Gymnastik- och idrottshögskolan, GIH

Although it is advocated that end-users are engaged in developing evidence-based injury prevention training to enhance the implementation, this rarely happens. The ‘Implementing injury Prevention training ROutines in TEams and Clubs in youth Team handball (I-PROTECT)’ uses an ecological participatory design incorporating the perspectives of multiple stakeholders throughout the project. Within the I-PROTECT project, the current study aimed to describe the development of holistic injury prevention training specifically for youth handball players through using knowledge from both end-users (coaches and players) and researchers/handball experts. Employing action evaluation within participatory action research, the cyclical development process included three phases: research team preparation, handball expert-based preparation and end-user evaluation to develop injury prevention training incorporating both physical and psychological perspectives. To grow the knowledge of the interdisciplinary research team, rethinking was conducted within and between phases based on participants’ contributions. Researchers and end-users cocreated examples of handball-specific exercises, including injury prevention physical principles (movement technique for upper and lower extremities, respectively, and muscle strength) combined with psychological aspects (increase end-user motivation, task focus and body awareness) to integrate into warm-up and skills training within handball practice. A cyclical development process that engaged researchers/handball experts and end-users to cocreate evidence-based, theory-informed and context-specific injury prevention training specifically for youth handball players generated a first pilot version of exercises including physical principles combined with psychological aspects to be integrated within handball practice.

OBJECTIVE: To assess the evidence for risk factors and prevention measures for shoulder injuries in overhead sports.

DESIGN: Systematic review with best-evidence synthesis.

DATA SOURCES: Medline (Ovid), PubMed (complementary search), Embase (Elsevier), Cochrane (Wiley), SPORTDiscus (Ebsco) and Web of Science Core Collection (Thomson Reuters), from 1 January 1990 to 15 May 2017.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials, cohort studies and case-control studies on risk factors or prevention measures for shoulder injuries in overhead sports. The eligible studies were quality assessed using the Scottish Intercollegiate Guidelines Network criteria.

RESULTS: Of 4778 studies identified, 38 were eligible for quality review and 17 met the quality criteria to be included in the evidence synthesis. One additional quality study presented a shoulder injury prevention programme. Most studies focused on baseball, lacrosse or volleyball (n=13). The risk factors examined included participation level (competition vs training) (n=10), sex (n=4), biomechanics (n=2) and external workload (n=2). The evidence for all risk factors was limited or conflicting. The effect of the prevention programme within the subgroup of uninjured players at baseline was modest and possibly lacked statistical power.

CONCLUSIONS: All investigated potential risk factors for shoulder injury in overhead sports had limited evidence, and most were non-modifiable (eg, sex). There is also limited evidence for the effect of shoulder injury prevention measures in overhead sports.

PROSPERO TRIAL REGISTRATION NUMBER: CRD42015026850.

Research has shown that high levels of stress and stress responsivity can increase the risk of injuries. However, most of the research that has supported this notion has focused on between-person relationships, ignoring the relationships at the within-person level. As a result, the objective of this study was to investigate if within-person changes in perceived stress symptoms over a one-month time period could predict injury rates during the subsequent three months. A prospective design with two measurement points (Time 1 - at the beginning of the season and Time 2 - one month into the season) was utilized. A total of 121 competitive soccer players (85 males and 36 females; Mage = 18.39, SD = 3.08) from Sweden and the United States completed the Kessler Psychological Distress Scale (KPDS) and a demographic sheet at Time 1. The KPDS was also completed at Time 2 and all acute injuries that occurred during the subsequent three-month period were recorded. A Bayesian latent change scores model was used to determine if within-person changes in stress symptoms could predict the risk of injury. Results revealed that there was a credible positive effect of changes in stress symptoms on injury rates, indicating that an increase in reported stress symptoms was related to an increased risk for injury. This finding highlights the importance of creating caring and supportive sporting environments and relationships and teaching stress management techniques, especially during the earlier portion of competitive seasons, to possibly reduce the occurrence of injuries. This article is protected by copyright. All rights reserved.

The creation of risk profiles using the model of stress and athletic injury (J Appl Sport Psychol. 1998;10(1):5) represents a proposed shift from the reductionism paradigm to the complex sport approach in an attempt to formulate prevention strategies to combat the increasing number of injuries being reported in sporting populations. As a result, the primary purpose of this study was to: (a) identify different risk profiles based on psychosocial factors associated with the Williams and Andersen's model of stress and athletic injury model; and (b) examine potential differences in the frequency of injuries across these risk profiles. A prospective research design was utilized with a sample of 117 competitive soccer players (81 males and 36 females) from Sweden and the United States of America. Data was collected at two time points over the course of three months. At time 1 (beginning of the season) - a demographic information sheet, the Life Event Survey for Collegiate Athletes (LESCA), Sport Competitive Anxiety Test (SCAT), and Brief Cope were administered. At time two (T2), three months after the initial data collection, participants' traumatic injuries were recorded. Latent profile analysis (LPA) showed that 3 profiles solution showed best fit to data. Players in profile 1 and 2 reported fewer injuries compared to players in profile 3. However, whereas individuals in profile 1 had a lower predictive risk of sustaining an injury when compared to those in profile 3, both profiles had similar anxiety levels and use of coping strategies with differing stress levels. These findings suggest that the interaction between different proposed risk factors might influence injury risk.

