Abstract
ves:Recent studies have identified rates of injuries in young elite athletes during major athletic events. However, no such data exist on master athletes. The aim of this study was to assess incidence and types of injuries during the 2012 European Veteran Athletics Championships as a function of age, performance and athletic discipline. Methods:Report forms were used to identify in- jured athletes and injury types. Analysis included age (grouped in five-year bands beginning at age 35 years), athletic event, and age-graded performance. Results:Of the 3154 athletes (53.2 years (SD 12.3)) that participated in the championships (1004 (31.8%) women, 2150 (68.2%) men), 76 were registered as injured; 2.8% of the female (29), 2.2% of the male (47) athletes. There were no fractures. One injury required operative treatment (Achilles tendon rupture). Injury rates were significantly higher in the sprint/middle distance/jumpsthan the throws, long distanceand decathlon/heptathlongroups (Χ² (3)=16.187, P=0.001). There was no significant interrelationship with age (Χ² (12)=6.495, P=0.889) or age-graded performance (Χ² (3)=3.563, P=0.313). Conclusions:The results suggest that healthy master athletes have a low risk of injury that does not increase with age or performance. Keywords:Master Athletes, Championships, Injury, Athletics, Track and Field Original Article Hylonome The authors have no conflict of interest. Corresponding author: Dr. Bergita Ganse, Division Space Physiology, German Aerospace Center (DLR), Institute of Aerospace Medicine, Linder Höhe, D- 51147 Cologne, Germany E-mail: bergita.ganse@dlr.de Edited by: S. Warden Accepted
a low risk of injury that does not increase with age or performance. Keywords:Master Athletes, Championships, Injury, Athletics, Track and Field Original Article Hylonome The authors have no conflict of interest. Corresponding author: Dr. Bergita Ganse, Division Space Physiology, German Aerospace Center (DLR), Institute of Aerospace Medicine, Linder Höhe, D- 51147 Cologne, Germany E-mail: bergita.ganse@dlr.de Edited by: S. Warden Accepted 26 April 2014
B. Ganse et al.: Injury rates in master athletics 149 attention has been drawn to sport injuries in children and adoles- cents in athletics championships 12 and master athletes (athletes of 35 years and older) have been followed at their domicile to register sport injuries 13-15 . Specific injuries and injury patterns in master athletics, for example injuries of the Achilles tendon and patellar tendinopathy, have been investigated 16-17 . However, there is currently nothing known with regards to the risk of injuries in older athletes during competition events. One could envisage that some competitive sports, particularly events such as pole vault and hurdles, could become dangerous at advanced age. If such a risk existed it would be unclear in how far it is modulated by age, athletic discipline and performance. The aim of the present pilot study was to assess the inci- dence and types of injuries during international championships for master athletes, and to test the hypothesis that the incidence of injuries is a function of age, age-graded performance and athletic discipline. As the opportunity arose, we chose the Eu- ropean Veteran Athletics Championships to gather first in- sights. As the project is ongoing, more data for further in-depth analyses will be available in the future. Materials and methods Study setting The study was performed at the 2012 European Veteran Athletics Championships (EVACS) in Zittau, Germany. Ethi- cal approval was obtained from the ethics committee of North Rhine Medical Association, number 2012157. The study was registered in the DRKS German clinical trial registry, number DRKS00004209. Reporting system for medical attention All athletes with complaints were directed to the German Red Cross medical service that was present at several locations within the stadium and in the surrounding areas during the champi- onships. Teams of Red Cross personal also patrolled the stadium and competition sites. To ascertain best coverage of injuries and a proper medical evaluation, all athletes with injuries were di- rected to one of the Red Cross medical doctors who filled in a study report form for each participating athlete with an injury. The medical service reported every
