|
Abstract
The Athens Olympic Games in 2004 represented a significant sporting and medical challenge. Major, rare and complex incidents can occur at any mass gathering sporting festival and team medical staff should be appropriately prepared for these. During the 2004 Olympic Games, injuries in all sport tournaments (men’s and women) were analyzed. A total of 624 injuries (520 soft tissue injuries and 99 bony injuries) were reported. The most prevalent diagnoses were contusions, sprains, fractures, dislocations and lacerations. Significantly more injuries in male (68%) versus female athletes (32%) were recorded. The incidence, diagnosis, and causes of injuries differed substantially between the team sports.
This study concerns an epidemiologic analysis to determine the incidence rate of foot and ankle injuries as also the treatment options of these lesions in the field and in short term during the time frame of the Games. Also analyze the function modalities of the Foot and Ankle Clinic and the co operation of the different medical specialities that dealing with foot and Ankle Sport Injuries.
Key words: Athens Olympic Games, foot and ankle injuries/sports injuries
Introduction
The Olympic Games represent the ultimate challenge for competitors. However they are associated with a certain risk of injury for the participating players or athletes. Appropriate planning and staffing for medical services at large-scale athletic events is essential to provide for a safe and successful contest. Increased public health surveillance was first described for the 1984 summer Olympic Games in Los Angeles. 12
The purpose of this study is to detail the foot and ankle injuries experiences of the 2004 Athens Olympic Games to assist in the planning of similar events in the future.
Materials and methods
Between 13 August and 29 August 2004, 10.625 athletes (4,329 women, 6,296 men) participated, from 201 countries for 17 days in 8 sports. Many physicians and other health personnel provided medical coverage at the primary, secondary and tertiary care levels. At each sporting event 24-hour first aid station was available. For all these type of injuries, the following information were to be documented: injured body part and type of injury, circumstances (noncontact, contact, foul play), and consequences of injury (referee’s sanction, treatment, time-loss in sport). Data analysed included also elaborate demographic variables (sex, age, height, weight and lineage). Because follow-up was not possible, the physicians were asked to state an estimate of the duration of the player’s likely absence from training and/or matches as a result of the injury. All team sports, as also the studied athletes, followed the methodology of the study. Information is collected from the logbooks and medical encounter forms. Data were available from the Olympic Village opened, through the end of the Olympics. In this study we retrospectively analysed the medical records of 624 patients. The mean age of athletes was 24 years (range, 21 - 32), whereas the mean age of the media, Olympic family and officials was older with mean age of 42 years (range 28 to 57 years old) Among all patients, there were more males, 423 (68%) than females, 201 (32%) Radiographs, ultrasound or magnetic resonance imaging (MRI) were performed when it was necessary.
Results
A total of 624 injuries were reported. 520 cases (83.3%) concern soft tissue injuries and 99 cases (15.8%) concern bony injuries. The soft tissue group include skin infections 11, nail infections-injuries 52, tendinitis 245 (Achilles 153, peroneal 64, anterior tibialis 28), shin splints 13, lesser toes sprains 45, turf toe 8, ankle sprains 138 (grade A 83, grade B 39, grade C 16), hindfoot sprains 5, plantar plate rupture 2 and Morton neuroma 6 (all 3rd web space). The bony injuries group include sesamoid fractures 3 (all medial), latelar malleolus fractures 7, bimaleolar fractures 2, Pillon fractures 2, stress fractures 29 (11 -2nd metatarsal, 4 -3rd metatarsal, 5-5th metatarsal, 3 navicular, 5 tibia), Freiberg disease both 2nd MT head 2, proximal phalanx hallux echondroma 1, hallux rigidus painful 21, hallux valgus painful 18, accesory bones injuries 9 (accessory navicular 7, 3 bilatelar, os peroneum 2), 5th MTT tubercule fractures 3, Jones fractures 2 (Table 1).
Regarding specific diagnoses, tendinitis was the most common reason for a visit (n=245, 39.2%), followed by ankle sprains (n=138, 22.1%), nail infections-injuries (n=52, 8.3%), lesser toes sprains (n=45, 7.2%), and stress fractures (n=29, 4.6%). Most of the patients treated by their own physicians were released. A total of 624 patients were transferred to the medical service department and 38 (6.1%) required emergency transferred to the hospital. Diagnoses among the 38 patients who transferred to the hospital included fractures (Jones, 5th MTT tubercule, stress), skin infections ….., while diagnoses of 27 (4.3%) patients who required emergency transport included fractures (latelar malleolus, bimaleolar fractures, Pillon), ankle sprains (grade C).