INTRODUCTION: Rock climbing is a rapidly growing sport in which performance may be affected by participant's weight and leanness, and there may be pressure on athletes with respect to their eating behaviour and body weight. However, there is sparse research performed on climbers, constituting a knowledge gap which the present study aims to fill. The primary outcomes of the study are to examine disordered eating and overuse injuries in rock climbers. Secondary variables are body image, indicators of relative energy deficiency, mental health problems, compulsive training, perfectionism, sleep quality and bone density.

METHOD AND ANALYSIS: This prospective longitudinal study aims to recruit Swedish competitive rock climbers (>13 years) via the Swedish Climbing Federation. A non-athlete control group will be recruited via social media (n=equal of the climbing group). Data will be collected using streamlined validated web-based questionnaires with three follow-ups over 2 years. Inclusion criteria for rock climbers will be a minimum advanced level according to International Rock-Climbing Research Association. The non-athlete control group is matched for age and gender. Exclusion criteria are having competed at an elite level in any sport as well as training more often than twice per week. Statistical analyses will include multinominal logistic regression, multivariate analysis of variance (MANOVA) and structural equation modelling (SEM). We will assess effect measure modification when relevant and conduct sensitivity analyses to assess the impact of lost to follow-up.

ETHICS AND DISSEMINATION: The Rock-Climbers' Longitudinal attitudes towards Injuries, Mental health and Body image study, CLIMB, was approved by the Swedish ethics authority (2021-05557-01). Results will be disseminated through peer-reviewed research papers, reports, research conferences, student theses and stakeholder communications.

TRIAL REGISTRATION NUMBER: NCT05587270.

PURPOSE: To investigate the association between common measures of trunk and lower extremity range of motion (ROM), strength, the results of one-leg jump tests at baseline and the incidence of subsequent substantial knee injuries in adolescent female football players.

METHODS: Players were assessed at baseline regarding (1) ROM of trunk, hip, and ankle; (2) trunk, hip, and knee strength; and (3) one-leg jump tests. Players were prospectively monitored weekly for 1 year regarding knee injuries and the volume of matches and training. Hazard rate ratios (HRRs) and 95% confidence intervals (CIs) were calculated with Cox regression for the association between the baseline tests and the incidence of substantial knee injury (moderate/severe reduction in training volume or performance, or complete inability to participate in football). Exposures were categorized in tertiles (high, medium and low values). The highest tertile was used as reference.

RESULTS: 376 players were included without substantial knee injury at baseline (mean age, 13.9 ± 1.1 years), and 71 (19%) reported at least one substantial knee injury during the follow-up. Several associations were found; the strongest was that players in the lowest tertile of knee extension strength had a higher incidence of knee injuries than players in the highest tertile (HRR, 2.28; 95% CI, 1.20-4.38). Players in the lowest tertile of trunk rotation ROM in lunge position half-kneeling (HRR, 0.50; 95% CI, 0.27-0.94) had lower incidence of knee injuries than players in the highest tertile.

CONCLUSIONS: Poor knee strength and high trunk ROM were associated with an increased incidence of substantial knee injury in adolescent female football players. Therefore, knee-strengthening exercises during season may be recommended.

LEVEL OF EVIDENCE: Level II.

OBJECTIVE: To study normative values of range of motion (ROM), strength, and functional performance and investigate changes over 1 year in adolescent female football players.

DESIGN: Cross-sectional.

PARTICIPANTS: 418 adolescent female football players aged 12-17 years.

MAIN OUTCOME MEASURES: The physical characteristic assessments included (1) ROM assessment of the trunk, hips, and ankles; (2) strength measures (maximal isometric and eccentric strength for the trunk, hips, and knees, and strength endurance for the neck, back, trunk and calves), and (3) functional performance (the one-leg long box jump test and the square hop test).

RESULTS: Older players were stronger, but not when normalized to body weight. Only small differences in ROM regarding age were found. ROM increased over 1 year in most measurements with the largest change in hip external rotation, which increased by 6-7° (Cohen's d = 0.83-0.87). Hip (d = 0.28-1.07) and knee (d = 0.38-0.53) muscle strength and the square hop test (d = 0.71-0.99) improved over 1 year.

CONCLUSIONS: Normative values for ROM and strength assessments of neck, back, trunk, hips, knees, calves and ankles are presented for adolescent female football players. Generally, fluctuations in ROM were small with little clinical meaning, whereas strength improved over 1 year.

BACKGROUND: Normative values of lifestyle characteristics in adolescent female football players may be used by clinicians and coaches to take actions because the potential important for well-being, performance on the pitch, and risk of injury. The aim was to report descriptive characteristics of lifestyle factors in adolescent female football players and potential changes over 1 year.

METHODS: We included 419 adolescent competitive female football players from 12 clubs and 27 teams (age 14 ± 1 years, range 12-17 years) and 286 were followed over 1 year. The players completed an extensive questionnaire regarding demographics, football-related factors, and lifestyle factors including tobacco consumption, alcohol use, medicine intake, eating and sleeping habits, well-being, stress, coping, and passion. Baseline data are presented for the total cohort and separately for 4 age groups (12, 13, 14, and 15-17 years).

