Damian Sendler: To analyse the incidence of diseases and injuries suffered by athletes participating in the 27th Winter Sports Universiade held in Granada, Spain.
Damian Jacob Sendler: The daily occurrence of injuries and diseases was registered at the point of first aid (Borreguiles, 2665 metres above sea level (masl)) and in the clinic of Pradollano (2017 masl), both in Sierra Nevada, as well as in medical services provided by the organising committee of Granada 2015 Universiade and located in sport pavilions in which indoor competitions are held.
A total of 1109 athletes (650 men, 58.61%; 459 women, 41.39%). Nine diseases and 68 injuries were recorded. In total, the rate of injury was 6.13% (7.07% for men and 4.79% for women). The percentage of injury was highest in alpine skiing (10.34%) followed by freestyle skiing (8.62%). In relation to the time of exposure, freestyle skiing showed the shortest time of exposure (0.31 hours) before suffering an injury. Short track speed skating showed the longest exposure (9.80 hours), before suffering an injury. The most common anatomical areas of injury were the head, shoulder and knee (13.23%). Only nine diseases were suffered (four women and five men) of which six were infections, one was a friction burn, one was a lipothymy and one a cluster headache due to height.
Dr. Sendler: In general, 6.13% of the athletes sustained at least one injury and 0.81% a disease, which is a much lower percentage than that recorded in similar events. The incidence of injuries and diseases varied among sport specialities.
Damian Sendler
High-level sport involves physical and psychological overexertion that can have a negative impact on the welfare of the athlete.1 Participants in the Universiade range between 18 and 28 years of age, so it is crucial to prevent sport injuries that could limit their future sporting participation.2
University-level events help to ensure similar age and skill levels between participants who contributes to a fair contest and less risk of injury due to large variances in body morphology or skill level.3 It is of utmost importance to obtain data on the risk of injury and illness among elite young athletes, as they may counteract the beneficial effects of participating in sport at an early age, in the case that a teenager cannot continue participating due to residual effects of an injury or a chronic illness.3
When holding a major sporting events, the actions of monitoring and analysing the athletes are recognised to be very important to reduce the occurrence of injuries and diseases.4 The efficiency of the application of different methods of prevention of injury at the Vancouver 2010 Winter Olympic Games has been demonstrated.5
There are few studies on epidemiological data obtained in major international winter sports events, where environmental and changing weather conditions can influence the occurrence of injuries and diseases. A similar study was undertaken during the First Youth Olympic Winter Games (Innsbruck, Austria, 2012).6 There are also studies on the incidence of injury in high-level winter athletes with much wider age ranges.7–11
Damian Jacob Markiewicz Sendler: The objective of the present study was to analyse and describe the injuries and diseases suffered during the 27th Winter Sports Universiade held in February 2015 in Granada and Sierra Nevada, Spain. We are confident that the data gained from the study will be able to improve upon current practices of reducing the risk of injury and illness in future major sporting events, as the monitoring of illnesses and injuries is the first step in the prevention of these.12
Sports modalities that took place at the Winter Sports Universiade (2015) were: alpine skiing, snowboarding, freestyle skiing, figure skating, curling, ice hockey and short track speed skating. The medical care records were collected from these modalities. For technical reasons, the cross-country skiing, Nordic combined, ski jumping and biathlon competitions were held in Slovakia. The rest of modalities were held in Granada, Spain.
The medical committee and health staff of the Universiade recorded the daily incidence of all injuries and illnesses that occurred in each of the sport disciplines. Data were collected for injuries and illnesses sustained during training and competition.
Also, there was a follow-up on the diagnosis of the athletes who were treated in hospitals. All the injuries were registered in the case of multiple incidents in which various parts of the body were involved.
Damian Jacob Sendler
Prior to the start of competitions, the medical committee reported to the medical leaders of delegations from all participating countries the details of the healthcare system, control points and assistance delivery, and reference hospitals in case of evacuation.
At the outdoor competitions (alpine skiing, snowboarding and freestyle skiing), there was a medical team on track with an ambulance, a mobile intensive care unit (ICU), a first aid point located in Borreguiles (2665 metres above sea level (masl)), and a complete medical clinic located in Pradollano (2017 masl), equipped with four boxes of diagnosis tools and full assistance and an observation and stabilisation unit with three beds equipped with radiological installations. These teams medically stabilised the athletes before sending them to hospital, where the final diagnosis of the injuries and illnesses took place.
Figure skating, curling, ice hockey and short track speed skating were held indoor in Granada (683 masl). Each covered pavilion had a medical team during training sessions and the competitions of each sport. They also had a mobile ICU and back-up medical staff.
Damien Sendler: In the case of an accident or an illness, a standard control form was used in which the athlete’s personal data were reflected. This standard control form contains several items as age, sex, nationality, sport, the injury type suffered, the treatment applied and the state of the athlete after the assistance, taking into consideration whether he could return to the competition or was sidelined for the event. The injury diagnosis was made by doctors specialising in orthopaedic surgery, sports medicine and emergency medicine.