the champi- onships. Teams of Red Cross personal also patrolled the stadium and competition sites. To ascertain best coverage of injuries and a proper medical evaluation, all athletes with injuries were di- rected to one of the Red Cross medical doctors who filled in a study report form for each participating athlete with an injury. The medical service reported every injury, even if transportation in an ambulance was necessary. Athletes were not approached actively by medical service personnel, but presented to the serv- ice. All athletes who presented and who had a registration num- ber of the championships (because they were participants) were registered for the study, independent from disqualifications. An injury was defined as sudden onset of a physical complaint severe enough to make the athlete seek help from the medical service. Injuries that were treated by the athletes themselves and not re- ported to the medical service were not considered in the study. Only one registration was counted if athletes presented several times. Furthermore, re-occurrence of injuries existing previous to the championships was registered. The report form included the athlete’s accreditation number, name, date of birth, description of complaint, description of treatment, medications given, whether or not the athlete was brought to hospital, weather conditions and temperature, as well as written informed consent. The project was presented to all team officials and medical personal, and was mentioned again each morning in the team leader meeting by the authors. Communication with the Red Cross team in the stadium (changing individuals) was frequent, and the authors were available for questions at all times. Disqualifications by safety judges In master athletics, according to World Master Athletics (WMA) competition rules, safety judges are appointed “with the authority to withdraw from competition any athlete who is improperly performing the event or whose continued partici- pation in that competition would, in the opinion of the safety judge, endanger the athlete’s health or the progress of other competitors” 18 . Information on the athletes disqualified by safety judges was collected from the official list of results 19 . Age groups Master athletes compete in five-year
athlete who is improperly performing the event or whose continued partici- pation in that competition would, in the opinion of the safety judge, endanger the athlete’s health or the progress of other competitors” 18 . Information on the athletes disqualified by safety judges was collected from the official list of results 19 . Age groups Master athletes compete in five-year age bands beginning internationally at the age of 35. Terminology works as follows: M=men, W=women. Age groups include athletes in the named age up to the next group; for example W35 includes women between 35 and 39 years of age, counting the age on the first competition day for those championships. M80 includes men between 80 and 84 years of age. Athletic events Most athletes participated in several events. For statistical analyses, athletes were grouped in four event groups according to their best event. Due to the large number of disciplines and the small number of injured athletes, it was not possible to per- form an analysis for individual disciplines. Event groups were defined as follows: - throws: Javelin throw, Shot put, discus throw, hammer throw, weight throw and throwing pentathlon - sprint/middle-distance/jumps: Short distance sprints and relays (100 m, 200 m, 400 m, 4x100 m relay and 4x400 m relay), mid- dle distance running (800 m, 1500 m), hurdles (80 m, 100 m, 110 m, 200 m, 300 m, 400 m) and jumping events (long jump, high jump, triple jump, pole vault) - long distance: long distance running (5000 m, 10000 m), track walk (5000 m), road walk (10 km, 20 km), steeplechase (2000 m, 3000 m), marathon - decathlon/heptathlon: Decathlon and Heptathlon. The last group is not named combined events in this paper as “throwing pentathlon” is a “combined event” as well, but was grouped in to throws. Throwing pentathlon is specific to master athletics and not part of IAAF and IAA championships in young athletes. It includes hammer throw, shot put, discus throw, javelin throw and weight throw. Performance Age-graded performance was reported as a percentage of the world record at the corresponding age. Each gender and
“combined event” as well, but was grouped in to throws. Throwing pentathlon is specific to master athletics and not part of IAAF and IAA championships in young athletes. It includes hammer throw, shot put, discus throw, javelin throw and weight throw. Performance Age-graded performance was reported as a percentage of the world record at the corresponding age. Each gender and
