Hamstring Injuries in Track & Field Aspetar Sponsored Symposium Sports Medicine Australia Be Active 2014 Conference Canberra

1. INJURIESIN ATHLETICS
Dr Juan Manuel Alonso MD PhD

2. Outline
•Background
•Methods
•Injury Rates
•Injury descriptors
•Risk Factors
•Limitations
•Future research directions
•Prevention Implications

4. •There have been recent studies on Athletics injury epidemiology.
•Osaka 2007 World IAAF Outdoors Championships FIRST INJURY SURVEILLANCE
•IAAF injury reporting system 2007-2013: 15 international championships
•There is a lack of prospective studies
–Bennell published Athletics prospective study in 1996
–Jacobsson published in 2012/13 another research
Background
Watson MD. Am J Sports Med 1987. Ahuja Br J Sports Med 1985. BennellK. AustJ SciMed Sport 1996. Jacobsson J. Br J Sports Med 2013. Alonso JM. Clin J Sports Med 2009. Feddermann-Demont N. Br J Sports Med 2014.

5. Methods
Differences in
•Design: prospective Vs retrospective
•Populationselection
•Observation period
•Injury Definition
•Data recording
•Reporting: incidences / exposure

6. All Season:
Incidence: 1.7-3 injuries/athlete/season
3.7-3.9 injuries/1000 h
Prevalence:46-78% athletes injured/season
Recurrence:8-33%
Subsequent Inj:54%
42-47 % athletes sustain > 1 injury/season
Up to 10% athletes drop out during the season
Injury Rates
Watson MD. Am J Sports Med 1987. Ahuja Br J Sports Med 1985. BennellK. AustJ SciMed Sport 1996. Jacobsson J. Am J Sports Med 2012. Jacobsson J. Br J Sports Med 2013.

7. Competition:
•Incidence: 81.1 injuries/1000 registrations (time-loss 36.7)
–Highest in Combined events
(169 x 1000 registrations)
–Marathon (113) and
–Long (77.6) and middle distance (71.5).
•Lowest incidence was
–Throwing events (19.7)
–Jumps and short distances (43)
Injury Rates
Feddermann-Demont N. J. Br J Sports Med 2014.

8. Chime out data
During the season:
•Half to 2/3 of the squad will get injured
•Average: 2-3 injuries per athlete
Competition:
•10% of your team could get injured
•More injured athletes at combined events, middle and long distance

9. InjuryDescriptors

10. Onset
All Season
•70-96 % Overuse
–55% Gradual onset
–41% Sudden onset
•4-20% Traumatic
Competitions
•60 % Overuse
–37% Sudden
–23% Gradual
•30 % Traumatic
Sprint/Hurdles/Jumps/Combined events HIGHER % of Acute Injuries. However, Overuse >50%
BennellK, AustJ SciMed Sport 1996. Jacobsson J. Br J Sports Med 2013. Alonso JM, Med Sci Sports Exerc 2009. Alonso JM. Clin J Sports Med 2009. Alonso JM, Br J Sports Med 2012.

11. When?
All Season
50
30
73
20
TRAINING
COMPETITION
When?
Bennell
Jacobsson
BennellK, AustJ SciMed Sport 1996. Jacobsson J. Br J Sports Med 2013.

12. •Lower extremity 75-89%
–ThighAll Season 21,5 %/ Competition 34.5 %
–Lower leg 15 %
–Foot 10 %
–Knee 10 %
•Injury location affected most frequently
–the thigh in Jumps, Sprints/Hurdles, Middle distance, Race walk and Combined events
–the foot in Marathon
–the leg in Long distance
–the upper extremity in Throws
Injury Site
BennellK, AustJ SciMed Sport 1996. Feddermann-Demont NJ,Br J Sports Med 2014.

13. Thigh 19-24%
Upper extremity 8-12%
Trunk 12-13%
Head & Neck 1-3%
Knee 13-15%
Lower leg 13-23%
Ankle 5-10%
Foot 6-8%
Hip & Groin 3-4%
Achilles tendon 4%
Alonso JM, Clin J Sports Med 2009.
Alonso JM, Br J Sports Med 2012.

14. Thigh 27-33%
Upper extremity 5-8%
Trunk 14%
Head & Neck 1%
Knee 7-10%
Lower leg 11-20%
Ankle 6-8%
Foot 5-9%
Hip & Groin 6-8%
Achilles tendon 4-5%
Alonso JM, Clin J Sports Med 2009.
Alonso JM, Br J Sports Med 2012.
.

15. Hamstring Injuries Incidencein Track and Field

16. 0
10
20
30
40
50
60
70
80
90
THIGH INJURIES
Injuries/1000 competing athletes
Athletics AthleticsOlympics Athletics Football
All Injuries 2012 OG 2012 OG 2012
Injuries/1000 competing athletes
Feddermann-DemontN. Br J Sports Med 2014. EngebretsenL. Br J Sports Med 2013.

