Incidence and Patterns of Overuse and Traumatic Injuries among Adolescent Elite Athletes in Canoe Sprint, Handball, and Triathlon

Abstract

Background

Adolescent elite athletes in Olympic sports often specialise at an early age, which increases the risk of overuse and traumatic injuries. The knowledge of injury patterns is a key aspect for prevention strategies. However, little is known about adolescent athlete’s injury patterns in most Olympic sports. This study aimed to analyse the incidence and pattern of traumatic and overuse injuries in adolescent elite athletes from three Olympic sports with various physical demands.

Methods

A retrospective data analysis was performed, including 348 initial orthopaedic consultations of adolescent elite athletes (m/f: 267/81, 15.9±1.7 years, 179±9 cm, 71±11 kg, 648±107 training hours/year). Athletes from handball (n=185), canoe sprint (n=112) and triathlon (n=51) presented at the local sports medicine centre. All consultations included a medical history obtained by a physician, an orthopaedic examination, and a documentation of anthropometric and training-related data. Injury patterns were classified for traumatic and overuse ratio, type, area, structure, and cause of injury. Incidence per 1000 hours (h) of exposure and injury ratio were analysed in the entire cohort and compared between sports.

Results

The mean injury incidence was 3.3/1000 h, while overuse injuries occurred approximately twice as often as traumatic injuries (2.0 versus 1.2/1000 h). Sport-specific total injury incidence was lowest in canoe sprint (1.6/1000 h) and highest in handball (4.7/1000 h). The traumatic versus overuse injury ratio was lowest in canoe sprint (0.13) and highest in handball (0.54). Injury incidence increased with age and training hours from 1.0/1000 h in young athletes (12–13 years) to 5.1/1000 h in older athletes (16–17 years). Type, area, structure and cause of injuries differed significantly between athletes of the three sports. Handball players presented with various traumatic and overuse pathologies, mostly located in the lower extremity. Canoeists and triathletes mainly suffered from tendon overload and muscle injuries of the extremities and the lower back.

Conclusion

Both the total incidence and the ratio of traumatic versus overuse injuries differ between athletes participating in handball, canoe sprint, and triathlon. Overuse injuries occurred approximately twice as often as traumatic injuries in the present cohort. Further investigation is required to evaluate whether the variety of injuries seen in individual and team sports is to be taken into consideration in the development of prevention strategies.

Zusammenfassung

Hintergrund

Nachwuchsathlet/-innen in olympischen Sportarten spezialisieren sich häufig frühzeitig, was das Risiko für Verletzungen und Überlastungen erhöht. Die Kenntnis von Verletzungs- und Überlastungsmustern ist ein wesentlicher Schlüssel für Präventionsstrategien. In den meisten olympischen Sportarten ist diesbezüglich jedoch wenig bekannt. Ziel der Studie war es, Häufigkeit und Muster von Verletzungen und Überlastungen bei Nachwuchsathlet/-innen aus 3 olympischen Sportarten mit unterschiedlichen körperlichen Belastungsformen zu analysieren.

Methoden

In einer retrospektiven Analyse wurden 348 orthopädische Erstvorstellungen von Nachwuchsathlet/-innen (m/w: 267/81, 15,9±1,7 Jahre, 179±9cm, 71±11kg, 648±107h/Jahr) aus Handball (n=185), Kanurennsport (n=112) und Triathlon (n=51) im Untersuchungszentrum ausgewertet. Es erfolgten ärztliche Anamnese, orthopädische Untersuchung und Erfassung anthropometrischer und trainingsbezogener Daten. Verletzungsmuster wurden nach Verletzung und Überlastung, Art, Lokalisation, Struktur und Ursache klassifiziert. Das Verhältnis von Verletzungen zu Überlastungen (Ratio) sowie deren Inzidenzen pro 1000 Stunden (h) Exposition wurden für die gesamte Kohorte analysiert und zwischen den Sportarten verglichen.