RESULTS: 12% skipped breakfast, 8% skipped lunch and 11% used protein supplements several days per week. 16% slept less than 8 h/night, 8% had impaired sleep with daytime consequences, and 22% stated that they were tired in daily activities several days per week. 32% experienced stress some or most days/week and 24% were classified as having psychological distress. Medicine intake (23% vs. 34%), skipping breakfast or lunch several days per week (10% vs. 47% and 20 vs. 33%), tiredness (20% vs. 27%), stress (26% vs. 40%), and psychological distress (27% vs. 37%) increased significantly (P = 0.031 to < 0.001) at the 1-year follow-up.

CONCLUSION: Many adolescent female football players skip breakfast and lunch, have insufficient sleep, experience stress and are classified as having psychological distress. These factors increased over 1 year.

The article presents the discussion on sports injuries having serious, long-term health implications for athletes which being a leading cause of athletes' retirement. Topics include injury occurrence being associated with less successful team performance having a significant impact on business and asset management; and personality factors, psychosocial stress, the stress response, and poorer coping resources being related to increased acute sports injury risk.

The manner in which health professionals and coaches act and decide on treatment and prognosis can influence athletes in a way that not only strengthens them, but it can also reduce their confidence in their own ability. The purpose was to determine who has the responsibility for child and adolescent psychosocial support needed in connection with a severe sports injury as well as investigate whether coaches, physiotherapists and parents are aware of the support that is needed. Qualitative interviews with coaches, parents and physiotherapists with experience of serious sports injuries in young people aged 12 to 16 years old from different sports were analysed using content analysis. The study showed that all actors independently imparted communica-tion as being the major problem and indicated that the role of a coordi-nator was missing. They imparted cognitive, emotional and behavioural reactions in children, which were considered to be more common in younger children as indicated in previous studies. Coaches felt they had lack of education and time; parents described their disappointment in caregivers and personality changes in their children in connection with the injury. Physiotherapists felt that rehabilitation was often served as a substitute for the sport and that they therefore had greater responsibili-ty for the child than they had been educated for. Results should be com-municated to participants who are involved in children’s and adoles-cent’s sports to increase their knowledge and thus allow them to be able to give our children the best possibility, regardless of whether they return to the sport or not.

Compliance with a rehabilitation program is significant among athletes following a sports injury. It is also one of the main factors that influence the rehabilitation process; moreover, the outcome is also influenced by the athlete's motivation. It is primarily an autonomous motivation, resulting in rehabilitation adherence. The aim of this study was to investigate the perceived motivation of female football players during rehabilitation after a sports injury and the extent to which these motivating factors were autonomous. Qualitative interviews, based on a semistructured interview guide with injured female football players undergoing rehabilitation, were analyzed using content analysis. The motivational factors that were described were their set goals, social support as well as external and internal pressures during rehabilitation. The perceived autonomy varied somewhat but overall, they experienced external motivation; therefore, the behavior was not entirely self-determined. Results are expected to provide a better understanding of women football players' motivation in relation to their rehabilitation; hence, physiotherapists and coaches who are part of the rehabilitation process can contribute by increasing the autonomous motivation, thus, improving the compliance and outcome of the rehabilitation.

INTRODUCTION: Gymnastics consists of several different disciplines, whereof TeamGym is one. TeamGym is a young discipline with sparse research. The aim of the study is to investigate the injury characteristics in Swedish elite gymnasts competing in TeamGym including training load and other physical and psychological factors associated with injury.

METHODS AND ANALYSIS: The Swedish TeamGym Injury Cohort is a longitudinal prospective cohort study for 52 weeks that includes the junior (15-17 years) and senior (≥18 years) Swedish female and male national teams in TeamGym. A baseline questionnaire will be sent out in an online application (SmartaBase) regarding demographics, previous injuries, gymnastics-related factors, for example, time at elite level and psychosocial factors such as stress, athletic identity, coping skills, personality traits and coach-athlete relation. A weekly questionnaire will be sent out in SmartaBase every Sunday and will monitor injuries using the Oslo Sports Trauma Research Centre Overuse Questionnaire, gymnastics-related factors, for example, landing surfaces, stress, recovery and training load. A test battery for the lower extremity will be performed. Data for ankle dorsiflexion, hop tests and ankle plantarflexion strength/endurance will be collected.

ETHICS AND DISSEMINATION: This project was approved by the Swedish Ethical Review Authority (2023-06653-01) and is performed according to the Declaration of Helsinki. The results will be published in peer-reviewed journals, scientific conferences and shared with the Swedish Gymnastics Federation.

OBJECTIVES: To examine the prevalence of mental health problems (depression, anxiety, and stress), sleep quality, and disability due to overuse injuries in advanced and elite rock-climbers. The rock-climbers were compared to a group of non-climbing controls.