For all team sports, most injuries affected the lower extremity. 23.8% in soccer, 21.6% in basketball, 16.8% in handball, 13.5% in apparatus work - gymnastic and obstacle race, 7.3% in volleyball, 1.7% in weight lifting and 1.6% in horse – riding.
The types of injuries were significantly different among the team sports. Severe injuries, such as fracture and ligament ruptures, seem to be more frequent in soccer handball, basketball than in the other sports.
The causes of injuries also varied substantially between the team sports. While 75% of apparatus work – gymnastic and 57% of volleyball injuries occurred without contact, the majority of injuries in soccer (100%), handball (86%) and basketball (83%) occurred because of contact with another player or an object.
Discussion
In 2004 the Olympic Games returned to Greece, the home of both the ancient Olympics and the first modern Olympics. For the first time ever a record 201 National Olympic Committees (NOCs) participated in the Olympic Games. The overall tally for events on the programme was 301 (one more than in Sydney 2000). Popularity in the Games reached soared to new highs as 3.9 billion people had access to the television coverage compared to 3.6 billion for Sydney 2000. Planning for medical services at the Olympics began in Atlanta in 1991 30,31
In reviewing the literature on sports injuries, we found only a few studies in which exposure related incidences of injury in different types of sport were compared using the same methods.5,6,7,13,14,21,26 Although all of these studies focus on injuries during a season, Cunningham5 surveyed the incidence of injuries during the 1994 Australian University Games, a mass gathering event featuring 5106 participants competing in 19 sports. The great advantages of conducting a comparative study during a sports tournament are that multiple sports with the players of a comparable skill level can be included and that the study period is defined by the event. Furthermore, in a topclass international tournament, a high standard of environmental factors, such as the quality of the playing fields and equipment, is guaranteed.
A comparison with previous studies on injuries in team sports is difficult because of the methodological problems such as heterogeneous definitions of injury, study populations, methods of assessment, and calculations of incidence. Furthermore, detailed prospective studies on the incidence, type of injuries, and circumstances of injuries could not be found for all team sports included in the present study.
Most information is available about injuries of elite male 1,8,15,16,27 and female 9,10,11,16,18,24 soccer players, and these studies are in agreement with the present results. Handball injuries have also been investigated in several studies 2,17,22,23,25,29 but the reported incidences and characteristics of injury varied substantially. However, injury rates similar to the present study have been reported from other tournaments 2,17 and in a retrospective study on self report injuries during the season.29 In two prospective studies on basketball injuries,19,20 the rates of injury were lower than in the present study, probably because of the lower skill level of the players and/or standards of the tournaments. Nevertheless, the results in relation to location and diagnosis of injury were in agreement with the present study. Both prospective studies on volleyball injuries are in agreement with the present study. 3,28
Conclusions
The 2004 Athens Olympic Games was a mass gathering with unique characteristics that created complex demands on medical service delivery.
During this event, the risk of injuries in some team sports tournaments was higher than in others. However, prevention of injury and promotion of fair play are relevant topics for almost all team sports.
The experience of Athens Olympic Games will inform the development of public health surveillance system for future Olympic Games, as well as other similar mass events.
References
1. Arnason A, Tenga A, Engebretsen L, Bahr R. A prospective videobased analysis of injury situations in elite male football: football incident analysis. Am J Sports Med. 2004;32:1459-1465.
2. Asembo JM, Wekesa M. Injury pattern during team handball competition in East Africa. East Afr Med J. 1998;75:113-116
3. Bahr R, Bahr IA. Incidence of acute volleyball injuries: a prospective cohort study of injury mechanisms and risk factors. Scand J Med Sci Sports. 1997;7:166-171.
4. Backx FJ, Beijer HJ, Bol E, Erich WB. Injuries in high-risk persons and high-risk sports: a longitudinal study of 1818 school children. Am J Sports Med. 1991;19:124-130.
5. Cunningham C, Cunningham S. Injury surveillance at a national multisport event. Aust J Sci Med Sport. 1996;28:50-56.
6. de Loes M. Epidemiology of sports injuries in the Swiss organization “Youth and Sports” 1987-1989: injuries, exposure and risks of main diagnoses. Int J Sports Med. 1995;16:134-138.