17. Hamstring injuries in Athletics
•No data of recurrence
•No data on time-loss impact

18. Diagnosis
0
5
10
15
20
25
30
Thigh (Hamstring) Strain
Stress Fractures
Ankle Sprain
Overuse Knee Injuries
Achilles / Foot Tendinosis
Medial Tibial Stress Syndrome
Lumbar Pain
Hip (adductor) strain
Lower Leg Strain
Plantar Fasciitis
Competition
All Season
AhujaBr J Sports Med 1985. BennellK, AustJ SciMed Sport 1996. Jacobsson J. Br J Sports Med 2013. Solaja A, Med Pregl 2013. Feddermann-Demont NJ Br J Sports Med 2014.

19. •Competition
–45 % absence 1 day
–30% absence 1-7 days
–3% absence higher than 4 weeks
•All season 50 % absence higher than 3 weeks
•Subsequent / Recurrent injuries more severe than first/index injuries
•Catastrophic
–Pole Vault
–Throwing
Injury Severity
Jacobsson J. Br J Sports Med 2013. Feddermann-Demont NJ Br J Sports Med 2014. Alonso JM, Br J Sports Med 2012

20. •Competition
–Athletes presenting with health problem
–Training more 12 h/week
–Combined events
•All season
–Severe injury (3 weeks) previous season
–Higher training hours and hard workouts
–Highest ranked athletes
–Increased age
–Higher flexibility
–Menstrual disturbances
Risk Factors
Bennell K, Aus J Sci Med Sport 1996. Jacobsson J. Br J Sports Med 2013. Feddermann-Demont NJ Br J Sports Med 2014. Edouard P, Br j Sports Med 2014

21. Limitations
•Competitions mainly
–World, Europe
–Lack of data from Africa, Asia, America, Oceania
–Newly incurred injuries
–Lack of information on overuse injuries
•Scarce prospective studies in athletics

22. •Prospective whole season surveillance
–Appropriate methods
–Overuse injuries
•Prevention interventions on:
–Hamstring Injuries
–Ankle injuries
–Stress Fractures
–Tendinopathies
Future Research Directions

23. Prospective Whole Season Cohort Studies
CHALLENGES:
•Athletics Training Structure
–Clubs seldom professional
–Rarely employ any health staff
–Athletes live apart from the club
–Athletes train individually/groups not linked to clubs
–Some (few) athletes have their own medical team
•Specificities Athletics Culture
–Tendency to medical nomadism
–Lack of concern by the medical follow-up
•Not well structured Medical organisation around athletes
–National Federations providing medical care ONLY in training camps or domestic/international competitions
Edouard P, Branco P Alonso JM. Br j Sports Med 2014

24. •Special attention should be paid to injuries in:
–Combined events
–Long distance including Marathon
–Short Distance
•Future prevention studies should focus on Thigh Strain
•Improve understanding of injury mechanisms and risk factors
•Analyse efficacy of adapted preventive measures
Prevention implications

25. Conclusions
•On average, 1 out of each 12 registered athletes (81.1 injuries per 1000 registrations) suffered one injury during 2007-2012 international Athletics competitions
•More injuries were incurred during competition that in training.
•The incidence of all and of time-loss was higher in outdoor than in indoor or youth/junior championships

26. Conclusions
•High injury incidence
•Overuse traumatic
•Training Competition
•4/5 Lower limb, 3/10 thigh
•Hamstring strain, stress fractures, ankle sprain
•Disciplines different locations and diagnosis
•Half of injuries more thatn 3 weeks
•Risk factors to be elucidated

27. Take home message
IF YOU WORK OR WANT TO WORK IN ATHLETICS EXPECT
•Half to 2/3 of your team will get injured
•Many of your athletes will suffer from 2-3 injuries/season
•10% of your team could get injured in competition
•You have to be good clinician dealing with:
–Overuse Injuries
–Hamstring and Calf Strains,
–Achilles, Patellar, Knee, Foot, Hip Tendinopathies,
–Stress Fractures,
–Ankle Sprains
–Lumbar Spine

28. AcknowledgementsGroup
•Prof.DrLarsEngebretsen,IOC
•KathrinSteffenPhD,IOC,OSTRC
•Prof.DrJiriDvorak,FIFA,
•PDDrAstridJunge,F-MARC
•Prof.DrPerRenström,IOC
•DrMargoMountjoy,FINA
•DrPascalEdouard,France
•DrMarcAubry,IIHF
•JennyJacobssonPTPhD,Sweden
•DrOlaRonsen,Norway
•DrPedroBranco,Portugal
•ProfToomasTimpka,Sweden
•Teamphysiciansofparticipantcountriesand
medicalstaffofallChampionships.