METHODS: A self-selected sample of advanced and elite Swedish rock-climbing athletes was recruited through the Swedish Rock-climbing Federation, local rock-climbing gyms and through social media. A control group, matched in size was recruited. Participants in the control group answered an online survey of validated questionnaires, examining symptoms of stress, anxiety, depression, sleep quality. The climbing participants answered the same survey as the non-climbing controls but with additional questions regarding musculoskeletal problems and disabilities related to these. Outcome measures used were the Depression Anxiety Stress Scale, Pittsburgh Sleep Quality Index and The Oslo Sports Trauma Research Center Overuse Injury Questionnaire.

RESULTS: A total of 183 participants were included in the rock-climbing group, and 180 participants in the control group. In the rock-climbing group the mean age (SD) was 28.2 (8.3) years among women and 30.5 (9.6) years in men. The mean BMI of women was 21.2 (2.2) and 22.8 (2.1) in men. A total of 30.6% of the rock-climbing group (26.7% of men, 35.9% of women) reported at least moderate levels of symptoms of depression and 23.1% (17.2% men, 30.8% women) at least moderate levels of symptoms of anxiety. A total of 48.4% of rock-climbers (39.1% men, and 61.6% women) reported at least moderate levels of symptoms of stress. Among the rock-climbers, 45.0% reported having poor sleep quality. There were no statistical significant differences (p = 0.052-0.96) in mental health problems or sleeping problems between the rock-climbers and the controls. Among rock-climbers, reports of one-week prevalence of injury related problems was: Finger and hand (49.5%), Shoulder (35.2%), Knee (29.1%), Lumbar back (26.4%), Arm (25.3%), Thoracic back and neck (17.0%), and Foot and lower leg (12.1%).

CONCLUSION: The overall results indicate high levels of symptoms of mental health problems and poor sleep quality in both rock-climbers and controls. Although no significant differences between the climbing group and the control group was displayed, symptoms that warrant clinical attention is high. Overuse injuries were commonly reported among the rock-climbers in all examined injury locations. Previous studies reporting mental health problems to be more prevalent among athletes were contradicted in this study. The results display the need for a broader perspective regarding climbers general health and the need to provide structured care and adequate support in order to come to terms with these concerns.

Previous research offers evidence that psychological factors influence an injured athlete during the rehabilitation process. Our first objective was to conduct a systematic review and meta-analysis of the results from all published studies that examined the relationships among negative affective responses after sport injuries, rehabilitation adherence, and return to play (RTP). The second objective was to use a meta-analytic path analysis to investigate whether an indirect effect existed between negative affective responses and RTP through rehabilitation adherence. This literature review resulted in seven studies providing 14 effect sizes. The results from the meta-analysis showed that negative affective responses had a negative effect on successful RTP, whereas rehabilitation adherence had a positive effect on RTP. The results from the meta-analytic path analysis showed a weak and nonsignificant indirect effect of negative affective responses on RTP via rehabilitation adherence. These results underline the importance of providing supportive environments for injured athletes to increase the chances of successful RTP via a decrease in negative affective responses and increase in rehabilitation adherence.

In this study, we examined knowledge and understanding of sport-related injuries among youth athletics (track and field) athletes and assessed their needs in managing any health problems. Qualitative data were collected via 12 focus groups with youth athletes (16-19 years) studying at Swedish sports high schools with an athletics specialism. All focus group discussions were audiorecorded and transcribed before being analysed using a thematic analysis approach. Four researchers independently reviewed the transcripts, generated codes and developed themes. Three overarching themes related to the athletes' knowledge and understanding of sport-related injury were developed: (1) awareness of injuries, (2) perception of injuries, and (3) factors contributing to injuries. The youth athletes were typically uncertain about how to acknowledge a sport-related injury. They expressed that knowledge about injuries was obtained in part by reflecting on the lived experiences of their peers. It was also demonstrated that there appears to be a 'culture of acceptance' regarding injury occurrence. In contrast, causes of injuries were viewed as dependent on multiple factors (eg, lack of context-specific knowledge about training practices). Regarding athletes' needs in managing injuries, an additional three themes were developed: (1) creating functioning elite sports environments, (2) application of knowledge and (3) fostering athletes. An apparent lack of structure and organisation related to the school environment was identified as an important issue to review to create opportunities for sustainable athletic development. The study identified areas that can be improved in Swedish sports high schools with an athletic specialism and could be applied in other youth sports contexts. The results of this study guide school stakeholders, alongside the sport governing bodies who have the mandate to influence activities in youth sports contexts, whereby special attention should be directed towards improving the social environment for youth athletes.

Objectives: Our primary aim was to determine if athletic identity is prospectively associated with shoulder overuse injuries. Secondly, we aimed to determine if athletic identity is prospectively associated with playing through pain and to describe how athletic identity relates to sex, age, playing level, weekly training load, and match volume.

Methods: A cohort of 269 adolescent tennis players were followed over a period of 52 weeks. Cox regression was used to estimate the hazard rate ratio (HRR) of first-time shoulder overuse injury associated with every 10-unit increase on the Athletic Identity Measurement Scale (AIMS).

Results: The adjusted HRR of shoulder overuse injury was 0.89 (95% CI: 0.36-2.20) and the odds ratio of playing through pain was 2.41 (95% CI: 0.74-8.96) for every 10 unit increase on AIMS. The level of athletic identity was higher among players at the national level than among players at the regional level and was weakly correlated to weekly hours of tennis matches, tennis training, and fitness training.

