnaire once a week during the entire season 2020/21 to report health problems. Exposure was captured by self-reported training time and officially-recorded competition time.ResultsSixty of 117 players (51%, 47 male, 13 female) of the national league participated with an average response of 93%. Seventy health problems (5.5/1000 exposure hours [95% CI: 4.9–6.1]) were reported, including 54 injuries and 16 illnesses. Prevalence of health problems was 60% (95% CI: 48–72). Most injuries affected the shoulder (32% of all injuries), cervical spine/neck (17%), and hand (13%). More overuse injuries (2.9/1000 exposure hours [95% CI: 2.5–3.3]) than acute injuries (1.3/1000 exposure hours [95% CI: 1.0-1.6]) occurred. Of all health problems, 53% were associated with time-loss. The incidences of all health problems, illnesses, injuries, and overuse injuries were higher in women than in men.ConclusionsCharacteristics and frequency of injuries and illnesses during wheelchair basketball season differed from those during major wheelchair basketball tournaments. The high proportion of overuse injuries and the higher injury rates in women should be regarded in the development of individualized prevention measures. Since results from previous studies during major tournaments are only partially comparable to wheelchair basketball league play, further studies should follow.

The effect of progressive and individualised sport-specific training on the prevalence of injury in football and handball student athletes: a randomised controlled trial.

To evaluate the effectiveness of communication and coordination combined with designing a progressive and individualised sport-specific training program for reducing injury prevalence in youth female and male football and handball players transitioning to a sports academy high school. An additional aim was to investigate the characteristics of the reported injuries. Forty-two Norwegian athletes were randomised into an intervention or control group. Mean age, height, weight and BMI was 15.5 ± 0.5 years, 178.6 cm ± 6.3 cm, 71.3 ± 9.8 kg, 22.3 ± 2.7 BMI for the intervention group (IG) (n = 23), and 15.4 ± 0.5 years, 175.6 cm ± 6.6 cm, 67.1 ± 9.8 kg, 21.7 ± 2.4 BMI for the control group (CG) (n = 19). During the summer holiday, the intervention group received weekly progressive, individualised sport-specific training programs and weekly follow-up telephone calls from the researchers. All athletes completed a baseline questionnaire and a physical test battery. Training data and injuries were recorded prospectively for 22 weeks using the Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H2). A two-way chi-square (χ2) test of independence was conducted to examine the relationship between groups and injury. Average weekly prevalence of all injuries was 11% (95% CI: 8%-14%) in IG and 19% (95% CI: 13%-26%) in CG. Average weekly prevalence of substantial injuries was 7% (95% CI: 3%-10%) in IG and 10% (95% CI: 6%-13%) in CG. The between-group difference in injuries was significant: χ2 (1, N = 375) = 4.865, p = .031, φ = .114, with 1.8 times higher injury risk in CG vs. IG during the first 12 weeks after enrolment. For student athletes transitioning to a sports academy high school, progressive individualised, sport-specific training programs reduced the prevalence of all-complaint injuries following enrolment. Clubs and schools should prioritise time and resources to implement similar interventions in periods where student athletes have less supervision, such as the summer holidays, to facilitate an optimal transition to a sports academy high school.

French Translation and Validation of the OSTRC-H2 Questionnaire on Overuse Injuries and Health Problems in Elite Athletes.