B. Ganse et al.: Injury rates in master athletics 150 age group has a specific world record for each athletic disci- pline that was taken from the official results list 19 . The per- formance was calculated for each reported injured athlete. The best performance was chosen if athletes participated in several disciplines. In combined events, the final number of points was used for analysis and not the single results of each discipline. Statistical analysis SPSS (IBM SPSS Version 20, Release 20.0.0) was used for data analysis. Data are presented as counts and percentages, and as means and their SD. Contingency of relative distribu- tions was tested by χ²-test. Furthermore, unifactorial ANOVA was used. Significance was assumed at P<0.05. Results Participation and coverage In total 3154 athletes participated in the 2012 EVACS cham- pionships; 1004 women (31.8%) and 2150 men (68.2%). The average age was 53.2 years (SD 12.3). Master athletes usually participate in more than one discipline. Figure 1 shows the number of disciplines per athlete. The average number of dis- ciplines per athlete was 2.8 (SD 2.8). During the champi- onships 21 (2.1%) women and 43 (2.0%) men were disqualified for different reasons (“DQ” in official terminol- ogy). Three of these athletes were disqualified by the safety judges. Table 1 gives details on these athletes. Thirty three (3.3%) women and 84 (3.9%) men did not start though they were accredited for the event (“DNS” in official terminology), and 27 (2.7%) women and 126 (5.9%) men did not finish an event despite starting (“DNF” in official terminology). Despite their disqualification, these athletes were included in the study if they presented to the medical service. Eleven athletes with injuries were registered for the study with recurrences. Weather conditions During the championships the weather conditions were dry and warm with the peak daily temperatures ranging from 27 to 32°C. Injuries Table 2 gives an overview over the injury sites. We regis- tered 76 injured athletes; 33 (2.9%) of the female and 47 Figure 1.Distribution of number of disciplines per athlete. Each discipline in combined events was counted as a single discipline.
championships the weather conditions were dry and warm with the peak daily temperatures ranging from 27 to 32°C. Injuries Table 2 gives an overview over the injury sites. We regis- tered 76 injured athletes; 33 (2.9%) of the female and 47 Figure 1.Distribution of number of disciplines per athlete. Each discipline in combined events was counted as a single discipline. Heats and finals were also counted as independent disciplines. The highest number of disciplines for an athlete at EVACS 2012 was 24. Event Competition classYear of birth 1500 m M90 1918 1500 m W75 1936 5000 m track race walk W75 1936 Table 1.In total three athletes were disqualified by safety judges (three individual persons).
B. Ganse et al.: Injury rates in master athletics 151 (2.2%) of the male participants. There were no bone fractures. None of the athletes presented with a severe knee injury, such as a cruciate ligament rupture. One injury had to be treated op- eratively in hospital (Achilles tendon rupture in a 49-year old woman). No athlete died during the championships. None of the knee and thigh injuries was clinically so severe that an ath- lete had to be directly admitted or brought to a hospital. Athletes with an injury had an average age of 54.0 years (SD 12.0). Three athletes presented with injuries that had occurred be- fore the championships and that caused pain again. One of them had a knee arthroscopy three months previously, one a toe fracture, and one a strained hamstring. The most frequent complaints were pain, bruises, wounds and strains. Injuries of muscles in the thigh were the most fre- quent type of injury followed by pain of the Achilles tendon and knee injuries. There were five sprains of the upper ankle joint and 20 athletes presented with wounds that were all treated on site. A total of 10 athletes (4 female and 6 male) with an average age of 59.2 years (SD 11.7) presented because of Achilles ten- don pain. Eight of them were from the group sprint/middle dis- tance/jumps, and one each from the group throwsand the group decathlon/heptathlon. The 18 athletes (6 female and 12 male) with an average age of 52.3 years (SD 11.4) presenting with problems of the thigh were also mainly (12 athletes) of the group sprint/middle distance/jumps. Two athletes each presented from the other three groups. Overall, the majority of Achilles tendon and thigh problems occurred in the sprint/middle distance/jumps-group. Regarding the age-graded performance, the 10 athletes with Achilles tendon pain had a mean value of 85.1 % (SD 9.4) while the 18 athletes with thigh injuries had a mean performance of 70.6 % (SD 33.4). The average perform- ance of the entire 3154 participants was 73.0 (SD 21.3). Age groups Figure 2 shows the number of athletes, and