Ergebnisse

Die durchschnittliche Inzidenz der Ereignisse betrug 3,3/1000h, während Überlastungen etwa doppelt so häufig waren wie Verletzungen (2,0 versus 1,2/1000h). Verletzungen und Überlastungen waren im Kanurennsport am niedrigsten (1,6/1000h) und im Handball am höchsten (4,7/1000h). Die Verletzungs-zu-Überlastungs-Ratio war im Kanurennsport am geringsten (0,13) und im Handball am höchsten (0,54). Die Inzidenz stieg durch höheres Alter und mehr Trainingsstunden von 1,0/1000h bei jungen (12–13 Jahre) auf 5,1/1000h bei älteren Athlet/-innen (16–17 Jahre). Im Handball waren Verletzungen der unteren Extremität vorrangig. Im Kanurennsport und Triathlon traten häufig Überlastungen sehniger und muskulärer Strukturen der Extremitäten bzw. des unteren Rückens auf.

Schlussfolgerung

Sowohl die Gesamtinzidenz als auch das Verhältnis von Verletzungen und Überlastungen sind bereits bei Nachwuchsathlet/-innen aus Handball, Kanurennsport und Triathlon verschieden, wobei in der Gesamtkohorte Überlastungen verglichen zu Verletzungen doppelt so häufig auftraten. Inwiefern die unterschiedlichen Verletzungs- und Überlastungsmuster in Individual- und Mannschaftssportarten in der Entwicklung von Präventionsstrategien zu berücksichtigen sind, ist zu überprüfen.

Keywords

Musculoskeletal - injury profiles - epidemiology - Olympic sports

Schlüsselwörter

Muskuloskelettale Beschwerden - Verletzungsprofile - Epidemiologie - Olympische Sportarten