To evaluate the burden of overuse injuries, the Oslo Sports Trauma Research Centre (OSTRC) questionnaire on health problems (OSTRC-H2) was developed in English in 2013. To translate and culturally adapt the OSTRC-H2 into French and investigate the reliability and validity of this new version. Cohort study (diagnosis); Level of evidence, 3. The OSTRC-H2 was translated from English to French according to international guidelines. A total of 80 elite athletes were then invited to complete the OSTRC-H2 weekly for 3 months. Potential ceiling effects, construct validity, and reliability were investigated. Convergent validity was measured using Pearson correlations for continuous items and kappa coefficients for binary items; internal consistency was measured using the Cronbach alpha coefficient; and test-retest reliability was measured using the intraclass correlation coefficient (ICC). Separate analyses were performed on the entire cohort of athletes (population 1 [P1]) and on athletes who reported a health problem during the follow-up (P2). A total of 80 elite athletes took part in this study. The response rate was very high, with 909 of 960 questionnaires returned (95%). The mean weekly prevalence of health problems was 19.6% during the follow-up period. Nineteen participants reported a health problem during the follow-up (P2). The OSTRC-H2 showed very good test-retest reliability for both populations (ICC, 0.85 [95% CI, 0.77-0.90] for P1; ICC, 0.90 [95% CI, 0.68-0.98] for P2). Internal consistency was very good for P2 (Cronbach α = .94). The OSTRC-H2 demonstrated high concordance with the visual analog scale of symptom intensity (r = 0.52; P < .05), and low concordance with the overtraining questions from the Questionnaire de la Société Française de Médecine du Sport (κ from -0.01 to 0.12; P > .05). The French version of the OSTRC-H2 was found to be valid and reliable when applied to French-speaking elite athletes.

Tennis Specialization and Consequence of Injury/Illness Following Retirement.

(1) Background: There is a lack of literature that examines the impact of early vs. late sport specialization on quality of life after retirement from tennis. Thus, the purpose of this study was to examine the relationship between early specialization in the sport of tennis and health outcomes after retirement from collegiate/professional sport; (2) Methods: Participants were recruited through social media posts, newsletters, and contacts with tennis organizations. Basic demographic and injury information was collected from 157 former tennis players, along with the age of tennis specialization and two questionnaires: the Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC), and the CDC HRQOL-14 "Healthy Days Measure" Questionnaire (HRQOL); (3) Results: Significant differences (F1,117 = 5.160, p < 0.025) in the specialization age between the low (11.9 ± 4.5 y) and high (9.8 ± 4.1 y) OSTRC groups were found after covarying for the current age. No difference (F1,72 = 0.676, p < 0.414) was shown among the high (10.9 ± 4.4 y) and low (11.28 ± 4.6 y) HRQOL groups for the specialization age after covarying for the current age. A weak negative correlation was identified between the OSTRC score and specialization age (r = -0.233, p = 0.008), while no significant changes were shown between the specialization age and HRQOL score (r = -0.021, p = 0.857), or between the OSTRC and HRQOL scores (r = 0.146, p = 0.208); (4) Conclusions: Retired tennis players with low injury/illness severity scores specialized in tennis later than those with high injury/illness severity scores, while no differences in the specialization age were noted when the sample was separated into HRQOL groups.

Can running-related injuries be prevented through an online behavioural intervention in adult novice runners? Results of a randomised controlled trial

ObjectiveTo evaluate the effectiveness of the Runfitcheck on time until the onset of a new running-related injury (RRI) among adult novice runners.MethodsA three-arm randomised controlled trial was conducted over 7...

Injury epidemiology in Chinese undergraduate classical dance students: A 14-week prospective study

ObjectivesThe aim of this study was to investigate the injury prevalence, incidence rate, injury proportions, and characteristics of injuries in Chinese undergraduate classical dance students by using the modified Oslo Sports Trauma Research Centre Questionnaire on Health Problems. DesignProspective study. SettingOnline survey. Participants63 Chinese classical undergraduate students (female: 40, male: 23; median age: 20 years, range: 17–20 years) completed the survey. Main outcome measuresThe injury prevalence (proportions) and incidence rate were calculated. The characteristics (severity, locations, injury type) of injuries were investigated. ResultsDuring the 14-weeks, 84% students reported injury occurrence more than one time. The injury incidence rate was 3.28 injuries per 1000h across 14-weeks. Weekly proportion for all injuries ranged from 38.2% to 61.9% and substantial injuries ranged from 7.5% to 22.7%. The lower back was the most frequently injured body location (38.9%), followed by the knee (17.3%) and the ankle (12.9%). In all reported injuries, overuse injury was the most prevalent type (78.9%, 95% CI: 73.2%–81.1%). ConclusionsChinese classical dance students are at a relatively high risk for injuries. Injury prevention programs in Chinese classical dance students should focus on the lower back and lower extremity.

Spanish Cross-Cultural Adaptation and Validation of the Oslo Sports Trauma Research Centre (OSTRC) Overuse Injury Questionnaire in Handball Players.