7. de Loes M, Goldie I. Incidence rate of injuries during sport activity and physical exercise in a rural Swedish municipality: incidence rates in 17 sports. Int J Sports Med. 1988;9:461-467.
8. Ekstrand J, Walden M, Hagglund M. Risk for injury when playing in a national football team. Scand J Med Sci Sports. 2004;14:34-38.
9. Engstrom B, Johansson C, Tornkvist H. Soccer injuries among elite female players. Am J Sports Med. 1991;19:372-375.
10. Faude O, Junge A, Kindermann W, Dvorak J. Injuries in female soccer players: a prospective study in the German national league. Am J Sports Med. 2005;33(11):1694-1700.
11. Giza E, Mithofer K, Farrell L, Zarins B, Gill T. Injuries in women’s professional soccer. Br J Sports Med. 2005;39:212-216.
12. Jorm LR, Thackway SV, Churches TR, Hills MW. Watching the Games: public health surveillance for the Sydney 2000 Olympic Games. J Epidemiol Community Health. 2003 Feb;57(2):102-8.
13. Junge A, Langevoort G, Pipe A et al. Injuries in Team Sport Tournaments During the 2004 Olympic Games. Am. J. Sports Med. 2006; 34; 565 – 576
14. Junge A, Cheung K, Edwards T, Dvorak J. Injuries in youth amateur soccer and rugby players: comparison of incidence and characteristics. Br J Sports Med. 2004;38:168-172.
15. Junge A, Dvorak J, Graf-Baumann T. Football injuries during the World Cup 2002. Am J Sports Med. 2004;32(suppl):23S-27S.
16. Junge A, Dvorak J, Graf-Baumann T, Peterson L. Football injuries during FIFA tournaments and the Olympic Games, 1998-2001: development and implementation of an injury-reporting system. Am J Sports Med. 2004;32(suppl):80S-89S.
17. Langevoort G, Junge A, Dvorak J. Injuries during major international tournaments. World Handball Magazine. 2004;3:80-89.
18. Mandelbaum BR, Silvers HJ, Watanabe DS, et al. Effectiveness of a neuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes. Am J Sports Med. 2005;33:1003-1010.
19. McKay GD, Goldie PA, Payne WR, Oakes BW, Watson LF. A prospective study of injuries in basketball: a total profile and comparison by gender and standard of competition. J Sci Med Sport. 2001;4:196-211.
20. Messina DF, Farney WC, DeLee JC. The incidence of injury in Texas high school basketball: a prospective study among male and female athletes. Am J Sports Med. 1999;27:294-299.
21. Nicholl JP, Coleman P, Williams BT. The epidemiology of sports and exercise related injury in the United Kingdom. Br J Sports Med. 1995; 29:232-238.
22. Nielsen AB, Yde J. An epidemiologic and traumatologic study of injuries in handball. Int J Sports Med. 1988;9:341-344.
23. Oehlert K, Drescher W, Petersen W, Zantop T, Gross V, Hassenpflug J. Injuries in Olympic handball tournaments: a video analysis. Sportverletz Sportschaden. 2004;18:80-84
24. Ostenberg A, Roos H. Injury risk factors in female European football: a prospective study of 123 players during one season. Scand J Med Sci Sports. 2000;10:279-285.
25. Seil R, Rupp S, Tempelhof S, Kohn D. Sports injuries in team handball: a one-year prospective study of sixteen men’s senior teams of a superior nonprofessional level. Am J Sports Med. 1998;26:681-687.
26. Yde J, Nielsen AB. Sports Injuries in adolescents’ ball games: soccer, handball and basketball. Br J Sports Med. 1990;24:51-54.
27. Yoon YS, Chai M, Shin DW. Football injuries at Asian tournaments. Am J Sports Med. 2004;32(suppl):36S-42S.
28. Verhagen EA, Van Der Beek AJ, Bouter LM, Bahr RM, Van Mechelen W. A one season prospective cohort study of volleyball injuries. Br J Sports Med. 2004;38:477-481.
29. Wedderkopp N, Kaltoft M, Lundgaard B, Rosendahl M, Froberg K. Injuries in young female players in European team handball. Scand J Med Sci Sports. 1997;7:342-347.
30. Wetterhall SF, Coulombler DM et al. Medical care delivery at the 1996 Olympic Games. JAMA, 1998;279:1463-1468
31. Woodfin BA, Eaton SB, Askew JL. Medical care at the 1996 Olympic Village. J Med Assoc Ga. 1997;86:15-17
|