Conclusions: Our results indicate that higher levels of athletic identity may be associated with a lower incidence of shoulder overuse injuries, and potentially with playing through pain, although these results are inconclusive due to wide confidence intervals.

There’s often a temptation to treat young athletes, especially those training in sport academies, as though they’re mini adults. This includes holding expectations that they’ll appreciate the risks of their sport and behave in ways to protect their own health. This is completely unrealistic. The processes of growth and maturation, which young athletes experience at different times and rates, affect psychological and social development alongside recognized physical changes. This means that younger, less mature athletes can struggle to grasp the consequences of their actions and are more likely to try risky maneuvers or ignore safety rules. Adolescent athletes in particular are vulnerable to social pressures and evidence suggests that they’re prone to over-estimating their own abilities, both of which can lead to increased injury risk. This chapter outlines the psychological factors that are unique to this population, drawing examples from traditional team sports as well as adventure sports such as snowboarding. It describes age-appropriate strategies for limiting risk exposure for young athletes while simultaneously encouraging them to develop risk assessment skills and addresses the psychological support needs of young athletes during injury rehabilitation.

BAKGRUND

Idrottsskador är vanligt förekommande hos unga fotbollsspelande flickor och för att kunna förebygga skador är det viktigt att identifiera riskfaktorer. Tidigare forskning har föreslagit både interna och externa riskfaktorer för skador såväl som fotbollsspecifika faktorer. De fotbollsspecifika faktorer kan undersökas genom fysiska tester som mäter rörlighet och styrka. För att kunna säkerställa att testsvaren är så pålitligliga som möjligt föreslås att inter- och intrareliabilitet undersöks.

SYFTE

Syfte med denna studie var att undersöka inter-och intrareliabilitet på 15 tester som ingår i Karolinska football injury cohort-studiens baslinjemätning. 

METOD

Studien genomfördes vid fyra tillfällen under liknande förhållanden. Sammanlagt fanns åtta teststationer och varje teststation hade en till två testledare, sammanlagt 12 personer. Deltagarna i studien var n=25 unga fotbollsspelande flickor, 14–16 år, och n= 22 högskolestudenter, 20-35 år. Deltagarna följde ett schema för i vilken ordning testerna skulle göras och fortsatte så tills alla testerna genomförts två gånger. Testerna bestod av styrka, uthållighet, koordination, koncentration samt rörlighet i fotled, knä, höft, bål och nacke. Mätningarna användes som underlag för beräkning av inter- och intrareliabilitet. 

RESULTAT

Intrareliabiliteten var i 40 av 41 mätningar av unga fotbollsspelande flickor i 19 tester ”Substantial” till ”Almost Perfect” med Intraclass Correlation Coefficients (ICC) 0,60–1,00. Interreliabiliteten hos samma grupp flickor var i 19 av 33 mätningar av 22 tester ”Substantial till ”Almost Perfect” (ICC: 0,60–1,00).

Intrareliabiliteten i mätningarna av studenterna var i 41 av 41 mätningar av 19 tester ”Substantial” till ”Almost Perfect” (ICC 0,60–1,00). Interreliabiliteten för samma grupp i 27 av 32 mätningar av 22 tester var ICC: 0,60–1,00.

KONKLUSION

Resultatet från denna studie visar att majoriteten av testerna har tillfredsställande inter- och intrareliabilitet och kan användas till screening i studier inom idrottsmedicin. 

CONTEXT: Despite the availability of specialized assessment tools, psychological readiness is usually not considered when deciding to return to sport (RTS) after sport injury. Re-injury anxiety, self-confidence, and functional attention may be associated with sport re-injury, making it important to evaluate these factors before RTS.

OBJECTIVE: This study aimed to predict lower extremity re-injury in soccer players using self- confidence, functional attention, and re-injury anxiety as predictive variables.

DESIGN: Prospective cohort study.

SETTING: Laboratory.

PATIENTS OR OTHER PARTICIPANTS: Sixty-two male soccer players, who were older than 18 years of age, suffered from lower extremity injuries, had completed the rehabilitation program, and were ready to RTS.

MAIN OUTCOME MEASURES: Prior to returning to the sport, participants completed a pre-season questionnaire on their previous injuries, self-confidence, re-injury anxiety, and level of functional attention. The primary outcome measured was the risk of re-injury during the upcoming competitive season, and logistic regression was utilized to calculate odds ratios (OR) with 95% confidence intervals to determine the association between each risk factor and re- injury.

RESULTS: Overall re-injury rate was 5.56 injuries per 1000 hours of play. Self-confidence scores ≤ 47 increased the risk of re-injury by 2.26 times (relative risk, 2.26; 95% CI, 1.31-3.91; OR, 5.00; 95% CI, 1.56-16.04) and each unit increase in self-confidence score reduced the risk of re-injury by 10% (OR:0.90; CI: 0.82-0.99, p=0.03). Regarding re-injury anxiety, a score >22 was associated with 2.43 times the risk of re-injury (relative risk, 2.43; 95% CI, 1.44-4.13; OR, 6.46; 95% CI, 1.93-21.69) and each unit increase in re-injury anxiety score increased the risk of injury by 45% (OR:1.45; CI: 1.13-0.87, p=0.004).