The aim of this study was the cultural adaptation, Spanish translation and validation of the Oslo Sports Trauma Research Centre (OSTRC) Overuse Injury Questionnaire in an adult population. In this study, a cross-sectional design was used. This study was divided into two phases: (1) cross-cultural adaptation of the original version of the OSTRC to a Spanish version (OSTRC-Sp) and (2) analysis of the psychometric properties of the OSTRC-Sp. A total of 427 handball players of both sexes and over 18 years of age participated in the study. The translated version of the questionnaire showed a very high internal consistency (Cronbach's α = 0.954), while the subscales showed an internal consistency between 0.832 and 0.961, with the endmost values being for shoulder and low back pain, respectively. On the other hand, when analysing item responses, the OSTRC-Sp showed ICC values ranging from 0.844 to 0.956, the former being for the first back question (back_1), and the latter for the fourth shoulder question (shoulder_4), in line with most published versions. The Spanish version of the OSTRC is a reliable and valid tool that can be used by researchers and clinicians in a Spanish-speaking population with musculoskeletal disorders.

Injury Surveillance and Training Load Methods Used by Health Professionals in Tennis: An Online Multinational Survey.

Injury surveillance and training load monitoring are both essential for the development of preventative strategies for gradual-onset musculoskeletal injuries in elite sport. Our aim was to survey health professionals working with elite tennis players on whether and how they monitor injuries and training load. A cross-sectional multinational online open-survey. The survey was developed and advertised in English, Spanish, and Portuguese languages on social media channels, a tennis academic journal, professional tennis associations, and clinical networks of the research team, from December 2020 to April 2021. 72 health professionals from 27 different countries working with elite tennis players responded to the survey. Injury surveillance is performed by 94% (68/72) of the survey respondents, with only 10% (7/68) using the consensus-recommended Oslo Sports Trauma Research Center questionnaire. Most common barriers identified by health professionals to injury surveillance are time constraints (66%), lack of knowledge (43%), and technology (31%). Training load monitoring is performed by 50% (36/72) of the health professionals working with elite tennis players. Main metrics monitored are weekly differences in training load (72%) and acute:chronic workload ratio (58%). Most common reasons for training load monitoring are injury prevention (94%), training planning (81%), and player feedback (53%). Despite a high percentage of health professionals implementing injury surveillance metrics, most of them do not use any validated method. Only half of health professionals working with elite tennis players monitor training load. Lack of knowledge and technology were the main barriers reported for adequately monitoring injuries.

Previous injury, sex and well-being are associated with injury profiles in 422 adolescent elite athletes of age 15–16 years: a 20-week longitudinal study

BackgroundAdolescent elite athletes have a high injury risk and many risk factors for injury have been suggested. However, there is a lack of prospective studies in adolescent elite athletes of...

Risk factors for injury and illness in youth floorball players – A prospective cohort study

ObjectivesTo investigate risk factors for injury and illness in female and male youth floorball players (12–17 years) during a 26-week floorball season. DesignProspective cohort study. SettingRecreational youth sport. Participants471 players (142 females) 12-17 years. Main outcome measuresWeekly survey including questions about stress, sleep quality, well-being, sport exposure and average weekly rating of perceived exertion (RPE). Acute:chronic workload ratio (ACWR) was calculated. The Oslo Sports Trauma Research Center questionnaire on health problems was used. Predictors of new injury and illness were examined using multi-level logistic regression models with weekly measures nested within individuals. ResultsHigher stress, poorer sleep quality and well-being increased the odds of a new injury in the subsequent week by 8% (2.0–13.5%), 10% (4.2–15.9%) and 8% (2.4–13.5%) per 1 unit increase. Higher stress, and poorer well-being increased the odds of illness by 8% (2.6–12.6%), and 12% (7.2–16.6%). ACWR below 0.8 or above 1.3 increased the odds of illness by 34% (4.9–70.8%). ConclusionsPerceived stress, well-being, and sleep quality were associated with injury and illness occurrence in the subsequent week. ACWR outside the range 0.8–1.3 was associated with illness the subsequent week. Trial registrationClinical Trials registration NCT03309904.