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International Paralympic Committee
Injury and Illness Epidemiology in Paralympic Sport – Lessons Learnt Prof Wayne Derman, MBChB PhD FFIMS International Paralympic Committe 06 September 2016
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Developing injury prevention programs?
Step 1 Quantify the problem:
Incidence Severity
Step 2 Establish the aetiology
and mechanism of injury
Step 3 Introduce a
preventive measure
Step 4 Assess it effectiveness
van Mechelen W, Hlobil H, Kemper HC. Incidence, severity, etiology and prevention of sports injuries. A review of concepts. Sports Med 1992;14(2):82-99
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Step 1 Quantify the problem:
Incidence Severity
Step 2 Establish the aetiology
and mechanism of injury
Step 3 Introduce a
preventive measure
Step 4 Assess it effectiveness
van Mechelen W, Hlobil H, Kemper HC. Incidence, severity, etiology and prevention of sports injuries. A review of concepts. Sports Med 1992;14(2):82-99
Developing injury prevention programs?
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Step 1 Quantify the problem:
Incidence Severity
Step 2 Establish the aetiology
and mechanism of injury
Step 3 Introduce a
preventive measure
Step 4 Assess it effectiveness
van Mechelen W, Hlobil H, Kemper HC. Incidence, severity, etiology and prevention of sports injuries. A review of concepts. Sports Med 1992;14(2):82-99
Developing injury prevention programs?
![Page 5: Injury and Illness Epidemiology in Paralympic Sport ...€¦ · 14 • Wheelchair/seated athletes competing in seated throws (field) experienced a higher incidence of injury than](https://reader033.vdocument.in/reader033/viewer/2022060211/5f04dd547e708231d4101814/html5/thumbnails/5.jpg)
Step 1 Quantify the problem:
Incidence Severity
Step 2 Establish the aetiology
and mechanism of injury
Step 3 Introduce a
preventive measure
Step 4 Assess it effectiveness
van Mechelen W, Hlobil H, Kemper HC. Incidence, severity, etiology and prevention of sports injuries. A review of concepts. Sports Med 1992;14(2):82-99
Developing injury prevention programs?
![Page 6: Injury and Illness Epidemiology in Paralympic Sport ...€¦ · 14 • Wheelchair/seated athletes competing in seated throws (field) experienced a higher incidence of injury than](https://reader033.vdocument.in/reader033/viewer/2022060211/5f04dd547e708231d4101814/html5/thumbnails/6.jpg)
Step 1 Quantify the problem:
Incidence Severity
Step 2 Establish the aetiology
and mechanism of injury
Step 3 Introduce a
preventive measure
Step 4 Assess it effectiveness
van Mechelen W, Hlobil H, Kemper HC. Incidence, severity, etiology and prevention of sports injuries. A review of concepts. Sports Med 1992;14(2):82-99
Developing injury prevention programs?
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Highlights
Web-based injury surveillance (IPC-IIS) ↑’s compliance Male and female athletes have similar injury rates In female athletes, pre-competition injury rates are higher
than competition injury rates Injury rates are the lowest in the younger athletes Half of all injuries seen at the summer Paralympics are
new onset acute injuries Highest rates of injury are shoulder, wrist/hand and elbow
injuries Highest rates of injury in football 5-a-side, powerlifting,
goalball, wheelchair fencing, wheelchair rugby, & athletics
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Injury rate by sport – London 2012
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Results – Overall
A total of 216 injuries were reported in 977 athletes
– IP = 18.4 injuries per 100 athletes – Track: IP = 17.1 – Field: IP = 19.8
– IR = 22.1 injuries per 1000 athlete-days (95% CI 19.5 – 24.7)
– Track: IR = 19.1 (95% CI 15.7 – 22.6) – Field: IR = 25.2 (95% CI 21.3 – 29.1)
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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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Wheelchair Sports
Mixed Sports
Non-Wheelchair Sports Wheelchair Field
Injuries/1000 athlete days - Sport v Athletics Field Wheelchair
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New findings from present studies: Athletics – track and field
• The risk of injuries in Paralympic Athletics (track and field)
differs by impairment and event discipline: A prospective cohort study at the London 2012
Paralympic Games
14
• Wheelchair/seated athletes competing in seated throws (field) experienced a higher incidence of injury than those competing in wheelchair racing (track).
• Ambulant athletes with cerebral palsy experienced a lower incidence of injury in track
disciplines when compared to other ambulant athletes. • For both ambulant and wheelchair/seated athletes, the majority of injuries occurred in
competition and do not result in time-loss from competition or training.