CONCLUSIONS: Increased re-injury anxiety and decreased self-confidence are associated with higher odds of lower extremity re-injury in male soccer players. To reduce the risk of re-injury, athletic trainers and sport psychologists should take these psychological factors into account when evaluating the psychological readiness of soccer players with a history of lower extremity injury to RTS.

OBJECTIVES: The inclusion of rock-climbing in the Olympic Games has increased participation in the sport and attention to athletes' health. In sports where the importance of low body weight is considerate, there is an increased risk of developing eating disorders (EDs). There is sparse research on EDs among rock-climbers. The primary aim was to map ED symptoms among rock-climbers compared with controls. The secondary aim was to analyze differences in body dissatisfaction. Comparisons between rock-climbing levels and sexes were performed.

DESIGN: This is a cross-sectional study in a larger prospective longitudinal study series, CLIMB: Climber's Longitudinal attitudes towards Injury, Mental health and Body image, using baseline data.

PARTICIPANTS: Swedish rock-climbers, at an advanced and elite level according to the International Rock Climbing Research Association, participated. Participants were at least 13 years old. 183 rock-climbers partook with a mean age of 29.5 (SD=9.1) with two participants under 15 years old. 180 controls partook with a mean age of 29.0 (SD=8.9). There were no control participants under 15 years of age.

PRIMARY AND SECONDARY OUTCOME MEASURES: Data was gathered through a self-report questionnaire collecting the primary outcome measure, ED symptoms (Eating Disorders Examination Questionnaire (EDE-Q) V.6.0) and the secondary outcome measure, body dissatisfaction (Body Shape Questionnaire-8C).

RESULTS: There were no differences between rock-climbers and controls regarding ED symptoms. Symptoms were higher among female rock-climbers (26%) than male (5.8%). Regarding body dissatisfaction, the control group reported higher levels compared with rock-climbers. At least a mild concern was observed in 13.3% of male rock-climbers, compared with 47.4% of females.

CONCLUSIONS: Although there was no difference in the EDE-Q V.6.0 between rock-climbers and controls, females reported significantly more symptoms than men. Regarding body dissatisfaction, female rock-climbers exhibited higher levels of dissatisfaction than males. Further, higher levels of dissatisfaction were reported in controls, especially in men, where symptoms were three times higher than rock-climbers.

TRIAL REGISTRATION NUMBER: NCT05587270.

Symposium

Topics: Prevention and rehabilitation

Keywords: Injury, prevention, rehabilitation, sport

Psychology of sports injuries: from pre-in jury to return to sport. Current research and practical implications

Chair(s): Ulrika Tranaeus (The Swedish School of Sport and Health Sciences, GIH, Sweden)

In addition to the physical consequences of sport injuries, athletes must contend with a range of psychosocial challenges – both in the immediate injury aftermath (pain, loss of function) and throughout the recovery process (motivational decrements, lack of confidence in return toplay). It is therefore important to identify factors influencing injury risk, recovery, and return to play. Evaluation of injury prevention strategies are also of evident importance.The purpose of this symposium is to examine psychosocial factors and interventions influencing injury risk, rehabilitation and return to play. By doing so, each presenter highlights empirical and applied implications. This symposium includes five presentations.The initial presentation overviews psychosocial risk factors for traumatic and overuse injuries and discussion regarding prevention strategies. A presentation of methodological implications for research on psychosocial risk factors will follow. This presentation includes how interactions of risk factors influence injury risk and recommendations for statistical analyses.The third presentation gives an example of a cognitive-behavioural therapy smartphone-based intervention programme. The intervention consists of daily use of a stress management programme delivered in a smartphone app aiming to reduce stress and prevent injuries.The fourth presentation articulates reviews some examples of future research strategies in rehabilitation. Longitudinal study designs that examines intra-individual changes will be discussed.Finally, the fifth presentation examines the role of psychosocial factors influencing return versus non-return to sport following injury, as well as the quality of post-injury performance. This will be discussed in the framework of the self-determination theory.

Presentations of the Symposium

Psychosocial risk factors for traumatic and overuse injuries in sport

Ulrika Tranaeus The Swedish Sch ool of Sport and Health Sciences, GIH

Despite the health benefits of sport participation, involvement in competitive sport is associated with injury risk. Injuries are classified into two kinds with different causation − traumatic injuries and overuse injuries. Traumatic injuries have a sudden onset with or without contact, while overuse injuries occur after repetitive load without feasible recovery (Fuller et al., 2006). The psychosocial risk factors for these kinds of injuries differ. Risk factors for traumatic injuries are described in various models, the most prominent and well-tested being the Williams and Andersen’s (1998) Stress-Injury Model. An evaluation of the model showed that the stress response had the strongest relationship to injury rates (Ivarssonet al., 2017). The magnitude of the stress response and the athlete’s appraisal of a stressful situation are suggested to be influenced by the interplay between various psychosocial factors: personality factors, history of stressors, and coping resources. With this knowledge, prevention programmes designed to address injury risk factors (e.g., stress perceptions) and subsequent injury occurrence have been evaluated. Risk factor studies for overuse injuries and overtraining have showed similarities such as intrapersonal factors (e.g., motivation, dealing with pain), interpersonal factors (e.g., communication, social support), and situational factors (e.g., stress in sport and/or from life events) (Richardson,Andersen, & Morris, 2008; Tranaeus, Johnson, Engström, Skillgate, & Werner, 2014). These factors are suggested to influence athletes’ excessive behaviours and limited recovery which may lead to overuse injuries. This presentation is germane for researchers and practitioners hoping to mitigate acute and overuse injury occurrence.