distance/jumps-group. Regarding the age-graded performance, the 10 athletes with Achilles tendon pain had a mean value of 85.1 % (SD 9.4) while the 18 athletes with thigh injuries had a mean performance of 70.6 % (SD 33.4). The average perform- ance of the entire 3154 participants was 73.0 (SD 21.3). Age groups Figure 2 shows the number of athletes, and the percentage of athletes registered with an injury, in each age group. It can be seen that the incidence of injuries did did not differ between age groups (Χ² (12)=6.495, P=0.889), indicating that the risk did not increase with age. Athletic events Table 3 shows the distribution of injuries per discipline group. The incidence of injuries differed significantly between the groups (Χ² (3)=16.187, P=0.001), where the group sprint/middle distance/jumpssuffered the highest injury rates. The following long distance, running and walking events were performed in Hradec (Czech Republic) and Bogatynia/ Zgorzelec (Poland): 5000 m, 10000 m, 5000 m track walk, 2000 m St, 10 km and 20 km road walk, marathon. In these places, probably not all injuries were reported for this study due to operational limitations. Even if we exclude the injuries Injury: Injuries Female Male Relative occurrence [%] Wounds 19 6 13 23.8 Head 202 2.5 Upper Extremity 615 7.5 Thigh 18 6 12 22.5 Knee 972 11.3 Ankle 514 6.3 Achilles tendon/heel/lower leg 15 87 18.8 Foot 532 6.3 Location unknown 110 1.3 Total 80 33 47 Table 2.Localization and numbers of injuries. Wounds are separately listed from locations of musculoskeletal injury. Four of the 76 injured athletes had several injuries in different locations that were counted separately for this table. No. of injuries No. of athletes Injuries [%] Short distance, middle distance and jumps 59 1830 3.2 Throws (incl. throwing pentathlon) 13 594 2.2 Long distance 2 232 0.9 Heptathlon/Decathlon 2 498 0.4 Total 76 3154 2.4 Table 3.Distribution of injuries in discipline groups.
B. Ganse et al.: Injury rates in master athletics 152 reported from these sites from the analysis, the sprint/middle distance/jumpgroup still had the highest incidence of injuries. Performance Table 4 gives an overview of the age-graded performance of the athletes and the number of musculoskeletal injuries in relation to the age-graded performance. There was no differ- ence found in the age-graded performance between age groups (unifactorial ANOVA P=0.142), nor was there a significant dif- ference in the incidence of injuries between athletes with a dif- ferent age-graded performance (Χ² (3)=3.563, P=0.313). Discussion The aim of this study was to assess the number of injuries during the 2012 European Veteran Athletics Championships and to unravel possible relationships with age, performance and athletic event. Currently no such data exists for master ath- letes. This type of study was implemented at a master athletics event for the first time. Our results suggest that the rate of in- juries in master athletes is rather low and not higher than that reported for younger athletes. However, larger studies in the future will be needed to corroborate this first study in the field. The hypothesis that the incidence of injuries is a function of age and age-graded performance cannot be supported while the hypothesis that the incidence of injuries depends on the athletic discipline can be supported. Method of data acquisition The studies that have been performed on young elite athletes during championships 7-11 usually acquired data on injuries through team physicians. As team physicians are uncommon in master Figure 2.Number of athletes and percent of injured athletes per age group. Performance [%] M/W 35-45 M/W 50-60 M/W 65-75 M/W 80-95 Total Injuries Injuries [%] <25 55 76 42 3 176 3 1.7 25-49 34 23 12 1 70 2 2.9 50-74 377 319 172 22 890 15 1.7 >74 706 807 445 60 2018 56 2.8 Total 1172 1225 671 86 3154 76 2.4 Table 4.Numbers of athletes grouped by age and performance (in percent of world record).
Description
The study investigates injury rates in master athletes during a major athletics event.