• impairment and discipline specific • Injury prevention programs should
particularly be focused on athletes competing in seated throws and ambulant jumps, given that these disciplines experience a higher incidence of injury.
Blauwet et al. 2015,
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Results
London 2012 Paralympics
London 2012 Summer Olympics Athletes
Beijing 2008 Summer Olympics Atheletes
Overall Incidence 19/100 athletes 12,9/100 athletes 9,6/100 athletes
Upper limb Incidence 7,2/100 athletes NR 2/100 athletes
Lower limb Incidence 4,7/100 athletes NR 5,5/100 athletes
Present study 2014
Engebretsen et al 2013
Junge et al 2008
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Results
London 2012 Paralympics
London 2012 Summer Olympics Athletes
Beijing 2008 Summer Olympics Atheletes
Overall Incidence 19/100 athletes 12,9/100 athletes 9,6/100 athletes
Upper limb Incidence 7,2/100 athletes NR 2/100 athletes
Lower limb Incidence 4,7/100 athletes NR 5,5/100 athletes
Present study 2014
Engebretsen et al 2013
Junge et al 2008
1,5 : 1 0,3 : 1
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Results Most commonly injured region
Incidence
0.0
1.0
2.0
3.0
4.0
Shoulder Upper arm Elbow Forearm Wrist &hand
Inju
ries/
1000
ath
lete
day
s
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Results Severity of injuries
Incidence
0.0
1.0
2.0
3.0
4.0
Shoulder Upper arm Elbow Forearm Wrist &hand
Num
ber o
f inj
urie
s
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Results Severity of injuries
Incidence
0.0
1.0
2.0
3.0
4.0
Shoulder Upper arm Elbow Forearm Wrist &hand
Num
ber o
f inj
urie
s
50% ended competition
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Results Severity of injuries
Incidence
0.0
1.0
2.0
3.0
4.0
Shoulder Upper arm Elbow Forearm Wrist &hand
Num
ber o
f inj
urie
s
50% ended competition
10% ended competition
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Risk Factors Gender
0.0
1.5
3.0
4.5
6.0
7.5
Shoulder Upper/Forearm/elbow Wrist & hand
Inju
ries/
1000
ath
lete
day
s
Females Males
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Risk Factors Age
0.0
1.0
2.0
3.0
4.0
13-25 yrs 26-34 yrs 35-67 yrs
Inju
ries/
1000
ath
lete
day
s
ShoulderUpper/Forearm/elbowWrist & hand
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Risk Factors Age
0.0
1.0
2.0
3.0
4.0
13-25 yrs 26-34 yrs 35-67 yrs
Inju
ries/
1000
ath
lete
day
s
ShoulderUpper/Forearm/elbowWrist & hand
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Risk Factors Onset
0.0
0.4
0.8
1.2
1.6
Acute Acute on chronic Chronic
Inju
ries/
1000
ath
lete
day
s
ShoulderUpper/Forearm/elbowWrist & hand
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Risk Factors Onset
0.0
0.4
0.8
1.2
1.6
Acute Acute on chronic Chronic
Inju
ries/
1000
ath
lete
day
s
ShoulderUpper/Forearm/elbowWrist & hand
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Risk Factors Onset
0.0
0.4
0.8
1.2
1.6
Acute Acute on chronic Chronic
Inju
ries/
1000
ath
lete
day
s
ShoulderUpper/Forearm/elbowWrist & hand
Rotator cuff injury Impingement
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Risk Factors Type of Sport
0.0
3.5
7.0
10.5
14.0
17.5
Athletics Swimming Powerlifting Table tennis Wheelchairbasketball
Goalball Judo
Inju
ries/
1000
ath
lete
day
s
ShoulderUpper/forearm/elbowWrist & hand
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Risk Factors Type of Sport
0.0
3.5
7.0
10.5
14.0
17.5
Athletics Swimming Powerlifting Table tennis Wheelchairbasketball
Goalball Judo
Inju
ries/
1000
ath
lete
day
s
ShoulderUpper/forearm/elbowWrist & hand
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Risk Factors Type of Sport
0.0
3.5
7.0
10.5
14.0
17.5
Athletics Swimming Powerlifting Table tennis Wheelchairbasketball
Goalball Judo
Inju
ries/
1000
ath
lete
day
s
ShoulderUpper/forearm/elbowWrist & hand
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1. Risk of upper limb injury 7,2% during the Games 2. Shoulder injuries most common 3. Risk factors
• >35 years • Male • Swimming, powerlifting, judo
Conclusion
Upper limb injuries are common in athletes with impairment
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Obrigado!
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