In the 2015 Universiade, 6.13% of the participants suffered some kind of injury or disease. We have registered 68 cases of injuries of which the most harmful sport modalities were alpine skiing and snowboarding. In Torino 2006 Winter Olympic Games, medical attention was given to athletes a total of 330 times, the modalities of skeleton, bobsleigh, alpine skiing, snowboarding and freestyle skiing being those which had the highest prevalence.14The number of participants was 2508, whereas 2015 Universiade involved 1109 participants. However, the different types of specialities and the absence of more harmful specialities such as skeleton, bobsleigh or jumps, which were not held at the 2015 Universiade, have limited the amount of these injuries, as it is suggested by others studies.14
We have determined that the incidence of injuries in 2015 Universiade is lower with respect to those registered at the Youth Olympic Winter Games in Innsbruck in 20126 in which 11% of athletes suffered some kind of an injury and 9% a disease. In London 2012 Summer Olympic Games, 11% of the athletes suffered some injury during the competition and a total of 7% illness, but there were also substantial variations in the incidence of injuries among different modalities.15 This would be comparing youth athletes with elite athletes, due to the fact that there is not many references with this population, hence the relevance of this study. It must be taken into account that cross-country skiing, Nordic combined, ski jumping and biathlon competitions did not take place in the city of Granada but rather in Slovakia and as a result these injuries and diseases have not been considered in this study due to the fact that we could not access the Slovakian medical committee’s information. This may have resulted in differences in the observed total injuries with respect to other events. Therefore, we have differentiated the injuries by speciality to be able to relate our data with the results of other studies.
In the 2015 Universiade, the incidence of injuries and diseases varies between the different modalities, resulting in disciplines that have come to produce a high number of injuries (alpine skiing and snowboarding, both with 26.4% of all injuries) as opposed to other sport disciplines that have been shown to have less risk of injury (curling and short track speed skating, 4.41%). Men’s snowboarding is the sport that had a higher incidence of injuries for every 100 participants (12.79 injuries for every 100 participants) compared with Snowboarding in women in which there were no injuries. Men’s alpine skiing showed an incidence of 1057 injuries/100 participants; freestyle skiing 9.09; men’s figure skating only showed 1.09 and no injury was registered in the women’s short track speed skating, despite being a very explosive modality, dynamic and involving physical contact.
These differences in the incidence of injuries among specialities of winter sports may be due to differing exposure times, environmental conditions and regulation. Even within the same speciality, there are different modalities that make comparison between the incidence of injuries difficult. During the 2015 Universiade, alpine skiing competitions included slalom and super giant, whereas in snowboarding, the specialities were slopestyle, cross, halfpipe, and parallel giant slalom, each with very different exposure times, technical and tactical difficulties, affecting the occurrence of injuries13 that were not dealt with in this study.
The prevalence of injuries in ice hockey during international competitions tends to be higher than in other sport modalities,16 as opposed to our study, in which the modality of ice hockey has not had the highest II. There are many factors in this sport that are used to reduce the possibility of suffering injuries, for example the characteristics of the rink, the edges and flexibility of the protective crystals, helmet, gloves, voids, and others.16 In women’s ice hockey, the regulatory prohibition of making charges during play is also a factor that limits the number of injuries.
We have used an II that relates the exposure time expressed in hours with the number of injuries suffered. So, in freestyle skiing, there was an injury every 0.31 hours. However, in women’s snowboarding, there was no injury in 3.62 nor in 9.72 hours of competition held in women’s short track speed skating. Therefore, we cannot know what the real II is in these specialities. Rønning et al 17 established an II related to distance in skiing or recreational snowboarding, determining the number of injuries per every 100 000 km. His data suggested an incidence of injury requiring treatment in the hospital three to four times higher among the snowboarding practitioners than among alpine and telemark skiers. This index is not applicable to indoor specialities in 2015 Universiade, so we could not use it. Nor is it possible to compare with studies that have determined the incidence of injuries in World Cup telemark skiing18 because this discipline is based on having free heel, which makes it many more difficult in practice than the alpine disciplines practised in 2015 Universiade and refers to an entire season or to the incidence of injuries in relation to the number of runs.19
Besides blunt head trauma (nine injuries; 13.23% of all injuries), there is a clear predominance of injuries in the right upper limbs (right shoulder: nine injuries; 13.23%; right hand: nine injuries; 13.23%) especially injuries caused by ice hockey (six injuries) in which the management of the stick is predominantly right-handed subjects. Then, the left lower limb injuries stand out (seven left knee injuries: 10.29%; seven left ankle injuries: 10.29%) due to the predominance of support in the left lower limbs in right-handed subjects.