Factors influencing sport injury risk, rehabilitation outcomes, and return to sport processes have been the focus in various research disciplines (sports medicine, psychology and sociology). One discipline, with over 50 years of scholarship, is the psychology of sport injury. Despite the research in this field, there is no evidence-based consensus to inform professional practice. The aim of this original and timely consensus statement is to summarise psychological sport injury research and provide consensus recommendations for sport practitioners seeking to implement psychological principles into clinical practice. A total of seven experts with extensive experience outlined the consensus objectives and identified three psychology of sport injury sub-domains: risk, rehabilitation and return to sport. The researchers, grouped in pairs, prepared initial drafts of assigned sub-domains. The group met in Stockholm, and the three texts were merged into a draft and revised in an iterative process. Stress responses are the strongest psychological risk factor for acute injuries. Intra- and interpersonal factors, as well as sociocultural factors, are demonstrated psychosocial risk factors for overuse injuries. Stress management and mindfulness interventions to prevent injuries have been successfully implemented. The rehabilitation process may influence athlete's cognitive, emotional, and behavioural responses. Social support, mindfulness, acceptance-based practices, and cognitive-behavioural based intervention programs reduce negative reactions. Return to sport includes various stages and different trajectories. Returning athletes typically experience concerns regarding competence, autonomy, and relatedness. It is recommended that athletes focus on the physical, technical, and psychological demands of their sport as they progress to increasingly intense activities. Interdisciplinary collaboration (e.g., sports medicine and psychology) would be beneficial in enhancing clinical practice and improving athlete outcomes.

Football is a popular sport among adolescent females. Given the rate of injuries in female footballers, identifying factors that can predict injuries are important. These injuries are often caused by complex reasons. The aim of this study was to investigate if the combination of demographic (age, number of training and match play hours/week), psychosocial (perceived stress, adaptive coping strategies) and physiological factors (functional performance) can predict a traumatic injury in adolescent female footballers. A cohort consisting of 419 female football players aged 13–16 years was established. Baseline questionnaires covered potential risk factors for sport injuries, and measurements included football-related functional performance tests. Data were collected prospectively with a weekly online questionnaire for 52 weeks covering, e.g., injuries, training, and match play hours/week. A total of 62% of the players reported at least one traumatic injury during the 52 weeks. The coping strategy “positive reframing” had the strongest association with the risk of traumatic injuries. The combination of more frequent use of the coping strategy, positive reframing, and high levels of physical performance capacity may prevent a traumatic injury in adolescent female footballers. Coaches are encouraged to adopt both physiological and psychological factors when preventing injuries in young female footballers.

BAKGRUND: Fotboll är en av de populäraste lagidrotterna även bland flickor/damer i Sverige. Skador, varav överbelastningsskador är en av skadekategorierna, är vanligt förekommande. Skadefrekvensen är högre bland män än kvinnor inom fotboll och allvarliga knäskador är vanligare hos fotbollsspelande kvinnor än män. Stress är en riskfaktor för traumatiska skador. Upplevd stress som riskfaktor för överbelastningsskador är ännu inte undersökt.

SYFTE: Syftet denna delstudie var att undersöka eventuella samband mellan upplevd stress och överbelastningsskador hos unga fotbollsspelande flickor.

METOD: Detta är en pågående prospektiv kohortstudie, The Karolinska Injury Cohort (KIC) study, med det övergripande syftet att identifiera riskfaktorer för skador hos fotbollsspelande flickor, 13-16 år på elitnivå. Från studiestart september 2016 till september 2018 var 280 spelare inkluderade. Målet är att inkludera 600 spelare. I samband med inkludering besvarades bland annat frågor om upplevd stress. Spelarna följdes veckovis under 53 veckor och besvarade frågor om skador samt begränsningar i träning och match på grund av smärta och/eller fysiska besvär. Varje skada följdes upp med mer detaljer kring skadan via telefon. I denna delstudie inkluderas spelarna vid första registrerade överbelastningsskada. Alla potentiella störfaktorer såsom coping, passion till sport, sömn, idrottspsykologisk träning samt fotbollsrelaterade frågor registrerades i baslinjen. En logistisk regressionsanalys utfördes i StataSE version 14.2 med kontroll för störfaktorer för sambandet mellan graden av upplevd stress och överbelastningsskador.