Publication History

Received: 14 June 2024

Accepted after revision: 12 January 2025

Article published online:
04 March 2025

• Literatur

• 1 Cassel M, Risch L, Intziegianni K. et al. Incidence of Achilles and Patellar Tendinopathy in Adolescent Elite Athletes. Int J Sports Med 2018; 39: 726-732
• 2 Edouard P, Samozino P, Escudier G. et al. Injuries in Youth and National Combined Events Championships. Int J Sports Med 2012; 33: 824-828
• 3 Simpson M, Rio E, Cook J. At What Age Do Children and Adolescents Develop Lower Limb Tendon Pathology or Tendinopathy? A Systematic Review and Meta-analysis. Sport Med 2016; 46: 545-557
• 4 Müller J, Müller S, Stoll J. et al. Back pain prevalence in adolescent athletes. Scand J Med Sci Sports 2017; 27: 448-454
• 5 Cassel M, Müller J, Moser O. et al. Orthopedic Injury Profiles in Adolescent Elite Athletes: A Retrospective Analysis From a Sports Medicine Department. Front Physiol 2019; 10: 544
• 6 Caine D, Caine C, Maffulli N. Incidence and distribution of pediatric sport-related injuries. Clin J Sport Med 2006; 16: 500-513
• 7 Engebretsen L, Steffen K, Bahr R. et al. The International Olympic Committee Consensus statement on age determination in high-level young athletes. Br J Sports Med 2010; 44: 476-484
• 8 von Rosen P, Heijne A, Frohm A. et al. High Injury Burden in Elite Adolescent Athletes: A 52-Week Prospective Study. J Athl Train 2018; 53: 262-270
• 9 Maffulli N, Longo UG, Spiezia F. et al. Aetiology and prevention of injuries in elite young athletes. Med Sport Sci 2011; 56: 187-200
• 10 Stracciolini A, Casciano R, Levey Friedman H. et al. Pediatric sports injuries: an age comparison of children versus adolescents. Am J Sports Med 2013; 41: 1922-1929
• 11 Stracciolini A, Casciano R, Levey Friedman H. et al. Pediatric sports injuries: a comparison of males versus females. Am J Sports Med 2014; 42: 965-972
• 12 Stracciolini A, Casciano R, Friedman HL. et al. A closer look at overuse injuries in the pediatric athlete. Clin J Sport Med 2015; 25: 30-35
• 13 Lathlean TJH, Gastin PB, Newstead SV. et al. The incidence, prevalence, severity, mechanism and body region of injury in elite junior Australian football players: A prospective cohort study over one season. J Sci Med Sport 2018; 21: 1013-1018
• 14 Leppänen M, Pasanen K, Clarsen B. et al. Overuse injuries are prevalent in children’s competitive football: a prospective study using the OSTRC Overuse Injury Questionnaire. Br J Sports Med 2019; 53: 165-171
• 15 Prieto-gonz P, Luis J, Miguel L. et al. Epidemiology of Sports-Related Injuries and Associated Risk Factors in Adolescent Athletes: An Injury Surveillance. Int J Environ Res Public Health 2021; 18 (09) 4857
• 16 Bell DR, Post EG, Biese K. et al. Sport Specialization and Risk of Overuse Injuries: A Systematic Review With Meta-analysis. Pediatrics 2018; 142: 20180657
• 17 Roos KG, Marshall SW, Kerr ZY. et al. Epidemiology of Overuse Injuries in Collegiate and High School Athletics in the United States. Am J Sports Med 2015; 43: 1790-1797
• 18 Owoeye OBA, Ghali B, Befus K. et al. Epidemiology of all-complaint injuries in youth basketball. Scand J Med Sci Sports 2020; 30: 2466-2476
• 19 Bergeron MF, Mountjoy M, Armstrong N. et al. International Olympic Committee consensus statement on youth athletic development. Br J Sports Med 2015; 49: 843-851
• 20 Zaremski JL, Zeppieri G, Tripp BL. Sport Specialization and Overuse Injuries in Adolescent Throwing Athletes: A Narrative Review. J Athl Train 2019; 54: 1030-1039
• 21 van Mechelen W, Hlobil H, Kemper HCG. Incidence, Severity, Aetiology and Prevention of Sports Injuries. Sport Med 1992; 14: 82-99
• 22 Caine D, Maffulli N, Caine C. Epidemiology of injury in child and adolescent sports: injury rates, risk factors, and prevention. Clin Sports Med 2008; 27: 19-50
• 23 Mayer F, Bonaventura K, Cassel M. et al. Medical results of preparticipation examination in adolescent athletes. Br J Sports Med 2012; 46: 524-530
• 24 Fuller CW, Ekstrand J, Junge A. et al. Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Br J Sports Med 2006; 40: 193-201
• 25 Olsen OE, Myklebust G, Engebretsen L. et al. Injury pattern in youth team handball: a comparison of two prospective registration methods. Scand J Med Sci Sports 2006; 16: 426-432
• 26 Toohey LA, Drew MK, Bullock N. et al. Epidemiology of elite sprint kayak injuries: A 3-year prospective study. J Sci Med Sport 2019; 22: 1108-1113
• 27 Zwingenberger S, Valladares RD, Walther A. et al. An epidemiological investigation of training and injury patterns in triathletes. J Sports Sci 2014; 32: 583-590
• 28 Gosling CM, Forbes AB, McGivern J. et al. A Profile of Injuries in Athletes Seeking Treatment during a Triathlon Race Series. Am J Sports Med 2010; 38: 1007-1014
• 29 Timpka T, Alonso JM, Jacobsson J. et al. Injury and illness definitions and data collection procedures for use in epidemiological studies in Athletics (track and field): consensus statement. Br J Sports Med 2014; 48: 483-490
• 30 Huxley DJ, O’Connor D, Healey PA. An examination of the training profiles and injuries in elite youth track and field athletes. Eur J Sport Sci 2014; 14: 185-192
• 31 Biese KM, Winans M, Fenton AN. et al. High School Sport Specialization and Injury in Collegiate Club-Sport Athletes. J Athl Train 2021; 56: 1271-1277
• 32 Mashimo S, Yoshida N, Takegami A. et al. Physical Therapy in Sport Injury pattern according to player position in Japanese youth handball: A cross-sectional study among 2377 players. Phys Ther Sport 2021; 50: 7-14
• 33 Biese KM, Post EG, Schaefer DA. et al. Evaluation of adolescent sport specialization and injury mechanism by sex: A secondary analysis. J Sci Med Sport 2020; 23: 721-725
• 34 Hopkins WG, Marshall SW, Batterham AM. et al. Progressive statistics for studies in sports medicine and exercise science. Med Sci Sports Exerc 2009; 41: 3-12