RESULTAT: Av de 280 inkluderade spelarna i KIC var det 145 spelare som angav att de var skadefria vid studiestart och som inkluderades i denna analys. Av dessa hade 31 spelare en överbelastningsskada och 17 (55 %) spelare rapporterade att de upplevde stress, medan resterande 14 (45 %) spelare inte upplevde stress. Spelare som rapporterade upplevd stress vid baslinjen hade inte en högre risk att få en överbelastningsskada under uppföljningsperioden (OR:1.1; 95 % CI: 0.6-2.1; p= 0.8), jämfört med spelare utan upplevd stress.

SLUTSATS: Denna delstudie visade inget samband mellan upplevd stress vid studiestart och överbelastningsskador under uppföljningstiden. Denna analys är baserad på få spelare och kommer att upprepas då 600 spelare är inkluderade i studien och information om upplevd stress från veckorapporten kommer att användas.

A systematic review of psychological risk factors for overuse injuries in athletes

Introduction

Based on the prevalence of overuse injuries, it is important to identify risk factors and develop preventive strategies. The knowledge regarding how an injury occur is rather established, why it occurs and the behaviour related to that is however not as evident. The aim of this systematic review was to identify psychological risk factors for overuse injuries.

Material and method

The databases Medline, PsycInfo and Web of Science were searched by librarians at Karolinska Institute using the combination of MeSh terms with appropriate truncations and Boolean combinations of words and operators: overuse injury, psychology, risk factor, athlete AND sport, limited to academic peer-reviewed journals in Swedish, English, German, Spanish and French. For assessment of quality and bias, a modified version of RoBANS for quantitative studies and Swedish agency for Health technology assessment’s scale for qualitative studies were used. Published papers without empirical data, overuse injuries or not assessing psychological factors were excluded as well as duplicates.

This study followed PRISMA’s guidelines and was registered in PROSPERO.

Results

The searches resulted in 6890 hits, the screening process led to 13 included studies. The risk factors were divided into intra-and interpersonal factors, social norms and culture. Risk factors were e.g. self-regulation, self-blame, body awareness, coach-athlete relationship, acceptance of pain, maladaptive coping, and communication. 

Conclusion

Psychological risk factors were identified, and some were considered as fluctuating states which imply that behavioural change is possible. An increased awareness of this knowledge and individualised interventions may reduce the prevalence of overuse injuries in athletes.

BACKGROUND: While the psychosocial risk factors for traumatic injuries have been comprehensively investigated, less is known about psychosocial factors predisposing athletes to overuse injuries.

OBJECTIVE: The aim of this review was to systematically identify studies and synthesise data that examined psychosocial risk factors for overuse injuries in athletes.

DESIGN: Systematic review.

DATA SOURCES: MEDLINE, Web of Science and PsycINFO databases, supplemented by hand searching of journals and reference lists.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Quantitative and qualitative studies involving competitive athletes, published prior to July 2021, and reporting the relationship between psychosocial variables and overuse injury as an outcome were reviewed. This was limited to academic peer-reviewed journals in Swedish, English, German, Spanish and French. An assessment of the risk of bias was performed using modified versions of the RoBANS and SBU Quality Assessment Scale for Qualitative Studies.

RESULTS: Nine quantitative and five qualitative studies evaluating 1061 athletes and 27 psychosocial factors were included for review. Intra-personal factors, inter-personal factors and sociocultural factors were found to be related to the risk of overuse injury when synthesised and reported according to a narrative synthesis approach. Importantly, these psychosocial factors, and the potential mechanisms describing how they might contribute to overuse injury development, appeared to be different compared with those already known for traumatic injuries.

CONCLUSIONS: There is preliminary evidence that overuse injuries are likely to partially result from complex interactions between psychosocial factors. Coaches and supporting staff are encouraged to acknowledge the similarities and differences between traumatic and overuse injury aetiology.

INTRODUCTION: Football is a popular sport among young females worldwide, but studies concerning injuries in female players are scarce compared with male players. The aim of this study is to identify risk factors for injury in adolescent female football players.

METHODS AND ANALYSIS: The Karolinska football Injury Cohort (KIC) is an ongoing longitudinal study that will include approximately 400 female football academy players 12-19 years old in Sweden. A detailed questionnaire regarding demographics, health status, lifestyle, stress, socioeconomic factors, psychosocial factors and various football-related factors are completed at baseline and after 1 year. Clinical tests measuring strength, mobility, neuromuscular control of the lower extremity, trunk and neck are carried out at baseline. Players are followed prospectively with weekly emails regarding exposure to football and other physical activity, health issues (such as stress, recovery, etc), pain, performance and injuries via the Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC-O). Players who report a substantial injury in the OSTRC-O, that is, not being able to participate in football activities, or have reduced their training volume performance to a moderate or major degree, are contacted for full injury documentation. In addition to player data, academy coaches also complete a baseline questionnaire regarding coach experience and education.

ETHICS AND DISSEMINATION: The study was approved by the Regional Ethical Review Authority at Karolinska Institutet, Stockholm, Sweden (2016/1251-31/4). All participating players and their legal guardians give their written informed consent. The study will be reported in accordance with the Strengthening the Reporting of Observational studies in Epidemiology. The results will be published in peer-reviewed academic journals and disseminated to the Swedish football movement through stakeholders and media.